There aren’t many exercises out there claiming that they can nearly eliminate a musculoskeletal injury single-handedly; the body is complex, and rehabilitative best-practices demand that injury recovery be equally dynamic. However, almost a decade ago, one clinician’s evidence-based innovation changed the way that physical therapists, occupational therapists, chiropractors, and other hands-on healthcare professionals treated tennis elbow forever. With thousands of people experiencing tennis elbow every year, this exercise is as essential as it is easy and effective. Today, we’re diving into this movement known around the world, and why it deserves all of this hype.
Tennis Elbow Treatment Basics
Risk Factors
Before we get into the exercise, let’s understand what we’re up against. While lateral epicondylitis, known on the streets as tennis elbow, is associated to athletics by name, patients of most ages and occupations can experience this repetitive microtrauma to the common extensor tendon, or the extensor carpi radialis brevis. This condition can stem from:
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- Over-gripping objects throughout the day
- Repetitive motions that cause stress to elbow and connecting musculature (ex. forearms)
This obviously puts tennis players at risk, but they only constitute a small percentage of tennis elbow cases throughout any given year. The average person is susceptible to lateral epicondylitis simply from gripping a phone, gripping weights at the gym or working a job where he or she is performing a manual task: painters, cooks, musicians, or anyone who carries or lifts objects are among a few professions that make up the majority of patients.
Evaluating and Diagnosing Tennis Elbow
If your patient is experiencing pain on the outside of his or her elbow, tennis elbow may be an obvious conclusion. However, there are a few tests you can keep in your clinical toolbox to better evaluate this condition:
- Point tenderness distal and medial to the lateral epicondyle
- Decreased grip strength in the effected arm
- Positive findings with special tests such as the Mills and/or Cozen test.
Eccentric Exercise: The Secret to Better Tennis Elbow Rehabilitation
Tim Tyler MS, PT, ATC knew that there had to be a better solution to treating tennis elbow. After treating one too many patients with lateral epicondylitis who had tried many times to eliminate their symptoms, he turned to the power of eccentric exercises to seek out much needed relief for his suffering patients. But why focus on eccentrics?
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While traditional concentric exercises (a more common form of movement or exercise) relies on the shortening of the muscle, eccentric motions lengthen and simultaneously contract the muscle. The result of combining load with length is a heightened absorption of energy that builds strength and repairs muscles and tendons.
“Isolated eccentrics using the FlexBar are so important is because there have been studies that show that, with isolated eccentrics, you can model the tendon into a healthy tendon,” said Tyler. “The tendinosis and that fibrotic tissue within the tendon actually goes away. They’ve shown that with ultrasound in the Achilles tendon model in humans as well.”
When utilized appropriately, other studies have found that, regardless of the duration of symptoms, the most effective therapeutic intervention for lateral epicondylalgia is eccentric training.
The One Exercise to Rule Them All (and Four Others for Good Measure)
Tyler’s revolutionary exercise, the Tyler Twist, is a culmination of his expertise in eccentric training and a movement that truly exemplifies simplicity. Using only a single TheraBand FlexBar, this world-renowned exercise has been proven to decrease lateral epicondylitis pain by 81% and increase strength by 79% (Tyler et al 2010; Tyler et al. 2014).
This exercise may be all your patients need to recover from tennis elbow, but building a comprehensive rehabilitation and strengthening program can potentially create longer-lasting results and a better clinical experience for your patients. In this segment of the Injury Management Series, you’ll find Tim Tyler’s top five tennis elbow rehabilitation exercises (including the Tyler Twist!). All you need is a FlexBar, a TheraBand CLX Elastic Resistance Band and a TheraBand CLX Door Anchor!
Hear from Tim Tyler himself while you check out the full playlist of his exercises.
Click here to save and use this PDF to incorporate these exercises into your practice for patients of all ages!
Sources:
Kenas A et al. 2015. Eccentric interventions for lateral epicondylalgia. Strength Condition J. 37(5):47-52
Tyler T, et al. 2010. Addition of isolated wrist extensor eccentric exercise to standard treatment for chronic lateral epicondylosis: A prospective randomized trial. J Shoulder Elbow Surg.19(6):917-922.
Tyler T et al. 2014. Clinical outcomes of the addition of eccentrics for rehabilitation of previously failed treatments of golfers elbow. Int J Sports Phys Ther. 9(3):365-70.
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