Comparative Effect of Tyler Twist Technique and Muscle Energy Technique on Lateral Epicondylitis.

NCT07807254 | Completed

• 1 other identifier: 2024-MS-PT-34
• Study Type: interventional
• Target: 34
• Locations: 1 country
• Sites: 1

Brief Summary

This thesis, titled "Comparative Effects of Muscle Energy Technique and Tyler Twist Technique on Grip Strength, Pain, and Function in Patients with Lateral Epicondylitis," investigates the efficacy of two widely used physical therapy methods for treating lateral epicondylitis (tennis elbow). Lateral epicondylitis is a common musculoskeletal illness characterised by pain across the lateral side of the elbow, reduced grip strength, restricted upper-limb function, and difficulty performing daily and professional responsibilities. If treatment is not received, the illness, which frequently affects people who do repeated wrist and forearm motions, can significantly lower quality of life. In this randomised clinical investigation, 34 people between the ages of 20 and 40 were split into two therapy groups. One group received the Muscle Energy Technique (MET), a manual therapy approach that improves neuromuscular function, joint mobility, and muscle flexibility by using controlled isometric contractions followed by stretching. The second group performed the Tyler Twist Technique, an eccentric strengthening exercise that targets the wrist extensor muscles and has gained popularity as a tennis elbow treatment, using a flex bar. The baseline examination, which revealed that both groups were similar in terms of demographic characteristics including age and gender as well as initial pain levels, demonstrated that the groups were well matched prior to the intervention. The results of the study demonstrated significant clinical improvements in both groups following treatment. Both the Tyler Twist and MET groups had a significant decrease in pain intensity from baseline on the Numerical Pain Rating Scale (NPRS), suggesting that both therapies were effective in lowering pain associated with lateral epicondylitis. Although each group saw a considerable reduction in pain, there was no statistically significant difference between the groups, suggesting that both approaches provide comparable benefits in terms of pain relief. To assess functional impairment, the Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire was employed. Upper-limb function significantly improved with both treatments, and disability scores decreased. However, during follow-up, PRTEE scores increased more in individuals who got the Tyler Twist Technique, indicating a better improvement in functional performance and the ability to do daily chores. Additionally, grip strength measurements showed significant increases in both groups, with the Tyler Twist group seeing somewhat larger gains. These findings support the hypothesis that eccentric strengthening exercises may aid individuals suffering from tennis elbow in regaining hand function and muscle performance. However, it was shown that the Muscle Energy Technique was better at improving elbow flexion range of motion and wrist flexion and wrist extension mobility. Improvements in neuromuscular relaxation, improved joint mechanics, and reduced soft-tissue stiffness brought about by the manual therapy component of MET may have contributed to greater mobility and flexibility around the elbow and wrist complex. When quality of life was assessed using the Short Form-36 (SF-36) questionnaire, both treatment groups demonstrated significant improvements in several aspects. This suggests that increases in physical functioning, engagement in everyday activities, and general well-being coincided with decreases in pain and impairment. The study's findings show that both the Muscle Energy and Tyler Twist approaches improve function, grip strength, pain relief, and overall quality of life for those with lateral epicondylitis. While MET was more successful in improving wrist and elbow mobility, the Tyler Twist approach produced better benefits in grip strength and functional recovery. These findings show that the therapy plan can be customised to the patient's demands, using Tyler Twist for strength and function and MET for range of motion gains. Because there were only 34 participants in the research, the results could not have been as relevant to bigger groups. Because of the short trial period, the therapy's long-term effects could not be evaluated. The study's applicability to elder patients was reduced by the participants' limited age range of 20-40 years. To increase the generalisability of the results, bigger and more varied sample sizes are advised for subsequent research. Long-term follow-up studies should be planned in order to assess the long-term impacts of the Muscle Energy method and the Tyler Twist method. To determine the combined impact, the outcomes of a treatment plan that includes both the Tyler Twist and the Muscle Energy Technique treatments should be examined for people with lateral epicondylitis.

Conditions

Tennis Elbow Syndrome

Outcome Measures

Primary Outcomes (1)

• Pain

  Pain was assessed by Numeric Pain Rating Scale (NPRS), function was assessed by patient rated tennis elbow evaluation questionnaire and grip strength by handheld dynamometer. It contains 1 to 10 scores, 1 shows minimum and 10 shows maximum value of pain severity

  4 weeks

Secondary Outcomes (1)

• Range of motion

  4 weeks

Study Arms (2)

Group A: Tyler Twist Technique plus baseline

EXPERIMENTAL

Ultrasound therapy is a component of conventional physiotherapy. The tenoperiosteal joint of the ECRB and the area of discomfort were treated with pulsed ultrasound for five to eight minutes at a 1:4 pulse ratio of 1 MHz at 1.5 W/cm2. Three sets of fifteen repetitions were completed, with a 30-second rest period in between sets. Each repeat lasted four seconds

Other: Tyler Twist Technique

Group B Muscle Energy Technique plus baseline

ACTIVE COMPARATOR

Ultrasound therapy is a component of conventional physiotherapy. The tenoperiosteal joint of the ECRB and the area of discomfort were treated with pulsed ultrasound for five to eight minutes at a 1:4 pulse ratio of 1 MHz at 1.5 W/cm2. The entire course of treatment was applied for twenty to thirty minutes. For five seconds, the participants were instructed to contract their forearm muscles with 15%. The exercise was required of the participants five times, with a one-minute break between each repeat and a five-second hold.

