Padel injury prevention: elbow, calf and knee, by the evidence

Padel looks gentle. The injury research says otherwise: most surveys find that around half or more of regular players report an injury, and the same three areas keep coming up: the elbow, the back of the lower leg and the knee. This guide sets out what the sports-medicine literature shows, flags where the evidence is borrowed from tennis or football, and ends with a warm-up and weekly routine for Dubai courts.

Note: This is general information, not medical advice. See a sports physician or physiotherapist for pain that persists.

How often padel players get hurt

The best summary is a 2023 systematic review in BMJ Open Sport & Exercise Medicine. Across eight studies and 2,022 players, it found an incidence of about 3 injuries per 1,000 hours of training and 8 per 1,000 matches, with prevalence between 40% and 95% depending on the study and time window (Dahmen et al., 2023). The elbow was the most commonly injured site, followed by the knee, shoulder and lower back, and tendon and muscle injuries were the most reported types.

Two caveats: the incidence figures come from a single Spanish study, and nearly all included studies were retrospective questionnaires. The authors also did not analyse risk factors.

Newer surveys broadly agree:

Study	Players	Key finding
Belgium, recreational (Declève et al., 2025)	457, median age 42	36.5% injured in the past year; 2.81 injuries per 1,000 h; 53.5% lower limb; median 30 days to recover
Portugal, nationwide (Ferreira et al., 2025)	426, mean age 41.7	69.2% lifetime injury; 3.4 per 1,000 h; elbow 18.0%, ankle 16.6%, knee 12.5%
Italy, recreational (Thomas et al., 2023)	127	78.8% injured in the past year; lower leg/Achilles 17.1%, elbow 13.8%
Chile, amateur leagues (Belmar-Arriagada et al., 2025)	364, mean age 37.4	53.8% injured in the past six months; ankle-foot most common
Germany, all levels (Meyer et al., 2025)	234	4.03 injuries per 1,000 h; knee the most injured region in non-professionals (19.6%)

All of these are cross-sectional and self-reported, so they describe patterns rather than prove causes.

Who gets hurt

Age. The picture is mixed. In the Belgian study, being over 30 was independently associated with injury (Declève et al., 2025). In Chile, prevalence was almost identical under and over 36 (53.2% vs 54.5%) (Belmar-Arriagada et al., 2025). What changes with age is the type of injury: a Spanish study of 131 players over 50 recorded elbow injury at 29.8% and tennis leg at 22.1%, as summarised in the Dahmen review (Castillo-Lozano, 2017, via Dahmen et al., 2023).

Hours played. In 950 amateurs, a larger share of injured players were on court more than six hours a week (24.7% of injured vs 17.5% of uninjured) (Muñoz et al., 2022). The Italian study linked 3.5 to 5 hours a week to higher injury probability (Thomas et al., 2023). More hours and more experience were both associated with more injuries in a Spanish sample of 216 players (Rocamora-López & Mateo-Orcajada, 2025).

Experience. Newer players get more elbow trouble, longer-serving players more calf trouble. In the Portuguese data, each extra year of experience was linked to lower odds of elbow injury (OR 0.87) but higher odds of posterior lower-leg injury (OR 1.13) (Ferreira et al., 2025).

Warm-up. The data here are messy. Two-thirds of Portuguese players (66.4%) warmed up for under 10 minutes (Ferreira et al., 2025). The Belgian study actually found warming up was associated with more injury (Declève et al., 2025). The authors say causality needs investigating; one plausible reading is that players start warming up after being hurt. No padel trial has yet tested a structured warm-up, so the case for one rests on evidence from other sports, covered below.

The elbow: lateral epicondylitis ("padel elbow")

Lateral elbow tendinopathy, commonly called tennis elbow, is pain on the outside of the elbow where the wrist extensor tendons attach. One clinical review of padel prevention puts it at more than 20% of all reported injuries (Bernal, 2023).

Risk factors

Age and volume. The classic tennis study of over 500 players found that incidence and recurrence both rose with age, and that more playing time per day raised incidence (Gruchow & Pelletier, 1979). In the general Finnish population, lateral epicondylitis peaked at ages 45 to 54 (Shiri et al., 2006). This is tennis and population data, not padel data.
Grip size. In the same tennis study, a larger grip was associated with more tennis elbow in the older group (Gruchow & Pelletier, 1979).
Racket weight. Among 950 amateur padel players, 83.0% of injured players used rackets of 350 g or more, against 77.1% of uninjured players. A small but significant difference (Muñoz et al., 2022). The Italian study flagged 356 to 375 g, or not knowing your racket's weight (Thomas et al., 2023).
Racket shape. Findings conflict. Round rackets were linked to more injury in women players (OR 1.43) (Escudero-Tena et al., 2026) and in the Italian study, but not in the larger Muñoz sample.
Coaching. In Portugal, instructor supervision was linked to better warm-up habits and lower odds of elbow injury (Ferreira et al., 2025). The estimates are imprecise, so treat this as a signal, not a size.

