In partnership with
STILL IN MOTION
Because slowing down isn’t in the plan.
THIS WEEK'S STORY
A man I play doubles with had tennis elbow for almost two years. Not mildly — the kind where shaking someone’s hand felt like a fire had been lit on the outside of his elbow. He wore a brace. He did ice. He had two cortisone injections that helped for a few weeks and then didn’t.
He finally saw a sports medicine physician who specialized in upper extremity injuries. The physician did not recommend another injection or surgery. He prescribed a single exercise: the Tyler Twist, performed eccentrically with a rubber bar, three sets per day.
Six weeks later the pain was 80 percent reduced. Twelve weeks later it was gone. He still does the exercise twice a week as maintenance.
Lateral epicondylitis — the clinical name for tennis elbow — is one of the most common overuse injuries in adults over 60 who play racket sports. It is also one of the most successfully treated with a very specific type of loading that most people have never heard of and almost no recreational players use.
THE MAIN MESSAGE
Lateral epicondylitis is not an inflammation problem. Research over the past two decades has consistently shown that chronic tendinopathy — which is what tennis elbow actually is at the tissue level — involves tendon degeneration, not active inflammation. This is why anti-inflammatory treatments (ice, NSAIDs, cortisone) provide only temporary relief and do not resolve the underlying tissue problem.
What actually resolves tendon degeneration is progressive mechanical loading — specifically eccentric loading that stimulates the tendon to remodel toward healthier, more organized collagen structure. The Tyler Twist is the most studied and most effective eccentric loading protocol for lateral elbow tendinopathy, with multiple randomized controlled trials showing complete symptom resolution in 70 to 85 percent of cases within 8 to 12 weeks.
The specific factors that cause lateral elbow tendinopathy in racket sport players over 60:
Grip strength decline: as grip strength decreases with age (Issue #22), the forearm extensors must work harder to stabilize the racket at ball contact, increasing the load on the extensor origin at the lateral epicondyle.
Reduced wrist extensor flexibility: tighter wrist extensors place the tendon under higher load at the same playing volume.
Technique changes: stroke mechanics that place more load on the arm rather than using the kinetic chain (body rotation driving the stroke) increase arm load dramatically. A one-handed backhand hit with arm rather than body rotation is one of the highest-risk strokes for lateral elbow load.
Equipment mismatch: strings that are too tight or a grip that is too small or too large both increase the vibratory and compressive load at the elbow.
The treatment hierarchy: eccentric tendon loading (the Tyler Twist protocol) is first. Equipment adjustment and technique modification are second. Cortisone injections are a short-term pain management tool only, not a curative intervention. Surgery is a last resort after 12 months of failed conservative care.
Two Minutes a Day. Visible Results.
Your skin keeps score. Every year of skipped SPF, bad sleep, and stress shows up at once — wrinkles, eye bags, dark spots, loss of firmness. Most men think that's just aging. It isn't. It's fixable. Particle Face Cream is a 6-in-1 formula engineered for men's skin. Reduces eye bags, dark spots, and wrinkles. Restores firmness, hydrates deeply, revives dull tone. Two minutes a day. No complicated routine. Over 1,000,000 men already use it. Try it risk-free with a 30-day money-back guarantee. 20% off with code BH20.
Stretch of the Week: Seated Wrist Extension Stretch with Elbow Extension
Why: This stretch targets the wrist extensor musculotendinous junction — the tissue directly involved in lateral epicondylitis — with the elbow in full extension, which is the position of maximum stretch for the extensor origin at the lateral epicondyle. Distinct from the wrist flexor and extensor table stretch in Issue #22, which is performed with the elbow flexed.
How to do it:
Sit at the edge of a chair, affected arm extended in front of you, elbow straight
With the opposite hand, gently bend the wrist downward — palm toward the floor — until a stretch is felt along the top of the forearm
Hold 30 seconds — the stretch should be felt along the extensor surface of the forearm, from wrist toward elbow
Release, then add a slight inward rotation of the forearm and repeat for a slightly different angle
2 rounds per arm, twice daily when managing active symptoms
Tuesday goes deeper with three forearm and elbow stretches in the specific sequence used by sports medicine clinicians for lateral epicondylitis management.
Strength Move of the Week: Eccentric Wrist Extension (Tyler Twist Variation)
Purpose: The single most evidence-supported intervention for lateral elbow tendinopathy. Eccentric loading of the wrist extensors stimulates tendon remodeling toward healthier collagen without the inflammatory response that injection approaches produce.
How to do it (band or light dumbbell version, no FlexBar required):
Hold a light dumbbell (1 to 2 lbs) in the affected hand, forearm resting on a table, palm facing downward
Use the unaffected hand to assist the wrist into full extension (bent upward)
Remove the assisting hand and slowly lower the wrist over 4 to 5 seconds until the wrist is fully flexed (bent downward)
Use the assisting hand to return to the extended position and repeat
The only active movement is the slow, eccentric lowering — the assisting hand performs the concentric return
15 reps, 3 sets, twice daily for 8 weeks
This will produce mild discomfort during the exercise that resolves within 24 hours. This is normal and expected. If it produces sharp or severe pain, or if pain persists beyond 24 hours, reduce the weight and consult a healthcare provider.
Thursday expands with three loading progressions and the specific criteria for advancing from one level to the next.
Suggested Equipment: FlexBar Resistance Bar (TheraBand FlexBar)
The FlexBar is the tool used in the original Tyler Twist research. It provides a specific combination of grip load and forearm rotation that produces a more effective eccentric stimulus than a dumbbell alone. The red (light) tension is appropriate for most adults beginning this protocol. Available at physical therapy supply stores and online for approximately twenty dollars.
Saturday covers the full elbow health toolkit, equipment considerations for racket sport players, and the complete eight-week recovery protocol.
SIM60 receives no commissions or affiliate compensation for any equipment referenced in this issue. All mentions are for illustration purposes only.
Tired of news that feels like noise?
Every day, 4.5 million readers turn to 1440 for their factual news fix. We sift through 100+ sources to bring you a complete summary of politics, global events, business, and culture — all in a brief 5-minute email. No spin. No slant. Just clarity.
THE TAKEAWAY
Tennis elbow is a tendon degeneration problem, not an inflammation problem. The treatment that works is progressive eccentric loading of the affected tendon, not rest, ice, or injection. Eight to twelve weeks of consistent eccentric wrist extension resolves the vast majority of cases. The injury is manageable. The approach just has to match the actual problem.
YOUR TURN
Have you had lateral elbow pain from racket sports or any other repetitive activity? Have you tried the eccentric loading approach or is this the first time you’ve heard it described this way? Reply and tell me — this is one of the most treatable chronic injuries in this age group and one of the most undertreated.
Still moving forward,
— The SIM60 Team
simsixty.com · Educational content only. Not medical advice. SIM60 receives no commissions or affiliate fees for any equipment referenced. All mentions are for illustration purposes only.
