Lateral EpicondylalgiaNCT07626632
Effects of the Tyler Twist Versus Eccentric Exercises
A study testing Tyler Twist Exercises and Traditional Eccentric Wrist Extensor Exercises in people with Lateral Epicondylalgia, run by Riphah International University at 1 site in Pakistan.
Trial summary
This study aims to compare the effects of the Tyler Twist exercise versus traditional eccentric exercises on pain, grip strength, and functional outcomes in patients diagnosed with lateral epicondylalgia. Read more about this study
- Who is it for?
- Ages 20 to 40 years
- Conditions the study is for
- Lateral Epicondylalgia
- What is being tested?
- Tyler Twist Exercises and Traditional Eccentric Wrist Extensor Exercises
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 38 participants
- Where
- 1 sitePakistan
- Study dates
- 1 Aug 2026to 13 Nov 2026
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 20 to 40 years
- All sexes
- No healthy volunteers
- Adult
Who may be able to join
- ● Males and female patients suffering from lateral epicondylagia in subacute and chronic phase.
- Age between 20yrs-40yrs.
- Patients screened with positive Cozen's test, positive Mill's test, positive Maudsley's test [14].
- NPRS pain score ≥ 4 on activity.
- Tenderness on palpation over the lateral epicondyle of humerus,
- Pain with gripping, Pain with resisted wrist extension.
Who cannot join
- History of recent trauma or surgery of elbow.
- Acute stage of lateral epicondylagia.
- Corticosteroid injection within the last 3 months.
- Neurological defeciency of the affected limb [16].
- Systemic inflammatory diseases, such as rheumatoid arthritis, lupus, or fibromyalgia.
- Diabetes mellitus (uncontrolled) due to its influence on tendinopathy.
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Pakistan1 site, 1 recruiting
- Recruiting
Ghurki Hospital Lahore
Lahore, Punjab Province, 54000
Hira Shaukat, Mphill, 03360405480, hirabutt7582@gmail.com
Hira Butt, 03360405480, hirabutt7582@gmail.com
About this study
Official title: Effects of the Tyler Twist Versus Eccentric Exercises in Patients With Lateral Epicondylagia
This study aims to compare the effects of the Tyler Twist exercise versus traditional eccentric exercises on pain, grip strength, and functional outcomes in patients diagnosed with lateral epicondylalgia. The primary objective is to determine which intervention offers greater improvement in clinical symptoms and overall function over a defined treatment period.
Read the detailed description
Conservative management is typically the first line of treatment, with eccentric exercises widely recognized for their effectiveness in promoting tendon healing and reducing pain. The "Tyler Twist," exercise is a variation using the TheraBand FlexBar, that has emerged as a superior potential alternative, that combines both eccentric and concentric loading in a functional and controlled way. However, direct comparative evidence between the Tyler Twist and conventional eccentric exercises has remained limited.
- Conditions
- Lateral Epicondylalgia
- Being tested
- Tyler Twist Exercises, Traditional Eccentric Wrist Extensor Exercises
- Keywords
- Hand Strength, Eccentric exercise, Resistance Training, Tyler Twist
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Tyler Twist ExercisesOther
- 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:
- The patient uses the unaffected hand to twist the FlexBar into a taut position while the affected hand resists the motion (eccentric loading).
- 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.
- Emphasis is placed on slow, controlled movement (2-3 seconds for untwist).
- 3 sets of 15 repetitions, once daily.
- Progress to higher resistance FlexBars as tolerated (e.g., from red to green to blue).
- Supervision during clinical visits (twice per week), rest is home-based
Traditional Eccentric Wrist Extensor ExercisesOther
- Position:
- Patient seated with the forearm resting on a table, palm facing down, wrist hanging off the edge.
- Elbow flexed to ~90 degrees.
- Eccentric Movement:
- The patient uses the unaffected hand to assist the affected wrist into extension (starting position).
- The affected wrist then slowly lowers the weight into flexion (eccentric contraction).
- The cycle is repeated, focusing on slow movement (2-4 seconds lowering phase).
- 3 sets of 10-15 reps, once daily.
- Weight increased progressively based on pain-free performance.
- Supervised sessions 2x/week; home exercise on other days
| Study group | Role | What they receive |
|---|---|---|
| Tyler Twist Exercises | Experimental | 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. Receives: Other: Tyler Twist Exercises |
| Traditional Eccentric Wrist Extensor Exercises | Active comparator | This protocol involves eccentric strengthening of the wrist extensor muscles (primarily ECRB)using a dumbbell (1-2 kg) or wrist cuff weight. Receives: Other: Traditional Eccentric Wrist Extensor Exercises |
What is being measured
The primary outcome is the main question the study is designed to answer.
Numeric pain rate scale (NPRS) for pain
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
Measured: 6 weeks
Handheld dynamometer for grip strength:
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
Measured: 6 weeks
Patient-Rated Tennis Elbow Evaluation (PRTEE) for functional disability
The PRTEE questionnaire is one of the most widely-used outcome measures that appreciates elbow
Measured: 6 weeks
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted4 Jun 2026
- Study start1 Aug 2026
- Primary completion20 Oct 2026 (estimated)
- Study completion13 Nov 2026 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (2)Papers the sponsor has linked to this study.
- Other trials for Lateral EpicondylalgiaStudies of the same condition, open and under way.
