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Tennis Elbow SyndromeTTT-METNCT07807254

Comparative Effect of Tyler Twist Technique and Muscle Energy Technique on Lateral Epicondylitis.

A study testing Tyler Twist Technique and Muscle Energy Technique in people with Tennis Elbow Syndrome, run by University of Faisalabad at 1 site in Pakistan.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This thesis, titled "Comparative Effects of Muscle Energy Technique and Tyler Twist Technique on Grip Strength, Pain, and Function in Patients with Lateral Epicondylitis," investigates the efficacy of two widely used physical therapy methods for treating lateral epicondylitis (tennis elbow). Read more about this study

Who is it for?
Ages 20 to 40 years
Conditions the study is for
Tennis Elbow Syndrome
What is being tested?
Tyler Twist Technique and Muscle Energy Technique
Could I receive a placebo?
No, everyone receives an active treatment
How many people
34 participants
Where
1 sitePakistan
Study dates
24 Apr 2026to 9 Aug 2026
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 20 to 40 years
  • All sexes
  • No healthy volunteers
  • Adult

Who may be able to join

  • Both gender
  • 20 to 40 years of age.
  • Tenderness felt above the humerus of lateral epicondyle
  • Cozen's test, Maudsley's test, Mill's test or all three favourable outcomes
  • Discomfort while griping
  • History of pain

Who cannot join

  • Cervical radiculopathy
  • Local steroid injections over the last six months
  • Pregnancy
  • Upper limb fractures
  • Surgery on the elbow region
  • RA

Trial locations and contacts

1 site in 1 country.

Pakistan1 site
  • Department of Rehabilitation Sciences, The University of Faisalabad.

    Faisalābad, Punjab Province, 38000

Other trials in Pakistan

About this study

Official title: Comparative Effects of Tyler Twist Technique and Muscle Energy Technique on Pain, Function and Grip Strength in Patient With Lateral Epicondylitis

This thesis, titled "Comparative Effects of Muscle Energy Technique and Tyler Twist Technique on Grip Strength, Pain, and Function in Patients with Lateral Epicondylitis," investigates the efficacy of two widely used physical therapy methods for treating lateral epicondylitis (tennis elbow). Lateral epicondylitis is a common musculoskeletal illness characterised by pain across the lateral side of the elbow, reduced grip strength, restricted upper-limb function, and difficulty performing daily and professional responsibilities. If treatment is not received, the illness, which frequently affects people who do repeated wrist and forearm motions, can significantly lower quality of life. In this randomised clinical investigation, 34 people between the ages of 20 and 40 were split into two therapy groups. One group received the Muscle Energy Technique (MET), a manual therapy approach that improves neuromuscular function, joint mobility, and muscle flexibility by using controlled isometric contractions followed by stretching. The second group performed the Tyler Twist Technique, an eccentric strengthening exercise that targets the wrist extensor muscles and has gained popularity as a tennis elbow treatment, using a flex bar. The baseline examination, which revealed that both groups were similar in terms of demographic characteristics including age and gender as well as initial pain levels, demonstrated that the groups were well matched prior to the intervention. The results of the study demonstrated significant clinical improvements in both groups following treatment. Both the Tyler Twist and MET groups had a significant decrease in pain intensity from baseline on the Numerical Pain Rating Scale (NPRS), suggesting that both therapies were effective in lowering pain associated with lateral epicondylitis. Although each group saw a considerable reduction in pain, there was no statistically significant difference between the groups, suggesting that both approaches provide comparable benefits in terms of pain relief. To assess functional impairment, the Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire was employed. Upper-limb function significantly improved with both treatments, and disability scores decreased. However, during follow-up, PRTEE scores increased more in individuals who got the Tyler Twist Technique, indicating a better improvement in functional performance and the ability to do daily chores. Additionally, grip strength measurements showed significant increases in both groups, with the Tyler Twist group seeing somewhat larger gains. These findings support the hypothesis that eccentric strengthening exercises may aid individuals suffering from tennis elbow in regaining hand function and muscle performance. However, it was shown that the Muscle Energy Technique was better at improving elbow flexion range of motion and wrist flexion and wrist extension mobility. Improvements in neuromuscular relaxation, improved joint mechanics, and reduced soft-tissue stiffness brought about by the manual therapy component of MET may have contributed to greater mobility and flexibility around the elbow and wrist complex. When quality of life was assessed using the Short Form-36 (SF-36) questionnaire, both treatment groups demonstrated significant improvements in several aspects. This suggests that increases in physical functioning, engagement in everyday activities, and general well-being coincided with decreases in pain and impairment.

