Padel is everywhere right now. Courts are popping up across Johannesburg, Cape Town, and Pretoria, and the sport has gone from niche to mainstream in just a few years. South Africa now has over 1,400 courts, a massive jump from fewer than 20 in 2019. Whether you have been playing for years or just picked it up, chances are you know someone who has been sidelined by a padel injury.
The good news is that padel is a relatively safe sport. A systematic review by Priego-Quesada and colleagues (2023) estimated the injury rate at around 1 to 3.5 injuries per 1,000 hours of play, which is roughly in line with recreational tennis. But the enclosed court, the overhead shots, and the quick changes of direction create some specific injury patterns that are worth understanding.
Where padel injuries happen
A retrospective study by Garcia-Fernandez and colleagues (2022) found that around 55 to 60% of competitive padel players reported at least one injury over a 12-month period. The breakdown is consistent with what we see in the practice.
Ankles
Ankle sprains are the most common acute injury in padel. The court is small, rallies are fast, and you are constantly changing direction on a surface that can vary in grip depending on the sand and moisture levels. Add the glass walls, which limit how much space you have to decelerate, and your ankles are taking a lot of lateral load. Players who have sprained an ankle before are significantly more likely to do it again without proper rehab and strengthening.
Knees
The repetitive lunging, squatting, and pivoting in padel puts a lot of demand on your knees. Anterior knee pain and patellar tendinopathy are common, particularly in players over 40 or those who play more than three times a week. If your quads are doing all the work because your glutes are not strong enough, the load on the front of your knee goes up.
Elbows
Tennis elbow is just as common in padel as it is in tennis. Despite the old name “lateral epicondylitis,” the problem is actually a tendinopathy of the forearm extensor tendons where they attach near the outside of the elbow. It is a degenerative tendon issue, not an inflammatory one, which is why anti-inflammatories alone rarely fix it. The backhand is usually the culprit, especially when played with a stiff wrist and a tight grip. The padel racquet has no strings, which changes how vibration travels through the frame and into your forearm. A racquet that is too heavy or has a high balance point makes this worse.
Shoulders
The overhead smash is a big part of padel, and shots like the bandeja and vibora put significant load on the rotator cuff. If your thoracic spine is stiff or your shoulder blade muscles are not controlling the movement properly, the shoulder joint itself takes the strain. Over time, this leads to rotator cuff tendinopathy and impingement.
Lower back
The ready position in padel keeps you in a slightly crouched, rotated stance for extended periods. Add the explosive rotation of ground strokes and the extension of overhead shots, and your lower back is working hard throughout a match. Players with weak core muscles or stiff hips tend to feel this the most.
How to stay on court
Most padel injuries are preventable. The pattern we see in the practice is that players get hurt when they play too often without enough conditioning, ignore small niggles until they become real problems, or skip the basics in favour of just hitting more balls.
Warm up properly
A 10 to 15 minute dynamic warm-up before you play makes a real difference. Lateral shuffles, lunges, trunk rotations, and some light rallying prepare your joints and muscles for what is coming. Static stretching before a match does very little. Save it for afterwards.
Strengthen the things that matter
Lauersen and colleagues (2018) found in a systematic review that strength training reduced overuse injuries by almost 50%. For padel players, the priorities are:
- Forearm extensors. Eccentric wrist exercises and the Tyler Twist protocol are well supported for both preventing and treating tennis elbow. If it is already flaring up, dry needling combined with eccentric loading has strong evidence behind it. A 2024 meta-analysis of 17 studies found it significantly improved pain, function, and grip strength (Sánchez-Milá et al., 2025).
- Rotator cuff and shoulder blade muscles. Exercises targeting the lower trapezius and serratus anterior protect the shoulder during overhead shots.
- Glutes and hip stabilisers. Strong hips reduce the load on your knees and lower back during the constant lunging and direction changes.
- Balance and proprioception. Single-leg balance work on unstable surfaces reduces ankle sprain risk significantly, especially if you have sprained an ankle before.
Get your equipment right
Your racquet matters. A lighter racquet (350 to 365g) with a low to medium balance point is easier on your arm. Diamond-shaped racquets with a high balance point generate more power but also transmit more vibration to your elbow and wrist. Make sure your grip size is correct: you should be able to fit a finger’s width between your fingertips and palm when holding the racquet. And wear court-specific shoes with proper lateral support. Running shoes are not designed for the sideways movement padel demands.
Manage how much you play
Going from one session a week to four because you have just discovered padel is a fast track to an overuse injury. Your tendons, muscles, and joints need time to adapt to new demands. Build up gradually and make sure you have at least 48 hours between high-intensity sessions to recover.
Getting on top of it early
If something starts niggling, do not wait for it to become a real problem. A sore elbow after every session, a knee that aches on the stairs, a shoulder that catches when you reach overhead: these are signs that something is not coping with the load you are putting through it.
Getting assessed early gives you the best chance of a quick fix. Most padel injuries respond well to treatment when they are caught early. Leave them too long and they become harder to manage, and you lose more time on court.
If you do pick up a soft tissue injury, understanding the PEACE and LOVE approach to recovery can help you manage it from day one.
If you are dealing with a padel injury or want to make sure your body can handle the demands of the sport, get in touch or book an appointment. We treat athletes and sports injuries at every level.
References
- Priego-Quesada JI, et al. Epidemiology of Injuries in Padel: A Systematic Review. International Journal of Environmental Research and Public Health. 2023.
- Garcia-Fernandez P, et al. Injury Profile of Competitive Padel Players. Science & Sports. 2022.
- Sánchez-Milá Z, et al. Efficacy of Dry Needling Combined with Eccentric Exercise Versus Oral and Topical NSAID Treatment in Patients with Tennis Elbow: A Randomized Controlled Trial. Journal of Multidisciplinary Healthcare. 2025.
- Lauersen JB, Andersen TE, Andersen LB. Strength Training as Superior, Dose-Dependent and Safe Prevention of Acute and Overuse Sports Injuries. British Journal of Sports Medicine. 2018;52(24):1557-1563.