The Tyler Twist: FlexBar exercises that earned their reputation

TL;DR. If your physio or a forum sent you here for "the FlexBar exercise", this is it. The Tyler Twist is an eccentric wrist-extensor exercise using a rubber TheraBand FlexBar: twist the bar with your healthy hand, release it slowly with the injured one. The studied dose is 3 sets of 15 reps daily for about 6 weeks, with a 4-second release. Most men start on green, most women on red. It complements, not replaces, a full loading program.

Educational only. Not medical advice. Consult a qualified clinician before starting any rehab program, especially if pain follows trauma or comes with numbness, tingling, or loss of grip.

Why one rubber bar got its own name

Tennis elbow (lateral epicondylitis, ICD-10 M77.1) is a degenerative tendinopathy of the wrist extensor origin, and the treatment with the strongest evidence base is progressive loading, especially slow eccentric work. The problem has always been practicality: classic eccentric wrist extension needs a dumbbell, a table edge, and the healthy hand to lift the weight back up between every rep.

In 2010, physical therapist Timothy Tyler and colleagues published a small randomized trial testing a workaround: a flexible rubber bar (the TheraBand FlexBar) twisted by the healthy wrist and released slowly by the injured one. Both the concentric and eccentric phases happen in a single self-contained movement, no bench, no dumbbell, no setup. The exercise has been called the Tyler Twist ever since.

The results got attention because the trial isolated one variable. Both groups received standard physiotherapy (stretching, massage, heat, ice); one group added the FlexBar eccentrics. After about 7 weeks the FlexBar group reported roughly 81% pain reduction versus 22% in the control group, with similarly large gaps in strength and DASH function scores. The trial stopped early at 21 patients because the difference was so pronounced. Small study, real limitation, but it remains one of the only single-exercise interventions for tennis elbow validated in an RCT.

Which FlexBar to buy

FlexBars come in four resistances, color-coded. The right one lets you finish 15 controlled reps with the last 3 feeling hard but not sharp.

Color	Resistance	Approx. force to bend	Who starts here
Yellow	Extra light	~6 lbs / 2.7 kg	Highly irritable cases, older or deconditioned users
Red	Light	~10 lbs / 4.5 kg	Most women, smaller-framed men, painful starts
Green	Medium	~15 lbs / 6.8 kg	Most men, active women, the Tyler trial's main bar
Blue	Heavy	~25 lbs / 11.3 kg	Progression target, strong athletes late in rehab

Buy one color down if in doubt. A too-heavy bar forces a fast, jerky release, which removes the eccentric stimulus you bought the bar for.

Tyler Twist, step by step

Example assumes the right elbow is the painful one. Mirror everything if it's the left.

1
Grip the bottom with the injured hand
Hold the FlexBar vertically in your right hand at the bottom end, wrist fully extended (bent back, knuckles toward your face). This extended position is your starting and finishing point; the injured wrist never twists into the bar, it only resists out of it.
2
Grip the top with the healthy hand
Grab the top end with your left hand, palm facing away from you. Your two grips now oppose each other, which is what lets the bar store a twist.
3
Twist with the healthy wrist only
Flex your left wrist to wind the bar up while the right wrist holds dead still in extension. The work so far has been done entirely by the healthy side; the injured tendon hasn't contracted concentrically at all. That's deliberate.
4
Extend both arms out front
Straighten both elbows until the bar is horizontal at chest height, keeping the twist loaded. Elbow extension matters: the wrist extensors cross the elbow, so a straight arm puts the tendon at working length.
5
Release slowly with the injured wrist
Allow your right wrist to flex slowly, about 4 seconds, letting the bar unwind under control. This slow lowering is the eccentric contraction, the entire therapeutic stimulus. Reset to the start position and repeat. 15 reps, 3 sets, once daily. Rest 30 to 60 seconds between sets.

Programming and progression

The studied dose

3 × 15 daily with a ~4-second release, continued for about 6 weeks. Discomfort up to 4/10 during the set is acceptable and expected with tendinopathy loading. Sharp pain, or a pain spike that's still there the next morning, means drop a color or cut reps to 3 × 10.

When to move up a color

When 3 × 15 feels controlled to the last rep, produces no next-day reaction, and has done so for about a week. Yellow → red → green → blue. Most people spend 2 to 4 weeks per color. Don't chase the blue bar; chase the clean 4-second release.

Where it fits in a full program

The Tyler Twist targets one tissue with one stimulus. A complete rehab arc also includes isometric grip holds, pronation/supination work, and progressive heavy slow resistance, the structure covered in our at-home rehab protocol. Use the Twist as your daily eccentric slot, not as the whole plan.

