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A 2.7-Gram Ball. Thousands of Wrist Snaps. One Small Tendon on the Outer Elbow.
Table tennis elbow is usually tennis elbow: pain on the outside of the playing elbow, from gripping the bat hard and snapping the wrist through backhands and serves.
Wrist pain in table tennis is usually on the little-finger side, from repeated wrist snaps on topspin and serves. Penhold players often get pain at the base of the thumb or the index finger.
Most players keep playing with grip and training changes. Tendon pain settles over weeks; established tennis elbow can take 6 to 12 months.
Where are you right now?
- Outer elbow: read “Why table tennis causes tennis elbow.”
- Inner elbow: that’s golfer’s elbow, often from heavy forehand topspin.
- Little-finger side of the wrist: read the wrist section.
- Penhold grip, thumb or index finger sore: the grip section is yours.
Why table tennis causes tennis elbow
The muscles that bend your wrist back start from one tendon on the outer elbow. They fire every time you grip, and they work hardest when you flick the bat through a backhand or a fast serve.
Thousands of those in a training session, with a grip you’re squeezing harder than you need…and the tendon falls behind.
It often follows a jump in training: multiball sessions, a new league season, or a new bat with a heavier blade.
Forrest Gump made ping pong look effortless. He didn’t do 500-ball multiball drills.
Wrist pain in table tennis
- Little-finger side: repeated wrist snaps with the palm turned are hard on the TFCC and the ECU tendon. Worse on serves and backhand flicks.
- Thumb side: De Quervain’s, especially with a tight grip.
- Back of the wrist: often a tendon irritation from wrist-heavy strokes.
Grip: shakehand and penhold
- Shakehand: relax the grip between points. Squeeze only at contact. A handle that’s too thin makes you squeeze harder.
- Penhold: the thumb and index finger pinch the blade, so the thumb base and the index finger knuckles take the load. Pain there is usually overload, sometimes thumb base arthritis in older players.
- Blade weight: a heavier blade or thick rubbers add load on every stroke. Go lighter while it settles.
Squeeze at contact, relax between points. Your outer elbow keeps count.
What to change
- Cut multiball and serve practice by half for 2 to 4 weeks. Keep match play.
- Use the body, not the wrist. More legs and trunk rotation, less wrist flick, on topspin.
- Build load slowly after a break or a new season.
- A counterforce strap helps some players with tennis elbow. See tennis elbow strap.
Table tennis pain, week by week
Pain while playing should stay at 3 out of 10 or less, and settle by the next morning.
- Weeks 0 to 2 (OPEN): half the drill volume, grip changes. Wrist isometrics: hold the wrist back against your other hand, about half effort, 5 holds of 30 to 45 seconds, once or twice a day.
- Weeks 2 to 6 (OPEN): slow wrist extensions with a light dumbbell, 3 sets of 15. Drill volume back up gradually.
- Weeks 6 to 12: full training for most wrist tendon problems.
- Months 3 to 12 (CLOSING if nothing has moved): tennis elbow that’s been rest-then-play-then-flare for 3 months needs a different plan. See how long tennis elbow lasts.
Is this normal?
Usually expected:
- Forearm tiredness after a long session that’s gone by morning.
- A tender spot on the outer elbow after a tournament weekend, easing over a few days.
Check with a doctor or hand therapist if the wrist clicks with pain, the pain wakes you, or it’s worse every week despite changes.
If it isn’t going to plan
Two months. You’ve rested, gone back, rested again. The elbow flares every time training builds.
Rest calms a tendon. It doesn’t strengthen it. Each return sends a weaker tendon back to the same load, and the cycles get longer. Little-finger-side wrist pain that keeps clicking can be a TFCC tear, which doesn’t settle with rest alone.
Get assessed by a hand therapist or sports doctor, and fix the load and the tendon together. See also tennis, badminton and squash injuries.
When can I…?
| Activity | Typical timing |
|---|---|
| Light rallying, relaxed grip | Usually straight away, if pain stays low |
| Full training and multiball | Often 2 to 6 weeks for wrist tendon pain |
| Competition after tennis elbow | Often 6 to 12 weeks, sometimes longer |
Get it checked today if
- Sudden sharp pain with a pop in the wrist or elbow, and you can’t grip.
- New numbness in the ring and little fingers.
Get it checked if
- Little-finger-side wrist pain with clicking that’s lasted more than 4 weeks.
- No improvement after 6 to 8 weeks of changes and exercises.
- Pain at night or at rest.
The ball weighs almost nothing. The grip and the drill volume are what your elbow is carrying.
Related: tennis elbow from golf · tennis elbow from weightlifting
Written by Nigel Chua, hand occupational therapist in practice since 2005. Thousands of hands, wrists and elbows assessed and treated. My credentials are here. This article explains; it doesn’t examine. If your wrist clicks and hurts on every serve, get it assessed.
Part of: Hand, wrist and elbow pain by job, sport and hobby
Every article on this site is written using the Closing Window Method: name the window your condition runs on, find where you are in it, and act while it’s still open.