New Eccentric Exercise Technique for Chronic Lateral Epicondylitis

Tennis Elbow

Chronic Lateral Epicondylitis/Tennis Elbow

Title: Eccentric Exercise Technique Offers Easy, Affordable Intervention for Chronic Lateral Epicondylitis

Authors: Timothy F. Tyler et al.

Reference: American Orthopaedic Society for Sports Medicine (AOSSM) 35th Annual Meeting: Abstract 8345. Presented July 11, 2009.

Study Design: RCT

Aims: To evaluate the impact of the addition to the “Tyler Twist” eccentric training exercise to “standard treatments” for patients with chronic lateral epicondylalgia.

Patient Group: Patients with pain from chronic lateral epicondylitis resulting from tennis or golf that lasted at least 6 weeks and who had undergone no previous surgical treatment
Randomisation: Patients were randomised into 2 groups: an eccentric group of 6 men and 5 women (average age, 47 ± 2 years); and a standard-treatment group of 4 men and 6 women (average age, 51 ± 4 years).
Standard Treatment: included wrist-extensor stretching, ultrasound, cross-friction massage, and heat and ice therapy. The standard-treatment group performed isotonic wrist-extensor strengthening.
The Eccentric Group: additionally performed isolated eccentric wrist-extensor strengthening using a rubber cylinder, called the Flex-bar (see video below). Peformed 3 sets of 15 repetitions daily.

Disability: The eccentric group reported an improvement of 76% in their Disability of the Arm, Shoulder and Hand score; the standard-treatment group reported an improvement of 12% (P = .01).
Pain: VAS improvement was 81% for the eccentric group and 22% for the standard-treatment group (P = .002), tenderness was improved by 70% in the eccentric group and 4% in the standard-treatment group (P = .003)
Strength: Wrist and middle finger was improved 72% in the eccentric group and 11% in the standard-treatment group (P = .032).

Limitations: To my knowledge this research article remains currently unpublished, whilst the data has been made available online. The groups are small (11 and 10), and the athletes involved must play either golf or tennis. These limitations, and any others you identify, must be considered when making clinical decisions.

Conclusions: Addition of the “Tyler Twist” exercise to a “standard treatment” program for lateral epicondylalgia lead to significant decreases in disability and pain and increases in strength compared with “Standard Treatment” alone.

Clinical Relevance/Implications: The majority of sports physiotherapists would know the importance of utilising eccentric loading exercises in the rehabilitation of tendinopathies. However, this new research indicates the clinical efficacy of the “Tyler Twist” exercise as a method of eccentrically loading the common extensor tendon in lateral epicondylalgia.

The Flex-Bar which costs less than 30AUD could be a more cost-effective option for athletes/patients than purchasing frequently expensive weight equipment/dumbbells. The Flex-Bar would also be a valued addition to a Sports Physiotherapy practice.

Please feel free to comment on this post. What are your thoughts on this research or the treatment of tendinopathies in general?


For original article see:

PURCHASE YOUR OWN FLEX-BAR or any other Sports Physiotherapy products use:


To watch the Tyler Twist:

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One comment on “New Eccentric Exercise Technique for Chronic Lateral Epicondylitis

  1. Pingback: The New Continuum Concept of Tendinopathy | The Sports Physiotherapist

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