Paddle & Tennis Injuries: Why Elbows, Hips & Knees Suffer Most
Paddle has gone from “that thing your mate’s into” to a regular fixture in a lot of people’s social calendars in the space of about two summers. Tennis has had its usual seasonal bump too. Both are brilliant — sociable, competitive, genuinely good exercise.
They’re also responsible for a fairly predictable pattern of injuries, and if you’ve started playing more this summer, it’s worth knowing where the strain actually lands and why.
The elbow: not just "tennis elbow" in name
Tennis elbow — pain on the outside of the elbow, technically a tendinopathy of the forearm extensor tendons — is genuinely one of the most common injuries in racquet sports generally, paddle included, despite the name suggesting it’s tennis-specific.
It’s not really an inflammation problem in the way people assume (which is part of why anti-inflammatories alone often don’t shift it). It’s a degenerative issue in the tendon caused by repeated microtrauma — usually from a stiff-wristed backhand, a racket that doesn’t absorb vibration well, or simply a sudden jump in how often you’re playing.
In padel specifically, elbow injuries account for a notable chunk of all reported injuries, with novice and intermediate players particularly affected while technique is still developing.
The knee: repetitive lunging adds up
Both sports involve constant changes of direction, quick lunges, and sudden stops — exactly the movement pattern that loads the patellar tendon (the one connecting kneecap to shin) repeatedly over a session. Patellar tendinopathy, sometimes called jumper’s knee despite there being no actual jumping involved in most rallies, is a common result.
A useful detail here: if your glutes aren’t doing their share of the work during lunges and direction changes, your quads compensate — and that shifts more load directly onto the front of the knee. This is part of why knee issues often show up alongside weak hip and glute strength rather than as a standalone knee problem.
The hip: the quiet contributor
Hips don’t always get mentioned in the same breath as tennis elbow or knee pain, but they’re doing a huge amount of work in both sports — explosive direction changes, rapid accelerations, repeated rotation. Overload here can show up as a dull ache that’s easy to dismiss, but it often sits upstream of both the knee and lower back issues that get more attention.
Why this cluster of injuries specifically
It’s not bad luck that these three areas come up again and again. They share a common thread: repetitive, asymmetric loading at speed, often before the surrounding muscles are strong enough to absorb it.
If you’ve come to paddle or tennis from running, football, or the gym, your cardiovascular fitness might be well ahead of your readiness for the specific demands of rapid lateral movement and racquet-arm load — which is exactly the gap where these injuries tend to appear.
What actually helps
A few things make a measurable difference, based on what tends to come up in clinic:
- Strengthen glutes and hip stabilisers, not just quads. Stronger hips take load off the knees during lunging and pivoting.
- Build forearm extensor strength specifically, rather than relying on general gym work to cover it — wrist extension exercises are the most directly relevant.
- Get technique looked at early, particularly your backhand. A lot of elbow trouble traces back to wrist position and grip rather than the volume of play itself.
- Check your equipment. A racket that’s too heavy or transmits too much vibration is a genuine, fixable contributor — not a minor detail.
- Don’t ignore a niggle that lingers past a couple of sessions. Tendon issues respond far better to early intervention than to being played through for a month.
If something's already bothering you
If you’ve got a nagging elbow, a knee that complains on the court but not elsewhere, or hip discomfort that’s crept in since you started playing more, a biomechanical MSK assessment is the most useful next step — it looks at how you’re actually moving, loading, and compensating, rather than just treating the spot that hurts.
For more general background, our Sports Injuries and Sports Performance pages cover related conditions and how we approach them.
Booking
If a niggle’s been hanging around since you picked the racquet back up this summer, it’s worth getting it looked at before your next match rather than after. Book an assessment online at a time that suits you.
