GOLPP is a progressive, degenerative disease that unfortunately does not have a cure. There are, however, things you can do to help your dog with the different aspects of living with the disease and many dogs can still maintain good quality of life and lifespan with proper care. What is Geriatric Onset Laryngeal Paralysis & Polyneuropathy? GOLPP is the term used to describe a grouping of three interconnected conditions caused by degradation of the dog’s nervous system: Laryngeal Paralysis, Megaesophagus, and Paraparesis, usually starting with the hind legs. The Larynx’s (aka the voice box) main functions are to protect the airway when we are eating and drinking, to open up wider when we need to take bigger breaths, and of course to make vocal sounds. It does this by opening and closing folds of cartilage on each side of the opening to the trachea, the primary airway to the lungs. Normal Dog Larynx Laryngeal Paralysis causes the Cartilaginous Folds to collapse inward, blocking the airway. When the muscles controlling those cartilaginous folds start to fail due to Laryngeal paralysis (aka LarPar), they no longer open and close like they used to. They might cough or just have louder breath sounds with even minimal exercise. Sometimes, a change in the sound of their bark is the first thing a pet parent notices. Dogs in severe respiratory distress will have pale or blue coloration of their gums and may completely collapse. Dogs in this state require emergency veterinary care immediately. LarPar dogs struggle to breathe normally, have difficulty cooling themselves in hot weather, and are at higher risk for aspiration. Megaesophagus occurs when the esophagus (the tube that connects your mouth to your stomach) loses its strength and elasticity. As food slides down, instead of being pushed along to the stomach, it builds up in the esophagus, causing further distention and enlargement. Because there isn’t enough muscle strength to move the food along, dogs with Megaesophagus often regurgitate their food. Since dogs with GOLPP aren’t able to protect their airway as a normal dog would, this significantly increases their risk of aspiration which can then turn into pneumonia. Hind Limb Paraparesis means that the dog’s hind limbs become weak and uncoordinated due to neurological deficits (the nerve pathways between the brain and the legs stop conducting signals). They may stumble or even knuckle over their paws and will progressively lose strength and muscle mass. This part of GOLPP is often misdiagnosed as arthritis, hip dysplasia, or “just getting old”. Who is at Risk for GOLPP? Labrador Retrievers certainly seem to be the breed most commonly affected by GOLPP, but Golden Retrievers, Borzoi, Newfoundlands, Greyhounds, German Shepherd Dogs, Siberian Huskies, and other large breeds, as well as mixed breeds, are known to be affected. While there is a congenital form, GOLPP typically affects middle-aged to senior and geriatric dogs, with the average age of onset at 11 years old. Diagnosing GOLPP In the beginning stages of reaching GOLPP as a diagnosis, there are other conditions that must first be ruled out. This is done by performing comprehensive bloodwork and radiographs. Megaesophagus may be visible on your dog’s x-ray, but sometimes requires more specialized imaging to clearly visualize. Your vet should also perform a thorough neurological exam to identify any delays or deficits in your dog’s reflex responses. If your dog’s blood work is within normal limits for their age and no other life-threatening conditions are discovered with radiographs, they will recommend sedating or anesthetizing your dog so they can examine their laryngeal function. Unfortunately, you can’t ask a dog to open up and “saw ahhhh” while a scope is used to look down their throat, so sedation or anesthesia is required to properly perform this exam. During this sedated exam, the veterinarian will watch how your dog’s laryngeal folds behave as they breathe to determine if one or both sides of the larynx are affected. Additional diagnostics like Nerve biopsies and Nerve conduction tests may be recommended as well. Treating GOLPP While there is no cure for GOLPP or even one single treatment, there are ways to treat the symptoms to keep your dog more comfortable. Post-Op Tie-Back Surgery For Laryngeal Paralysis, the Gold Standard treatment is a surgery called a Laryngeal Tie-Back, which should be performed by a Board-Certified Veterinary Surgical Specialist. Most General Practice Veterinarians are not equipped for this specialized surgery. The procedure involves anchoring at least one of the Laryngeal Cartilage folds open, so that the dog can breathe more easily. The downside is that this also means that the larynx cannot properly close to food or liquids, so dogs that enjoy swimming or tend to eat/drink very quickly are at high risk for aspirating (breathing in) water or food into their lungs. Aspiration pneumonia is a serious, potentially life-threatening condition that requires strong antibiotics, sometimes multiple courses, to treat but fortunately it usually responds well to medical treatment. The goal of Laryngeal Tie-Back surgery is to improve quality of life for the affected dog, but it will not improve laryngeal function. Dogs that are unable to get Laryngeal Tie-Back surgery will continue to struggle to breathe, remain at risk for heat stroke during warmer weather, and they still have an increased risk for aspiration. Both surgical and non-surgical patients will need to live in a calm environment, as stress can also instigate respiratory distress. For Megaesophagus, there is no treatment. Instead, changes to the dog’s feeding routine are key for reducing food regurgitation, therefore improving Quality of Life. Many patients with this condition do better with a softened or liquid diet over kibble. They also need a little help from gravity to get the food where it needs to go. This might look like raising your dog’s food bowl or even feeding your dog on stairs with the bowl at the highest step. For the worst cases of Megaesophagus, a Bailey Chair is an excellent option. The Bailey Chair is sometimes called a dog high chair and it certainly looks like one. The concept is that by feeding the dog in an upright position and then keeping them in that position for a short time after feeding, gravity helps pull the food down out of the esophagus into the stomach, after which the dog can safely resume normal activity and retain all the nutrition of the meal. Your veterinarian may also prescribe medications to support the gastrointestinal system. For the hind limb paresis, Physical Rehabilitation is the best course of treatment to maintain strength and coordination in those limbs for as long as possible. By using exercises and treatments specifically designed for GOLPP patients, CROC can slow down your dog’s muscle wasting and neurological decline. Because Physical Rehabilitation at CROC is performed by experienced and licensed veterinary professionals, our team knows how to handle medically fragile patients, carefully challenging your dog’s body without overworking them or putting them at risk for heatstroke. What Does Rehab for GOLPP Look Like? First, our team will evaluate your dog to determine how far their GOLPP has progressed so that we can truly tailor your dog’s therapy to their condition. You will be sent home with target exercises specifically prescribed for you and your dog to do together between Rehab Sessions. Generally, in-clinic Physical Rehabilitation for GOLPP includes: Target exercises to work on balance, coordination, and strength Hydrotherapy for safely improving stamina and maintaining muscle Thermotherapy, Therapeutic Massage, and Laser Therapy to soothe sore, overworked muscles Veterinary Medical Acupuncture to stimulate the nervous system and reduce pain Because CROC utilizes an Underwater Treadmill for hydrotherapy sessions, your dog is at significantly lower risk of aspiration than if they were swimming in a pool since we have precise control over the water level and your dog will remain on their feet for the session. Underwater Treadmill therapy is also more effective for strengthening the back legs than swimming. Lastly, CROC maintains the water at a therapeutic temperature to help support arthritic joints and relax tight muscles, while the buoyancy helps your dog get all the benefits of a high-resistance work out with little to no impact. Through their treatment plan, CROC continues to challenge your pet with a variety of exercises while also treating any pain that your pet experiences. Thermotherapy and Therapeutic Massage help to relieve tense muscles and increase blood flow. Therapeutic Laser therapy not only helps increase circulation to the tissues, but it also encourages healing at a cellular level. Veterinary Medical Acupuncture stimulates the nervous system while also releasing endorphins which helps with pain relief. As your dog’s physical abilities change, CROC continues to adjust their therapy as needed at every single session to make sure they get the most benefit out of every visit. Fortunately, while your dog will be predisposed to pain from compensating for their weak back legs, the disease process itself is not painful. Safety for GOLPP Patients Changing Habits: Remember that GOLPP is a chronic, progressive disease; it never goes away and will continue to worsen. At home, some simple changes can make all the difference to help your dog maintain good quality of life. The goal with home modifications is to make mobility as easy as possible, reduce falling injuries, reduce risk of aspirating food or water, and to reduce risk of heat stroke. Adding rugs or yoga mats to hard slippery floors will help your dog grip the ground better and stay on their feet when getting around their home. Assisting your dog up or down stairs, or even just blocking them off from your dog altogether, will be necessary for safety reasons. Ramps may be helpful for them to traverse small sets of stairs or make it easier to get in and out of the car, but these should also be used under supervision. Raising the food and water bowls may help reduce regurgitation from the megaesophagus, but you may also need to have a schedule for access to these resources or start using a Bailey Chair depending on your dog’s symptoms. Lastly, temperature control will be incredibly important at home. Your dog will not be able to cool themselves on a hot day like a normal dog can. Avoiding strenuous exercise and maintaining cool temperatures inside with Air Conditioning and/or fans is a non-negotiable part of living with this condition. Swimming: Sadly, swimming is NEVER appropriate for GOLPP patients. There is a video viewable in our article, The Deep Dive into Swimming , that provides a visual for this, but we’ll explain here too. When dogs swim, they generally paddle fiercely with their front legs while keeping their back legs tucked up alongside their body. This type of movement means they are overworking their already strained front legs while barely working the back legs that actually need the exercise. Swimming also puts immense stress and twisting movements on the spine. Most importantly, swimming puts a GOLPP dog at extremely high risk of aspiration on dirty pool water. Aspiration Pneumonia: The GOLPP dog will forever be at increased risk for aspiration pneumonia, so it’s important to familiarize yourself with the signs and symptoms. Catching aspiration pneumonia early will make it easier and cheaper to treat and get your dog breathing easier sooner. Signs of pneumonia include lethargy, coughing, sneezing, nasal discharge, inappetence, and/or fever. If you even slightly suspect that your GOLPP dog may be exhibiting signs of aspiration pneumonia, have them seen by a veterinarian as soon as possible. This is usually confirmed by radiographs of their lungs and then antibiotics are sent home, as well as appetite stimulants if needed. Regarding Chiropractics... We know this is a soft spot and that many people enjoy chiropractic for themselves. In our industry, it is a very controversial and divisive topic. We do not want to shame anyone for previous choices made with the intention of helping their pet. We do feel compelled as thoroughly educated Veterinary Medical Professionals to share our perspective. At CROC, we have treated multiple patients that were receiving chiropractic care and were in significant pain when they came to us, which resolved when chiropractic sessions stopped while proper Physical Rehabilitation Therapy continued. A good percentage of CROC patients arrive here after being referred by their veterinarian. Because of this, we have developed very close relationships with the local Neurological and Orthopedic Veterinary Specialists. CROC does not offer Chiropractic services because not a single one of these Board-Certified Specialists will support or recommend Chiropractic for GOLPP patients. Even when consulting with Boarded Neurologists outside of Orange County, we have yet to find one that would approve of their patients undergoing Chiropractic treatments. At this time, there are no Peer-Reviewed studies to substantiate claims that Chiropractic is an appropriate (or even safe) treatment for Veterinary patients. In addition, the American Veterinary Medical Association, America’s leader in advancing the science and practice of veterinary medicine to improve animal and human health, has not published any policies supporting Chiropractic. Here's an example of the dangers of Chiropractics: T his is the normal healthy spine of a young dog. Notice that the vertebrae and the spaces between them are very well defined. This is a senior dog with severe Spondylosis Deformans (spinal osteoarthritis). As intervertebral disks degrade, the spine starts to move abnormally and osteophytes (bone spurs) will form in an attempt to stabilize each joint. Eventually, osteophytes can become so severe that they bridge between each vertebrae. At this point, we have a spine that is poorly cushioned by degraded intervertebral disks and surrounded by extra bone. Bone rubbing on bone and nerve impingement become chronic sources of pain and stiffness. Pain and stiffness are common reasons that pet owners will pursue Chiropractic for their pet. Could you imagine applying jarring and intense force on a spine like this?!?! OUCH!!! If your dog is experiencing enough pain that you are exploring other treatments like Chiropractic, please check in with us or your regular veterinarian first . There are certainly better and safer options for pain relief available. The End Goal Ultimately, our goal is to try to keep your pet as independently mobile as possible for as long as possible. We can’t stop GOLPP from progressing, but we can slow it down and have multiple methods of treating your dog’s pain and weakness. Because Physical Rehabilitation at CROC is performed in a controlled environment, your GOLPP dog can also come in for therapy on a day that might otherwise be too hot for them to get any exercise. Tools To Make Your Lives Easier We've gathered links and examples of the following tools on our Gear & Resources page. As your pet’s neurological condition declines, they will frequently drag their hind legs, so it is key to protect their paws from the scuffing and abrasions that will happen. Lots of dog booties are readily available for purchase, but our favorite is a rubber variety called Pawz. We like these best because they protect the paw while still allowing your pet to feel the textures of the ground and providing extra grip. With any dog booties, care should be given to appropriately size your pet’s paws and to only leave them on when your dog is on a surface that is harmful to their skin to rub on. Booties left on for too long can cause skin infections, reduced circulation, or worst case – be chewed off and eaten! Use of any collars around your dog’s neck will no longer be safe so a good harness is a must! Your dog will increasingly depend on you for assistance, so your choice of harness makes all the difference in comfort for both you and your dog. Our favorite harness for GOLPP dogs is called the Help ‘Em Up Harness. It was created to help owners better assist their dogs without hurting their own backs in the process. It comes in two pieces, one to go around the chest and one to go under and around the pelvis. In the early stages, your pet may not need the back half, but as their coordination and strength declines, the back half of the harness will become necessary. It is comfortable enough that your pet can wear it for extended periods, and it is more ergonomic for you and your dog than just lifting them or using a sling. If you are interested in purchasing this harness for your dog, be sure to speak to us as sizing and fitting your dog can be trickier than it might appear. Please note that this harness still needs to be removed each day and kept clean to prevent any abrasions or skin infections. To learn more, check out our Help 'Em Up Harness article. Is There Anything Else? One of the best things you can do for your GOLPP dog is keep them lean! We generally recommend a Body Condition Score (BCS) of about 4 out of 9. The less weight there is for them to haul around, the easier it will be to continue lifting and moving their own body. Many GOLPP dogs are also old enough to have developed osteoarthritis , so all the more reason to reduce any extra work on their joints. Check out our article to learn more about Body Condition Score & Canine Weight Loss . Some dogs will need medication to control their pain. CROC works closely with you to make sure your dog is on the right pain control regimen. Joint supplements are also helpful to support their joints as the front of their body takes on the extra load, compensating for the weaker back end. A supplement for muscle growth/maintenance called Myos Canine Muscle Formula may be helpful for the GOLPP dog and is available online. For more information regarding medications and supplements, such as side effects to be aware of or how to pick a quality product, stay tuned for our upcoming article Pain Meds & Supplements . CROC strongly discourages the use of marijuana products for GOLPP patients. While emerging research shows some promise for marijuana products in veterinary medicine, there is much more to be done and GOLPP patients are already weak and have limited coordination, making them poor candidates for this treatment. Rear-wheel carts are sometimes an option for GOLPP patients, but this is not commonly recommended. By the time your dog might benefit from the mobility assistance a cart could offer, they are no longer strong enough to be able to pull the cart and the weight of the back half of their body. To learn more about carts, check out The Wheel Deal: Let's Talk About Carts . Quality of Life We touch on this subject for your sake as well as your dog’s. Compassion fatigue is a prevalent concern for clients caring for GOLPP dogs. The hope is that Physical Rehabilitation will help your dog maintain independent mobility for as long as possible, reducing the amount of effort you will need to put into their care as much as we can. For dogs whose GOLPP is more advanced or who don’t have control of their bowels and bladder, the strain on you to keep them clean and safe, as well as the physical strain of carrying them around, is enough to wear down even the most dedicated owners. We bring this up because we want you to know that we are available to you as you navigate your pet’s condition. We frequently support our clients through the big decisions and help them to find the plan that works best for them while keeping quality of life as high as reasonably possible for all involved. GOLPP can be particularly difficult to come to terms with, as these patients generally maintain mental acuity and brightness despite their physical decline. It can be a long, challenging road, but we are here to walk it with you and support you and your pup through the entire journey. If you are considering euthanasia, visit our Quality of Life article for more information on when and how to make the decision and what you can expect.

