Effects of Off-Axis Elliptical Training on Reducing Pain and Improving Knee Function in Individuals With Patellofemoral Pain
Related Experiment Video
Updated: Apr 18, 2026
The Lower Body Positive Pressure Treadmill for Knee Osteoarthritis Rehabilitation
Published on: July 22, 2019
Liang-Ching Tsai1, Song Joo Lee, Aaron J Yang
1*Department of Physical Therapy, Georgia State University, Atlanta, Georgia; Departments of †Physical Medicine and Rehabilitation; and ‡Biomedical Engineering, Northwestern University, Chicago, Illinois; §Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado; ¶Rehabilitation Institute of Chicago, Chicago, Illinois; and ‖Department of Orthopaedic Surgery, Northwestern University, Chicago, Illinois.
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.
