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.

This protocol involves eccentric strengthening of the wrist extensor muscles (primarily ECRB)using a dumbbell (1-2 kg) or wrist cuff weight.

• 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

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

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

The PRTEE questionnaire is one of the most widely-used outcome measures that appreciates elbow