Skip to main content
OpenTrials
Not Yet Recruiting

NCT Number: NCT07626632

Effects of the Tyler Twist Versus Eccentric Exercises

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.

Not Yet Recruiting

Trial opening soon.

Get Notified

Key information

Conditions

Lateral Epicondylalgia

Age range

20 year–40 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

About this study

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.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

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.

Treatment and study plan

Tyler Twist Exercises

Other
  • 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

Traditional Eccentric Wrist Extensor Exercises

Other
  • 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:
  • 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

Primary outcomes

  1. Numeric pain rate scale (NPRS) for pain

    Time frame: 6 weeks

    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

  2. Handheld dynamometer for grip strength:

    Time frame: 6 weeks

    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

  3. Patient-Rated Tennis Elbow Evaluation (PRTEE) for functional disability

    Time frame: 6 weeks

    The PRTEE questionnaire is one of the most widely-used outcome measures that appreciates elbow

Study contacts

Contact information is provided by the study sponsor or research team.

Imran Amjad, PhD

CONTACT

[email protected]

03324390125

Sponsors and collaborators

Lead sponsor

Riphah International University

Other

Registry information

Official study title

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

Important dates

Study start
2026
Primary completion
2026
Study completion
2026
First posted
Jun 4, 2026
Registry last updated
Jun 4, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

Related clinical trials

Published trials that share one or more normalized conditions with this study.