Quick answer: A flex bar lets you load the forearm tendons with a slow, controlled lowering movement. This is the “eccentric” phase that tendon research focuses on.
- Routine: 3 sets of 15, once a day.
- Discomfort: mild discomfort is okay if it settles by the next morning.
- Progression: move to a firmer bar once 3 x 15 feels easy.
- When to get assessed: if eight weeks of consistent loading hasn’t changed things, book an assessment.
Technique reviewed by Ian Pau, MChiro, Chiropractor (AHPRA CHI0001616665), Tensegrity St Leonards and Sydney CBD.
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Who this is for
Tennis elbow and golfer’s elbow are overuse problems of the tendons that attach the forearm muscles to the elbow.
Tennis elbow (lateral elbow tendinopathy) is felt on the outside of the elbow. It is often aggravated by gripping, lifting with the palm down, or using a mouse.
Golfer’s elbow (medial elbow tendinopathy) is felt on the inside of the elbow. It is often aggravated by gripping, carrying, or lifting with the palm up.
Despite the names, most people we see aren’t elite players. They’re club tennis and padel players, golfers, tradies who grip tools all day, and desk workers who spend hours on a keyboard and mouse. The age range is usually 35 to 60. October is National Safe Work Month, a good time to deal with an elbow that’s been nagging for months.
Why a flex bar?
Tendons respond to load. Rest alone tends to leave them no more tolerant than before. A flex bar is a rubber bar that you twist and then slowly let untwist. That slow untwisting loads the forearm tendons in a controlled, eccentric way.
In a randomised trial of people with chronic tennis elbow, adding a daily flex bar eccentric exercise (the “Tyler twist”) to standard care led to greater improvement than standard care alone (Tyler et al., Journal of Shoulder and Elbow Surgery, 2010). That trial is the main reason this is the protocol we teach in clinic.
What you’ll need: a flex bar. Start with a lighter resistance. Most people start on the lighter end.
Protocol 1: Tennis elbow (outside of the elbow)
This movement is commonly called the Tyler twist.
- Grip the bottom. Hold the bar upright in your sore-side hand, with your wrist bent back (extended).
- Grip the top. Take the top of the bar with your other hand, palm facing away from you.
- Twist. Twist the bar with your top hand so your sore-side wrist stays bent back while the top wrist bends forward.
- Straighten your arms out in front of you, holding the twist.
- Lower slowly. Let your sore-side wrist slowly bend forward, untwisting the bar over about 4 seconds. This is the important part.
- Reset and repeat. Use your good hand to do the twisting, so the sore side only does the slow lowering.
Protocol 2: Golfer’s elbow (inside of the elbow)
The reverse Tyler twist loads the wrist flexors instead.
- Grip the bottom. Hold the bar upright in your sore-side hand, palm facing up, wrist bent forward (flexed).
- Grip the top. Take the top of the bar with your other hand.
- Twist the bar so your sore-side wrist stays bent forward.
- Straighten your arms out in front of you, holding the twist.
- Lower slowly. Let your sore-side wrist slowly bend back over about 4 seconds as the bar untwists.
- Reset with your good hand and repeat.
Sets, reps and progression
| Dose | 3 sets of 15 slow lowering reps |
| Frequency | Once a day |
| Rest | About 30 to 60 seconds between sets |
| Comfort | Mild discomfort during the exercise is acceptable if it settles by the next morning |
| Back off | If pain is sharp, builds through the set, or is worse the next day, reduce reps or use a lighter bar |
| Progress | When 3 x 15 feels easy, move up to the next bar resistance |
Consistency matters more than intensity. Tendons adapt over weeks, not days.
Where a strap, sleeve and mouse fit in
- Elbow strap (counterforce brace). Worn just below the elbow during aggravating activity, such as a hit of tennis, a round of golf, or a day on the tools. Some people find it makes those activities more comfortable while they build tolerance. It doesn’t replace the loading program.
- Elbow sleeve. A compression sleeve for warmth and comfort, mostly worn during activity or cooler mornings.
- Vertical mouse. A standard mouse keeps your forearm turned palm-down all day. A vertical mouse lets your forearm rest in a more neutral “handshake” position, which many desk workers find easier on the outside of the elbow.
When this isn’t enough
If you’ve done the protocol consistently for eight weeks and nothing has changed, it’s time to get it assessed. We’ll check whether the elbow is the main driver. Sometimes the neck, shoulder or grip technique plays a part. We’ll also review your technique and loading, and talk through other options.
For persistent tennis elbow, one of the options we use is shockwave therapy, alongside continued loading. Research on shockwave is mixed, so we’ll go through whether it suits your situation before you start. Read more about shockwave therapy for elbow pain at Tensegrity, or see our guide to tennis elbow and guide to golfer’s elbow.
Book an assessment
Or book at your nearest clinic:
See a GP promptly instead if your elbow pain followed a fall or a sudden injury, or if it comes with swelling, redness, fever, numbness or tingling into the hand, or weakness you can’t explain.
Frequently asked questions
Which flex bar resistance should I start with?
Start lighter than you think. You should be able to finish all 3 sets of 15 with slow, controlled lowering. If you can’t, the bar is too firm for now.
Should it hurt?
Mild discomfort during the exercise is common and acceptable, as long as it settles by the next morning. Sharp pain, pain that builds through the set, or pain that’s worse the next day means you should scale back.
Can I keep playing tennis or golf?
Usually, yes, at a level your elbow tolerates. Many people reduce volume for a while and use a strap during play. Your practitioner can help you plan this.
Do I need a referral?
No. You can book directly. If you have private health extras that cover chiropractic, we can process your claim on the spot.