- More trials run by Riphah International UniversityThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind
- Who is masked
- Participant, Outcomes assessor
- Enrolment
- 38 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Riphah International University
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Hira Shaukat, Mphill, Principal investigator, Riphah International University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07626632
- Sponsor's protocol ID
- REC/RCR&AHS/25/0121
- Status last verified
- Sep 2026
- First submitted
- 1 Jun 2026
- Last updated
- 24 Sep 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Cancela-Cilleruelo I, Rodriguez-Jimenez J, Fernandez-de-Las-Penas C, Cleland JA, Arias-Buria JL. Widespread Pressure Pain Hyperalgesia Is Not Associated With Morphological Changes of the Wrist Extensor Tendon in Unilateral Lateral Epicondylalgia: A Case-Control Study. Phys Ther. 2024 Sep 4;104(9):pzae075. doi: 10.1093/ptj/pzae075.
PubMed 38832712Karabinov V, Georgiev GP. Lateral epicondylitis: New trends and challenges in treatment. World J Orthop. 2022 Apr 18;13(4):354-364. doi: 10.5312/wjo.v13.i4.354. eCollection 2022 Apr 18.
PubMed 35582153
Study at a glance
From the registry record, last updated by the sponsor on 24 Sep 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Effects of the Tyler Twist Versus Eccentric Exercises in Patients With Lateral Epicondylagia
- ClinicalTrials.gov ID
- NCT07626632
- Acronym / sponsor ID
- REC/RCR&AHS/25/0121
- Conditions
- Lateral Epicondylalgia
- Keywords
- Hand Strength, Eccentric exercise, Resistance Training, Tyler Twist
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 38 participants (estimated)
- Lead sponsor
- Riphah International UniversityUniversity, hospital or other
- Study start
- 1 Aug 2026 (actual)
- Primary completion
- 20 Oct 2026 (estimated)
- Study completion
- 13 Nov 2026 (estimated)
- First posted
- 4 Jun 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This study aims to compare the effects of the Tyler Twist exercise versus traditional eccentric exercises on pain, grip strength, and functional outcomes in patients diagnosed with lateral epicondylalgia. The primary objective is to determine which intervention offers greater improvement in clinical symptoms and overall function over a defined treatment period.
Detailed description
Conservative management is typically the first line of treatment, with eccentric exercises widely recognized for their effectiveness in promoting tendon healing and reducing pain. The "Tyler Twist," exercise is a variation using the TheraBand FlexBar, that has emerged as a superior potential alternative, that combines both eccentric and concentric loading in a functional and controlled way. However, direct comparative evidence between the Tyler Twist and conventional eccentric exercises has remained limited.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind (participant, outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Tyler Twist Exercises | Experimental | Other: Tyler Twist ExercisesThe 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. |
| Traditional Eccentric Wrist Extensor Exercises | Active comparator | Other: Traditional Eccentric Wrist Extensor ExercisesThis protocol involves eccentric strengthening of the wrist extensor muscles (primarily ECRB)using a dumbbell (1-2 kg) or wrist cuff weight. |
Who may qualify
- Ages
- 20 to 40 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult
Key inclusion criteria (6 listed)
- ● Males and female patients suffering from lateral epicondylagia in subacute and chronic phase.
Key exclusion criteria (6 listed)
- History of recent trauma or surgery of elbow.
- Acute stage of lateral epicondylagia.
- Corticosteroid injection within the last 3 months.
- Neurological defeciency of the affected limb [16].
- Systemic inflammatory diseases, such as rheumatoid arthritis, lupus, or fibromyalgia.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Tyler Twist Exercises* 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 | Other | Tyler Twist Exercises |
| Traditional Eccentric Wrist Extensor Exercises* Position: * Patient seated with the forearm resting on a table, palm facing down, wrist hanging off the edge. * Elbow flexed to ~90 degrees. * Eccentric Movement: 0. The patient uses the unaffected hand to assist the affected wrist into extension (starting position). 1. The affected wrist then slowly lowers the weight into flexion (eccentric contraction). 2. The cycle is repeated, focusing on slow movement (2-4 seconds lowering phase). 3. 3 sets of 10-15 reps, once daily. 4. Weight increased progressively based on pain-free performance. 5. Supervised sessions 2x/week; home exercise on other days | Other | Traditional Eccentric Wrist Extensor Exercises |
Primary outcome
Numeric pain rate scale (NPRS) for pain
Time frame: 6 weeks
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
Handheld dynamometer for grip strength:
Time frame: 6 weeks
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
Patient-Rated Tennis Elbow Evaluation (PRTEE) for functional disability
Time frame: 6 weeks
The PRTEE questionnaire is one of the most widely-used outcome measures that appreciates elbow
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 24 Sep 2026.
- Background: PubMed 38832712Cancela-Cilleruelo I, Rodriguez-Jimenez J, Fernandez-de-Las-Penas C, Cleland JA, Arias-Buria JL. Widespread Pressure Pain Hyperalgesia Is Not Associated With Morphological Changes of the Wrist Extensor Tendon in Unilateral Lateral Epicondylalgia: A Case-Control Study. Phys Ther. 2024 Sep 4;104(9):pzae075. doi: 10.1093/ptj/pzae075.
- Background: PubMed 35582153Karabinov V, Georgiev GP. Lateral epicondylitis: New trends and challenges in treatment. World J Orthop. 2022 Apr 18;13(4):354-364. doi: 10.5312/wjo.v13.i4.354. eCollection 2022 Apr 18.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Hira Shaukat, Mphill principal investigator
Riphah International University
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Tyler Twist Exercises and Traditional Eccentric Wrist Extensor Exercises in people with Lateral Epicondylalgia, run by Riphah International University at 1 site in Pakistan.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 6 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 24 Sep 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Pakistan. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Imran Amjad, PhD (03324390125, Imran.amjad@riphah.edu.pk), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Numeric pain rate scale (NPRS) for pain (time frame: 6 weeks). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT07626632, which also lists 2 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 24 Sep 2026.