Tyler Twist Exercise: One Simple Tennis Elbow Treatment

Tennis Elbow Pain
Elbow Pain Getting You Down?

Do you have an elbow pain that you’ve been told is possibly tennis elbow?

Your confused though because you don’t play tennis yet your elbow is so sore when you try grip things. Maybe you do play tennis, or even golf, and it is stopping you from playing properly cos of the pain in your elbow.

I stumbled upon probably the easiest and most simple tennis elbow treatment to do. The best part is you can treat your elbow pain yourself at home. The exercise I’m going to let you know more about was published in a research paper in 2010, but you probably haven’t heard of it before.

Today you will learn first what is tennis elbow, the basic anatomy involved. I will let you know what is the typical conservative care and more advanced medical treatment for tennis elbow. Then find out how to do the Timothy Tyler eccentric contraction tennis elbow treatment exercise.

Tennis Elbow Quick Facts

Tennis elbow was coined in 1883 as “lawn tennis elbow” and as “writers cramp” in 1873.

  • 1-3% of the population get it.
  • 19% of men by the age of 50 have had it.
  • The most common age to experience this painful elbow condition is at age 42.
  • It is more common than its partner golfers elbow or pain on the inside of the elbow.

Elbow Anatomy

Elbow Anatomy
Muscles of the Elbow

I always like to first let you know the basic anatomy of the painful area I’m discussing.

Your elbow is a hinge type joint. It is the connection between the forearm bone the ulna and the humerus bone in the upper arm. The area of concern is the radius bone attachment to the lateral epicondyle of the humerus via the radial head.

In tennis elbow the muscles group involved are the wrist extensor muscles.

This group of muscle helps to extend the wrist joint and attaches higher up at elbow, specifically at the lateral epicondyle of the humerus.

The muscles involved are:

  • Extensor carpi radialis longus,
  • Extensor digitorum communis,
  • Extensor carpi ulnaris
  • Extensor carpi radialis brevis (ECRB)

The last muscle I bolded is the damaged muscle in tennis elbow, the extensor carpi radialis brevis.

The major nerve involved is the radial nerve and occasionally branches from the musculocutaneous nerve.

The blood vessel involved is the radial recurrent artery.

How the Damage Starts

Now you know which bones, muscles, nerves and blood vessel are involved in tennis elbow you’ll want to know what causes it.

Tennis players have to control the tennis racket when the ball hits it at pace. When a tennis player hits a back hand shot they use their wrist extensor muscles to control the racket. Try it yourself imagine you’re at Wimbledon playing a back hand return see how you want to cock your wrist backwards to flick the racket. You are using your wrist extensor muscles. To absorb the force of the ball hitting the racket you use these muscles.

However, it is not only in tennis that you use these muscles and tendons. Golfers use them as well to control the golf club in the golf swing. Ordinary people like office workers, factory workers, manual laborers, mothers all can get this type of outside elbow pain.

The original damage that occurs is thought to be tears in the tendon area of the extensor carpi radialis brevis (ECRB).

A muscle becomes a tendon to attach into bone. A tendon is structurally different from a muscle, with a big point being it has a poor blood supply. This means a tendon injury will typically take longer to heal and more likely become a chronic injury.

So there is an initial repetitive, overuse injury to the elbow tendon that creates microtears and inflammation. But whoa, hang on there!

Did you know it should NOT be called lateral epicondylitis.

The fact is this type of tendon injury is originally an inflammation response.

However, it is now believed the actual cause of pain is a failure for the tendon to heal after the initial injury. This is called tendinosis. There is no long-term inflammation.

So the correct medical term for tennis elbow is lateral epicondylosis.

It is not an actual trapped nerve either, but pain signal is transmitted along the radial nerve that supplies the radial recurrent artery into the tendon area.


The major symptom should be outside pain on the outside of the elbow which is tender to touch and painful to use.

I mentioned above anyone can experience this type of elbow pain. Some other ways you might know you have a problem is:

  • It hurts to open a jar,
  • Twist a bottle top,
  • Turn a door handle,
  • Even to shake hands with someone.

How to Test For Lateral Epicondylosis

It can be painful to bend at the elbow. Your chiropractor or doctor might do some specific orthopaedic tests like:

  1. Maudsley’s test – positive pain with resisted extension of the middle finger.
  2. Cozen’s test – positive pain with resisted wrist extension.

