Tyler, T.F., 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. 19(6): p. 917-922.

In the prospective, randomized, quasi-control study, 22 LE patients were assigned to either a standard physical therapy (PT) treatment group (control) or a group that received standard PT in addition to the FlexBar exercise. There was no significant difference between the groups prior to the intervention. Standard PT included stretching, cross-friction massage, ultrasound, heat and ice. Subjects were assessed for pain (Visual Analog Scale), subjective disability (Disability of Arm, Shoulder and Hand questionnaire : DASH), tenderness (pressure algometer), and wrist and finger strength (hand-held dynamometer). A power analysis determined that 15 patients would be required in each group to detect meaningful changes in the DASH score for 80% power at p<.05. The authors reported on the reliability of their strength and tenderness assessments, noting lower reliability of middle finger extension strength.

The FlexBar exercise was performed for 3 sets of 15 each day (See Figure 1). Each repetition took 4 seconds to complete, and there was a 30 second rest between each set of 15 repetitions. The exercise was performed both during clinic visits and at home. Once the patients could perform 3 sets of 15, they progressed to the next color FlexBar, indicating a higher intensity of resistance. The treatment continued until the patient had a resolution of symptoms, averaging 7 weeks of treatment with 10 clinic visits.

Subjects performing the FlexBar exercise in addition to PT had significantly more improvement than the group receiving only standard PT; in particular, the eccentric exercise group improved their pain level 81% vs. 22% in the standard group. Strength also significantly improved more in the eccentric group, 79% vs. 15% improvement in the standard group. The DASH Score improved 76% in the FlexBar group compared to 13% in the control group.