Other: Muscle Energy Technique

Interventions

Tyler Twist Technique OTHER

A blue-colored FlexBar with the least resistance was used to complete the FlexBar workout program, also called the Tyler Twist. While the opposing hand clutched the other end of the FlexBar and twisted it with the unaffected wrist, the afflicted wrist was maintained at maximal extension. The unaffected wrist was at maximal flexion and the afflicted wrist was in maximal extension while both arms were placed maintaining the twist while extending their elbows in front of the body. The afflicted wrist was then flexed, allowing the FlexBar to untwist and causing an eccentric contraction of the wrist extensors. Three sets of fifteen repetitions were completed, with a 30-second rest period in between sets. Each repeat lasted four seconds

Group A: Tyler Twist Technique plus baseline

Muscle Energy Technique OTHER

For five seconds, the participants were instructed to contract their forearm muscles with 15% of their entire power in opposition to the therapist's force. They were then instructed to perform the countermovement until the force was felt. The identical exercise was required of the participants five times, with a one-minute break between each repeat and a five-second hold. The MET sought to tense the forearm muscles isometrically

Group B Muscle Energy Technique plus baseline

Eligibility Criteria

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

You may qualify if:

• Both gender
• to 40 years of age.
• Tenderness felt above the humerus of lateral epicondyle
• Cozen's test, Maudsley's test, Mill's test or all three favourable outcomes
• Discomfort while griping
• History of pain

You may not qualify if:

• Cervical radiculopathy
• Local steroid injections over the last six months
• Pregnancy
• Upper limb fractures
• Surgery on the elbow region

Sponsors & Collaborators

• University of Faisalabad: lead

Study Sites (1)

Department of Rehabilitation Sciences, The University of Faisalabad.

Faisalābad, Punjab Province, 38000, Pakistan

Location

Related Publications (21)

• Trivedi P, Arunachalam R, Vaittianadane K et al. (2019) Efficacy of muscle energy technique with plyometric exercises in chronic lateral epicondylitis. Int J Health Science Research 9(2): 108- 14.

  BACKGROUND

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  BACKGROUND

• Sadeghifar A, Zanderahimi F, Karamoozian F et al. (2025) Lateral Epicondylitis (Tennis Elbow): A comprehensive review of historical perspectives, etiology, and emerging treatment modalities. Journal of Kerman University of Medical Sciences 32(1): 1- 10.

  BACKGROUND

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• Rompe JD, Overend TJ, MacDermid JC. Validation of the Patient-rated Tennis Elbow Evaluation Questionnaire. J Hand Ther. 2007 Jan-Mar;20(1):3-10; quiz 11. doi: 10.1197/j.jht.2006.10.003.

  PMID: 17254903 BACKGROUND

• Young I, Dunning J, Escaloni J, Maselli F, Prall J, Mourad F, Fernandez-de-Las-Penas C. Reliability, construct validity, responsiveness and minimum clinically important difference of the numeric pain rating scale and shoulder pain and disability index in patients with subacromial pain syndrome. Musculoskelet Sci Pract. 2025 Oct;79:103372. doi: 10.1016/j.msksp.2025.103372. Epub 2025 Jun 28.

  PMID: 40614306 BACKGROUND

• Kalai, BR and Subramanian S (2023) Effect of theraband flex bar versus strengthening exercise in patients with lateral epicondylitis. Journal of Health and Allied Sciences NU 13 (2): 241- 246.

  BACKGROUND

• Sumedha G, Gurudut P, Welling A (2024) Eccentric training vs muscle energy technique in adjunct to low-level laser therapy for lateral epicondylitis. Physiotherapy Quarterly 32(2): 84- 91.

  BACKGROUND

• Kazi F, Patil DS. Effects of the Tyler Twist Technique Versus Active Release Technique on Pain and Grip Strength in Patients With Lateral Epicondylitis. Cureus. 2023 Oct 10;15(10):e46799. doi: 10.7759/cureus.46799. eCollection 2023 Oct.

  PMID: 37954758 BACKGROUND

• Jalil R, Gul Khan L and Afzal MF (2024) Effects of eccentric tyler twist extensor strengthening exercises in lateral epicondylitis. Journal Riphah College of Rehabilitation Sciences 12(1): 45- 50.

  RESULT

Study Design

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

Study Record Dates

• First Submitted: August 15, 2026
• First Posted: September 8, 2026
• Study Start: April 24, 2026
• Primary Completion: June 24, 2026
• Study Completion: August 9, 2026
• Last Updated: September 8, 2026

Record last verified: 2026-08

Locations

PA (1)