Effects of the Tyler Twist Versus Eccentric Exercises

NCT07626632 | Not Yet Recruiting

• 1 other identifier: REC/RCR&AHS/25/0121
• Study Type: interventional
• Target: 38
• Locations: 1 country
• Sites: 1

Brief Summary

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.

Conditions

Lateral Epicondylalgia

Keywords

Hand Strength; Eccentric exercise; Resistance Training; Tyler Twist

Outcome Measures

Primary Outcomes (3)

• 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

Study Arms (2)

Tyler Twist Exercises

EXPERIMENTAL

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

Traditional Eccentric Wrist Extensor Exercises

ACTIVE COMPARATOR

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

Interventions

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: 1. The patient uses the unaffected hand to twist the FlexBar into a taut position while the affected hand resists the motion (eccentric loading). 2. 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. 3. Emphasis is placed on slow, controlled movement (2-3 seconds for untwist). 4. 3 sets of 15 repetitions, once daily. 5. Progress to higher resistance FlexBars as tolerated (e.g., from red to green to blue). 6. Supervision during clinical visits (twice per week), rest is home-based

Tyler Twist Exercises

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: 0\. The patient uses the unaffected hand to assist the affected wrist into extension (starting position). 1. The affected wrist then slowly lowers the weight into flexion (eccentric contraction). 2. The cycle is repeated, focusing on slow movement (2-4 seconds lowering phase). 3. 3 sets of 10-15 reps, once daily. 4. Weight increased progressively based on pain-free performance. 5. Supervised sessions 2x/week; home exercise on other days

Traditional Eccentric Wrist Extensor Exercises

Eligibility Criteria

• Age: 20 Years - 40 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• ● 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.

You may not qualify if:

• 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.

Sponsors & Collaborators

• Riphah International University: lead

Study Sites (1)

Ghurki Hospital Lahore

Lahore, Punjab Province, 54000, Pakistan

Location

Related Publications (2)

• 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.

  PMID: 38832712 BACKGROUND

• 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.

  PMID: 35582153 BACKGROUND

Study Officials

• Hira Shaukat, Mphill

  Riphah International University

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Imran Amjad, PhD

CONTACT

03324390125; Imran.amjad@riphah.edu.pk

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: June 1, 2026
• First Posted: June 4, 2026
• Study Start: June 15, 2026
• Primary Completion (Estimated): October 10, 2026
• Study Completion (Estimated): November 13, 2026
• Last Updated: June 4, 2026

Record last verified: 2026-06

Data Sharing

• IPD Sharing: Will not share

Locations

PA (1)