CROC commonly treats FCE patients in an attempt to restore as much normal bodily function as possible. Patients can present with a wide range of symptoms, from mild limping or incoordination all the way to near complete paralysis. While no one can guarantee that your pet will regain 100% normal function, there’s plenty to be done to give them the very best chance of doing so. Check out Marley's recovery from her FCE! She presented with the most severe symptoms CROC has ever seen and was successfully rehabbed! What is a Fibrocartilaginous Embolism? Fibrocartilaginous Embolism, or FCE, is when a piece of connective tissue enters the blood supply to the spinal cord and blocks the flow of blood to the spinal cord tissues. This lack of blood supply causes part of the spinal cord tissues to die from lack of oxygen and nutrients, leading to neurological deficits for the patient. It is still not known exactly how this connective tissue enters the bloodstream. This condition is also referred to as a Spinal Stroke or Spinal Cord Infarct. While it is rare for a dog to experience more than one FCE, it is absolutely possible. Symptoms of FCE occur quickly. Often during exercise or play time, FCE dogs generally experience significant acute pain and some will cry out from discomfort. They may limp, struggle to walk, or even experience complete paralysis immediately or within hours of the FCE. Usually, the worst of the symptoms have appeared within the first 12-24 hours and patients will start to improve from that point, with pain subsiding within 24 hours. Severity of symptoms is dependent on the location of the embolism along the spinal cord. Patients with embolisms higher up the spinal cord (closer to the head vs the tail) or those that cause larger sections of spinal tissue to die off tend to be the worst affected. FCE’s typically affect one side of the body more so than the other, but they are known to occasionally affect both sides. Severely affected patients are unlikely to return to completely normal function, but with dedicated and intensive care, they can regain the ability to walk independently and relieve themselves appropriately. In the best-case scenario, an FCE dog will only experience mild neurological deficits in one leg and never lose sensation in the affected limb. These dogs often make a full or nearly full recovery to normal function. In the worst-case scenario, the FCE will cause paralysis and loss of sensation in all four legs. While certainly a challenge, patients in this scenario are not without hope! CROC has successfully treated cases of FCE in which the patient is unable to even lift their head or swallow. Who is at Risk for Fibrocartilaginous Embolism? FCEs most commonly affect large and giant breeds like German Shepherds and Irish Wolfhounds, though it sometimes occurs in small breeds like Shelties and Miniature Schnauzers and can happen with any breed or breed mix . It can occur in dogs of all ages but is most frequently seen in young to middle aged dogs. FCEs are not predictable or preventable. Diagnosing Fibrocartilaginous Embolism Because FCE symptoms can look like many other serious conditions, FCE patients often undergo several diagnostics to reach the correct diagnosis. General Practice Veterinarians can perform blood tests and radiographs to rule out other conditions but cannot confirm FCE using those diagnostics. Ultimately, FCEs are diagnosed by Veterinary Neurologists using Magnetic Resonance Imaging (MRI). MRI allows the Veterinarians to see the loss of perfusion to the spinal cord, therefore definitively diagnosing FCE. Treating Fibrocartilaginous Embolism There is no surgery or medication for FCE . Instead, treatment is focused on supporting the dog while they heal, encouraging limb use, and preventing muscle atrophy. They may need pain relief during the first 24 hours, but they are generally not painful after that initial period. Dogs with minimal symptoms may just need some assistance getting up or walking around but dogs that cannot walk will need more intensive care including assistance to relieve themselves and frequent repositioning to avoid the development of Decubital Ulcers (bed sores). The worst affected patients will need additional veterinary care to support hydration and nutrition if they cannot eat or drink on their own. This may look like hospitalization for several days with intravenous fluids and medications, after which, the dog will still require dedicated, round-the-clock care once back at home to ensure that they are kept clean, hydrated, and regularly repositioned. As soon as your veterinarian deems it safe, starting Physical Rehabilitation Therapy as soon as possible will significantly increase your dog’s chances of maximum recovery. It’s important to note that dogs with minimal neurological deficits may recover fairly quickly, but those experiencing profound paralysis will require a significant commitment of your time and energy over at least the next 6 months, sometimes more. CROC will guide you through all the steps, stages, and details of this recovery but it will be up to you to follow through with the Prescribed Homecare between Rehab Sessions. Failure to participate in Home Care Exercises will severely impede your dog’s level of recovery. What Does Rehab for Fibrocartilaginous Embolism Look Like? The maximum healing of neurological tissue takes place over approximately 6 months. This means that we have 6 months from the time of injury to Rehabilitate your pet to their maximum physical ability. Some pets will regain independent mobility before then, but it’s important to stick with the 6-month plan, as many pets quickly lose ground if they stop Rehab too early in the recovery process. Success of Rehab does depend on your pet’s condition at the time they start Rehab. Pet’s that don’t have any movement or feeling in their legs will be at a greater disadvantage than those that are just weak and uncoordinated. Generally speaking, we can get a good idea of your dog’s potential for recovery within the first few weeks of Rehabilitation Therapy. FCE patients begin their Rehab journey with Target Exercises intended to kickstart neurological activity. The nerves must be firing to be able to tell the muscles what to do. CROC often uses Electrostimulation Therapy (E-Stim) to help with this process. E-Stim uses low doses of electricity to stimulate nervous function but it doesn’t hurt. It can feel strange, like a tickle or in the best case, a big muscle twitch! Please note that E-Stim therapy requires us to shave small patches of your pet’s fur to allow electrical conduction through the tissues. We’ll also start simulating the body’s normal movement to help your pet “remember” what that feels like and to work on maintaining good Range of Motion in all the limbs. Once we start to see any sort of muscle contractions in the legs, we’ll step up our exercises to get that muscle moving as much as possible, while also stimulating more nerves and muscles to join in. We’ll practice weight bearing, essentially re-teaching your pet how to stand on their own. Many exercises for FCE patients are focused on improving Proprioception or knowing where your body is in space. Because of the damage to the spinal cord, many FCE patients often can’t feel their environment or have no sensations to tell them where their legs and feet are. This is important because if we want to get your dog to the point of consciously controlled leg movement, they have to know where to move their legs in order to stand and eventually walk. This initial stage of rehab is frequently the hardest for pet parents. It can be discouraging to be a few weeks into Rehab Sessions without seeing obvious improvement. Meanwhile, us Rehabbers are getting super excited over the tiniest little muscle twitch or spontaneous kick or even a few seconds of weight bearing. We’re excited about these seemingly insignificant improvements because they are big indicators for what your pet will eventually be capable of, so hang in there! Hydrotherapy can be an exciting phase of their recovery. The buoyancy of the water allows for more movement with less effort, so we often see legs moving in the Underwater Treadmill before we see it on land. The Underwater Treadmill also allows them to feel the ground beneath them, so that continues to stimulate nervous function. Because they are walking in the water, instead of swimming in it, exercise in the Underwater Treadmill is low-impact, high resistance with slower, more controlled movements. Through their recovery process, CROC continues to challenge your pet with a variety of exercises while also treating any pain that your pet experiences. Thermotherapy and Therapeutic Massage help to relieve tense muscles and increase blood flow. Therapeutic Laser not only helps increase circulation to the tissues, but it also encourages healing at a cellular level. Veterinary Medical Acupuncture stimulates the nervous system while also releasing endorphins which helps with pain relief. Safety for FCE Patients Change up some habits. Since many FCE patients rarely make a complete return to the level of function they had before the FCE, some simple changes at home can make all the difference in making it easier for them to get around. Rugs or yoga mats strategically placed around the house will help your dog to grip the flooring better, which reduces their risk of falling. The softer surfaces also make abrasion wounds on their paws less likely, although rug burn is certainly a possibility for some dogs. Ramps can make obstacles like stairs less challenging, although care should still be taken to monitor your pet while using these. Some pets will no longer be able to navigate stairs safely, so you might need to block them off entirely. Especially in the earlier stages of recovery, it can be beneficial to keep resources like food, water, bedding, or outside access closer to your dog and easier to get to. Closely supervise play time with housemates or other doggie friends since your dog will be weaker and more prone to falling. Swimming is rarely recommended for FCE patients. There is a video viewable in our article, The Deep Dive into Swimming , that provides a visual for this, but we’ll explain here too. When dogs swim, they generally paddle fiercely with their front legs while keeping their back legs tucked up alongside their body. This type of movement means they are over-working their front legs and barely working the back legs. Swimming also puts immense strain and twisting movements on the spine. Regarding Chiropractic... We know this is a soft spot and that many people enjoy chiropractic for themselves. Human Chiropractic has been practiced since the late 19th Century but is still in contention regarding its efficacy today. In Veterinary Medicine, Chiropractic is a very controversial and divisive topic. We do not want to shame anyone for previous choices made with the intention of helping their pet. We do feel compelled as thoroughly educated Veterinary Medical Professionals to share our perspective. At CROC, we have treated multiple patients that were receiving chiropractic care and were in significant pain when they came to us, which resolved when chiropractic sessions stopped while proper Physical Rehabilitation Therapy continued. A good percentage of CROC patients arrive here after being referred by their veterinarian. Because of this, we have developed very close relationships with the local Neurological and Orthopedic Veterinary Specialists. CROC does not offer Chiropractic services because not a single one of these Board-Certified Specialists will support or recommend Chiropractic therapy for their patients. Even when consulting with Boarded Neurologists outside of Orange County, we have yet to find one that would approve of their patients undergoing Chiropractic treatments. In addition, the American Veterinary Medical Association, America’s leader in advancing the science and practice of veterinary medicine to improve animal and human health, has not published any policies supporting Chiropractic. At this time, there are no Peer-Reviewed studies to substantiate claims that Chiropractic is an appropriate (or even safe) treatment for Veterinary patients. Reviewing Chiropractic on a basic level - Chiropractic treatment involves applying jarring and intense force on the body. Your dog’s spinal cord is trying to heal and is particularly fragile so the force of Chiropractic can push your dog to further injury. If your dog is experiencing enough pain that you are exploring other treatments like Chiropractic, please check in with us or your regular veterinarian first. There are certainly better and safer options for pain relief available. The End Goal Ultimately, our goal is to try to get your pet as independently mobile as possible. We hope that your pet can regain the ability to walk or even run and maintain control of their bowels and bladder. This isn’t possible for every patient and the ones that do… well, sometimes they learn how to do it in a different way than pet parents might have expected. Not all patients can regain conscious movement of their legs but instead learn something called a “spinal walk”. Spinal Walking is when a dog still doesn’t have sensation or proprioception in their legs, but they develop a reflexive walk. Since the signals aren’t getting through the spinal cord to the brain (and vice versa), they are instead relying on more basic reflex signals to get their legs moving enough for them to be able to walk. This reflexive walk isn’t always pretty but it is functional. If we’re given the choice between paralysis and a goofy looking walk, we’ll take goofy any day of the week. What If They Still Can’t Walk? At CROC, we always want to give Neurological patients the full 6 months of treatment before throwing in the towel. If we’ve reached the 6-month mark and still haven’t seen significant improvement, that’s when we start looking at a Cart, sometimes referred to as a Doggie Wheelchair. It’s important not to jump into using a cart too soon as once your dog starts getting around without using their legs, that pretty much seals the deal that they never will. For more information regarding Carts and what the process for getting one looks like, be sure to check out our in-depth article, The Wheel Deal: Let's Talk About Carts . The good news is that CROC rarely, if ever, sees FCE patients require wheels. However, not all FCE dogs regain independent mobility and the task of caring for a physically debilitated dog is a hefty one. It’s essential that you keep Quality of Life for you both as a top priority. If your dog is not recovering well and you are not prepared for years of intensive care, it’s time to start discussing the reality of the situation. We touch on this subject for your sake as well as your dog’s. Compassion fatigue is a prevalent concern for clients caring for FCE dogs with severe Neurological deficits. The hope is that as your dog progresses through rehab, the amount of effort you will need to put into their care will decrease. For dogs whose paralysis is more advanced or who don’t have control of their bowels and bladder, the strain