A lighter racket, a grip that is not oversized and some coaching are cheap, low-risk changes. None has been tested in a padel trial.

What helps once it hurts

Progressive loading is the core. A systematic review of 12 studies concluded that eccentric exercise should be part of a multimodal programme for lateral epicondylitis, though only one low-quality study tested eccentrics on their own (Cullinane et al., 2014).

The Tyler twist. In a small randomised trial of 21 patients with chronic tennis elbow, adding an eccentric wrist-extensor exercise with a rubber Flexbar to standard physiotherapy improved disability scores by 76% vs 13% and pain by 81% vs 22% over about seven weeks (Tyler et al., 2010). It is cheap and home-friendly, but the trial was small, so do not take the effect size at face value. The same group's later work on the inner elbow used three sets of 15 twice daily with a five-second slow release (Tyler et al., 2014); ask a physio to set your dose and show you the technique.

Isometrics. Static holds are popular for calming tendon pain. A 2026 systematic review of 13 trials (two on the lateral elbow) found they are tolerable and may give short-term pain relief, but there is limited support for them being better than other loading (Soliman et al., 2026).

Counterforce braces. A meta-analysis of 17 trials found physiotherapy beat braces, especially long term, though braces may help pain in under-45s over the first six weeks (Shahabi et al., 2020). A Cochrane review could draw no firm conclusion on orthotic devices (Struijs et al., 2002). A brace is a short-term comfort aid, not a fix.

Be wary of cortisone. In a 165-patient trial, corticosteroid injection led to worse one-year outcomes than placebo (83% vs 96% recovered or much improved) and far more recurrence (54% vs 12%) (Coombes et al., 2013).

The calf and Achilles: tennis leg and tendon trouble

Tennis leg

"Tennis leg" is a tear at the junction of the medial gastrocnemius and soleus, the inner calf. It typically comes from a sudden overstretch, and most cases recover with conservative care in 6 to 12 weeks (Schwach et al., 2026). A padel-specific clinical review describes it as the typical padel muscle injury, often on single-leg landings after overhead shots (Bernal, 2023). That mechanism comes from clinical experience rather than a measured study.

The lower leg features heavily in padel data. In the Italian survey, the lower leg and Achilles was the most common injury site at 17.1% (Thomas et al., 2023), and in the over-50 Spanish sample tennis leg reached 22.1% (via Dahmen et al., 2023).

Achilles rupture

There is no padel-specific rupture data. In US emergency data, 81.9% of Achilles ruptures happened during sport or recreation, and the biggest rise over 2012 to 2016 was in people aged 40 to 59 (a 78% increase) (Lemme et al., 2018). In a Shanghai series of 252 sport-related ruptures, badminton caused 27.0%, and acceleration or a running start was the most common action. Of those who had not warmed up, 22.4% ruptured within the first 10 minutes of play, against 5.5% of those who had (Teng et al., 2022). That is observational data from another racket sport, but the push-off is similar.

Prevention and loading

There is no trial showing that calf strengthening prevents tennis leg in padel. The broader evidence is encouraging: a meta-analysis of 25 trials found strength training cut sports injuries to less than a third (RR 0.315), while stretching had no effect (RR 0.963) (Lauersen et al., 2014).

For established Achilles tendinopathy, the Alfredson protocol is the best-known option: eccentric heel drops off a step, with straight and bent knee, three sets of 15, twice a day, seven days a week for 12 weeks (Hasani et al., 2021). In the original study, all 15 recreational athletes (mean age 44) were back to full running after 12 weeks (Alfredson et al., 1998). That study was small and not randomised. A later randomised trial of 58 patients found heavy slow resistance training worked as well as eccentric training, with better session adherence (92% vs 78%) (Beyer et al., 2015). If 180 heel drops a day will not happen, heavy slow calf work is a credible alternative; a physio can set the dose.

The knee: tendon, meniscus and ACL

The knee is a top-three padel injury site in the systematic review (Dahmen et al., 2023) and the most injured region among German non-professionals (Meyer et al., 2025). The padel studies rarely break this down into patellar tendinopathy, meniscus or ACL, so there are no reliable padel-specific rates for each.

Fatigue plays a part. In a lab study of a 135-minute padel match, maximal knee-extensor strength fell by 10% by the end (Jamotte et al., 2026). That is a reason to be careful in the third hour of a long session.

