A few years ago, sports physical therapist Tim Tyler developed a revolutionary exercise for tennis elbow using the TheraBand Flexbar. Using “eccentric” resistance, patients with chronic tennis elbow significantly improved in strength and pain. His results using the “Tyler Twist” were published in the Journal of Shoulder and Elbow Surgery, and received international media attention. The popularity of his exercise led him to develop the “Reverse Tyler Twist” for people with golfers elbow, (aka “medial epicondylitis) which is pain on the inner side of the elbow.
Tyler and his colleagues published the results of their clinical study on the golfers elbow exercise in the International Journal of Sports Physical Therapy. They had 20 patients with medial elbow pain diagnosed as golfers elbow in the study. All the patients had failed previous conservative treatments such as medication, injections and physical therapy. 18 of the 20 patients were competitive athletes; 70% of the patients were golfers.
They received physical therapy for an average of 12 visits each over 6 weeks consisting of stretching, ultrasound, massage, heat, and ice. In addition, they used a TheraBand Flexbar to perform the Reverse Tyler Twist for 3 sets of 15 repetitions with 60 seconds of rest in between sets. On the days they didn’t have physical therapy, the patients performed the exercise twice a day until they felt discomfort.
The researchers used the DASH reporting scale to measure patient improvement. The DASH scale is a self-report questionnaire that patients can rate their symptoms and ability to perform certain activities. The patients improved by 77% in their DASH score (from 34.7 to 7.9).
While there was no control group, this study included patients who had previously failed treatment, which can be considered a “quasi-control”. The researchers stated, “A prescription of 3 sets of 15 repetitions daily for approximately 6 weeks appeared to be an effective treatment in the majority of patients who had already failed a previous intervention for this disorder.”
This study added further evidence that eccentric exercise can be effective for tendonopathies. Further research should evaluate longer term outcomes and comparison of the Reverse Tyler Twist to other therapies.
REFERENCE: Tyler TF, Nicholas SJ, Schmitt BM, Mullaney M, Hogan DE. Clinical outcomes of the addition of eccentrics for rehabilitation of previously failed treatments of golfers elbow. Int J Sports Phys Ther. 2014 May;9(3):365-70.
Disclosure: Performance Health provided the FlexBars used in this study