The study's findings show that both the Muscle Energy and Tyler Twist approaches improve function, grip strength, pain relief, and overall quality of life for those with lateral epicondylitis. While MET was more successful in improving wrist and elbow mobility, the Tyler Twist approach produced better benefits in grip strength and functional recovery. These findings show that the therapy plan can be customised to the patient's demands, using Tyler Twist for strength and function and MET for range of motion gains.

Because there were only 34 participants in the research, the results could not have been as relevant to bigger groups. Because of the short trial period, the therapy's long-term effects could not be evaluated. The study's applicability to elder patients was reduced by the participants' limited age range of 20-40 years. To increase the generalisability of the results, bigger and more varied sample sizes are advised for subsequent research. Long-term follow-up studies should be planned in order to assess the long-term impacts of the Muscle Energy method and the Tyler Twist method. To determine the combined impact, the outcomes of a treatment plan that includes both the Tyler Twist and the Muscle Energy Technique treatments should be examined for people with lateral epicondylitis.

Read the detailed description

Background: Tennis elbow is characterized by self-limiting pain on the outside of the elbow that gets worse with rotation of the forearm and wrist extension. The prognosis of a number of medical diseases is known to be influenced by lifestyle factors like alcohol consumption, smoking, and eating habits. Compared to non-smokers, smokers had a greater risk of developing lateral epicondylitis. There are other synonyms for tennis elbow, such as peritendinitis of the elbow, lateral epicondylitis, tendonitis of the same extensor origin, lateral epicondylalgia, and lateral elbow pain. Tennis elbow is characterised by pain when the wrist, middle finger, or both are resisted in their dorsiflexion, as well as tenderness and soreness across the lateral epicondyle of the humerus.

Objectives: The main objective was to investigate how Tyler Twist Technique and the Muscle Energy Technique affected lateral epicondylitis patients' grip function, pain, and grip strength.

Study design: Randomized Clinical Trial Setting: DHQ Hospital Chiniot Sample size: 34 participants (17 per group). Sample size calculated (Novianti et al., 2023) by using open epi tool and attrition rate (n=2).

Eligibility Criteria:

Inclusion Criteria

  • Both gender
  • 20 to 40 years of age.
  • Tenderness felt above the humerus of lateral epicondyle
  • Cozen's test, Maudsley's test, Mill's test or all three favourable outcomes
  • Discomfort while griping
  • History of pain Exclusion Criteria
  • Cervical radiculopathy
  • Local steroid injections over the last six months
  • Pregnancy
  • Upper limb fractures
  • Surgery on the elbow region
  • RA Intervention Protocol: After screening subjects were requested to sign informed consent form. After that participant were at random divided in 2 groups. Group A and group B by chit draw method. Group A received tyler twist technique while group B received muscle energy technique. Both groups received treatment for 4 weeks and 3 sessions was given in each week.

Outcome measures:

Primary outcomes

  • Pain
  • Function
  • Grip strength Secondary Outcome
  • ROM
  • QOL

Statistical Analysis:

Normality of data was assessed by Shapiro-Wilk test. Within group comparison was used Paired sample t-test for normally distributed data and wilcoxon signed-rank test for non-normal distributed data. Between group comparison was used independent t-test for normally distributed data and Mann-Whiteny U test for non-normal distributed data. A p value less than 0.05 was considered statistically significant. Results was presented in graphical and tabular form using SPSS version 2026.

