Injuries in Padel: Shoulder, Elbow, Knee, and Prevention

To learn more, consult the guide on Swimmer’s Shoulder: Causes and Prevention. To learn more, consult the guide on Spring Muscle Injury Prevention: The Complete Guide to Getting Back in Shape Safely. To learn more, consult the guide on Tennis Injuries: Shoulder, Elbow, and Prevention.

Padel has experienced exponential growth in recent years, transforming from a niche sport into a global mass phenomenon. Its accessibility, smaller court size, and initially rapid learning curve attract players of all ages and fitness levels. However, this immense popularity has brought with it a parallel and significant increase in musculoskeletal pathologies associated with this practice. A thorough understanding of the triad padel injuries prevention is fundamental to ensuring a safe, continuous sports practice free from long-term consequences on the joint system. The very nature of the game, characterized by short sprints, sudden changes of direction, jumps, and repetitive overhead shots, subjects the body to considerable biomechanical stress, requiring careful clinical analysis and a structured preventive approach.

Padel: Biomechanics and Risk Factors

Padel biomechanics examines movement patterns and forces affecting shoulders, elbows, and knees, identifying structural stress points that predispose players to overuse injuries and acute trauma. Before analyzing individual joints, it is essential to understand the specific biomechanics of padel. Unlike tennis, the padel court is enclosed by glass walls and metal grilles, which keeps the ball in play much longer, reducing recovery times between rallies. The playing surface, typically synthetic grass with a thin layer of silica sand, offers a particular coefficient of friction that can either lock the foot during twists or, conversely, cause uncontrolled slips.

Specific padel shots, such as the bandeja, vibora, and smash, require extreme mobility of the shoulder and thoracic spine, combined with solid core stability (abdominal and lumbopelvic musculature). When the kinetic chain – the sequence of muscle activation that starts from the feet, passes through the trunk, and reaches the arm – is ineffective or interrupted due to muscle weakness or poor technique, the load is disproportionately concentrated on peripheral joints: shoulder, elbow, and knee.

Shoulder Injuries in Padel

The shoulder is the most mobile joint in the human body, but this mobility comes at a price in terms of stability. In padel, the shoulder is subjected to enormous stress, especially during overhead shots.

Causes and Mechanisms of Injury

The most common shoulder pathologies in padel players include rotator cuff tendinopathy (particularly of the supraspinatus tendon) and impingement syndrome (subacromial conflict).
The injury mechanism is rarely acute traumatic; it is almost always a functional overload (overuse). During the preparation of a smash or a vibora, the shoulder is brought into maximum abduction and external rotation. If the scapular stabilizing muscles are weak, the subacromial space reduces, compressing the rotator cuff tendons and the subacromial bursa against the bony roof. Furthermore, repeated impact with an often heavy ball (due to humidity or wear) generates microtraumas that, over time, exceed the tendon tissue’s self-repair capacity, leading to degeneration (tendinosis). Another risk factor is GIRD (Glenohumeral Internal Rotation Deficit), a common condition in racket sports where the dominant shoulder loses degrees of internal rotation, altering joint biomechanics.

Symptoms and Diagnosis

The main symptom is pain localized in the anterior or lateral part of the shoulder, which exacerbates during arm elevation movements (the painful arc, typically between 60° and 120° of abduction). The pain can radiate along the deltoid muscle and, in more advanced stages, also appear at rest or during the night, disturbing sleep if lying on the affected side. A sensation of weakness during the shot and a loss of power may also be noted.
Diagnosis must be made by a doctor or physical therapist through specific clinical tests (such as Neer’s test, Hawkins-Kennedy’s test, and Jobe’s test). Musculoskeletal ultrasound or Magnetic Resonance Imaging (MRI) are conclusive instrumental examinations to evaluate the structural integrity of the tendons and the presence of intra-articular effusions or bursitis.

Physiotherapeutic Treatment and Rehabilitation

Conservative treatment is the first line of intervention. In the acute phase, the goal is to reduce pain and inflammation. Instrumental physical therapies are used (such as high-power laser therapy, tecartherapy, or shockwave therapy for calcific tendinopathies) associated with manual therapy to relax the cervico-dorsal musculature and restore correct scapulohumeral kinematics.
Once the acute phase is overcome, rehabilitation focuses on progressive strengthening. Current scientific evidence advises against prolonged absolute rest for tendons; on the contrary, controlled mechanical loading (mechanotransduction) is essential to stimulate new collagen synthesis.

