The Tyler Twist: The Best Tennis Elbow Exercise
The research-backed eccentric exercise that helps players recover from chronic tennis elbow when other approaches fail.
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If you have tennis elbow and you've tried rest, bracing, and anti-inflammatories without full resolution, the Tyler Twist is probably what you need next. Named after Todd Tyler, the physical therapist who popularized the protocol, and grounded in a 2010 study published in the Journal of Shoulder and Elbow Surgery, this eccentric loading exercise has become the most-cited home rehabilitation technique for lateral epicondylopathy. It requires one cheap tool (a TheraBand FlexBar) and about 5 minutes a day. This guide walks through exactly how to do it, how to progress, and what to expect.
Why the Tyler Twist Works
Tennis elbow — medically, lateral epicondylopathy — is a breakdown of the tendon where the wrist extensor muscles attach to the outer elbow. For decades, the standard treatment was rest, NSAIDs, and braces. The problem: once the rest ended and play resumed, the pain frequently returned. The tendon had stopped being acutely painful, but it hadn't been rebuilt.
Modern tendon research shows that damaged tendons need controlled loading to remodel. The loading has to be progressive, patient-tolerated, and most importantly, eccentric — meaning the muscle lengthens under tension rather than shortens. Eccentric loading is the specific stimulus that drives tendon adaptation and remodeling.
The Tyler Twist delivers eccentric load to the wrist extensor tendon using a simple rubber bar (the FlexBar). The 2010 Tyler et al. study found that adding this exercise to standard care produced substantially better outcomes — pain reduction and strength gains — compared with standard care alone. Multiple follow-up studies have supported the approach.
What You Need
The original protocol uses the TheraBand FlexBar, which comes in color-coded resistances: Yellow (lightest), Red, Green, Blue, Black (highest). Most tennis elbow protocols start with Red (medium) for women and Green (heavy) for men, though individual tolerance varies.
Alternative brands like DMOOSE offer similar flex bars at lower prices. They work the same way; pick whatever is available and affordable. What matters most is consistency, not brand. The FlexBar typically runs $15–25 and lasts years.
TheraBand FlexBar — Medium (Red)
The standard starting resistance for most players with tennis elbow. Can be ordered from Amazon and most sporting-goods retailers. See our gear listings for direct links.
Step-by-Step Tyler Twist
Follow these steps precisely. The form matters — a rushed or sloppy Tyler Twist gives minimal benefit.
1. Hold the FlexBar vertically in front of you with your affected arm (the one with tennis elbow). Grip the lower end with your wrist fully extended — palm facing away, back of hand facing your body.
2. Place your unaffected hand on the top of the bar with your wrist fully flexed — palm facing your body, back of hand facing away.
3. Extend both arms out in front of you at shoulder height. The bar is now twisted between your two wrists. This is the starting position.
4. Slowly allow your affected wrist to rotate back toward neutral (the unaffected hand holds its position). The untwisting should take about 4 seconds. This is the eccentric phase where the tendon is loaded. Focus on slow and controlled.
5. Use your unaffected hand to reset to the twisted starting position. The injured wrist passively follows. The injured side only works during the slow untwist — this is why it's called eccentric loading.
6. Repeat for 15 reps. Rest 60 seconds. Do three sets total.
Perform once per day, 5 days per week. The full protocol runs 6–12 weeks.
What to Expect During and After
Mild discomfort during the exercise is normal and is part of the research literature — tendinopathy exercises often produce some discomfort as the tissue loads. As long as it's mild (roughly 3–4 out of 10), you're working in the therapeutic zone.
Sharp pain is not acceptable. Neither is pain that's significantly worse the next day. If either happens, drop the resistance one level (e.g., Green to Red, Red to Yellow) and retry. The exercise becomes easier as the tendon rebuilds — most players can progress resistance after 4–6 weeks.
Expect gradual improvement, not instant relief. By week 2, many players notice less daily soreness. By week 4–6, lifting a coffee cup should feel dramatically better. By week 8–12, most cases resolve substantially. Chronic cases may take longer but respond over time with consistency.
When the Tyler Twist Isn't Right
This protocol is designed for lateral epicondylopathy (tennis elbow, outer elbow). If your pain is on the inner elbow — golfer's elbow — you need the Reverse Tyler Twist, which uses the bar in the opposite direction to load the wrist flexor tendon. Doing the wrong version loads the healthy tendon and leaves the injured one untreated.
If you're in the acute phase (first 1–2 weeks of a significant flare, severe pain, or a specific new injury event), wait until acute pain has subsided before starting. The protocol is for subacute to chronic tendinopathy, not acute injury. A physical therapist can confirm readiness.
If you have recent elbow surgery, nerve symptoms (numbness, tingling), or significant swelling, consult a clinician before starting.
Frequently Asked Questions
How long until the Tyler Twist starts working?
Most players notice reduced daily soreness within 2–3 weeks of consistent practice. Meaningful functional improvement (lifting objects, shaking hands without pain) usually shows up at 4–6 weeks. Full resolution for most cases is 8–12 weeks. Chronic cases that have been present for many months may take 4+ months of consistent work.
Can I keep playing pickleball while doing the Tyler Twist protocol?
Usually yes, at reduced volume. A counterforce brace during play, shorter sessions, and lower grip pressure let most players continue modified play during rehab. Stop immediately if symptoms worsen meaningfully during or after play. See our tennis elbow guide for the full load-management framework.
Which resistance should I start with?
Most protocols start women with Red (medium) and men with Green (intermediate). Individual strength and tolerance vary. If the exercise feels easy at the current level and produces minimal next-day soreness, move up. If it produces sharp pain or significant next-day increase in symptoms, move down.
Can I just do regular wrist exercises instead?
Regular wrist curls and reverse wrist curls use concentric loading (muscle shortening) which provides far less tendon remodeling stimulus. The specific value of the Tyler Twist is the eccentric pattern under rotational torque. Other eccentric wrist exercises with a light dumbbell can work but tend to be harder to do with good form.
Do I need to see a PT or can I do this alone?
Home practice is how most people successfully complete this protocol, and the research supports it. That said, a single session with a physical therapist to verify your form and resistance choice is worth the cost if you can afford it. Poor form reduces the benefit considerably.
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