Being tested
Tyler Twist Technique, Muscle Energy Technique

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Tyler Twist TechniqueOther

    A blue-colored FlexBar with the least resistance was used to complete the FlexBar workout program, also called the Tyler Twist. While the opposing hand clutched the other end of the FlexBar and twisted it with the unaffected wrist, the afflicted wrist was maintained at maximal extension. The unaffected wrist was at maximal flexion and the afflicted wrist was in maximal extension while both arms were placed maintaining the twist while extending their elbows in front of the body. The afflicted wrist was then flexed, allowing the FlexBar to untwist and causing an eccentric contraction of the wrist extensors. Three sets of fifteen repetitions were completed, with a 30-second rest period in between sets. Each repeat lasted four seconds

  • Muscle Energy TechniqueOther

    For five seconds, the participants were instructed to contract their forearm muscles with 15% of their entire power in opposition to the therapist's force. They were then instructed to perform the countermovement until the force was felt. The identical exercise was required of the participants five times, with a one-minute break between each repeat and a five-second hold. The MET sought to tense the forearm muscles isometrically

Study groups in NCT07807254
Study groupRoleWhat they receive
Group A: Tyler Twist Technique plus baselineExperimentalUltrasound therapy is a component of conventional physiotherapy. The tenoperiosteal joint of the ECRB and the area of discomfort were treated with pulsed ultrasound for five to eight minutes at a 1:4 pulse ratio of 1 MHz at 1.5 W/cm2. Three sets of fifteen repetitions were completed, with a 30-second rest period in between sets. Each repeat lasted four seconds
Receives: Other: Tyler Twist Technique
Group B Muscle Energy Technique plus baselineActive comparatorUltrasound therapy is a component of conventional physiotherapy. The tenoperiosteal joint of the ECRB and the area of discomfort were treated with pulsed ultrasound for five to eight minutes at a 1:4 pulse ratio of 1 MHz at 1.5 W/cm2. The entire course of treatment was applied for twenty to thirty minutes. For five seconds, the participants were instructed to contract their forearm muscles with 15%. The exercise was required of the participants five times, with a one-minute break between each repeat and a five-second hold.
Receives: Other: Muscle Energy Technique

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Pain

    Pain was assessed by Numeric Pain Rating Scale (NPRS), function was assessed by patient rated tennis elbow evaluation questionnaire and grip strength by handheld dynamometer. It contains 1 to 10 scores, 1 shows minimum and 10 shows maximum value of pain severity

    Measured: 4 weeks

Secondary outcomes (1)
  1. Range of motion

    Range of motion was assessed by goniometer and quality of life was assessed by SF-36 questionnaire.

    Measured: 4 weeks

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted8 Sep 2026
  2. Study start24 Apr 2026
  3. Primary completion24 Jun 2026
  4. Study completion9 Aug 2026

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
34 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07807254
Sponsor's protocol ID
2024-MS-PT-34
Acronym
TTT-MET
Status last verified
Aug 2026
First submitted
15 Aug 2026
Last updated
8 Sep 2026
Results posted
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Publications

  • Trivedi P, Arunachalam R, Vaittianadane K et al. (2019) Efficacy of muscle energy technique with plyometric exercises in chronic lateral epicondylitis. Int J Health Science Research 9(2): 108- 14.

  • Sinha I and Khatik B (2026) A comparative analysis of muscle energy technique versus myofascial release with plyometric training in individuals with chronic lateral epicondylitis. inflammation 5(1): 156- 160.

  • Sadeghifar A, Zanderahimi F, Karamoozian F et al. (2025) Lateral Epicondylitis (Tennis Elbow): A comprehensive review of historical perspectives, etiology, and emerging treatment modalities. Journal of Kerman University of Medical Sciences 32(1): 1- 10.

