New Eccentric Exercise For Tennis Elbow

There was a great discussion after my last post on tennis elbow straps.  While the article we discussed dealt with the efficacy of straps, there was some discussion on treatment in general, including the use of eccentric exercises.

A new study presented at this year’s AOSSM meeting looked at the effect of an eccentric exercise using the Thera-Band FlexBar.  81% of patients using this eccentric exercise reported improvement in comparison to only 22% in the control group.  Interesting results and worth considering in your patients as the Thera-Band FlexBar is fairly inexpensive and a good home exercise program adjunct (get them here from Amazon for under $20).

The injured wrist holds the bar in position as the healthy wrist adds a twist (still not injured wrist movement). Then, the eccentric component is the injured wrist slowly flexing to let the twisted bar release back to normal.  Below is a clip of the exercise in action.   In this video clip, the injured wrist is the right wrist:


See the full article > AOSSM: Tennis Elbow Eases With Eccentric-Twist-of- Wrist Exercise

Buy a Flex-Bar here and try it yourself > Thera-Band FlexBar from Amazon

15 replies
  1. Prakash
    Prakash says:

    I have tennis elbow in both arms – moderate pain in the right elbow and mild pain in the left. Can I use the Thera Band Flexi Bar?

  2. jay
    jay says:

    This looks really interesting. I’m diagnosed with a Tennis Elbow myself. I will see a Physio Therapist tomorrow. However, wouldn’t mind to give this a try as well maybe. Which colour do you recommend to use for this rehab exercise?

  3. Christopher Johnson
    Christopher Johnson says:

    As someone who was working at the Nicholas Institute of Sports Medicine while this study was taking place, I would like to say that the results are beyond impressive. Strict adherence to the HEP is critical for success and patients must be made well aware that if they are doing this eccentric training program sporadically, all bet’s are off. Another item to consider is what is going on with the radial nerve during this exercise since there are some elements of a radial nerve glide with the movement namely being humeral internal rotation and wrist flexion? My only qualm with the videos is that I do think we can modify the exercise to minimize the potential for performing it in an impingement position. I wrote a post a few months back about how much the initial set up of this exercise reminds me of the Hawkins Kennedy Position (especially in the second video) and that we must strive to minimize potentially deleterious forces on the shoulder while trying to improve the elbow. Otherwise, I applaud the authors for coming up with a simple, effective approach to treating a debilitating condition that will save the healthcare system and patients lots of time and money. I also wanted to comment on one person’s reply about whether or not they will need to do it indefinitely. The bottom line is that we don’t yet have the data to say yes or no. I do want to mention, however, that we do progress patients from red to green over the course of a 12 week period as their pain is improving and they are able to tolerate more resistance. So before you jump to introduce a needle in to the elbow for a PRP or corticosteroid, which I strongly discourage, definitely give this eccentric program a go.

      • anonymous
        anonymous says:

        I have begun doing similar excercises by slowly lowering a light (3-5 lb) weight in the hand from a fully flexed position to a fully extended position while the arm rests palm-down on a bench or table (with the hand overhanging the edge). I take care to lift the hand to the fully flexed position with the non-injured hand on each rep. 3 sets of 5-10 reps twice per day. I have had very good results doing this regimen for about two weeks, with symptoms declining significantly after 4 months of no improvement.

  4. Mike Reinold
    Mike Reinold says:

    You actually can not do it with a towel, the bar has some spring to it, it wants to return to it's starting position, which the towel wouldn't. So literally, the bar is pulling you back and you have to eccentrically control the force. It is nothing other than an eccentric contraction, but a neat way for patients to do at home.

  5. Anonymous
    Anonymous says:

    After enduring tennis elbow for over a year and a half along with two cortisone shots, physical therapy, a variety of inflammation medications and ice application, I'm (knock on wood) happy to report that after nearly three weeks of using the flexbars, I seem to be improving! I still have days that I seem to relapse some in pain but, prior to using the flexbar, I was on a serious downhill trend again only 4 months after my last cortisone shot. This is the first thing I've done that seriously seems like it has improved my situation.

    Do you know whether the people in the study who showed improvement actually had no pain after 7-8 weeks? Is this the type of thing that I'll need to continue doing indefinitely??

  6. Mike Reinold
    Mike Reinold says:

    Agree with you guys, there are some issues but I wouldn't say I'm "skeptical." The bar does allow for a nice smooth eccentric contraction that may be easier for patients to use at home. Seems like patients just don't perform eccentrics with weights as easily.

    As a clinician, I always recommend that you take every study with a grain of salt. I don't interpret this study as saying that using this device is the best way to treat lat epi, but that it is a useful way to perform an eccentric exercise, which we all agree is important. Think of it as another tool, not a solution.

  7. rhart426
    rhart426 says:

    I'm skeptical as well, for the same reasons, plus:

    – No reason eccentrics can't be done with tubing or small weights
    – No testing vs. sham.
    – The bar exercise includes an element of active supination/pronation, which is an important part of strengthening in L.E. cases, that wasn't included in the control group.


  8. Christie Downing, PT, DPT, Dip MDT
    Christie Downing, PT, DPT, Dip MDT says:

    I am a bit skeptical on this one until the full study is finally published.

    This mainly includes limiations of:
    1. Small sample size
    2. Who funded the study
    3. It describes that the control group used "isotonic" exercises but does not describe what they actually were, nor if there were eccentric in nature
    4. What were the baseline characteristics of the two groups.

    I get skeptical when a "device" is said to produce better results than "standard" treatment. I prefer to stay with ordinary objects patients have in their homes to remain active participants in their program without having to "buy" extra things.

  9. Mike Reinold
    Mike Reinold says:

    Good clip Selena thanks, that should clarify. I have updated the post above to include that clip and some clarification on how to perform the exercise. That is an actual clip from Tim Tyler (that's his voice), the author of the study. In this video clip, the injured wrist is the right wrist.

    The injured wrist holds the bar in position as the healthy wrist adds a twist (still not injured wrist movement). Then, the eccentric component is the injured wrist slowly letting the twisted bar release back to normal.

  10. UofMWolverine81
    UofMWolverine81 says:

    I'm probably just a bit slow, but I wanted to clarify this just to be sure. You actively flex the uninjured wrist and twist the bar, and then you'd allow the "injured" wrist to begin to flex as you resist the untwisting of the bar to some extent.

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