on you to keep them clean and safe, as well as the physical strain of carrying them around, is enough to wear down even the most dedicated owners. We bring this up because we want you to know that we are available to you as you navigate your pet’s condition. We frequently support our clients through the big decisions and help them to find the plan that works best for them while keeping quality of life as high as reasonably possible for all involved. If you are considering euthanasia, our Quality of Life article may help you to evaluate all aspects and know what to expect should you proceed. Tools To Make Your Lives Easier We've gathered links and examples of the following tools on our Gear & Resources page. Protect the Paws While your pet is re-learning to walk, they will frequently drag their legs and/or paws, so it is key to protect their paws from the scuffing and abrasions that will happen. Lots of dog booties are readily available for purchase, but our favorite is a rubber variety called Pawz. We like these best because they protect the paw while still allowing your pet to feel the textures of the ground and providing extra grip. With any dog booties, care should be given to appropriately size your pet’s paws and to only leave them on when your dog is on a surface that is harmful to their skin to rub on. Booties left on for too long can cause skin infections, reduced circulation, or worst case – be chewed off and eaten! A Good Harness is a Must! Your dog will depend on you for assistance, so your choice of harness makes all the difference in comfort for both you and your dog. Our favorite harness for FCE dogs is called the Help ‘Em Up Harness. It was created to help owners better assist their dogs without hurting their own backs in the process. It comes in two pieces, one to go around the chest and one to go under and around the pelvis. Depending on your dog’s abilities, your pet may or may not need the back half, but if they do, as their coordination and strength improves, the back half of the harness will become less necessary. It is comfortable enough that your pet can wear it for extended periods, and it is more ergonomic for you and your dog than just lifting them or using a sling. If you are interested in purchasing this harness for your dog, be sure to speak to us as sizing and fitting your dog can be trickier than it might appear. Please note that this harness still needs to be removed each day and kept clean to prevent any abrasions or skin infections. Our Help 'Em Up Harness article covers this device in greater depth. Keep Things Clean If your dog doesn’t have complete control of their bladder and bowels, diapers and belly bands become good options to help keep your dog and your home clean. Some dogs lose urinary control before fecal, so in those cases, belly bands are a nice alternative for male dogs over a full diaper. Just as with humans, good hygiene when using diapers and belly bands is a must! Dogs left in dirty diapers for too long are at risk for urinary tract infections and skin infections. It’s also important to note that dogs instinctively want to avoid their waste, so being stuck in it is not great for their mental health. Disposable and washable options are readily available for purchase online or at major pet stores. Use a High Quality Dog Bed Orthopedic Memory Foam beds are ideal. Your dog’s bed should be at least 1 1⁄2 times as long as your dog and at least 1-2 inches of thickness for every 40lbs of body weight. Encourage your dog to change positions, such as switching which side of their body they lay on. Laying in one position for extended periods of time can lead to decubital ulcers (bed sores) and significant stiffness. If your dog is unable to reposition themselves, it is recommended to move them from one side of their body to the other every 4 hours to prevent ulcers from forming. Once formed, decubital ulcers are difficult to heal, extremely painful, and highly prone to infection so prevention is best! Is There Anything Else? One of the best things you can do for your dog is keep them lean! We generally recommend a Body Condition Score (BCS) of about 4 out of 9. The less weight there is for them to haul around, the easier it will be to start lifting and moving their own body. Some FCE dogs are also old enough to have started developing arthritis, so all the more reason to reduce any extra work on their joints. For more information, read our article Body Condition Score & Canine Weight Loss . CROC works closely with you to make sure your dog is on the right supplement and pain medication regimen. Joint supplements, like Dasuquin w/ MSM, are helpful to support their joints as some parts of the body will be compensating for the weakness of other areas. A supplement for muscle growth/maintenance called Myos Canine Muscle Formula may be helpful for the FCE dog and is available online. To learn more, visit our Pain Meds & Supplements  article. We cover commonly prescribed medications, side effects to watch for, and how to pick quality supplements. CROC strongly discourages the use of marijuana products for FCE patients. While emerging research shows some promise for marijuana products in veterinary medicine, there is much more to be done and FCE patients are already weak and have limited coordination, making them poor candidates for this treatment. To Summarize Fibrocartilaginous Embolisms are a serious condition, but not a death sentence. Many dogs show signs of healing quickly after the incident, but those that don’t will require consistent and intensive rehabilitation for several months. CROC has had great success rehabbing our severely affected patients back to independent mobility but cannot make any promises that we can do so for every dog. It can be a long, challenging road, but we are here to walk it with you and support you and your pup through the entire journey.

You might have heard about a human athlete that tore their ACL and how it took them out for the season. The ACL (anterior cruciate ligament) is responsible for stabilizing your knee, especially during high intensity activities that require your legs to twist or pivot. In dogs, this ligament is referred to as the CCL (cranial cruciate ligament) and the knee is referred to as the stifle, but it’s the same ligament with the same job and it can be just as devastating.   How Does This Happen?   The canine CCL often degenerates over time, leading to a partial or complete tear, though trauma to a healthy ligament from high impact twisting of the leg or hyperextension of the knee, can have the same result. In most cases, the dog’s CCL will slowly weaken until it eventually ruptures completely. Within 1 year of injury, approximately 60% of dogs will rupture their other CCL. In early stages (partial tears), your dog’s discomfort may be very subtle, such as putting less weight on the leg when standing or intermittent and very mild limping. As the ligament continues to degrade, your dog may start limping more, especially after activities like running or jumping. Your dog may take longer to rise up or sit down. Osteoarthritis, the gradual wearing away of cartilage, begins in the joint and can eventually lead to bone rubbing on bone. Dogs with painful, arthritic, unstable stifles often sit on their rump with the affected leg held out to the side to avoid bending the stifle as they would with a normal sitting position. As it becomes more and more painful to use the injured leg, they are likely to lose muscle mass on that side and put additional stress on their other legs which can cause further compensatory injury.    Who Is At Risk? There are several variables that can increase a dog’s risk for CCL disease. Obesity and poor body condition play a huge role , so keeping your dog at a lean, healthy weight and regularly exercised can help prevent this type of injury. “Weekend Warriors” and high intensity activities, such as wrestling with other dogs or agility sports, are common contributors to CCL rupture. Some breeds, like Labrador Retrievers, Staffordshire Terriers, Rottweilers, Boxers, and Mastiffs are predisposed, but any dog can be affected. Anecdotally, CROC has seen a high incidence of CCL disease in Labradoodles, Goldendoodles, and similar crosses. The Weekend Warrior spends most of their time hanging around the house with minimal exercise but then goes all out with high intensity and/or long bouts of exercise only every once in a while. This might look like being a couch potato during the week while parents are working and then going on a 10 mile run alongside a bicycle on Saturday. A recipe for trouble! There is emerging research regarding the time of spaying or neutering and the correlated risks for orthopedic conditions like CCL disease. The hormones produced by the sex organs are largely responsible for telling the growth plates when to close at physical maturity. When these hormones are removed before the growth plates close, there is only a very small bit of hormones being produced elsewhere in the body, so the bones continue to grow long after they were supposed to stop. Dogs spayed or neutered at a young age are frequently lighter in build, taller and leaner, with narrower skulls. The theory of how early spaying/neutering causes increased risk for CCL disease is that due to the bones growing beyond their intended size, the knee joint becomes unbalanced, therefore putting abnormal strain on the Cranial Cruciate Ligament.   So, your dog has a CCL tear. What do you do now?   When the ligament is damaged, the knee is no longer stable and bones start to move and rub in ways they were not meant to, causing significant pain, difficulty walking, and osteoarthritis to develop. The meniscus, a cartilaginous structure between the tibia and femur, is often damaged from the abnormal strain causing significant pain. For this reason, it is best to surgically correct this condition as soon as possible.   Surgery is often a scary and expensive endeavor, so why is it the Gold Standard (how veterinary medicine labels the best course of treatment)? Once the CCL has ruptured, there is no fixing it. The joint’s condition will only continue to worsen as osteoarthritis sets in and increased strain is placed on the other ligaments, causing increased pain. Partial tears may be medically managed for a time, but will more than likely progress into a full tear. Osteoarthritis will form in the joint regardless of surgery, but patients who have surgical correction sooner rather than later will have less pain and arthritis than those who went without surgery or even those who pursued surgery months or years after the CCL ruptured. Keep in mind most dogs with a CCL tear are likely to tear their other CCL. Preventing undue stress on the uninjured leg can potentially give you and your dog more time before the other CCL ruptures.   Can I brace my dog’s knee instead of pursuing surgery?   We absolutely understand the desire to avoid surgery but for most cases, we will strongly advise against the use of a brace. While a brace might provide some degree of stabilization, it does so by restricting movement of the joint, reducing the knee’s Range of Motion. A joint that is without its full Range of Motion will become more stiff, more inflamed, and more painful. This restriction in movement also causes significant muscle atrophy. Muscles that aren’t exercised waste away. Just like if you have your leg in a cast for several weeks, when the cast finally comes off, your leg muscles will have atrophied from lack of use. Reduced musculature will only make your dog's situation worse because the joint will have even less support when it needs it most.   Surgical Solutions   Example of TPLO First and foremost, make sure your dog’s surgeon is a board-certified veterinary surgeon that specializes in orthopedics. The official credential of a board-certificated veterinary surgeon is Diplomate, American College of Veterinary Surgeons, often presented as DACVS or ACVS Diplomate. These veterinarians perform complicated surgical procedures every day and have all the unique tools and years of experience to give your dog the very best chance of successful surgery and an excellent recovery. There are 3 surgical techniques to address CCL ruptures. Based on your dog’s anatomy and any concurrent problems, your dog’s surgeon will choose which technique will work best.   Tibial Plateau Leveling Osteotomy (TPLO)   The TPLO is the Gold Standard (best available) solution for a CCL tear. This surgery involves cutting a portion of the Tibia (the shin bone), rotating it, and securing it in the new position using a metal plate and screws. The new position will prevent the abnormal movement that occurs with a torn CCL.   Tibial Tuberosity Advancement (TTA)   As the TPLO has proven to be the most effective technique for CCL tears, TTA is falling out of favor because some dog’s bones are shaped in such a way that would make this surgery inappropriate or less likely to succeed. Like the TPLO, the TTA involves cutting into the tibia and using metal hardware to secure it. The tibial tuberosity is moved to change where the quadriceps muscles attach in conjunction to the knee to stabilize the joint. Since both surgeries are equally invasive and the TPLO has better success rates, we would not recommend use of this technique.   Extra-Capsular Suture Stabilization This procedure can also be referred to as a Lateral Fabellar Suture Stabilization or the Fishing Line Technique. Rather than cutting into the bone or using metal hardware, this procedure attempts to “replace” the CCL with a strong suture. Premature breakdown or failure of the suture is a very common complication with this technique, leaving a post-surgical patient with a painful and unstable stifle despite the cost and effort of the surgery. While this approach is usually less expensive and less invasive, it is also best reserved for smaller breeds and older, less active dogs because there is a high rate of failure when used with medium or larger breeds and more active dogs. We generally do not recommend this technique because the body will eventually break down that suture material. The hope is that during the time that the suture was in place, the stifle will have developed enough scar tissue and bony changes to stabilize the joint. Unfortunately, osteoarthritis will form in the stifle, which will cause pain, limit full range of motion, and decrease functional use of the joint.   