Effects of the Tyler Twist Versus Eccentric Exercises

Effects of the Tyler Twist Versus Eccentric Exercises in Patients With Lateral Epicondylagia

This study aims to compare the effects of the Tyler Twist exercise versus traditional eccentric exercises on pain, grip strength, and functional outcomes in patients diagnosed with lateral epicondylalgia. The primary objective is to determine which intervention offers greater improvement in clinical symptoms and overall function over a defined treatment period.

Study Overview

• Status: Not yet recruiting
• Conditions: Lateral Epicondylalgia
• Intervention / Treatment: Other: Tyler Twist Exercises; Other: Traditional Eccentric Wrist Extensor Exercises

Detailed Description

Conservative management is typically the first line of treatment, with eccentric exercises widely recognized for their effectiveness in promoting tendon healing and reducing pain. The "Tyler Twist," exercise is a variation using the TheraBand FlexBar, that has emerged as a superior potential alternative, that combines both eccentric and concentric loading in a functional and controlled way. However, direct comparative evidence between the Tyler Twist and conventional eccentric exercises has remained limited.

• Study Type: Interventional
• Enrollment (Estimated): 38
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Imran Amjad, PhD; Phone Number: 03324390125; Email: imran.amjad@riphah.edu.pk

Study Locations

• Pakistan
  • Punjab Province
    • Lahore, Punjab Province, Pakistan, 54000
      • Ghurki Hospital Lahore
      • Contact: Hira Shaukat, Mphill; Phone Number: 03360405480; Email: hirabutt7582@gmail.com
      • Contact: Hira Butt; Phone Number: 03360405480; Email: hirabutt7582@gmail.com
      • Principal Investigator: Hafiza Nukhba SIBGHAT, MSOMPT

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• ● Males and female patients suffering from lateral epicondylagia in subacute and chronic phase.

  • Age between 20yrs-40yrs.
  • Patients screened with positive Cozen's test, positive Mill's test, positive Maudsley's test [14].
  • NPRS pain score ≥ 4 on activity.
  • Tenderness on palpation over the lateral epicondyle of humerus,
  • Pain with gripping, Pain with resisted wrist extension.

Exclusion Criteria:

• History of recent trauma or surgery of elbow.
• Acute stage of lateral epicondylagia.
• Corticosteroid injection within the last 3 months.
• Neurological defeciency of the affected limb [16].
• Systemic inflammatory diseases, such as rheumatoid arthritis, lupus, or fibromyalgia.
• Diabetes mellitus (uncontrolled) due to its influence on tendinopathy.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Tyler Twist Exercises; The Tyler Twist is a specific eccentric exercise using the TheraBand FlexBar, designed to target the extensor carpi radialis brevis (ECRB), which is primarily involved in lateral epicondylalgia.	Other: Tyler Twist Exercises; Position:; The patient holds the FlexBar in both hands.; The affected arm is placed in front with the elbow extended and wrist in slight extension.; The unaffected hand grips the other end of the FlexBar.; Twisting Motion:The patient uses the unaffected hand to twist the FlexBar into a taut position while the affected hand resists the motion (eccentric loading).Once the FlexBar is twisted, the patient extends the arms in front and slowly untwists the bar with the affected wrist, creating a controlled eccentric contraction.Emphasis is placed on slow, controlled movement (2-3 seconds for untwist).3 sets of 15 repetitions, once daily.Progress to higher resistance FlexBars as tolerated (e.g., from red to green to blue).Supervision during clinical visits (twice per week), rest is home-based
Active Comparator: Traditional Eccentric Wrist Extensor Exercises; This protocol involves eccentric strengthening of the wrist extensor muscles (primarily ECRB)using a dumbbell (1-2 kg) or wrist cuff weight.	Other: Traditional Eccentric Wrist Extensor Exercises; Position:; Patient seated with the forearm resting on a table, palm facing down, wrist hanging off the edge.; Elbow flexed to ~90 degrees.; Eccentric Movement:0. The patient uses the unaffected hand to assist the affected wrist into extension (starting position).The affected wrist then slowly lowers the weight into flexion (eccentric contraction).The cycle is repeated, focusing on slow movement (2-4 seconds lowering phase).3 sets of 10-15 reps, once daily.Weight increased progressively based on pain-free performance.Supervised sessions 2x/week; home exercise on other days

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Numeric pain rate scale (NPRS) for pain	To determine the degree of pain that the patient will report, the Numeric Pain Rating Scale (NPRS) will be utilized. This scale consists of 11 points ranging from 0-10, where zero indicates no pain, five represents moderate pain intensity, and ten signifies severe pain intensity	6 weeks
Handheld dynamometer for grip strength:	For pain-free grip strength assessment, the patient's arm is positioned comfortably with the shoulder adducted and neutrally rotated, the elbow flexed to 90 degrees.20, the forearm in a neutral position, and the wrist in slight extension and ulnar deviation. The patient is instructed to squeeze as tightly as possible for 3-5 seconds, with multiple trials and an average of three repetitions recorded. A brief pause is provided between trials to prevent muscle fatigue. Hand-held dynamometers have been shown to have excellent internal validity and reliability, with reported values of 0.31-0.69 in the upper extremities	6 weeks
Patient-Rated Tennis Elbow Evaluation (PRTEE) for functional disability	The PRTEE questionnaire is one of the most widely-used outcome measures that appreciates elbow	6 weeks

Collaborators and Investigators

• Sponsor: Riphah International University
• Investigators: Principal Investigator: Hira Shaukat, Mphill, Riphah International University

Publications and helpful links

General Publications

• Cancela-Cilleruelo I, Rodriguez-Jimenez J, Fernandez-de-Las-Penas C, Cleland JA, Arias-Buria JL. Widespread Pressure Pain Hyperalgesia Is Not Associated With Morphological Changes of the Wrist Extensor Tendon in Unilateral Lateral Epicondylalgia: A Case-Control Study. Phys Ther. 2024 Sep 4;104(9):pzae075. doi: 10.1093/ptj/pzae075.
• Karabinov V, Georgiev GP. Lateral epicondylitis: New trends and challenges in treatment. World J Orthop. 2022 Apr 18;13(4):354-364. doi: 10.5312/wjo.v13.i4.354. eCollection 2022 Apr 18.

Study record dates

Study Major Dates

• Study Start (Estimated): June 15, 2026
• Primary Completion (Estimated): October 10, 2026
• Study Completion (Estimated): November 13, 2026

Study Registration Dates

• First Submitted: June 1, 2026
• First Submitted That Met QC Criteria: June 1, 2026
• First Posted (Actual): June 4, 2026

Study Record Updates

• Last Update Posted (Actual): June 4, 2026
• Last Update Submitted That Met QC Criteria: June 1, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: Resistance Training; Eccentric exercise; Hand Strength; Tyler Twist
• Other Study ID Numbers: REC/RCR&AHS/25/0121

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No