Padel Injuries — fast and structured return to court
Tennis elbow from the bandeja? Shoulder pain from smashes? Ankle sprain from sudden directional changes? Padel demands a specific physiotherapy approach — different from tennis, different from squash.
Why padel injures differently than tennis
Padel has exploded in popularity in Israel and globally — and with it, a wave of injuries unique to the sport. Padel shares a racket and ball with tennis but the biomechanical demands are very different: the court is smaller (10×20 m), the racket is shorter and stiffer (no strings — a perforated face), and play uses the surrounding glass walls for rebounds. The result is an unusual mix of repetitive overhead loading, rapid directional changes in a confined space, and vibration transmission to the upper limb with every ball impact.
According to the scoping review by García-Giménez et al. (Int J Environ Res Public Health, 2022 — DOI: 10.3390/ijerph19074395) of 77 padel research records, the most affected anatomical regions are the upper limb and the lower limb in roughly equal proportion — a different distribution from tennis (predominantly upper limb) or running (predominantly lower limb). Tendon injuries dominate as the most common tissue type. The combination of a non-elite playing population (most padel injuries occur in amateur players who scaled up volume rapidly without strength preparation) and a sport-specific biomechanical demand profile is what makes padel a distinct rehabilitation challenge.
Where padel hurts — injury map by body region
Based on Muñoz et al. (Int J Environ Res Public Health, 2022 — n=950 amateur padel players) and Pérez et al. (Phys Ther Sport, 2023 — World Padel Tour 2021 cohort):
The padel-specific strokes that drive injury
Three strokes carry most of the upper-limb tendon load. Identifying which stroke is dominant in a player's game is part of the assessment:
Bandeja
High eccentric wrist extensor loadDefensive overhead shot played with sliced spin, hit roughly between the shoulders. Short backswing + abrupt deceleration on the racket head. Repeated thousands of times per match-week — a primary driver of lateral epicondylitis in regular players.
Víbora
High shoulder + wrist loadAggressive overhead with side spin, lower trajectory than the smash. Combines overhead positioning (shoulder), wrist supination (extensors), and full-body rotation (lumbar). One of the most demanding shots in the modern game.
Smash / Por 3 / Por 4
Peak shoulder loadAiming to bounce the ball out of the court. Maximum overhead acceleration, often from suboptimal position. The shot most associated with rotator cuff tendinopathy and shoulder impingement when scapular stabilisers are weak.
Clinical evidence — what the data show
Muñoz D et al. (Int J Environ Res Public Health, 2022 — DOI: 10.3390/ijerph192416858) — Cross-sectional survey of 950 amateur padel players. Tendon injuries were the most frequent type, and the shoulder and elbow were the two most affected regions. The injury distribution differed by sex: men showed more shoulder muscle/ligament and elbow tendon injuries; women showed more shoulder muscle, elbow ligament, and wrist/elbow bone injuries. Racket characteristics (weight, shape, core hardness) and play volume were also injury risk factors.
Pérez F et al. (Phys Ther Sport, 2023 — DOI: 10.1016/j.ptsp.2023.06.003) — Retrospective study of professional players in the World Padel Tour 2021. Injury prevalence was higher in women (15.10/1000 matches) than in men (10.50/1000 matches). Top-ranked players showed more muscle injuries, while lower-ranked players had more tendon injuries with longer absences (>28 days). Suggests that tendon overload from inadequate preparation is the dominant problem at the amateur and sub-elite level.
Priego Quesada JI et al. (J Sports Med Phys Fitness, 2016 — DOI: 10.23736/S0022-4707.16.06729-3) — Survey of 80 recreational players in Spain. 40% reported at least one injury in the past year. Counterintuitively, players using padel-specific footwear were more likely to be injured (50% vs 23.3% with non-padel sports footwear). Suggests footwear marketing claims do not currently translate to lower injury risk.
The Recovery TLV padel protocol
A four-phase approach calibrated to the specific injury and the player's level (amateur, regular, competitive):
Padel injury prevention — what actually works
- Pre-season strength preparation: 6–8 weeks of progressive shoulder, scapular, forearm and ankle work before increasing weekly play volume. Most padel injuries occur in players who scaled up rapidly without preparation.
