HIGH REPETITION JUMP TRAINING COUPLED WITH BODY WEIGHT SUPPORT IN A PATIENT WITH KNEE PAIN AND PRIOR HISTORY OF ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: A CASE REPORT

BACKGROUND AND PURPOSE

Patients frequently experience long-term deficits in functional activity following anterior cruciate ligament reconstruction, and commonly present with decreased confidence and poor weight acceptance in the surgical knee. Adaptation of neuromuscular behaviors may be possible through plyometric training. Body weight support decreases intensity of landing sufficiently to allow increased training repetition. The purpose of this case report is to report the outcomes of a subject with a previous history of anterior cruciate ligament (ACL) reconstruction treated with high repetition jump training coupled with body weight support (BWS) as a primary intervention strategy.

CASE DESCRIPTION

A 23-year old female, who had right ACL reconstruction seven years prior, presented with anterior knee pain and effusion following initiation of a running program. Following visual assessment of poor mechanics in single leg closed chain activities, landing mechanics were assessed using 3-D motion analysis of single leg landing off a 20 cm box. She then participated in an eight-week plyometric training program using a custom-designed body weight support system. The International Knee Documentation Committee Subjective Knee Form (IKDC) and the ACL-Return to Sport Index (ACL-RSI) were administered at the start and end of treatment as well as at follow-up testing.

OUTCOMES

The subject's IKDC and ACL-RSI scores increased with training from 68% and 43% to 90% and 84%, respectively, and were retained at follow-up testing. Peak knee and hip flexion angles during landing increased from 47 ° and 53 ° to 72 ° and 80 ° respectively. Vertical ground reaction forces in landing decreased with training from 3.8 N/kg to 3.2 N/kg. All changes were retained two months following completion of training.

DISCUSSION

The subject experienced meaningful changes in overall function. Retention of mechanical changes suggests that her new landing strategy had become a habitual pattern. Success with high volume plyometric training is possible when using BWS. Clinical investigation into the efficacy of body weight support as a training mechanism is needed.

LEVEL OF EVIDENCE

Level 4 - Case Report.

Injection of oxotremorine in nucleus accumbens shell reduces cocaine but not food self-administration in rats

Mesencephalic dopamine neurons form synapses with acetylcholine (ACh)-containing interneurons in the nucleus accumbens (NAcc). Although their involvement in drug reward has not been systematically investigated, these large aspiny interneurons may serve an important integrative function. We previously found that repeated activation of nicotinic cholinergic receptors enhanced cocaine intake in rats but the role of muscarinic receptors in drug reward is less clear. Here we examined the impact of local changes in muscarinic receptor activation within the NAcc on cocaine and food self-administration in rats trained on a progressive ratio (PR) schedule of reinforcement. Animals were given a minimum of 9 continuous days of drug access before testing in order to establish a stable breaking point (BP) for intravenous cocaine infusions (0.75 mg/kg/infusion). Rats in the food group acquired stable responding on the PR schedule within 7 days. On the test day, rats were bilaterally infused in the NAcc with the muscarinic receptor agonist oxotremorine methiodide (OXO: 0.1, 0.3 or 1 nmol/side), OXO plus the M(1) selective antagonist pirenzepine (PIRENZ; 0.3 nmol/side) or aCSF 15 min before cocaine or food access. OXO dose dependently reduced BP values for cocaine reinforcement (-17%, -44% [p<0.05] and -91% [p<0.0001] for 0.1, 0.3 and 1.0 nmol, respectively) and these reductions dissipated by the following session. Pretreatment with PIRENZ blocked the BP-reducing effect of 0.3 nmol OXO. Notably, OXO (0.1, 0.3 and 1.0 nmol/side) injection in the NAcc did not affect BP for food reward. The results suggest that muscarinic ACh receptors in the caudomedial NAcc may play a role in mediating the behavior reinforcing effects of cocaine.

Cocaine- and alcohol-mediated expression of inducible transcription factors is blocked by pentobarbital anesthesia

Identifying the neurocircuitry involved in behavioral responses to drugs of abuse is an important step towards understanding the mechanisms of drug addiction. The present study sought to distinguish brain regions involved in pharmacological effects of cocaine and ethanol from secondary effects by administering these drugs in the presence or absence of pentobarbital anesthesia. Changes in neuronal activity were assessed by immunohistochemical analysis of expression of an inducible transcription factor (ITF), c-Fos, in the brain of rats habituated to repeated pentobarbital anesthesia or saline administration. Cocaine administration (15 mg/kg, i.v.) in non-anesthetized animals produced a strong induction of c-Fos in the striatum and large number of other brain areas. Ethanol administration (2 g/kg, i.p.) induced c-Fos in a smaller number of characteristic brain areas, including the central nucleus of amygdala and paraventricular nucleus of hypothalamus. However, neither of these drugs was able to induce c-Fos in pentobarbital-anesthetized rats (50 mg/kg, i.v.). The suppressive effects of pentobarbital were not specific to c-Fos, such that pentobarbital also suppressed expression of ITFs FosB and Egr1 in the striatum of cocaine-treated rats. On the other hand, pentobarbital by itself strongly induced c-Fos expression in the lateral habenula of saline-, cocaine-, and ethanol-injected rats. It is not clear whether the suppressive effects of anesthesia on ITF expression in other areas are mediated by activation of lateral habenula, or are independent of this event. Our data suggest that in the absence of conscious awareness of drug-associated cues, cocaine and alcohol activate only a fraction of the neural elements engaged in the unanesthetized state.

Self-administration of cocaine increases the release of acetylcholine to a greater extent than response-independent cocaine in the nucleus accumbens of rats

RATIONALE

The neurochemical effects of psychostimulant exposure may depend on how these drugs are encountered. A useful method for examining this issue is to compare neurotransmitter release following response-dependent, or self-administered, drug exposure and response-independent exposure.

OBJECTIVES

This experiment examined the effect of active and passive cocaine administration on acetylcholine (ACh) efflux in the shell region of the nucleus accumbens (NAc) in rats.

METHODS

One group of rats (CSA: cocaine self-administration) was trained to lever-press for intravenous infusions of cocaine (0.42 mg/kg per infusion) on a fixed-ratio-1 schedule of reinforcement. Cocaine infusions were accompanied by the onset of a stimulus light that signaled a 20-s time-out period. Control rats received intravenous cocaine (cocaine non-contingent: CNC) or saline (SAL) in a manner that was not contingent upon their behavior. Drug infusions in these groups were determined by the lever-press behavior of the animals in the CSA group, i.e. they were yoked to rats in the self-administration group such that CNC animals received equal amounts of cocaine as CSA rats. Animals received cocaine or saline in 3-h sessions for 13 consecutive days before testing. On day 14, extracellular ACh was measured in 15-min intervals before, during and after a 3-h session of cocaine exposure using unilateral microdialysis probes located in the NAc shell coupled with HPLC.

RESULTS

ACh efflux was significantly increased above baseline in both groups of rats that received cocaine but CSA rats had significantly higher ACh levels during the self-administration period compared to their yoked counterparts. In addition, ACh efflux remained elevated longer in CSA animals relative to CNC rats following cessation of cocaine exposure.

CONCLUSIONS

These results demonstrate that ACh interneurons in the NAc shell are responsive to cocaine exposure. In addition, these findings suggest that the manner in which the drug is administered (i.e. either by active self-administration or passive exposure) may be relevant to the magnitude of the neural response.