Exercise Delivers Relief for Tennis Elbow
Efficacy of Novel Thera-Band® FlexBar®
Study reveals a cost-effective, in-office and at-home treatment
Research has shown that isokinetic eccentric training of the wrist extensors is effective for
treating chronic lateral epicondylitis -- a.k.a. tennis elbow. However, isokinetic dynamometry is
not widely available or practical for daily exercise prescription.
Recognizing these limitations, a team at the Nicholas Institute of Sports Medicine and Athletic
Trauma in New York City, led by Timothy F. Tyler, PT, ATC, Clinical Research Associate,
decided to search for an as effective, but more readily available treatment; ideally a treatment that
would work at home.
"Up until now, the only way to do isolated eccentrics for the tennis elbow was on a big, $50,000
isokinetic machine that would be in someone's office," stated Tim Tyler. “With up to three
percent of the population suffering annually with tennis elbow -- a condition attributed to racket
sports but can occur from simply everyday activities -- we felt this population deserved some
additional treatment options.”
The team, wanting a way to make therapy work at home, began to assess the efficiency of a novel
eccentric wrist extensor exercise when added to the standard physical therapy treatments for
chronic lateral epicondylitis. The exercise involved the Thera-Band® FlexBar®, a ridged-surface
flexible bar initially designed to be used for wrist, forearm and hand rehabilitation.
The study involved 21 patients who had reported chronic symptoms of tennis elbow for at least
six weeks, but had no prior surgical treatment for it. The patients were separated into two groups;
everyone in the study received standard physical therapy, which included wrist extensor
stretching, ultrasound, cross friction massage, and heat and ice for seven weeks. Additionally, the
Standard Treatment Group performed isotonic wrist extensor strengthening and the Eccentric
Group performed isolated eccentric wrist extensor strengthening using the FlexBar. Eccentric
exercise involves putting tension on a muscle as it opposes a stronger force which causes the
muscle to lengthen as it contracts.
The eccentric exercise involved twisting the Thera-Band FlexBar with concentric wrist flexion of
the uninjured arm and slowly releasing the twist with eccentric wrist extension of the injured arm.
Three sets of 15 repetitions were performed daily as part of a home program with intensity
increased progressively through the three levels of FlexBar resistance during the treatment period.
A variety of pain and movement scales were utilized to determine progress. Patients using the
FlexBar had vastly better results on all scales, especially related to strength.
"All outcome measures for chronic lateral epicondylitis were markedly improved with the
addition of the FlexBar exercise to the standard physical therapy routine. Ethically, we stopped
the study because we saw such a vast improvement in the FlexBar group; we didn't feel that it
was ethical to keep people that weren't getting better on the standard treatment protocol on that
protocol," continued Tyler.
“We recognize that this study was limited by its small sample size, however its at-home use is
practical, inexpensive, does not require direct medical supervision, and has no significant side
effects. The ‘maximal’ efficacy of this new treatment would thus likely compare favorably
against anything else available and could lower healthcare costs” added Tyler.
The findings of this study were presented at the American Orthopaedic Society for Sports
Medicine’s Annual Meeting in Keystone, Colorado earlier this year. The complete study and
abstract can be viewed at http://info.thera-bandacademy.com/flexbarelbow
Performance Health / Hygenic Corporation is a leading designer, manufacturer and marketer of a broad
portfolio of products for the therapy, rehabilitation, massage and wellness markets. Maker of marketleading Biofreeze® and Thera-Band® products, Performance Health / Hygenic Corporation provides
evidence-based protocols, education, turn-key dispensing and pain management solutions. The Thera-Band
FlexBar is available from Performance Health. For more information visit www.biofreeze.com,
www.thera-band.com, www.thera-bandacademy.com or call 800-321-2135.