Post Operative Recovery   Recovery from stifle surgery can be challenging as it typically requires several weeks of strict exercise restriction to allow the bone to heal. Limiting your dog’s activity according to the surgeon’s recommendations is not optional. Too much activity too soon can be devastatingly destructive to a bone that is healing; potentially causing failure to heal, fractures, or even requiring additional surgery to repair the leg. This healing surgery site may look okay, but a major infection was brewing beneath! Use of an e-collar (aka the cone of shame) is incredibly important as any licking of the incision/stitches is likely to cause a serious infection of a fresh orthopedic surgery site. Your dog’s surgeon will tell you when the e-collar is no longer needed. Pain medications and antibiotics are typically prescribed and should be given as directed. Do not stop or decrease these medications without consulting with the surgeon first. Some pets benefit from sedating or anti-anxiety medications during the recovery period to help keep them calm and less likely to over exercise. It may be helpful to use baby gates to block off certain parts of your home during the recovery period, especially stairs or areas with slick floors. Good traction and controlled movements are key elements for safety and smooth recovery. If you have other pets in your home that typically play together, it is best to keep them separated during the first few weeks. Just like when we have a freshly broken bone, your dog will need to avoid any high-impact activities which sadly includes play time with housemates. Your surgeon may provide instructions for low-impact exercises as your pet heals. This may include Passive Range of Motion or standing exercises. Walks are typically restricted to slow and short outings, but can be increased each week as your surgeon recommends.   This dog has severe muscle atrophy on the left leg Sticking to your pet’s prescribed exercises is important, not only to prevent over-stressing the surgical site, but also to maintain what muscle mass and flexibility they currently have. Atrophy and reduced range of motion is the most common post-operative complication that we treat. Prolonged disuse of a leg can cause Muscle Contracture, a condition where atrophy has become so severe that adhesions form between the bone, periosteal tissues (a thin layer of tissue that surrounds the bone), and quadriceps muscles, essentially locking the thigh muscles down and preventing normal movement of the leg. Muscle contracture is very painful and extremely difficult to resolve , often requiring multiple therapy sessions a week for several months to give a patient the best chance at regaining normal limb use.   Supplements Dasuquin Advanced with MSM  is an excellent daily joint supplement that many of our team members choose to use for their own pets. It includes Chondroitin, Glucosamine, and other ingredients to support joint health and it comes in a tasty, chewy treat, making it an easy addition to your daily routine. Fish Oil  added to your pet’s meals is another easy addition to help keep joints happy (and it helps their coat too!). Start with 500-600mg per day, then increase to 1000-1200mg per day. It is important to start slow with this as some pets may be sensitive and have GI symptoms if started too quickly. Myos Canine Muscle Formula  is a supplement containing Fortetropin, a natural bioactive supplement made from fertilized egg yolk. Myos has been credited with improving muscle health, helping to reduce muscle loss (atrophy) and helping regain muscle after surgery or with other disease processes. It has also been shown to help skin, coat, cognitive, and bone health. Medications Adequan (Polysulfated glycosaminoglycan)  is a series o f injections that stimulates cartilage healing, slows the progression of osteoarthritis, and decreases pain and inflammation. It begins with an initial series of 8 injections with one injection given every 3-4 days. Once that is complete, many pets can drop down to a maintenance schedule of one injection every 1-6 months. For larger dogs, this can be a costly investment to get started, but we have seen significant improvement for many dogs using this medication. If you have concerns about giving your dog injections, be sure to speak to your veterinarian for options like an in-person demo or having their staff perform the injections for you. You can also speak to the CROC team. Common NSAIDS  - Rimadyl (carprofen), Metacam (meloxicam), Deramaxx (deracoxib), and their Generics are Non-Steroidal Anti-inflammatory medications that can be extremely helpful for managing pain and inflammation and since many generics exist, it can be easier to find one that fits your budget. They can have long term side effects to the liver and kidneys so regular bloodwork is strongly recommended to catch any change in organ function early. They must also be given with food! Some pets don’t tolerate these medications well and can have serious GI side effects like stomach ulcers and gastrointestinal bleeding. It is important to monitor your dog for any signs of vomiting, diarrhea, or dark stools while on these medications. Some pets REALLY like the taste of the flavored tablets so store these medications with caution, securely out of reach of your pet. Galliprant (grapiprant)  is a newer type of Non-Steroidal Anti-inflammatory that has less side effects than the more widely known NSAIDS listed above. It is reported to have less effects on liver, kidneys, and GI tract and can be safely used alongside a wider selection of other medications. Because it is newer and a more specific medication, it is generally more costly than the above listed NSAIDS that have been around longer. Neurontin (gabapentin)  is a medication primarily used to treat nerve pain, though it can also help with anxiety. Many pets experience some level of drowsiness when they first start this medication, but they usually become accustomed to it and return to their normal energy level after some time. Besides sedation, other side effects are extremely rare. This medication is a good option for pets that cannot tolerate NSAIDS and it can also be used alongside NSAIDS and many other medications. Tramadol  is a synthetic opioid that has been commonly used to treat moderate to severe pain in dogs. Newer studies on this medication show that it may be less effective than previously thought, with only a small fraction of dogs getting any pain relief from it. Side effects from Tramadol include sedation, vomiting, diarrhea, constipation, and loss of appetite Librela (bedinvetmab)  is the newest Osteoarthritis treatment in the US; a once monthly injectable medication only for use in dogs. It must be administered by your veterinarian and may take up to 6 weeks for observable results. Librela is a monoclonal antibody (a protein that has been engineered to bind to a single target) that targets Nerve Growth Factor which helps reduce pain caused by Osteoarthritis. It can be extremely effective for the right patient. Side-effects and adverse reactions from Librela are still being discovered. Dogs with neurological conditions should not be given Librela as it is likely to worsen neurological conditions. Some Owners are not aware that their dog has a neurological condition until their dog has an adverse reaction to Librela. Adverse neurological reactions may include: generalized weakness, inability to control bladder and/or bowels, stumbling, knuckling, dragging paws, and/or inability to walk. Should your pet experience any of these symptoms, Librela should not be given again until your pet has been evaluated by a Veterinary Neurologist. It may take up to 3 months for a patient to recover from a Librela-induced neurological decline although patients with Degenerative Myelopathy are extremely unlikely to regain any lost ability. Dogs with inflammation caused by auto-immune conditions should not be given Librela as it is likely to make these conditions worse. Studies on Librela were performed on young dogs free from other health conditions. Consider that senior dogs struggling with arthritis pain are the most likely patients to receive Librela but are also nearly guaranteed to have other conditions that may be complicated by Librela. Due to potentially severe side-effects, we recommend that your pet be thoroughly evaluated before starting Librela. This should include bloodwork and radiographs at a minimum  and may require evaluation with a neurological or orthopedic specialist. Electing to give your pet Librela without prior diagnostic screening is a gamble! Librela is not indicated to treat CCL disease or post-operative pain, nor is it labeled for treating pain related to any other types of chronic pain other than Osteoarthritis. Librela does not cure Osteoarthritis. Dogs on Librela sometimes feel so good (since they can’t feel the pain) that they overdo it and cause further injury to themselves. It is best to introduce Librela alongside a structured exercise plan to avoid injury and only after thorough diagnostic screening to rule out auto-immune and neurological conditions. What About Rehab?   Remember that Rehab cannot fix a CCL rupture. However, initiating therapy after surgery can improve their recovery by addressing their muscle atrophy, increasing their range of motion, stimulating healing, and relieving any pain that might remain. Your dog’s surgeon will decide when your dog can begin therapy, but they may want to take follow up x-rays to confirm appropriate healing beforehand. Every case will be different, so recommended commencement of therapy can range from 2 to 8 weeks after your dog’s surgery. Post-operative Rehab consists of multiple modalities to address the entire body; not just the surgical leg. Your dog has been compensating for the affected leg by walking differently and putting more weight on their other legs. This often means that their other legs are overworked and sore. Back pain is not uncommon after spending so much time walking with poor ergonomics. Therapy often begins with Thermotherapy, Massage, and Stretching. Thermotherapy and Massage help to relax tense muscles and increase blood flow to the tissues. Stretching is necessary to maintain your dog’s full range of motion in all joints, but should not be performed until after Thermotherapy and Massage. Laser therapy is an excellent tool to promote healing and relieve pain and inflammation. However, recovery takes more than just the “feel goods”. The goal is to restore your dog’s comfort and mobility, which will not improve without exercise. Low impact Target exercises will be prescribed to your dog in order to address any deficiencies and encourage normal limb use. You will be instructed to have your dog do some of these exercises at home on a daily basis. Hydrotherapy using an Underwater Treadmill provides a high resistance but very low impact workout, encouraging muscle growth needed to support the joint and keeping the unaffected leg strong. Take note that Hydrotherapy in an Underwater Treadmill is recommended, but due to less benefit and higher risks, swimming is not. Our article The Deep Dive Into Swimming provides a visual and more detailed explanation for this, but we’ll briefly explain here too. When dogs swim, they generally paddle fiercely with their front legs while keeping their back legs tucked up alongside their body. This type of movement means they are over-working their already strained front legs and barely working the back legs that actually need the exercise. If they do kick their back legs, it is generally in a quick, spastic movement that does not encourage muscle building but does put more stress on a fresh orthopedic surgery. The CROC Team has treated multiple post-op patients with severe complications caused by swimming, such as migrated surgical screws and avulsion fractures of the tibia.   Long Term Care Even with surgery, your pet will develop Osteoarthritis (albeit slower than a dog that did not have surgery) and as they get older, it will only become more challenging for them to build muscle and lose weight. By keeping them lean and well-muscled from the start, you are giving your dog a solid foundation for a longer, more active, and healthier life. The most impactful thing you can do at home to keep your pet comfortable and active is to maintain a lean body weight and good musculature. Visit our article Body Condition Score & Canine Weight Loss to learn more. Joint supplements with Fish Oil, Glucosamine, Chondroitin, and MSM may be helpful to stimulate cartilage matrix production and inhibit enzymes that break down cartilage. For more information about Osteoarthritis care, check out our article Crunchy Doggos - Managing Osteoarthritis .   If this is your dog’s first CCL injury/surgery, you should prepare yourself for the likelihood that your dog’s other knee will also be affected and require surgical intervention. The above-described care tips may also help your dog’s intact CCL stay that way longer, but ultimately there is no way to prevent a tear.   What If Surgery Is Not An Option?   Because surgery is the only way to resolve a CCL injury, it will always be the top recommendation. However, there are some circumstances that make surgery a poor choice. Often, financial constraints are the first to come to mind. We get it; it’s an expensive option! However, without surgery, your dog will require long term treatments (Rehab, medications, etc) to try to control their pain. If your dog is a young dog, you will likely spend at least the same, but likely more money on these “band-aids” than if the surgery was performed at the beginning. If your pet is a senior or geriatric pet, it may not make sense to put them through anesthesia and a big surgery. Pets with co-morbidities like heart disease, liver shunts, or clotting disorders can also be high-risk anesthetic candidates. Certain auto-immune conditions may complicate your pet’s ability to heal or fight off infection.   In these cases, your goal will be to maintain your pet’s comfort and mobility as best as possible. As the cartilage in their knee degrades, they will begin to experience more pain and therefore be more likely to rely on their other legs instead, setting them up for compensatory injury or rupturing their other CCL. Pain medications, supplements, and Rehab are all good options for relieving pain and inflammation. More information on these options is available in our above mentioned “Crunchy Doggos - Managing Osteoarthritis” article.   To Summarize   CCL ruptures are painful and can be expensive to resolve but they don’t have to keep your dog on the sidelines forever. Utilizing services from a board-certified veterinary surgeon and a certified veterinary rehab specialist is likely to give your dog the best results. Whil e bra ces and medications might be appealing solutions, they will not resolve your pet’s condition and could potentially make it worse. With surgery and the right home routine, your dog can enjoy good, pain-free mobility even after a CCL injury. For dogs that cannot undergo surgery, there are options to help control their pain but surgery is still the most effective solution for this condition.  If you still have questions about Cranial Cruciate Ligament injuries, our team of licensed veterinary professionals at Canine Rehab of Orange County is happy to consult with you. CCL injuries are among the most common conditions that we see and we aim to help you find the best options for you and your dog. In some instances, we start therapy before surgery to maintain comfort and muscle mass as much as possible. We frequently see CCL patients after surgery to help them achieve the best and fastest recovery. Feel free to reach out to us with any questions or if you would like to move forward with a consultation, visit our New Patients page to get started.

