Lateral Epicondylalgia
Conditions
Keywords
Hand Strength, Eccentric exercise, Resistance Training, Tyler Twist
Brief 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. 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.
Interventions
* 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
OTHERTraditional 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
Sponsors
Riphah International University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
20 Years to 40 Years
Healthy volunteers
No
Inclusion criteria
* ● 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.
Exclusion criteria
* 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.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Numeric pain rate scale (NPRS) for pain | 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: | 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 | 6 weeks | The PRTEE questionnaire is one of the most widely-used outcome measures that appreciates elbow |
Countries
Pakistan
Contacts
CONTACTImran Amjad, PhD
PRINCIPAL_INVESTIGATORHira Shaukat, Mphill
Riphah International University
Outcome results
None listed