Pickleball Elbow

• Pickleball elbow is overuse strain of the outer-elbow tendons, often worsened by technique that does not absorb impact well.
• Per Dr. Kendall Perrine, ND (Purist Natural Medicine, Arroyo Grande), tendons frequently lack the nutritional raw materials to keep up with repair demand. Recovery is not just about time off.
• Rest alone often falls short because micro-tears may need active rehabilitation, not just absence of play.
• Regular NSAID use can work against tendon healing, in her clinical view. Controlled inflammation is a necessary part of wound healing, and blunting it also blunts the blood supply that carries in the nutrients and the cellular clean-up crew that signal repair.
• The non-surgical ladder: exam, then technique and equipment adjustments, then strengthening, then regenerative options such as ozone, prolotherapy and PRP, typically 1 to 10 sessions by severity.

The tendons on the outside of the elbow become irritated and inflamed, usually from overuse or repetitive strain. A lot of the time, the tendon simply doesn't have the raw materials it needs from nutrition and recovery to keep up with the repair demand.

Dr. Kendall Perrine, ND, Purist Natural Medicine (Arroyo Grande, CA)

Two things in that answer most players have never heard: the technique piece, where the force your swing does not absorb your tendon does, and the nutrition piece, where tendon repair requires raw materials such as protein, collagen and vitamin C that many diets undersupply.

Because rest removes the aggravation without addressing the damaged tissue.

Rest can help, but if there's already arthritis in the joint or micro-tears in the tendon, that tissue often needs more than time off to heal. So the cycle is: rest, feel a little better, go back, pain returns, because the underlying tissue damage was never addressed.

Dr. Kendall Perrine, ND, Purist Natural Medicine (Arroyo Grande, CA)

If that rest-and-relapse cycle sounds familiar, you are not imagining it. It is the defining pattern of tendon injuries.

Possibly, if you are using it to keep playing. Dr. Perrine's clinical view starts from a point that surprises most players: controlled inflammation is a necessary part of wound healing, not the enemy. Inflammation is what brings blood supply to an injured tendon, and that blood supply is what delivers the nutrients and the cellular clean-up crew that signal repair. Anti-inflammatories decrease inflammation, so if we impede the inflammation signal, we may impede the healing that depends on it. Occasional use for comfort is one thing; daily NSAIDs as a play-enabler also mask the signal your body is sending, and playing on a masked tendon is how micro-tears grow.

Step 1, technique and equipment. Get your swing looked at, because a lesson pays for itself here, and check paddle weight and grip size. Too heavy or too thin transmits more shock to the tendon.

Step 2, strengthening. Eccentric forearm work and grip strengthening build the tendon's capacity. Physical therapy lives here, and many cases settle at this step.

Step 3, when physical therapy helps but does not finish the job.

I start with a thorough physical exam. If physical therapy helped some but not fully, that tells me the injury needs a nudge PT alone can't give. From there I often start with ozone and reassess, then move to prolotherapy or PRP depending on their history. Treatment courses run anywhere from one to ten sessions depending on severity.

Dr. Kendall Perrine, ND, Purist Natural Medicine (Arroyo Grande, CA)

These regenerative options are used to target the damaged tendon tissue itself, the layer rest and strengthening do not reach. They are available locally: regenerative treatment for tendon injuries in Arroyo Grande. The full local guide is here: Read more