Hip Dysplasia is a common condition, especially in large breeds, that often leads to pain and lameness. Given its prevalence and considerable impact on a dog’s life, it should be taken seriously. Fortunately, there are many things you can do to help keep your dog active and comfortable despite the condition. What is Hip Dysplasia? The hip joint consists of the acetabulum (the concave socket in the pelvis) and the femoral head (the ball on the femur), as well as cartilage to ensure easy movement and several muscles to support and move the joint. A normal hip joint has a snug but smooth fit, allowing for pressure to be evenly distributed throughout the joint. Dysplastic hips develop abnormally, leading to laxity between the acetabulum and femoral head which then causes excess wear and tear. The body tries to stabilize the joint by developing Osteoarthritis but this further contributes to the pain a hip dysplasia patient experiences. Who is Affected? Hip Dysplasia is most common in large and giant breeds, especially Labrador Retrievers, Golden Retrievers, German Shepherd Dogs, Saint Bernards, Old English Sheepdogs and Bulldogs, but it can occur in any breed or mix. It is a genetic condition, but there are additional factors that can increase risk or severity such as nutrition, exercise, and weight. Body weight has been shown to be the most significant variable. Early spaying/neutering may also increase risk. How is it Diagnosed? Some dogs will show symptoms of Hip Dysplasia at a very young age, while others won’t until they are much older. Signs of Hip Dysplasia include: Stiffness Weakness Limping Abnormal gait Difficulty rising, laying down, or sitting Reluctance to use stairs Thigh muscle atrophy Enlarged shoulder muscles Pain Radiographs (x-rays) are the easiest way to assess a dog for Hip Dysplasia, but proper positioning and the age of the dog can impact the accuracy of hip radiographs. If the radiographs are not definitive, sedation may be recommended to get better quality images and having the radiographs performed by a Veterinary Orthopedic specialist can be helpful as well. Ask your veterinarian if they regularly perform OFA (Orthopedic Foundation for Animals) and/or PennHip ( University of Pennsylvania Hip Improvement Program)  radiographs , as the technique for these has been proven to be the best for accurate imaging.  Your veterinarian should evaluate your dog’s gait, range of motion, and musculature. As the hips become more painful, dogs will use their front legs to compensate by shifting more of their weight forward and off the hind legs. It is also common for them to have an exaggerated sway of their rear end because they are using their back to swing the rear legs forward instead of the hip muscles. When they avoid moving their hips due to pain, their Range of Motion will decrease and the muscles of the hind legs will atrophy.  Treatment varies pending the severity of dysplasia and level of pain it causes. Some dogs can get by with Physical Rehabilitation Therapy and Non-Steroidal Anti-inflammatory Drugs (NSAIDs) as needed , while others require orthopedic surgery to address their pain and loss of mobility. Symptoms usually worsen as the dog ages because more osteoarthritis will have formed and increased pain leads to less activity and thus atrophy of the muscles that support the joint. Surgical Treatments Surgery isn’t always required for a dysplastic dog to have a comfortable and happy life, but it can be a game changer for dogs with moderate to severe Hip Dysplasia. There are 3 surgeries available to treat this condition. Femoral Head Ostectomy (FHO) This is the most commonly performed Hip Dysplasia surgery because it is less complicated, less expensive, and has a good success rate with few complications. An FHO consists of removing the femoral head, or the ball part of the joint. The muscles and ligaments around the joint will then take over, creating a “false joint”. Since the limb will be supported exclusively by soft tissues, Physical Rehabilitation Therapy will be of utmost importance in order to maintain strong hip muscles. Recovery from this procedure is typically around 6 weeks, with active pets often recovering better than inactive ones. As FHO patients age and normal age-related muscle loss occurs, they often return to Physical Rehabilitation Therapy to rebuild those hip muscles that are essential for mobility. Total Hip Replacement (THR) This is now considered the Gold Standard procedure for Hip Dysplasia. Our local Orthopedic specialists are finding that "95% of dogs that undergo this procedure regain normal function and maintain it for life". THR used to be limited to dogs that were fully mature and finished growing, but newer developments make this procedure more accessible for a variety of ages and the array of implant sizes means that surgeons can mix and match for the perfect fit for each patient. Previous techniques and hardware for this surgery were not as successful, so if you are interested in pursuing this procedure for your dog, make sure to utilize a board certified veterinary surgical specialist that is experienced with newer methods. Much like the human hip replacement, this surgery involves removing the dysplastic parts of the joint and replacing them with artificial implants. A metal implant is used to replace the femoral head and a plastic implant replaces the acetabulum. Recovery from this procedure is typically around 3 months, with exercise restriction being integral to boney healing in the early stages. Physical Rehabilitation Therapy will improve this patient’s recovery by safely reintroducing exercise and rebuilding lost musculature so they can return to their favorite activities more quickly. Double or Triple Pelvic Osteotomy (DPO/TPO) Because hip dysplasia causes excess laxity in the joint, the femoral head can dislocate from the acetabulum. The pelvis consists of four bones that fuse together at maturity. This surgery involves 2-3 incisions and 2-3 cuts into the pelvis to manipulate those bones before they have fused to better surround the femoral head, thus preventing it from dislocating. Because this surgery must be performed before the pelvic bones have fused together, it can only be used on young dogs with minimal osteoarthritis formation. Recovery from this surgery can take around 4 months and activity restriction will be extremely important while the pelvis is healing. Physical Rehabilitation Therapy will improve this patient’s recovery by safely reintroducing exercise and rebuilding lost musculature. Juvenile Pubic Symphysiodesis (JPS) If Hip Dysplasia is diagnosed at a very young age, this surgery can be performed to improve joint stability and reduce osteoarthritis formation for both hips at once. This procedure involves cauterizing the growth plate of the pubis in order to stop growth in that area of the pelvis. As the dog matures, the acetabulum will end up in a better position to enclose the femoral head, thus avoiding the laxity that then leads to osteoarthritis. Because this procedure’s success depends on interrupting growth, it should be done before 5 months of age and ideally no later than 4 months of age for maximum benefit.  Medication We'll briefly cover commonly prescribed medications here but encourage you to visit our Pain Meds & Supplements article to learn more about how they work, side effects to watch out for, and how to choose quality supplements. Adequan (Polysulfated glycosaminoglycan) is a series of injections that stimulates cartilage healing, slows the progression of osteoarthritis, and decreases pain and inflammation. It begins with an initial series of 8 injections with one injection given every 3-4 days. Once that is complete, many pets can drop down to a maintenance schedule of one injection every 1-6 months. For larger dogs, this can be a costly investment to get started, but we have seen significant improvement for many dogs using this medication. NSAIDs like Rimadyl (carprofen) and Metacam (meloxicam) are commonly used to relieve pain caused by osteoarthritis and hip dysplasia. These are usually well tolerated, but bloodwork should be performed to ensure that your dog has normal liver and kidney function before using these medications long term and it is good practice to regularly check bloodwork during use. Some dogs can experience gastrointestinal upset with these medications, so they should be given with food and discontinued if symptoms continue. If a dog cannot tolerate Rimadyl or Metacam, Galliprant (grapiprant) is another NSAID option that functio ns differently and should be better tolerated. However, because it is a newer drug, it does not yet have a generic available and is often more expensive than other NSAIDs. Neurontin (gabapentin) is a human medication that is commonly used off-label for dogs and cats to manage pain and anxiety. It’s not entirely known how it works, but it is thought to block nerve cells from communicating pain signals. Lethargy is a common side effect, but after some time, most dogs will acclimate and no longer experience lethargy while still benefiting from the pain relief Gabapentin offers.  A Quick Note About Librela Librela (bedinvetmab)  is the newest Osteoarthritis treatment in the US; a once monthly injectable medication only for use in dogs. It must be administered by your veterinarian and may take up to 6 weeks for observable results. It can be extremely effective for the right patient , allowing dogs to return to their favorite activities while potentially reducing the need for daily medications. However, the adverse effects reported with this new medication are highly concerning and side effects are still being discovered. Due to potentially severe side-effects, we recommend that your pet be thoroughly evaluated before starting Librela . This should include bloodwork and radiographs at a minimum and may require evaluation with a neurological or orthopedic specialist. To learn more, visit our article A Look at Librela . Dogs with neurological conditions, auto-immune conditions, breeding dogs, or dogs that are skeletally immature should not be given Librela. Librela does not cure Hip Dysplasia. Dogs on Librela sometimes feel so good (since they can’t feel the pain) that they overdo it and cause further injury to themselves. It is best to introduce Librela alongside a structured exercise plan to avoid injury and only after thorough diagnostic screening to rule out auto-immune and neurological conditions. Supplements We'll briefly cover supplements here, but we recommend that you visit our Pain Meds & Supplements article to learn more about how they help and how to pick quality supplements. Dasuquin Advanced with MSM is an excellent daily joint supplement that many of our team members choose to use for their own pets. It includes Chondroitin, Glucosamine, and other ingredients to support joint health and it comes in a tasty, chewy treat, making it an easy addition to your daily routine. Fish Oil added to your pet’s meals is another easy addition to help keep joints happy (and it helps their coat too!). Start with 500-600mg per day, then increase to 1000-1200mg per day. It is important to start slow with this as some pets may be sensitive and have GI symptoms if started too quickly. Myos Canine Muscle Formula is a supplement containing Fortetropin, a natural bioactive supplement made from fertilized egg yolk. Myos has been credited with improving muscle health, helping to reduce muscle loss (atrophy) and helping regain muscle after surgery or with other disease processes. Weight Management Keeping your dog at a lean body weight is the most important aspect of managing this condition. Fortunately, it’s also one of the easiest! Sometimes, it’s as simple as adjusting their meal portions. Other times, a complete switch to a new food is necessary. These days, there are a wide variety of AAFCO formulated Weight Management or Weight Loss diets readily available for purchase. Some are even specifically formulated for Senior Pets or for those needing extra Joint Support. Be sure to look for diets that are high in Essential Fatty Acids. Generally speaking, your goal Body Condition Score for a dysplastic dog is a 4 out of 9, a little on the skinny side. If you'd like more information about managing your dog's weight, be sure to read through our article, Body Condition Score & Canine Weight Loss . Exercising at Home As part of your Consultation with us, you will be provided with Veterinarian Prescribed Rehab Exercises (your dog’s Homework). These exercises will help keep your dog limber and improve their strength and stamina while maintaining their range of motion. Always have your pet warm up before exercise and cool down after exercise. There should never be sudden changes between inactivity and exercise. Osteoarthritis flare-ups are common and can even be caused by changes in the weather. Regular walks, tailored to your pet’s abilities are an important part of keeping those arthritic joints moving, reducing stiffness. Make sure to do shorter, more frequent walks instead of one long walk every day. Avoid becoming the “Weekend Warrior” as over-exercising and acrobatic activities such as ball and Frisbee chasing are recipes for pain and stiffness later. Unfortunately, this also applies to rough play with housemates and other animal friends. Your dog may have once been the rough and tumble, go-go-go type, but it’s important to think of a Hip Dysplasia dog as an antique luxury car. They’re still wonderful and should be taken out to enjoy the world, but great care should be applied when doing so. Regular maintenance and preparation will make all the difference for your dog’s experience. Our article, Motion is the Lotion , discusses the importance of consistent but safe exercise in maintaining range of motion and muscle mass. Swimming is frequently thought of as a low impact and helpful exercise for Hip Dysplasia dogs, however it commonly causes significant abuse to the elbows, shoulders, and hip joints leading to inflammatory flare-ups. The act of swimming can also put a lot of stress and extra movement on the spine. Opt instead for walking in warm water at your dog’s armpit level. Do this at very slow intervals to decrease the repetitive grinding of any arthritic joints. Swimming exercises typically do not help pets become better or stronger at walking outside of the water. To learn more, check out our Medical Library article, The Deep Dive into Swimming . Physical Rehabilitation Participating in Physical Rehabilitation Therapy at CROC allows your dog to get exactly the exercises and pain relief that they need on a regular basis to keep them comfortable and mobile, while also slowing the progression of their osteoarthritis and atrophy. Our team closely monitors your pet’s abilities and adjusts their sessions as needed while also keeping you updated as your pet progresses. Therapy Sessions at CROC include multiple pain relief modalities like Thermotherapy, Cryotherapy, Laser Therapy , Therapeutic Ultrasound, PEMF, E-Stim, and Massage Therapy to be used as appropriate for your pet’s condition. Veterinary Medical Acupuncture is another option CROC offers to provide pain relief and increase circulation. Prescribed Target Exercises and Underwater Treadmill Hydrotherapy build muscle and maintain good range of motion while avoiding soreness or pain associated with other types of exercise. Daily participation in at-home exercises wearing you down? Let us do some of that work for you and take your pet home feeling better than when you dropped them off. As your pet ages, it will be even more important to maintain a lean body weight and good musculature to support their dysplastic joints. Resuming therapy before their mobility declines will help keep your pet strong and mobile well into their senior years. For FHO patients, this will be of particular importance since musculature is the only thing keeping their hind limbs functional. Environmental Modifications Use a good quality dog bed! Memory foam is an ideal material. Your dog’s bed should be at least 1 1⁄2 times as long as your dog and at least 1-2 inches of thickness for every 40lbs of body weight. Encourage your dog to change position frequently, such as switching which side of their body they lay on. Laying in one position for extended periods of time will lead to significant stiffness and pain once they go to get up. Slippery, hard floors are tough on Hip Dysplasia dogs. Rugs, yoga mats, and the like are extremely beneficial to help keep your dog on their feet and avoid slips and falls. Can Hip Dysplasia Be Prevented? Hip Dysplasia is the most common inherited condition, so efforts to reduce a dog’s risk of developing it begin with the breeder. A responsible breeder will have their dogs’ hips evaluated using OFA and/or PennHIP standards and will only move forward with the breeding if both dogs have healthy hips. PennHip radiographs can only be performed by a veterinary professional that has been certified by the PennHIP program and sedation/anesthesia is required but it has been proven to be accurate for dogs as young as 4 months old. OFA requires that a dog be at least 2 years of age and while sedation/anesthesia is recommended, it is not required.  