There might be times advanced testing is done like:

  1. MRI scan – ask the radiologist to tell you if there is swelling in the ECRB on the T2 weighted images,
  2. Cortisone injection – this is used for testing for and treating tennis elbow with pain relief meant to occur,
  3. Ultrasound scan – non-invasive test less expensive than MRI and less painful than cortisone.

You can NOT use an x-ray of the elbow to diagnose lateral epicondylosis.

Treatment Options

Sorry I know it has taken awhile for you to get here. Thank-you for reading to this point.

Common tennis elbow treatments would include:

  • Rest from sport and repetitive activity causing the pain,
  • Icing the elbow,
  • Use a tennis elbow brace or strap,
  • Soft tissue techniques like:
    • Active release technique
    • Graston technique
    • Cross-friction
    • Massage
    • Dry needling
  • Various elbow stretches and strengthening exercises
  • Shock-wave therapy
  • Prolotherapy
  • Low-level laser therapy

For more drastic chronic elbow pain relief then you’d be referred to an orthopaedic surgeon for:

  • Cortisone injection into the tendon of the elbow,
  • Lateral release surgery of the elbow.

Long-term use of oral anti-inflammatory medications do not help. Ask any tennis elbow sufferer the medication doesn’t take the pain away.

That is why I am pleasantly surprised by the positive results of doing just this one elbow exercise.

Timothy Tyler Elbow Exercise

In 2010 a physiotherapist in the USA, Timothy Tyler, did some research on using eccentric muscle contractions to fix chronic tendinosis injuries of the elbow.

An eccentric contraction is when you control a muscle while it is being lengthened. In this case you contract the painful muscle first then slowly let it stretch out.

He heard how using expensive equipment called a isokinetic dynamometer got good results. So he looked at something simpler. He found a cheap rubber bar called a Flexbar® from Thera-Band®.

There are four colours available. These are in order from easiest to hardest resistance:

  1. Yellow
  2. Red
  3. Green
  4. Blue

Again so you understand the difference in colour options. Yellow is the easiest resistance strength then red is next, then green and finally blue is the hardest resistance option you can get. I would recommend to start with a red Flexbar® then progress up the colours as you get stronger and feel you want more of a challenge.

I have the instructions you need to know how to use the Flexbar® below.


How to Do Eccentric Muscle Elbow Exercise
The Tyler Twist Exercise using a Flexbar

Here is a step by step guide to the Tyler Twist:

  1. Have your sore elbow by your side and bent at 90°
  2. Hold the Flexbar® in the hand of the sore elbow
  3. Extend or bend the wrist backwards
  4. Now grab the top end of the rubber bar with the other hand
  5. Flex or twist the bar forward with the top hand
  6. Don’t let the bottom hand move whilst twisting the top
  7. Hold the twist and level the rubber bar in front of you
  8. Control hand of the sore elbow side whilst letting it flex bend forward
  9. You should feel pain or discomfort at the outside of the elbow
  10. Do 15 x repetitions of 3 x sets once a day for 6 weeks minimum.

Here is an instructional video of how to do the eccentric elbow contraction exercise by Timothy Tyler exercising the right elbow.

In the research study Timothy Tyler did he got a 70% improvement in the group who did this elbow exercise above.

To ease any pain from doing the exercise you can use ice or biofreeze pain relief rub.

The Bottom Line

Tennis elbow is pain on the outside of the elbow. It is medically termed a lateral epicondylosis. It is an injury to the extensor carpi radialis brevis tendon. The trapped nerve in the elbow is thought to be the radial nerve supplying the radial recurrent artery.

Doing the ‘Tyler Twist’ elbow eccentric contraction exercise could be very helpful in tennis elbow treatment that you can do yourself at home. Let me know if this exercise helps you get rid of your pain.

Image Credit: Some rights reserved by Evil Erin

Further Reading:

  1. Tyler TF, Thomas GC, Nicholas SJ, McHugh MP. Addition of isolated wrist extensor eccentric exercise to standard treatment for chronic lateral epicondylosis: a prospective randomized trial. J Shoulder Elbow Surg. 2010 Sep;19(6):917-22.
  2. Maffulli N, Regine R, Carrillo F, Capasso G, Minelli S. Tennis elbow: an ultrasonographic study in tennis players. Br J Sports Med. 1990 Sep;24(3):151-5.
  3. Bishai SK, Plancher KD. The Basic Science of Lateral Epicondylosis: Update for the Future Tech Orthop. 2006 21(4):250–255.
  4. Phys Ed: An Easy Fix for Tennis Elbow? – NYTimes.com Aug 2009