Recommended Exercises

• External Rotator Strengthening: Using a light resistance band, with the elbow flexed at 90° and tucked against the side (perhaps with a small rolled towel under the armpit to maintain proper tendon vascularization), perform slow and controlled external rotations. 3 sets of 15 repetitions.
• Scapular Stabilization (Y-T-W Exercises): Prone on a bed or a fitball, raise the arms forming the letters Y, T, and W, focusing on bringing the shoulder blades together and lowering them. 3 sets of 12 repetitions for each position.
• Posterior Capsule Stretch (Sleeper Stretch): Lying on the side of the dominant shoulder, arm flexed at 90°. With the opposite hand, gently push the forearm downwards (internal rotation) until a slight tension is felt, holding for 30 seconds. Repeat 3 times.

Elbow Injuries: Epicondylitis (Tennis Elbow)

Despite its name, lateral epicondylitis is extremely common in padel, often with a higher incidence than in tennis due to the intrinsic characteristics of the padel racket (pala), which is rigid, stringless, and transmits a high amount of vibrations directly to the upper limb.

Causes and Mechanisms of Injury

Epicondylitis is an insertional tendinopathy affecting the extensor muscles of the wrist and fingers, at the point where they anchor to the lateral epicondyle of the humerus. From a histological point of view, it is not a true inflammation (tendinitis), but a degenerative process of collagen (tendinosis) caused by repeated microtraumas and a failed reparative response of the body (angiofibroblastic hyperplasia).
In padel, triggering causes include:

• Delayed Impact: Hitting the ball too far behind the body forces the wrist into a compensatory forced extension, overloading the tendons.
• Incorrect Grip: A grip that is too tight or too loose forces the forearm muscles into a constant and disproportionate isometric contraction.
• Racket Characteristics: A racket that is too heavy, with an excessively head-heavy balance, or made with overly rigid materials, exponentially increases vibratory stress.

Symptoms and Diagnosis

The pathognomonic symptom is pinpoint pain localized on the outer bony prominence of the elbow. The pain often radiates along the dorsal aspect of the forearm. Patients report sharp pains during trivial daily activities, such as pouring water from a bottle, turning a doorknob, shaking hands, or lifting a padel bag.
Clinical evaluation by a doctor or physical therapist includes palpation of the epicondyle and provocative tests such as Cozen’s test (wrist extension against resistance) and Mill’s test (passive stretching of the extensors). Ultrasound is useful for confirming the degree of tendon degeneration and the possible presence of calcifications or fissures.

Physiotherapeutic Treatment and Rehabilitation

The treatment of epicondylitis requires patience, as the biological recovery times for tendon tissue are slow (often 3 to 6 months). Physical therapies such as focused shockwave therapy have demonstrated excellent scientific efficacy in promoting neoangiogenesis (formation of new blood vessels) and stimulating tissue regeneration. Manual therapy focuses on treating trigger points in the forearm muscles and on joint mobilization of the elbow and wrist. The use of a brace (pressure strap for epicondylitis) placed approximately two fingers below the epicondyle can help relieve mechanical tension during daily activities and return to play.

Recommended Exercises

The gold standard for tendinopathy rehabilitation is eccentric exercise.

• Eccentric Wrist Extensions: Seated, forearm resting on a table with the wrist extending over the edge, palm facing down. Hold a small weight (1-2 kg). Use the healthy hand to lift the weight (concentric phase), then release the healthy hand and slowly lower the weight (in 4-5 seconds) using only the injured wrist (eccentric phase). 3 sets of 15 repetitions, once or twice a day.
• Flexbar Exercise (Tyler Twist): Using a flexible rubber bar (Flexbar), a specific twisting movement is performed that isolates the eccentric contraction of the wrist extensors. This exercise has strong support in scientific literature for the resolution of epicondylitis.
• Extensor Stretch: Arm extended forward, elbow straight, flex the wrist downwards with the help of the other hand until tension is felt on the forearm. Hold for 30 seconds, 3 times.

Knee Injuries: Tendinopathies and Ligamentous Lesions

The knee is the joint that bears the most load during movements on the padel court. Continuous changes of direction (pivoting), abrupt braking, and jumps to perform smashes put tendons, menisci, and ligaments under severe strain.