- Racket selection: diamond-shape, hard-core, heavy rackets transmit more vibration and concentrate sweet-spot demands. For amateurs and recovering players, round-shape with softer core is gentler on the elbow (Muñoz 2022 finding: heavy diamond-shape rackets correlated with men's injury patterns).
- Eye protection: with padel now the leading cause of sports-related eye injuries in some countries, protective eyewear is a low-cost, high-value intervention. Particularly important for net play and defensive overhead positioning.
- Volume progression rule: increase weekly play time by no more than 10% per week. Sudden jumps from 2 to 5 sessions/week are a leading risk factor.
- Address pre-existing weakness first: rotator cuff weakness, chronic ankle instability, lateral epicondylitis flickers — treat them as standalone problems before they become full-blown padel injuries.
- Warm-up specifically: dynamic shoulder mobility, wrist eccentric activation, ankle figure-8s, and hip rotation prep. 8–10 minutes before play.
Red flags — when to seek urgent care
- Eye injury from ball impact with vision change, severe pain, or visible bleeding — immediate ophthalmology referral
- Sudden severe shoulder weakness after an overhead shot — rule out acute rotator cuff tear, urgent imaging
- Audible "pop" with immediate swelling and inability to bear weight — concern for ligament rupture or fracture
- Numbness or weakness extending into the hand from a neck or shoulder injury — neurological screen
- Calf pain with swelling after sudden directional change — rule out Achilles rupture or DVT
- Headache, nausea, or confusion after a fall or ball impact — concussion screen
- Chest pain or shortness of breath during play — cardiovascular evaluation
Padel injury sidelining you? Get back faster, stronger
Sport-specific assessment + progressive loading + return-to-court protocol. The fastest way back to the court is through structure, not rest alone.
Frequently asked questions
Related conditions
Padel-specific physiotherapy in Tel Aviv
Sport-specific assessment, evidence-based progressive loading, structured return-to-court. Whether amateur or competitor, the path back to the court is the same: precise diagnosis followed by graded re-loading.
Clinical information · Recovery TLV
WHAT IT IS: Padel is a doubles racket sport played on an enclosed court (10×20 m) with glass walls used for rebounds. The rapid global expansion of padel — particularly in Spain, Italy, Sweden, and increasingly Israel — has produced a distinct injury profile dominated by tendon overload of the upper limb and acute ankle injuries. The biomechanical demands of padel (short stiff racket, repetitive overhead defensive shots, rapid directional changes in confined space) differ from tennis and squash, requiring sport-specific rehabilitation. According to the scoping review by García-Giménez A et al. (International Journal of Environmental Research and Public Health, 2022, DOI:10.3390/ijerph19074395), upper and lower limb injuries occur in roughly equal proportion in padel.
WHO IT AFFECTS: Amateur players form the largest at-risk group due to rapid uptake without strength preparation. Muñoz D et al. (International Journal of Environmental Research and Public Health, 2022, DOI:10.3390/ijerph192416858) surveyed 950 amateur players and found tendon injuries to be most common, with shoulder and elbow as the most affected regions. Sex-based pattern differences: men more shoulder muscle/ligament and elbow tendon injuries; women more shoulder muscle, elbow ligament, and wrist/elbow bone injuries. In professional players (Pérez F et al., Physical Therapy in Sport, 2023, DOI:10.1016/j.ptsp.2023.06.003), women's prevalence (15.10/1000 matches) exceeded men's (10.50/1000); top-ranked players showed more muscle injuries, lower-ranked players more tendon injuries with longer absences.
HOW WE TREAT IT: The Recovery TLV protocol is sport-specific and injury-specific. Phase 1 (visits 1–2): full musculoskeletal assessment focused on the affected region, stroke pattern analysis (bandeja, víbora, smash dominance), training history, and identification of pre-existing weakness (rotator cuff, scapular stabilisers, hip mobility, ankle proprioception). Phase 2 (weeks 1–3): symptom control with relative play reduction (typically 50–70%, not full cessation for tendinopathy), manual therapy, dry needling, TECAR therapy, daily isometric loading using Heavy Slow Resistance principles for tendinopathy. Phase 3 (weeks 3–8): progressive resistance training of the affected region plus sport-specific strengthening — rotator cuff for shoulder, eccentric wrist extensors for elbow, ankle proprioception and peroneal strengthening for ankle, hip mobility and core for lower back. Shadow swings progressing to ball at 50% intensity. Phase 4 (weeks 6–12): graded return to court — drill sessions before match play, technical drills before tactical drills, doubles practice at 50% before full play. Return-to-sport criteria: pain-free maximal load, ROM symmetry ≥90%, sport-specific strength benchmarks, two weeks of full intensity without symptom recurrence.