  • Hong QN, Durand MJ, Loisel P. Treatment of lateral epicondylitis: where is the evidence? Joint Bone Spine. 2004 Sep;71(5):369-73. doi: 10.1016/j.jbspin.2003.05.002.

    PubMed 15474386
  • Chen D, Lin Z, Liu Y et al. (2023). Diagnosis, treatment, and prevention of tennis elbow. Second international conference on biological engineering and medical science (icbiomed 2022). SPIE 12611(1): 833- 840.

  • Akbar H, Akbar S, Saddique MN, Sarfraz MS. Prevalence of lateral epicondylitis among housewives in Lahore: a cross-sectional study. BMC Musculoskelet Disord. 2024 Oct 15;25(1):815. doi: 10.1186/s12891-024-07889-x.

    PubMed 39407258
  • Dundar U, Turkmen U, Toktas H, Ulasli AM, Solak O. Effectiveness of high-intensity laser therapy and splinting in lateral epicondylitis; a prospective, randomized, controlled study. Lasers Med Sci. 2015 Apr;30(3):1097-107. doi: 10.1007/s10103-015-1716-7. Epub 2015 Jan 23.

    PubMed 25614134
  • Bisset L, Coombes B, Vicenzino B. Tennis elbow. BMJ Clin Evid. 2011 Jun 27;2011:1117.

    PubMed 21708051
  • Bunata RE, Brown DS, Capelo R. Anatomic factors related to the cause of tennis elbow. J Bone Joint Surg Am. 2007 Sep;89(9):1955-63. doi: 10.2106/JBJS.F.00727.

    PubMed 17768192
  • Zhang C, Jia Z, Li J, Wang X, Yang S. Impact of lifestyle and clinical factors on the prognosis of tennis elbow. Sci Rep. 2024 Feb 6;14(1):3063. doi: 10.1038/s41598-024-53669-x.

    PubMed 38321129
  • Cutts S, Gangoo S, Modi N, Pasapula C. Tennis elbow: A clinical review article. J Orthop. 2019 Aug 10;17:203-207. doi: 10.1016/j.jor.2019.08.005. eCollection 2020 Jan-Feb.

    PubMed 31889742
  • Karabinov V, Georgiev GP. Lateral epicondylitis: New trends and challenges in treatment. World J Orthop. 2022 Apr 18;13(4):354-364. doi: 10.5312/wjo.v13.i4.354. eCollection 2022 Apr 18.

    PubMed 35582153
  • Brazier JE, Harper R, Jones NM, O'Cathain A, Thomas KJ, Usherwood T, Westlake L. Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ. 1992 Jul 18;305(6846):160-4. doi: 10.1136/bmj.305.6846.160.

    PubMed 1285753
  • Kiatkulanusorn S, Luangpon N, Srijunto W, Watechagit S, Pitchayadejanant K, Kuharat S, Beg OA, Suato BP. Analysis of the concurrent validity and reliability of five common clinical goniometric devices. Sci Rep. 2023 Nov 27;13(1):20931. doi: 10.1038/s41598-023-48344-6.

    PubMed 38017058
  • Huang L, Liu Y, Lin T, Hou L, Song Q, Ge N, Yue J. Reliability and validity of two hand dynamometers when used by community-dwelling adults aged over 50 years. BMC Geriatr. 2022 Jul 15;22(1):580. doi: 10.1186/s12877-022-03270-6.

    PubMed 35840905

Questions about this trial

What is this clinical trial studying?

A study testing Tyler Twist Technique and Muscle Energy Technique in people with Tennis Elbow Syndrome, run by University of Faisalabad at 1 site in Pakistan.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 8 Sep 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Pakistan. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Pain (time frame: 4 weeks). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT07807254, which also lists 21 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 8 Sep 2026.

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