Causes and Mechanisms of Injury

Knee injuries in padel are mainly divided into two categories: overuse (tendinopathies) and traumatic (meniscal and ligamentous lesions).

• Patellar Tendinopathy (Jumper’s Knee): This is caused by continuous jumping and landing on a relatively hard surface. The patellar tendon, which connects the patella to the tibia, undergoes microtraumas in traction leading to degeneration.
• Meniscal Lesions: The menisci act as shock absorbers. In padel, the typical injury mechanism occurs when the foot remains stuck on the synthetic grass surface while the knee and femur rotate abruptly (torsion under load).
• Ligamentous Lesions (ACL and MCL): The Anterior Cruciate Ligament (ACL) and the Medial Collateral Ligament (MCL) can suffer sprains or complete ruptures due to sudden decelerations associated with changes of direction (dynamic valgus), often aggravated by poor strength in the gluteal muscles which fail to stabilize the pelvis and femur.

Symptoms and Diagnosis

In patellar tendinopathy, pain is localized at the inferior pole of the patella, typically appearing at the beginning of activity, disappearing when warmed up, and returning intensely after the match.
In meniscal lesions, pain is felt on the joint line (internal or external), delayed swelling (the next day), and sometimes actual joint locking or giving way.
In ACL lesions, the event is usually acute: an audible “crack” is felt, followed by immediate swelling (hemarthrosis) and a strong sensation of instability.
Diagnosis requires careful evaluation by a doctor or physical therapist. Clinical tests such as the Lachman test (for the ACL) or McMurray’s test (for the menisci) are fundamental, invariably followed by Magnetic Resonance Imaging to confirm the extent of structural damage.

Physiotherapeutic Treatment and Rehabilitation

For patellar tendinopathy, passive rest is ineffective. Heavy Slow Resistance (HSR) protocols or isometric exercises are applied to reduce cortical pain and remodel the tendon. Therapies such as tecartherapy or laser help manage symptoms.
For degenerative or minor meniscal lesions, conservative treatment aims at strengthening the quadriceps and hamstring muscles to stabilize the joint.
For severe ligamentous lesions (such as ACL rupture), the approach may be surgical, followed by a long rehabilitation process (6-9 months) that includes recovery of joint mobility, muscle strengthening, proprioceptive re-education, and specific re-athleticization for padel.

Recommended Exercises

• Isometric Squat (Spanish Squat): Using an inextensible strap fixed to a pole and passed behind the knees, perform a squat holding the position for 30-45 seconds. This exercise loads the patellar tendon, reducing pain. 4-5 sets.
• Eccentric Strengthening on an Inclined Plane (Decline Squat): Perform a squat on a 25-degree inclined board, slowly descending on one leg and ascending with two. Excellent for patellar tendinopathy. 3 sets of 15 repetitions.
• Proprioceptive Exercises: Use unstable boards (BOSU or Freeman boards) performing single-leg squats or simulating the technical gesture of a volley shot, to improve neuromuscular reactivity and prevent sprains.

Global Prevention Strategies

Prevention is the most effective weapon against injuries. A holistic approach must include physical preparation, training load management, and the correct choice of equipment.

Warm-up and Cool-down

Entering the court and starting to hit the ball hard without an adequate warm-up is the quickest way to injury. The warm-up should last at least 10-15 minutes and follow the RAMP protocol (Raise, Activate, Mobilize, Potentiate).

• Thermal Elevation: Light jogging, skipping, lateral movements to increase body temperature and heart rate.
• Activation and Mobilization: Arm circles, torso twists, dynamic lunges. Avoid prolonged static stretching before the match, as it reduces the muscle’s contractile capacity. Prefer dynamic stretching.
• Cool-down: At the end of the match, dedicate 5-10 minutes to static stretching of quadriceps, calves, glutes, pectorals, and forearm muscles to restore resting muscle length.

Equipment Choice

Equipment plays a crucial role in prevention.