For patellar tendinopathy, a randomised trial found heavy slow resistance training gave good short- and long-term results, while corticosteroid injections helped short term but deteriorated by six months (Kongsgaard et al., 2009).

Neuromuscular warm-ups: borrowed evidence

The strongest prevention evidence comes from football and other pivoting sports, not padel. A meta-analysis of FIFA 11+, a structured warm-up for amateur football, found it reduced injuries by 39% (Thorborg et al., 2017). Benefits appeared when it was done at least twice a week (Bizzini & Dvorak, 2015). Across ACL prevention programmes, a meta-analysis of meta-analyses found about a 50% reduction in all ACL injuries, though most data came from female athletes and evidence in men was insufficient (Webster & Hewett, 2018).

Padel involves similar decelerations, lunges and direction changes, so the principles transfer reasonably. The size of any benefit for padel players is unknown.

The Dubai angle: heat, surfaces and courts

Heat and hydration

The IOC consensus on sport in the heat is the most useful reference for outdoor summer padel (Racinais et al., 2023):

Acclimatise. Aim for 60 to 90 minutes a day of heat exposure for at least two weeks, with at least four sessions a week to build it and two a week to keep it.
Avoid losing more than 2% of body mass to dehydration. The ACSM position stand sets the same 2% line and recommends weighing yourself before and after play to estimate your own sweat rate (ACSM, Sawka et al., 2007).
Rehydrate after with roughly 100% to 120% of the body mass lost.
Add sodium (about 0.5 to 0.7 g per litre) if you play for over an hour.
Shorten the warm-up in heat, but do not skip it, and use cold towels or cool drinks at changeovers.

The IOC also warns that WBGT, the heat-stress index, often reads lower than air temperature, so a "low" number on an app can mislead. In UAE outdoor measurements, radiant heat contributed far more to heat stress than metabolic or convective load, and the authors recommended scheduling outdoor work early or after sunset with shaded breaks (Ahmed et al., 2020). That study was of construction workers, but the sun-load lesson applies to an exposed court.

Artificial turf and sand

Padel courts use sand-filled synthetic turf. A systematic review of synthetic grass found surface temperatures 9.4 to 33.7 °C higher than natural grass, though it was unclear whether that raises overall heat-stress risk (Singh et al., 2024a). In a crossover trial in about 33 °C heat, calf skin temperature reached 40.1 °C on synthetic grass versus 33.4 °C on natural grass, with a higher sweat rate (Singh et al., 2024b). Both studies used football-type turf, not padel courts.

On injury, one Spanish study found muscle and ligament injuries were more common on sand courts (Rocamora-López & Mateo-Orcajada, 2025). The Portuguese study also found surface type shifted injury patterns (Ferreira et al., 2025). Match your shoe sole to the court surface (Bernal, 2023).

Indoor vs outdoor

No study found here compares injury rates on indoor and outdoor padel courts. Indoor, air-conditioned courts remove most of the heat load; outdoors in summer, the heat guidance above matters most.

Practical checklist

10-minute pre-match warm-up

Minutes	What to do	Why
0 to 2	Easy jog, side shuffles, carioca across the court	Raise temperature
2 to 4	Walking lunges with a twist, lateral lunges, leg swings	Hip and knee range
4 to 6	2 x 10 double-leg calf raises, 1 x 10 single-leg each side, 10 squats	Load calf and knee before sprinting
6 to 8	Split-step drills, 3 short accelerations, 5 small hops landing softly on each leg	Prepare push-off and landings
8 to 10	Wrist circles, 10 light wrist extensions per arm, then soft volleys building to full strokes	Prepare forearm and shoulder

In serious heat, keep the structure but drop the intensity, and drink before you start. This sequence is built from the principles above; it has not been tested as a padel programme.

Weekly prevention routine (two to three sessions, about 20 minutes)

A starting template based on the strength-training evidence, not a tested padel protocol.

Calf strength: heavy calf raises, straight and bent knee, three sets of 8 to 15. Add load as they get easy.
Wrist extensors: a slow eccentric Flexbar exercise or a light dumbbell, three sets of 15.
Legs: split squats or step-ups, three sets of 8 to 10 each side.
Balance and landing: single-leg balance and controlled hop-and-stick, two to three sets.
Trunk: front and side planks.

Load and kit

Increase weekly court hours gradually, especially past about six hours a week.
If you are over 40 or new to the game, consider a lighter racket and check your grip size.
Book a few lessons. Supervision was linked to fewer elbow injuries in the Portuguese data.
Treat persistent pain as a reason to reduce load and get assessed, not to play through.