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STILL IN MOTION
Because slowing down isn’t in the plan.
THURSDAY DEEP DIVE: THE STRENGTH MOVE
Part 1 introduced Eccentric Wrist Flexion, the Reverse Tyler Twist. Today we place it in a three-level progression, because starting at the wrong level is the most common reason people abandon this protocol in the first two weeks.
The rule that governs all three levels: mild discomfort during the exercise that resolves within 24 hours is acceptable and expected. Sharp pain during the movement, or soreness that persists past a day, means the load is too high for the current level of tissue tolerance. Reduce the load. Do not stop the protocol.
Tendon adapts slowly. A twelve-week timeline on the medial side is realistic, and progress is rarely linear — most people report a good week followed by a flat week followed by two good weeks. Judge by the four-week trend, not the daily reading.
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LEVEL 1: ISOMETRIC WRIST FLEXION HOLD
Start here if: gripping a coffee mug hurts, the elbow is painful at rest, or symptoms are less than six weeks old and still highly irritable.
Isometric loading has a useful property in irritable tendinopathy — it provides mechanical stimulus with minimal movement through range, and moderate-duration holds often reduce pain for a period afterward. It is the entry point when eccentric work is not yet tolerable.
How to do it:
Forearm resting on a table, palm facing up, wrist at the table edge in a neutral straight position
Place the opposite hand against the palm of the affected hand
Press the affected hand upward into the opposing hand at roughly 50 to 60 percent of maximum effort, with no movement occurring
Hold 30 to 45 seconds
Rest 60 seconds
5 repetitions, twice daily
Advance to Level 2 when: you can complete all five holds with no more than mild discomfort, and gripping objects in daily life no longer produces sharp pain. For most people this takes one to three weeks.
LEVEL 2: ECCENTRIC WRIST FLEXION — THE REVERSE TYLER TWIST
Start here if: pain is present with activity but daily gripping is manageable, and there is no pain at rest.
This is the core intervention and the level where most of the tissue change happens. The eccentric phase — the slow lowering under load — is what produces the remodeling stimulus. The concentric return is deliberately removed by having the opposite hand do the lifting.
How to do it (light dumbbell version):
Sit with the forearm resting on a table, palm facing upward, wrist just past the table edge
Hold a 1 to 2 pound dumbbell in the affected hand
Use the unaffected hand to assist the wrist into full flexion, curled upward
Remove the assisting hand and lower the wrist over a slow count of 4 to 5 seconds until fully extended, hanging toward the floor
Use the assisting hand to return to the top and repeat
15 reps, 3 sets, twice daily
Load progression:
Increase by roughly 1 pound only when all 3 sets of 15 are completed with minimal discomfort for a full week
Typical progression over 12 weeks runs from 1 to 2 pounds up to 5 to 8 pounds
If a load increase produces pain lasting beyond 24 hours, return to the previous weight for one full week before trying again
Advance to Level 3 when: you can complete 3 sets of 15 with 4 to 5 pounds, with discomfort that clears within a few hours rather than a full day, and playing or working produces no more than mild symptoms.
LEVEL 3: COMBINED ECCENTRIC FLEXION WITH PRONATION
Start here if: you have completed at least six weeks at Level 2 and meet the advancement criteria above.
The flexor-pronator group does two jobs. Level 2 loads the flexion half. Level 3 adds the rotational half, which matters because pronation is the actual demand in a golf swing and a topspin forehand. Skipping this level is why some people resolve their symptoms at rest and then find them returning the first week back on the course.
Version A — FlexBar Reverse Tyler Twist:
Hold the FlexBar vertically in the affected hand, palm facing up, gripping the bottom of the bar
Grasp the top of the bar with the unaffected hand, palm facing away from you
Twist the bar using the unaffected hand to wind it up, keeping the affected wrist in flexion
Hold both arms out in front of you with elbows extended
Slowly allow the affected wrist to unwind over 4 seconds, resisting the bar's return the entire way
15 reps, 3 sets, once to twice daily
Version B — Eccentric Pronation with a Hammer:
Forearm resting on a table, elbow at 90 degrees, holding a light hammer or a dumbbell with weight on one end only, gripped at the far end of the handle
Begin with the palm facing upward, handle vertical
Slowly rotate the palm downward over 4 to 5 seconds, controlling the descent, until the handle points down
Use the opposite hand to return the handle to vertical
Shorten your grip on the handle to reduce the lever and lengthen it to increase load
15 reps, 3 sets, once daily
Run Version A and Version B on alternating days rather than stacking both in one session. Level 3 carries meaningfully more load than Level 2 and the tissue needs the recovery day.
THE WEEKLY STRUCTURE
Weeks 1 to 3: Level 1 isometrics twice daily, plus the Tuesday stretch sequence once daily
Weeks 3 to 9: Level 2 eccentrics twice daily, stretch sequence once daily, isometrics retained on any flare day
Weeks 9 to 16: Level 3 on alternating days, Level 2 on the days between, stretch sequence once daily
Maintenance thereafter: Level 2 or Level 3 twice weekly, indefinitely
That last line is not a formality. The most common pattern of recurrence is stopping the loading work the week the pain disappears. Twice weekly maintenance is roughly ten minutes and it is the difference between a resolved problem and an annual one.
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WHEN TO STOP AND SEE SOMEONE
Numbness, tingling, or weakness in the ring or little finger at any point
Pain that increases progressively across three consecutive weeks despite reducing load
Any locking, catching, or a sense that the elbow gives way
No measurable change at all after twelve weeks of genuinely consistent work
COMING UP
Part 4 on Saturday closes the series with the complete medial elbow toolkit — FlexBar tension selection, counterforce brace placement for the medial side, the golf grip sizing question, and the return-to-play criteria that tell you when the elbow is actually ready.
Still moving forward,
— The SIM60 Team
simsixty.com · Because slowing down isn't in the plan.
Educational content only. Not medical advice. SIM60 is not a medical provider and does not diagnose or treat any condition. Consult your physician or a licensed physical therapist regarding your specific symptoms before beginning any exercise described here.
SIM60 receives no commissions or affiliate compensation for any equipment referenced. All mentions are for illustration purposes only.
