Improvement in off-axis neuromuscular control through pivoting elliptical training: Implication for knee injury prevention

The goal of this study was to investigate the efficacy of off-axis neuromuscular control training using a pivoting elliptical machine. Although knee motion is mainly in flexion/extension, injuries to the knee are usually associated with excessive off-axis movement (tibial axial rotation and valgus/varus). A pivoting elliptical training system was developed to improve neuromuscular control about the off-axes. Six week training was conducted in nine healthy individuals and seven healthy individuals served as control and only participated in evaluation sessions. Our results showed that following the pivoting elliptical training, individuals were able to reduce pivoting instability across different phases of the elliptical cycle (p <; 0.01) and also mediolateral instability at mid and terminal swing phase (p <; 0.05). A trend of reduced response time and phase dependent changes in EMG patterns were also observed. The results showed that the pivoting elliptical training is effective to improve off-axis neuromuscular control in healthy individuals and such training protocol can potentially be implemented to prevent knee injury.