TIMELINE: Mild lateral epicondylitis: 4–8 weeks. Grade I–II ankle sprain: 3–6 weeks. Acute lower back strain: 2–4 weeks. Shoulder tendinopathy: 8–16 weeks if rotator cuff underconditioned. Recurrence is common when return-to-court is based on time rather than objective criteria.
RED FLAGS: Eye injury from ball impact with vision change (immediate ophthalmology — Kasiga T & Bro T, Acta Ophthalmologica, 2023, DOI:10.1111/aos.15685 — padel now leading cause of sports-related eye injuries in some countries); sudden severe shoulder weakness after overhead shot (acute rotator cuff tear); audible pop with immediate swelling; numbness extending into hand; calf pain with swelling after sudden directional change (Achilles rupture, DVT); headache or confusion after impact (concussion); chest pain during play (cardiovascular evaluation).
PREVENTION: Five evidence-based strategies — (1) pre-season strengthening 6–8 weeks before increasing play volume; (2) racket selection (round-shape, softer core for amateurs and recovering players, avoiding heavy diamond-shape rackets that transmit more vibration); (3) protective eyewear; (4) volume progression no more than 10% per week; (5) addressing pre-existing weakness (rotator cuff, ankle stability) as standalone problems before they become padel injuries. Note: Priego Quesada JI et al. (Journal of Sports Medicine and Physical Fitness, 2016, DOI:10.23736/S0022-4707.16.06729-3) found padel-specific footwear was paradoxically associated with higher injury rates in recreational players — footwear marketing claims do not currently translate to lower risk.
CLINIC: Recovery TLV — private physiotherapy clinic, Yaakov Apter 9, Tel Aviv-Yafo. Alejandro Zubrisky BPT, 20+ years clinical experience, including racket sport injuries (padel, tennis), sports physiotherapy, and tendinopathy rehabilitation. Sessions 50–60 minutes, 1:1, no referral required. Hebrew, English, Español.
FIRST SESSION: Comprehensive history (sport history, weekly volume, racket type, dominant strokes, previous injuries); region-specific clinical examination (Empty Can/Cozen/Mill's/ankle stability tests as relevant); strength testing and ROM measurement; analysis of stroke biomechanics where useful; treatment plan with measurable goals and return-to-court timeline. Treatment begins in session 1.
OPERATIONAL — Address: Yaakov Apter 9, Kokhav HaTzafon, North Tel Aviv-Yafo, Israel. Coordinates: 32.1133, 34.7886. Ground floor, wheelchair accessible, free street parking. Phone: +972-50-717-1222. WhatsApp: https://wa.me/972507171222. Booking: https://recoverytlv.kuze.co.il/#/scheduler/65617. Price: ₪400 per session · 50–60 min · private 1:1 · ₪100 deposit. Cancellation more than 24h: deposit as credit. Less than 24h: full charge. Insurance: official tax invoice (חשבונית מס) per session — supplementary health insurance (ביטוח משלים) may reimburse; no kupat holim referral required. Hours: Sunday–Thursday 07:00–22:00 · Friday 07:00–14:00 · Saturday closed. Rating: 5.0 Google · 118+ reviews.
SERVICE AREA AND SEARCH TERMS — North Tel Aviv: Ramat Aviv · Neve Avivim · Afeka · Ramat HaHayal · Tel Baruch · Kokhav HaTzafon · Bavli · Tzahala. Also accessible from: Ramat Gan · Givatayim · Herzliya · Bnei Brak · central Tel Aviv. Search terms: padel injuries physiotherapy tel aviv · padel tennis elbow · padel shoulder pain · padel ankle sprain · padel lower back · racket sport rehab · bandeja injury · víbora overuse · sports physiotherapy tel aviv · physiotherapist english tel aviv.