A puppy’s risk for developing Hip Dysplasia can also be heavily impacted by exercise, nutrition, and body weight. Puppies under 3 months old that exercise on hard, slippery floors or have access to stairs as well as dogs under 2 years of age that frequently play fetch are at higher risk. Excess body weight puts unnecessary strain on the body and during periods of growth, can negatively affect skeletal maturity. For this reason, it’s important to feed measured portions and to use puppy food that is nutritionally balanced and appropriate for your breed. Large breed puppy foods are formulated specifically for the immense growth they experience to give them the support they need without causing inappropriately accelerated growth. To Summarize Responsible breeding is the first step of reducing a puppy's risk for Hip Dysplasia and dogs should be evaluated using OFA or PennHIP standards before being bred. Body weight, activity level, and nutrition are significant variables for dogs of all ages. Hip Dysplasia can impact your dog's life, but there are options to relieve your dog's pain and keep them active such as medications, Physical Rehabilitation Therapy, and/or surgery. It can be difficult to know which are the right options for your pet but the CROC team is always available to discuss your pet's case specifically and to help you find a management plan that fits your lifestyle and your dog's needs. Thank you to Izzy's mom, Dina, for permitting us to share Izzy's pre- and post-operative Total Hip Replacement radiographs! We wish her well on her recovery journey! <3 the CROC Team

How often have you seen a little dog walk along with an extra skip in their step? It might look cute until you learn that the most common cause for that skip is pain from Medial Patellar Luxation. If your dog is experiencing patellar luxation, it’s important to address it promptly because the sooner it's treated, the less damage is incurred and the less invasive measures will be required to fix it. How Does Patellar Luxation Happen? Medial Patella Luxation is a hereditary condition, most common in small and toy breeds, and typically affects both legs. The patella (aka the kneecap) is held in place by the patellar tendon, which connects the thigh muscles to the tibia (the main lower leg bone) and sits within the trochlear groove of the femur. As your dog’s leg moves, the patella slides up and down in that groove.  If the patella is too thick, the trochlear groove is too shallow, the patellar tendon’s attachment points aren’t quite right, and/or the dog’s femur or tibia are malformed, the patella gets pulled to the side which causes it to grind up against one side of the trochlear groove. For dogs with MPL, the patella will get pulled inward to their midline - think towards your dog’s belly button. Over time, that grinding erodes that side of the trochlear groove, allowing the patella to luxate (slide out) of the groove when the leg is in movement and then slide back into the groove in the next step. This hurts, hence the skipped steps. The longer MPL is allowed to occur, the more bone erosion takes place, the more pain the dog experiences, the less they want to use the leg, and the weaker the tendon becomes, all of which continue to exacerbate the issue. The Four Grades of MPL Grade 1:  This is the earliest stage of MPL and can be tough to catch unless your veterinarian is looking for it. At this point, the patella will only luxate when pressure is applied, but it returns to normal position once released. This stage can be addressed with physical rehabilitation. Grade 2: At this stage, the patella will sometimes luxate when your dog flexes (bends) their leg and will remain out until the leg is fully extended (straightened) again, at which point it will slide back into place. This stage can be addressed with physical rehabilitation to decrease to a Grade 1. Grade 3: The patella now spends more time luxated than not, but it can be physically manipulated back into place. Surgery is required once your dog reaches this point. At CROC, we do not wish to cause more pain or suffering to a pet. Though you can find places that will exercise your dog on a dislocated kneecap, we believe that if your dog is a surgical candidate at grade 3, your time and resources are better spent on surgery than Physical Rehabilitation . Grade 4: This is the most severe stage of MPL. The patella is now permanently luxated and unable to be manipulated back into place. Surgery is required once your dog reaches this point. At CROC, we do not wish to cause more pain or suffering to a pet. Though you can find places that will exercise your dog on a dislocated kneecap, we believe that if your dog is a surgical candidate at grade 4, your time and resources are better spent on surgery than Physical Rehabilitation . Diagnosing MPL A change in your dog’s gait (the way they walk) is often the earliest outward sign that there’s something wrong. They might skip a step, intermittently limp, or you might see them struggle to bend the leg until they stretch it out to get the patella to pop back in place. Gait analysis is included in exams for all CROC patients because it can tell us so much about a dog’s pain, structural abnormalities, or neurological deficiencies. MPL can be diagnosed by your veterinarian after brief palpation of your dog’s stifle. They will move the leg to feel for any palpable changes in the bone structure or reduction in range of motion and apply pressure to the patella to see if it moves abnormally. If there are any abnormal findings, your Veterinarian will likely recommend radiographs (x-rays) to evaluate how much bone damage has occurred and if your dog’s legs have any other structural abnormalities. Sometimes MPL isn’t identified until a patient presents with pain elsewhere in the body. For example, a dog that is compensating for MPL may experience back pain or stiff front legs from trying to reduce the workload on the MPL leg.  Contributing Factors   Selective breeding may help decrease a dog’s risk for MPL, but it cannot otherwise be prevented. However, there are multiple controllable factors that can increase your dog’s chances for luxation. Weight: This is the easiest way to decrease risk! Every ounce of excess weight puts extra strain on an already compromised joint. That means more pressure on the patellar tendon, making luxation more likely. Diet is the most impactful influence and it’s easy to not realize how the treats and table scraps add up. Your dog should be on a measured amount of an AAFCO approved diet and if they’re getting treats too, their main meal should be reduced to account for those extra calories. Take a look at our article, Body Condition Score & Canine Weight Loss , for tips and tricks to help your pup get to a healthy weight. Exercise: Of course, this goes hand in hand with diet to maintain a healthy body weight, but there’s a less obvious culprit here. If you do not exercise, you do not build muscle. In fact, muscle starts to degrade after just 72 hours of inactivity. If your dog’s leg muscles are underdeveloped, their stifle (knee joint) will not have the support it needs and it will be that much easier for luxation to occur. Maintaining beefy quads (thigh muscles) help pull the patella tightly into the patellar groove, making luxation less likely and less severe. Plus exercise is just good for overall physical and mental health! Read our article, Motion is the Lotion  to learn more. Time: We frequently hear from owners that they were told about their dog’s MPL when they were young but it wasn’t a problem until they got older. The truth is that the dog has been dealing with MPL their whole life, but it only became apparent to the owner once the dog could no longer hide the pain it was experiencing and the physical deficiencies that were compensated in youth are no longer able to be ignored. By addressing this condition early, you save your dog from irreversible orthopedic injury and pain while also potentially sparing you from the cost of surgery. How long you wait to address this condition will directly influence the severity of your dog’s symptoms because the longer the patella is allowed to luxate, the more permanent damage occurs. MPL & Cranial Cruciate Ligament Rupture (CCLR) There is a correlation in risk between MPL and CCLR because the CCL and the patellar tendon are both extremely important structures that work alongside several others to stabilize the stifle. When the patella is not in the correct position, there is an increase of rotational forces on the stifle, which over time can lead to CCL rupture. If your dog has MPL, they are also more likely to develop a CCL injury. Addressing the MPL sooner rather than later can help decrease that risk. To learn more, read our article about Cranial Cruciate Ligament Injury . What about Lateral Patellar Luxation (LPL)? When a dog has LPL, the mechanics are very similar to MPL but the patella is being pulled outward away from the body. This condition is less common than MPL and can be hereditary or acquired after trauma. While LPL can occur in any dog, it is most common in large and giant breeds, especially Labrador Retrievers, Great Danes, Boxers, and St. Bernards. So, your dog has Grade 1 or 2 MPL. What do you do now?   You’re in luck! Surgery is usually not required. Physical Rehabilitation Therapy can reduce a Grade 2 to a Grade 1 and a Grade 1 can be reduced to nearly zero. A Rehab treatment plan for the MPL patient consists of multiple modalities to address the entire body; not just the MPL leg(s). Your dog has been compensating by walking and/or standing differently and putting more weight on their other legs. This often means that their other legs are overworked and sore. Back pain is not uncommon after spending so much time walking with poor ergonomics. Therapy often begins with Thermotherapy, Massage, and Stretching. Thermotherapy and Massage help to relax tense muscles and increase blood flow to the tissues. Stretching is necessary to maintain your dog’s full range of motion in all joints, but should not be performed until after Thermotherapy and Massage. Stretching should only be performed with great care as inappropriate stretching can make MPL worse, but prescribed stretches will help keep the Patellar Tendon soft enough to work with. Laser therapy is an excellent tool to promote healing and relieve pain and inflammation.  However, recovery takes more than just the “feel goods”. The goal is to restore your dog’s comfort and mobility by improving how the patella is held in place. This will only improve with careful exercise! Low impact Target exercises that avoid any twisting movements will be prescribed to your dog in order to address any deficiencies and encourage normal limb use. You will be instructed to have your dog do some of these exercises at home on a daily basis. Hydrotherapy using an Underwater Treadmill provides a high resistance but very low impact workout, encouraging muscle growth needed to support the joint. Take note that Hydrotherapy in an Underwater Treadmill is recommended, but due to less benefit and higher risks, swimming is not .  Our article The Deep Dive Into Swimming  provides a visual and more detailed explanation for this, but we’ll briefly explain here too. When dogs swim, they generally paddle fiercely with their front legs while keeping their back legs tucked up alongside their body. This type of movement means they are over-working their already strained front legs and barely working the back legs that actually need the exercise. If they do kick their back legs, it is generally in a quick, spastic movement that does not encourage muscle building but does put more stress on a compromised joint. .  So, your dog has Grade 3 or 4 MPL. What do you do now? Sadly, the patella’s displacement is now so significant that surgery is required. Rehab for Grade 1 or 2 MPL is focused on building muscle, but because the Grade 3 or 4 stifle is so painful and/or completely luxated, exercise would be excruciating and unethical to pursue . We recommend getting a consultation with a board-certified veterinary orthopedic surgeon and making sure your dog gets some pain relief in the meantime. Your dog’s condition will likely get worse the longer you wait and as your dog ages, their anesthetic risks often increase. Remember that they are also compensating for their luxating patellas by putting extra strain on other parts of their body, which frequently leads to pain or even injury of those parts. For these reasons, we recommend having your dog’s MPL corrected as soon as possible. Initiating therapy after surgery can improve your dog’s recovery by addressing their muscle atrophy, increasing their range of motion, stimulating healing, and relieving any pain that might remain. Your dog’s surgeon will decide when your dog can begin therapy, but they may want to take follow up x-rays to confirm appropriate healing beforehand. Every case will be different, so recommended commencement of therapy can range anywhere from 2 to 8 weeks after your dog’s surgery. Can I brace my dog’s knee instead of pursuing surgery? We absolutely understand the desire to avoid surgery but for most cases, we will strongly advise against the use of a brace. While a brace might provide some degree of stabilization, it does so by restricting movement of the joint, reducing the knee’s Range of Motion. A joint without its full Range of Motion will become more stiff, more inflamed, and more painful. This restriction in movement also causes significant muscle atrophy. Muscles that aren’t exercised waste away. Just like if you have your leg in a cast for several weeks, when the cast finally comes off, your leg muscles will have atrophied from lack of use. Reduced musculature will only make your dog's situation worse because the joint will have even less support when it needs it most. Surgical Options   Tibial Tuberosity Transposition (TTT) or Tibial Crest Transposition (TCT) The Tibial Tuberosity is an attachment point on the tibia for the Patellar Tendon. If the Tibia is malformed or the Tibial Tuberosity just isn’t in the right spot, it ruins the alignment of the stifle joint and the Patella can get pulled off to the side when the Quadriceps flex. This surgery involves cutting into the bone to release the Tibial Tuberosity, then uses pins and wire to reattach it in the new position to restore the joint’s alignment and redirect the forces from the Quadriceps. Trochlear Wedge Recession or Trochlear Block Recession The Trochlear Groove is the “valley” of the femur that the patella slides up and down in. The groove is lined with cartilage to ensure smooth movement. A Trochlear Groove that is too shallow is a common cause of MPL so this surgery aims to deepen the groove, making luxating less likely. First, part of the cartilage is temporarily removed to allow access to the bone underneath. Some of the bone is removed to carve a deeper groove, then the cartilage is put back in place followed by the patella. Lateral Capsular Imbrication This surgery is often used in conjunction with the other surgical procedures. The soft tissues on the inside of the stifle can become tight over time and continue to pull the patella medially (toward your dog’s belly). Similarly, the soft tissues on the outside of the stifle can become overly stretched from chronic luxation. This technique creates an incision to release the tissues that are too tight on the inside and uses overlapping sutures to tighten up the loose tissues on the outside.  