"Tyler Twist" - Tennis Elbow Cure or Shoulder Impingement Creator?

Tyler et al. recently published a study in the Journal of Shoulder and Elbow Surgery entitled “Addition of isolated wrist extensor eccentric exercise to standard treatment for chronic lateral epicondylosis: a prospective randomized trial.” The authors found that patients with chronic tennis elbow enjoyed improved outcomes when a novel eccentric training exercise (AKA the “Tyler Twist”) was added to standard physical therapy. While the results of this study are beyond impressive, I have been shocked that there has been little to no mention regarding the position of the noninvolved arm while performing the Tyler Twist. It is readily apparent that the model in this video is falling in to a position of subacromial impingement that is nearly identical to the starting position of the Hawkins-Kennedy maneuver. Perhaps this eccentric training exercise may be addressing lateral epicondylosis but is it potentially creating shoulder imingement on the noninvolved arm? Since this research suggests that incorporating the Tyler Twist in to the physical therapy program of a patient presenting with chronic lateral epicondylosis will engender optimal results, proper execution is critical. So make sure to instruct your patients to keep their elbow down (below 60 degrees) to protect them while they are performing the Tyler Twist. Otherwise they may be returning to the clinic for complaints of shoulder pain. Curious to hear your thoughts on this topic. Hope everyone is having a good weekend.

Chris Johnson