• The Racket (Pala): Players prone to elbow or shoulder problems should opt for round rackets (with low balance, towards the handle), of moderate weight (under 365 grams for men, under 350 for women) and with a soft rubber core (FOAM or soft EVA), which absorbs vibrations better.
• The Grip: The handle size must be appropriate for one’s hand. A handle that is too thin forces one to grip too tightly; the use of overgrips is recommended to achieve the ideal thickness. Specific anti-vibration grips (e.g., Hesacore) are also available on the market that reduce stress on the tendons.
• The Shoes: Must be specific for padel. The sole must ensure the right compromise between grip and slide. On courts with a lot of sand, a herringbone sole (clay) is recommended; on new generation courts (Mondo), a mixed or omni sole is preferable. A worn shoe loses its cushioning power, increasing the load on the knees and spine.

Specific Athletic Preparation

Padel is not just played to stay in shape; one must be in shape to play padel. A parallel athletic preparation program, performed 1-2 times a week, should focus on:

• Core Stability: A strong core transfers energy from the legs to the arms, reducing the load on the shoulder and lower back. Exercises such as planks, side planks, and cable rotations (woodchopper) are fundamental.
• Lower Limb Strength: Squats, lunges, and deadlifts strengthen the musculature that protects the knees.

Agility and Plyometrics: Exercises with the speed ladder* and controlled jumps improve tendon reactivity and coordination.

Frequently Asked Questions (FAQ)

Frequently Asked Questions

What is the significance of core stability in preventing padel-related injuries?

Core stability is paramount for maintaining optimal biomechanics and efficient force transfer throughout the body during padel play. A robust core helps to stabilize the trunk, mitigating excessive stress on the shoulder, elbow, and knee joints, which are frequently impacted in the sport.

How does proper playing technique influence injury prevention in padel?

Correct technique is essential for distributing forces appropriately across the musculoskeletal system, preventing localized overload on specific joints and tissues. It minimizes repetitive strain during dynamic movements and overhead shots, significantly reducing the likelihood of both acute and overuse injuries.

What role does footwear and foot stability play in injury prevention on a padel court?

Given the unique surface of a padel court, appropriate footwear providing excellent grip and support is critical for managing rapid directional changes and sudden stops. Ensuring optimal foot stability helps to prevent common lower limb injuries, such as ankle sprains, which are prevalent due to the sport’s dynamic nature.

What types of specific athletic preparation are recommended for padel players to minimize injury risk?

Specific athletic preparation for padel should encompass strength training, focusing on the entire kinetic chain, and proprioceptive exercises to enhance balance and agility. These preparations build resilience in muscles and joints, improving the body’s capacity to handle the sport’s intense demands and reduce overall injury susceptibility.

Resources

Listen to this article

---

Summary infographic

Click to enlarge. Download and share freely, citing the source.

Sources and Scientific References

1. Castillo-Lozano R, Casuso-Holgado MJ. Incidence of musculoskeletal sport injuries in a sample of male and female recreational padel-tennis players. J Sports Med Phys Fitness. 2017;57(6):816-821. DOI: 10.23736/S0022-4707.16.06240-X
2. Priego-Quesada JI, Olaso-Melis J, Llana-Belloch S, et al. Padel practice injuries. J Sports Med Phys Fitness. 2013;53(3):284-291.
3. Courel-Ibanez J, Sanchez-Alcaraz BJ, Canas J. Effectiveness of padel training on body composition, physical fitness and cardiovascular risk factors. Scand J Med Sci Sports. 2019;29(1):10-18. DOI: 10.1111/sms.13305

Sources and Scientific References

1. Schellekens M et al. (2025). Reliability of the Athletic Shoulder test in asymptomatic and symptomatic overhead racquet athletes. Phys Ther Sport. 72:86-94. DOI | PubMed
2. Dahmen J et al. (2023). Incidence, prevalence and nature of injuries in padel: a systematic review. BMJ Open Sport Exerc Med. 9:e001607. DOI | PubMed
3. Catalfamo LM et al. (2022). Maxillofacial Injuries in Padel Game. J Maxillofac Oral Surg. 21:1393-1396. DOI | PubMed
4. Muñoz D et al. (2022). Incidence of Upper Body Injuries in Amateur Padel Players. Int J Environ Res Public Health. 19. DOI | PubMed
5. Kasiga T et al. (2024). Padel an increasing cause of sport-related eye injuries in Sweden. Acta Ophthalmol. 102:74-79. DOI | PubMed
6. Ferreira RM et al. (2025). Sport-Related Injuries in Portuguese Padel Practitioners and Their Characteristics. Medicina (Kaunas). 61. DOI | PubMed