Golfer's elbow? Reverse it

Medial elbow pain loads the wrist flexors instead, the reverse Tyler Twist mirrors the grips and twist direction so the slow release happens into extension. If your pain is on the inside of the elbow, start with tennis vs golf elbow to confirm which one you have, then see the medial epicondylitis rehab guide.

Common mistakes

Mistake 1: Twisting with the injured wrist.
The injured side should never wind the bar up. Its only job is the slow release. If you catch your painful wrist doing the twisting, you've converted a controlled eccentric into an aggressive concentric and the tendon will let you know tomorrow.
Mistake 2: Letting the bar snap back.
A 1-second release is a wasted rep. The remodeling stimulus scales with time under tension; count the 4 seconds out loud if you have to. If you can't control the release, the bar is too heavy.
Mistake 3: Bent elbows.
Doing the release with elbows tucked at your sides shortens the extensor chain and cuts the load on the tendon at the exact range you're trying to treat. Arms straight, bar horizontal, chest height.
Mistake 4: Quitting at 2 weeks.
Tendon adaptation runs on collagen timelines, not muscle timelines. The trial measured outcomes at ~7 weeks; many people feel the corner turn somewhere in weeks 3 to 5. Stopping early because "it isn't working yet" is the most common failure mode of this otherwise reliable exercise.

No FlexBar? Two substitutes

Dumbbell eccentric wrist extension

Forearm on a table, wrist over the edge, palm down. Lift the weight up with the healthy hand, lower it over 3 to 4 seconds with the injured one. Same tissue, same stimulus, slightly more setup. 1 to 4 kg covers most cases. This is the load used in our home protocol.

Rolled towel twist

Wring a tightly rolled towel with the same grip pattern as the Twist. The movement is right but the resistance is whatever your healthy hand provides, impossible to standardize or progress. Acceptable on holiday; don't build six weeks of rehab on it.

Red flags, stop and see a clinician

Numbness, tingling, or weakness in the hand
Sudden trauma onset (fall, direct blow)
Joint swelling, redness, or warmth at the elbow
Night pain unrelated to position
No improvement after 12 weeks of consistent loading
Locking, catching, or instability of the elbow

FAQ

Which FlexBar color should I start with for tennis elbow?

Most adult men start with green (medium, about 15 lbs of force to bend) and most adult women with red (light, about 10 lbs). If you cannot complete 15 controlled reps with a 4-second release, drop one color. If 3 sets of 15 feel easy with no next-day reaction, move up one color.

How many Tyler Twists should I do per day?

The studied protocol is 3 sets of 15 repetitions once daily, with a roughly 4-second eccentric release per rep, continued for about 6 weeks. Mild discomfort up to 4/10 during the set is acceptable; sharp pain or a pain spike lasting into the next day means reduce the resistance or rep count.

Does the Tyler Twist actually work?

In the original randomized trial (Tyler et al. 2010), patients adding FlexBar eccentrics to standard physiotherapy improved substantially more in pain and function than physiotherapy alone over roughly 7 weeks. It is one of the few tennis elbow exercises validated as a stand-alone addition in an RCT, though the trial was small (n=21).

Can I do the Tyler Twist without a FlexBar?

You can load the same tissue with a dumbbell eccentric wrist extension: lift the wrist up with your healthy hand, lower slowly over 3 to 4 seconds with the injured one. A rolled towel twist approximates the movement pattern but the resistance is hard to standardize, fine for travel, not ideal as your main protocol.

Is there a Tyler Twist for golfer's elbow?

Yes, the reverse Tyler Twist loads the wrist flexors eccentrically for medial epicondylitis. The grip and twist direction are mirrored so the slow release happens into wrist extension on the injured side.

Evidence

Tyler TF et al. — Addition of isolated wrist extensor eccentric exercise to standard treatment for chronic lateral epicondylosis: a prospective randomized trial. J Shoulder Elbow Surg 2010. PubMed 20303293
Page P. — A new exercise for tennis elbow that works! N Am J Sports Phys Ther 2010. PubMed 21589664
Cullinane FL et al. — Is eccentric exercise an effective treatment for lateral epicondylitis? A systematic review. Clin Rehabil 2014. PubMed 24213031
NICE Clinical Knowledge Summaries — Tennis elbow. cks.nice.org.uk/topics/tennis-elbow

Last verified 13 June 2026. Educational content only. Not medical advice.