Effects of Off-Axis Elliptical Training on Reducing Pain and Improving Knee Function in Individuals With Patellofemoral Pain

Clin J Sport Med. 2015 Nov;25(6):487-93. doi: 10.1097/JSM.0000000000000164.


Objective: To examine whether an off-axis elliptical training program reduces pain and improves knee function in individuals with patellofemoral pain (PFP).

Design: Controlled laboratory study, pretest-posttest.

Setting: University rehabilitation center.

Participants: Twelve adult subjects with PFP.

Interventions: Subjects with PFP completed an exercise program consisting of 18 sessions of lower extremity off-axis training using a custom-made elliptical trainer that allows frontal plane sliding and transverse plane pivoting of the footplates.

Main outcome measures: Changes in knee pain and function posttraining and 6 weeks after training were evaluated using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and International Knee Documentation Committee (IKDC) scores. Lower extremity off-axis control was assessed by pivoting and sliding instability, calculated as the root mean square (RMS) of the footplate pivoting angle and sliding distance during elliptical exercise. Subjects' single-leg hop distance and proprioception in detecting lower extremity pivoting motion were also evaluated.

Results: Subjects reported significantly greater KOOS and IKDC scores (increased by 12-18 points) and hop distance (increased by 0.2 m) after training. A significant decrease in the pivoting and sliding RMS was also observed after training. Additionally, subjects with PFP demonstrated improved pivoting proprioception when tested under a minimum weight-bearing position.

Conclusions: An off-axis elliptical training program was effective in enhancing lower extremity neuromuscular control on the frontal and transverse planes, reducing pain, and improving knee function in persons with PFP.

Clinical relevance: This study provides a novel intervention approach to enhance the control of the frontal and transverse plane motions of the lower extremities during functional weight-bearing activities. This novel off-axis elliptical training may be incorporated with other common treatment options currently available for PFP to augment the effects of musculoskeletal rehabilitation for the PFP population.

Publication types

  • Controlled Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Exercise Therapy / instrumentation*
  • Exercise Therapy / methods
  • Female
  • Humans
  • Knee Joint / physiopathology*
  • Male
  • Middle Aged
  • Patellofemoral Pain Syndrome / physiopathology
  • Patellofemoral Pain Syndrome / rehabilitation*
  • Recovery of Function
  • Young Adult