Pickleball Elbow in St. Louis: Why It Won't Quit — and How We Fix It

St. Louis has gone all-in on pickleball. Every park and rec center in town has a line of people waiting for a court — and in my office, a line of people rubbing the outside of their elbow.

If you've got that dull ache that flares when you grip the paddle, pick up a coffee mug or shake someone's hand, you're not alone. And no, you don't have to quit.

What "pickleball elbow" actually is

Pickleball elbow is almost always the same problem as tennis elbow: irritation of the tendon that attaches the forearm muscles to the bony bump on the outside of your elbow. Those muscles extend your wrist and stabilize your grip — which means they work on every single shot.

Less often, the pain is on the inside of the elbow (the golfer's elbow side). Same idea, different tendon.

Here's the part most people get wrong: this usually isn't a simple "inflammation" problem. In most cases that hang around for weeks, the tendon itself has become irritated and overloaded — it's lost some of its ability to handle load. That's why ice and ibuprofen take the edge off but don't make it go away.

Why pickleball is so hard on elbows

Pickleball looks gentle. It isn't — at least not on your forearm.

• Lots of short, punchy shots. Dinks, volleys and resets are all wrist and forearm, over and over.
• A light paddle and a hard ball. Off-center hits send vibration straight up the arm.
• Death-grip habits. Squeezing the paddle tight at the kitchen line keeps those forearm muscles loaded for the whole rally.
• Wristy backhands. Flicking the backhand with the wrist instead of turning the shoulders is a classic setup.
• Going from zero to five days a week. Your enthusiasm ramps up faster than your tendons can adapt.

Add in a desk job with a mouse and keyboard, and the forearm never gets a break.

Why rest alone rarely fixes it

The typical cycle: it hurts, you take two weeks off, it feels better, you play a long weekend tournament, it's right back.

Rest calms the symptoms. It doesn't rebuild the tendon's tolerance for load. And if the real driver is how your neck, shoulder, wrist or grip is working, rest doesn't touch that either.

How we work it up: test, don't guess

Not every sore elbow is a tendon problem. Pain on the outside of the elbow can also come from the neck — an irritated nerve root in the lower cervical spine can refer pain and tingling down the arm. Treat the elbow when the neck is the issue, and you'll chase it forever.

So before we treat, we test:

• Hands-on exam of the elbow, wrist and forearm — grip strength, resisted wrist and finger tests, where exactly it hurts
• Neck and shoulder screening — range of motion, nerve tension tests, reflexes and sensation
• Motion Study X-Rays when the exam points toward the neck or another structural issue
• Your game — how often you play, your paddle, your grip, which shots hurt

Then we tell you straight what we're dealing with.

What treatment looks like

Every plan is built on your exam, but for a true pickleball elbow it usually includes:

• Radial Shockwave Therapy — acoustic pressure waves aimed right at the irritated tendon. This is one of the main reasons people come to us for stubborn elbows that haven't responded to rest and straps.
• Chiropractic adjustments to the elbow, wrist, shoulder or neck where motion is restricted
• Soft-tissue work on the forearm muscles that have been gripping for dear life
• Progressive loading exercises — the piece most people skip. We rebuild the tendon's ability to handle force, gradually, so it holds up on the court.

We'll also talk equipment and habits: grip size, a looser grip between shots, letting the shoulders drive the backhand, and how to ramp your playing time back up without a relapse.

Can you keep playing? Often, yes — with some changes. We'll be honest about what your elbow can handle right now. See how we handle active patients on our sports injury page.

When it's not a chiropractic problem

Get seen by a medical provider promptly — or go to the ER — if you have:

• A pop followed by sudden weakness, bruising or a change in the shape of your arm
• Elbow pain after a fall with swelling or trouble moving the joint
• A hot, red, swollen elbow, especially with fever
• Numbness or weakness in the hand that's getting worse
• Inability to fully straighten or bend the elbow

The bottom line

Pickleball elbow is common, it's fixable, and it doesn't mean hanging up the paddle. But a strap and a few weeks off is a pause button, not a plan. Find out what's actually driving it, treat the tendon directly and rebuild it so it can take the load.

If your elbow has been talking to you for more than a couple of weeks, let's get you tested and back on the court.