Post Operative Recovery   Recovery from stifle surgery can be challenging as it typically requires several weeks of strict exercise restriction to allow the bone to heal. Limiting your dog’s activity according to the surgeon’s recommendations is not optional.   Too much activity too soon can be devastatingly destructive to a bone that is healing; potentially causing failure to heal, fractures, or even requiring additional surgery to repair the leg. Use of an e-collar (aka the cone of shame) is incredibly important as any licking of the incision/stitches is likely to cause a serious infection of a fresh orthopedic surgery site. Your dog’s surgeon will tell you when the e-collar is no longer needed. Pain medications and antibiotics are typically prescribed and should be given as directed. Do not stop or decrease these medications without consulting with the surgeon first. Some pets benefit from sedating or anti-anxiety medications during the recovery period to help keep them calm and less likely to over exercise. It may be helpful to use baby gates to block off certain parts of your home during the recovery period, especially stairs or areas with slick floors. Good traction and controlled movements are key elements for safety and smooth recovery. If you have other pets in your home that typically play together, it is best to keep them separated during the first few weeks. Just like when we have a freshly broken bone, your dog will need to avoid any high-impact activities which sadly includes play time with housemates. Your surgeon may provide instructions for low-impact exercises as your pet heals. This may include Passive Range of Motion or standing exercises. Walks are typically restricted to slow and short outings, but can be increased each week as your surgeon recommends. Sticking to your pet’s prescribed exercises is important, not only to prevent over-stressing the surgical site, but also to maintain what muscle mass and flexibility they currently have.  Prolonged disuse of a leg can cause Muscle Contracture, a condition where atrophy has become so severe that adhesions form between the bone, periosteal tissues (a thin layer of tissue that surrounds the bone), and quadriceps muscles, essentially locking the thigh muscles down and preventing normal movement of the leg. Atrophy and reduced range of motion is the most common post-operative complication that we treat.   Muscle contracture is very painful and extremely difficult to resolve, often requiring multiple therapy sessions a week for several months to give a patient the best chance at regaining normal limb use. Long Term Care The most impactful thing you can do at home to keep your pet comfortable and active is to maintain a lean body weight and good musculature. Even with surgery, your pet will develop Osteoarthritis (albeit slower than a dog that did not have surgery) and as they get older, it will only become more challenging for them to build muscle and lose weight. By keeping them lean and well-muscled from the start, you are giving your dog a solid foundation for a longer, more active, and healthier life. For more information, check out our article Crunchy Doggos - Managing Osteoarthritis . If your dog has only had MPL diagnosed in one knee, you should prepare yourself for the likelihood that your dog’s other knee will also be affected and potentially require surgical intervention. Some activities are more likely to aggravate patellar luxation than others, so we recommend removing them from your routine or reducing them as much as possible. Fetch involves a lot of twisting movements to quickly turn and run for the ball, then turn and rush back so fetch should be replaced with a safer game. Jumping on and off furniture or in and out of vehicles forces your dog’s joints to absorb a hefty impact, so we recommend assisting your dog or providing stairs or ramps. Slow, controlled exercise will always be preferred. What If Surgery Is Not An Option?   Because surgery is the only way to resolve a Grade 3 or 4 MPL, it will always be the top recommendation. However, there are some circumstances that make surgery a poor choice. Often, financial constraints are the first to come to mind. We get it; it’s an expensive option! However, without surgery, your dog will require long term treatments like medications and pain relief focused Rehab. If your dog is a young dog, you will likely spend at least the same, but likely more money on these “band-aids” than if the surgery was performed at the beginning. If your pet is a senior or geriatric pet, it may not make sense to put them through anesthesia and a big surgery. Pets with co-morbidities like heart disease, liver shunts, or clotting disorders can also be high-risk anesthetic candidates. Certain auto-immune conditions may complicate your pet’s ability to heal or fight off infection. In these cases, your goal will be to maintain your pet’s comfort and mobility as best as possible. As the damage to the bone worsens, they will begin to experience more pain and therefore be more likely to rely on their other legs instead, setting them up for compensatory injury. Pain medications, supplements, and Rehab are all good options for relieving pain and inflammation. Check out our Pain Meds & Supplements article for more information regarding commonly prescribed pain medications, our favorite supplements, and how to choose quality products. To Summarize   MPL is painful but it doesn’t have to keep your dog on the sidelines forever. Utilizing services from a board-certified veterinary surgeon and a certified veterinary rehab specialist is likely to give your dog the best results. While the expense of surgery may be off-putting, in the long run, it is usually cheaper to invest in the surgery early on rather than paying for a lifetime of pain relief. While braces and medications might be appealing solutions, they will not resolve your pet’s condition and are likely to make it worse.  With the right home routine and/or surgery, your dog can enjoy good, pain-free mobility. For dogs that cannot undergo surgery, there are options to help control their pain and increase their limb strength which, depending on the severity of luxation, may resolve their symptoms. However, surgery is still the most effective solution for grade 3 & 4 MPL cases. If you still have questions about Medial Patellar Luxation, our team of licensed veterinary professionals at Canine Rehab of Orange County is happy to consult with you. The CROC Team is Here for You! MPL is among the most common conditions that we see and we aim to help you find the best options for you and your dog. In some instances, we start therapy before surgery to maintain comfort and muscle mass as much as possible. We frequently see MPL patients after surgery to help them achieve the best and fastest recovery. Feel free to reach out to us with any questions or if you would like to move forward with a consultation, visit our New Patients page to get started.

What's the problem with swimming? When is swimming the right exercise? We'll discuss the mechanics of a dog's body when they are swimming and why it isn't the best exercise for most Physical Rehabilitation patients. But first, let's start with a quick visual: Thanks to Dexter's examples, we can clearly see some big differences in how a dog exercises while swimming versus walking in an Underwater Treadmill. Now, let's get into some details! What Swimming IS Good For: Swimming is a great choice for dogs needing to exercise their front limbs that have no other injuries or conditions that would be aggravated by vigorous exercise. For example, puppies that have developed Swimmer Puppy Syndrome often benefit from swimming because, at least at first, they are unable to use the Underwater Treadmill. Swimmer's Syndrome Puppies develop splayed legs and flattened chests early in life and must be rehabbed as soon as possible to have any chance of being able to walk. Swimming, used alongside other Rehab Modalities, encourages them to work their front leg and chest muscles, helping to bring their splayed legs underneath their body instead of out to the side. Swimming can also be beneficial for dogs that refuse to bear any weight on a front leg and continue to hold the leg up in the Underwater Treadmill. Great care must be used in these cases to ensure that these patients don't overwork or further injure themselves while swimming. At CROC, when utilizing swimming for a patient, they are outfitted with a life vest and held in place the entire time so that we have complete control over their session. Dogs that are free of any health concerns certainly benefit from varied exercise to challenge different aspects of the body. It is important to note that 1 minute of swimming is equivalent to 5 minutes of vigorous dry exercise. It is easy to accidentally overdo it when they're having so much fun in the water. Regardless of medical status, knowing your dog's physical limits and slowly introducing them to new forms of exercise is imperative to prevent overexertion or injury. What Swimming is NOT Good For: When dogs swim, their front legs are paddling almost violently, in fast and poorly controlled motions. These intense movements can be hard on joints, especially those with osteoarthritis . Arthritic joints are missing the normal lubrication to protect the bones from grinding against each other and may even have bone spurs. Think of that crunchy, painful joint experiencing high-intensity, high-speed exercise - OUCH! Arthritis patients frequently have muscular atrophy, where the muscles waste away, and therefore need careful, controlled exercise to avoid overworking their weakened body . With swimming, you can't tell a dog to swim slowly; there's swimming or not swimming and no in-between. While they're paddling in the front, dogs tend to tuck their back legs up close to their body, rarely kicking. Therefore, the stress of holding the back half of the body up is placed on the neck and back muscles, as well as the spine itself. Along with the added strain, the spine experiences quick, twisting movements when the dog is swimming. For our patients with spinal conditions or injuries, like Intervertebral Disc Disease , increased straining and quick, twisty movements are a perfect recipe for re-injury and pain. Families of spinal surgery patients or those hoping to medically manage a spinal condition without surgery should never permit swimming as an activity. The little bit of kicking that the rear legs do while swimming is generally periodic, spastic, and forceful, therefore not beneficial for the strengthening and coordination training that is sought after in Rehab Therapy. Swimming does not allow for the loading and unloading cycle the muscles experience when a dog bears weight on their leg. This loading cycle is what causes the muscles to strengthen, addressing the muscle atrophy and weakness most patients present with. The mechanics of swimming can actually cause increasingly severe pain in arthritic joints or even re-injure healing surgical sites. For example, dogs participating in swimming exercise after a TPLO knee surgery have been known to displace the surgical plate and even snap off surgical screws during the forceful kicking motion. Lastly, because you cannot control how deep the dog is in a swimming pool and pools are extremely difficult to clean and sanitize, swimming is not safe for dogs with any sort of respiratory compromise . For example, a dog with Laryngeal Paralysis would be at extremely high risk for aspirating (breathing in) the water they are swimming in. Worse - that water is full of fecal particulates, urine, dirt, hair, and large amounts of chemicals to try to compensate for that. Now our Laryngeal Paralysis patient has aspirated water and all of those contaminants into their lungs - YIKES! Why Underwater Treadmill Therapy? Hydrotherapy is incredibly beneficial for a variety of medical conditions, so Veterinary Medicine had to find a way to make it safer. Using an Underwater Treadmill allows us to have control over all variables a dog might encounter while participating in Hydrotherapy. Water Quality: Starting at the most basic level, the water is cleaner. Because the Underwater Treadmill is drained and filled between each patient, we can ensure that every patient gets fresh, clean water in which to exercise. Many Rehab Patients have trouble controlling their bladder or bowels, so accidents happen. When they happen in the Underwater Treadmill, the entire batch of water is drained and the treadmill is sanitized from top to bottom before another patient hops in. Before a patient ever uses it, our water is also filtered and heated to the perfect temperature to soothe aching muscles and joints. Pools are rarely, if ever, drained to be scrubbed and disinfected but our Underwater Treadmill is deep-cleaned and sanitized at least daily, if not more frequently. Customized Exercise Environment: At the beginning of an Underwater Treadmill Therapy Session, our patients walk into a dry, empty treadmill which for dogs that don't like water, is much less scary than being instantly submerged in a pool. The water is then slowly allowed to fill from the bottom up and stopped at the exact height for that dog's needs. Exercising in water has the benefit of offering increased resistance, but also increased buoyancy. Because we can precisely control the water level a dog is standing in, we can fine tune exactly how much buoyancy and resistance any one patient needs. Slow and controlled exercise in a low-impact, high-resistance environment allows our medically fragile patients to build muscle and improve stamina without overworking or re-injuring themselves. For patients needing a more intense workout, the water level can be decreased so that the water no longer supports their body but still provides increased resistance. We can also control exactly how fast or slow the dog walks in the Underwater Treadmill by controlling the speed of the treadmill belt that they walk on. For dogs needing more intense exercise or exercises focused on shifting weight to their back legs or lower back, CROC also has an Underwater Treadmill that has the ability to incline so that the patient can walk uphill while in the water. Spine Safe Exercise: Because the dog is standing or walking in the Underwater Treadmill, there is never a time where one part of the spine is under more stress than another. In fact, because of the buoyancy the water provides, dogs in the Underwater Treadmill experience even less strain on their back than they would outside the water. They also don't have to work as hard to move their body, which is a game changer for dogs suffering from paralysis or paraparesis. These patients have decreased or no voluntary movement of their legs outside the water, but in the water, they may be able move their legs a tiny bit since it takes less effort. A little movement means a little muscle growth and a little more nerve conduction which eventually builds to more independent movement. Lastly, because they are on their feet, there is no additional twisting motion on the spine. How Do You Know Which One to Use? At CROC, all exercises are prescribed by a Veterinarian and performed by Licensed Veterinary Professionals with years of experience treating a wide variety of Medical Conditions. When a patient comes to see us for Physical Rehabilitation, we thoroughly evaluate them beyond the presenting complaint. A deep understanding of canine anatomy and physiology, as well as how various conditions affect the body, means that we can then custom design a patient's treatment plan to address their weaknesses without causing further pain or injury. Your dog should be evaluated by Licensed Veterinary Professionals that have also been formally educated in Veterinary Physical Rehabilitation before starting any Physical Rehabilitation exercises.

L ibrela is the newest osteoarthritis treatment in the US and of course, everyone is excited about a once monthly treatment to treat your dog’s pain. It can be extremely effective when used appropriately. However, in addition to the benefits, we are also seeing some concerning trends with the use of this drug and want you to be aware of the potential risks before pursuing it for your dog. What is Librela (bedinvetmab)? Librela is a monthly canine monoclonal antibody injection that must only be administered by your veterinarian and may take up to 6 weeks for observable results. A monoclonal antibody is a biological agent, a medical product that is isolated from a living creature rather than a chemical, that has been engineered to bind to a single target. Examples of biological agents include gene therapy, vaccines, and blood components.¹ Librela targets Nerve Growth Factor (NGF) to help reduce pain caused by Osteoarthritis. NGF is necessary for neurological development and maintenance though as an animal matures, it becomes part of the body’s sensation of and response to pain. NGF also contributes to healing and cardiovascular health. Librela works by stopping the healing, growth, or maintenance of nerve tissues in the body. The dog’s pain stops when the nerves don't work and can no longer send pain signals to the brain.  What Librela Can’t Do It does not cure osteoarthritis. While it can lessen the sensation of pain caused by osteoarthritis, it does not stop the inflammation and physical damage that is present and occurring within the joint. In fact, we frequently see dogs that feel so much better on Librela that they return to more intense activity which then contributes to accelerated osteoarthritis formation. To learn more, check out our article Crunchy Doggos: Managing Osteoarthritis . It should not be used to address any other conditions. This includes chronic or post-operative pain, like that associated with Cranial Cruciate Ligament (CCL/ACL) rupture or Tibial Plateau Leveling Osteotomy (TPLO). It cannot help those conditions and should not replace conventional methods of pain relief in those cases. It should not be used in any case where nerve growth is required such as dogs that are breeding (including males), pregnant, or lactating. It should not be used in dogs that are physically immature and still growing. Keep in mind that many large or giant breed dogs do not reach physical maturity until 2-3 years of age. Neurological Side Effects Because Librela targets Nerve Growth Factor, it typically results in poorer nerve tissue health. The veterinary community is becoming increasingly aware of neurological adverse side effects associated with Librela including: Generalized weakness Inability to control bladder and/or bowels Stumbling Knuckling Dragging paws Inability to walk Seizures In many cases, a dog may have had very mild neurological dysfunction that had gone unnoticed by their family until they were given Librela. That neurological dysfunction can worsen as soon as hours to weeks after a dose of Librela.  Should your pet experience any of these symptoms, Librela should not be given again until your pet has been evaluated by a Veterinary Neurologist. It may take up to 3 months for a patient to recover from a Librela-induced neurological decline although patients with Degenerative Myelopathy are extremely unlikely to regain any lost ability.  If your dog has any sort of neurological condition, such as Intervertebral Disc Disease , Degenerative Myelopathy , or Geriatric Onset Laryngeal Paralysis & Polyneuropathy , they should not be given Librela as it is likely to worsen their symptoms. The Blood Brain Barrier is a semi-permeable membrane that protects the brain by filtering out harmful substances within the body while allowing oxygen and nutrients in. If it is intact, Librela should not be able to affect brain tissue or cognition, however the Blood Brain Barrier weakens with normal aging and its break down can be accelerated by other age-related disease.  The affects of Librela on the brain are not yet known, but given Librela's effects on nerve tissue and that senior dogs who are likely to have a compromised blood brain barrier are most common patient to be given this medication, there is the potential for harm to the brain. Autoimmune Side Effects There are anecdotal reports of Librela worsening autoimmune conditions. This is especially concerning when it comes to conditions like Immune Mediated Polyarthritis (IMPA). Dogs with IMPA can present identically to dogs with “normal” osteoarthritis/degenerative joint disease but require very different treatment. For example, dogs with osteoarthritis are commonly prescribed NSAIDs like Rimadyl to address their pain, but dogs with IMPA require immunosuppressant drugs to control their pain. If a dog goes to the vet for pain, stiffness, or limping and thorough diagnostics are skipped in favor of jumping straight to medication, a dog with undiagnosed IMPA might be given Librela, then experience an increase in pain and inflammation. Autoimmune side effects are still being discovered, so we recommend that dogs with any autoimmune conditions should not be given Librela. Unknown & Long Term Safety Concerns Safety and efficacy studies on Librela were only 84 days long (less than 3 months!) and were performed on young dogs free from other health conditions. Consider that senior dogs struggling with arthritis pain are the most likely patients to receive Librela and are also nearly guaranteed to have other conditions that may be complicated by Librela.  There are no long term safety studies. We are discovering long term side effects only after Librela was approved for widespread use in the US. It is not known what will happen to dogs that are on Librela long term. A 2025 study published in Frontiers in Veterinary Science found that “ Ligament/tendon injuries, polyarthritis, fractures, musculoskeletal neoplasia, and septic arthritis were reported nine times more frequently in Librela-treated dogs ”.² The same study compared Librela’s reports of adverse effects between November 2020 (its european release) and 2024 against a 20 year period for other, better established drugs. Most shockingly, Librela accumulated 3 times more reports of adverse effects than all comparator drugs combined. “Librela has accumulated 20 times more reports [of adverse effects] than the highest-ranking comparator drug (Rimadyl)”. NGF Inhibitor Treatments in Humans Monoclonal antibodies are used in human medicine for many different applications, but development of those that target NGF in humans were halted by the FDA from 2010-2012 due to significant reports of Rapid Progression Osteoarthritis (RPOA) and Osteonecrosis (bone death). “RPOA is characterized by an accelerated deterioration of joint structures, leading to severe pain and functional impairment."³ Incidence and severity increased the longer a patient was on an NGF inhibiting treatment , but some patients developed symptoms after only one dose. The concurrent use of NSAIDs like Advil or Aleve, the most common treatment for OA, may have also been a contributing factor. Research and development later resumed, but RPOA and adverse neurological side effects have continually been observed in studies on multiple variations of human NGF inhibiting treatment. In 2021, the FDA rejected Pfizer’s human NGF inhibitor tanzumab  because there was no evidence that it was more effective than traditional painkillers like Ibuprofen and it posed too great a risk for RPOA . 4 Teva & Regeneron’s fasinumab  is currently in development and a December 2024 study still shows an increased risk for neurological and musculoskeletal adverse effects that increased with higher dosage. 5 As of August 2025, Librela is being further investigated due to case reports of Rapid Progression Osteoarthritis (RPOA) in dogs given Librela. As of September 2025, there are no NGF inhibiting treatments approved for use in humans. How to Use Librela as Safely as Possible Try Other Treatments First Studies have shown that NSAIDs are equally effective at treating osteoarthritis pain when compared to Librela. All medications have some level of risk but at least NSAID related side effects are well documented and can be reduced if your dog’s bloodwork is checked on a regular basis, which is recommended for all senior dogs anyway. Commonly used NSAIDs include Rimadyl (carprofen), Metacam (meloxicam), and Galliprant (grapiprant). Some patients respond better to one than the other, so be prepared to potentially switch to a different NSAID if your dog doesn’t tolerate the first one you try. Other non-NSAID medications, like Gabapentin or Adequan, are also good, well-established options. Read our Pain Meds & Supplements article to learn more about commonly used medications. Physical Rehabilitation Rehab is recommended with or without Librela! A prescribed Rehab treatment plan may even be enough to avoid using Librela all together. Dogs on Librela still need the other aspects of their osteoarthritis attended to including weight management and safe exercise. Weight management is the most impactful aspect of treating osteoarthritis. CROC’s treatment plans include an evaluation of your dog’s diet to make sure all nutritional requirements are met while optimizing weight and muscle mass. Safe exercises, like those prescribed by CROC’s medical team, will help improve musculature that is integral for supporting your dog’s joints and preserve range of motion, all of which helps your dog remain comfortably mobile.  Don’t Skip Diagnostics! Electing to give your pet Librela without prior diagnostic screening is a big gamble! Due to potentially severe side-effects, we recommend that your pet be thoroughly evaluated to rule out auto-immune and neurological conditions before starting Librela. This should include a nose-to-tail physical exam, bloodwork (chemistry + complete blood count) and radiographs at a minimum. Depending on the results of those initial diagnostics, your dog may require evaluation with a neurological or orthopedic specialist instead of Librela. To Summarize While Librela can be a very effective method of pain relief, it is not well studied and serious side effects are still being discovered. Studies show that well established drugs like Rimadyl or Metacam are equally effective at treating pain and have fewer reports of adverse effects. Librela doesn’t treat inflammation or the physical damage that occurs within the joint, so it should not be used as the only treatment for your dog’s osteoarthritis. Weight management and safe exercise are still integral to your dog’s comfort and mobility. Dogs with neurological or autoimmune conditions should never be given Librela. Dogs that are breeding (even males), pregnant, lactating, or still growing should not be given Librela. The FDA has not approved any human equivalents to Librela because the risk of patients developing Rapid Progression Osteoarthritis (RPOA) was too great. RPOA is being reported in Librela patients now. Librela should not be a first line treatment and before starting Librela, your dog should be thoroughly evaluated and have comprehensive bloodwork and x-rays performed.  References Enomoto, M., Mantyh, P.W., Murrell, J., Innes, J.F., Lascelles, B.D.X., (2019). Anti-nerve growth factor monoclonal antibodies for the control of pain in dogs and cats. Veterinary Record of the British Veterinary Association . https://bvajournals.onlinelibrary.wiley.com/doi/10.1136/vr.104590 Farrel, M., Waibel, F.W.A., Carrera, I., Spattini, G., Clark, L., Adams, R.J., Von Pfeil, D.J.F., De Sousa, R.J.R., Villagra, D.B., Amegual-Vila, M ., Paviotti, A., Quinn, R., Harper, J., Clarke, S.P., Jordan, C.J., Hamilton, M., Moores, A.P., & Greene, M.I. (2025). Musculoskeletal adverse events in dogs receiving bedinvetmab (Librela). Frontiers of Veterinary Science, volume 12 . https://www.frontiersin.org/journals/veterinary-science/articles/10.3389/fvets.2025.1581490/full Mobasheri, A., Hanson, P., Larkin, J., (2025). Rapidly progressive osteoarthritis (RPOA) in companion animals treated with bedinvetmab (Librela™): an expected pathophysiological phenomenon or a cause for concern?. Frontiers of Veterinary Science, Volume 12 - 2025 . https://www.frontiersin.org/journals/veterinary-science/articles/10.3389/fvets.2025.1640217/full Jimenez, D., (2021). FDA panel votes against Pfizer’s tanezumab for osteoarthritis pain. Pharmaceutical Technology . https://www.pharmaceutical-technology.com/news/fda-pfizer-tanezumab-safety/ DiMartino, S.J., Mei, J., Schnitzer, T.J., Gao, H., Eng, S., Winslow, C., Ho, T., Turner, K.C., Hassan, H.E., Patel, Y., Davis, J.D., Trinh, N., Manley, A., Manvelian, G., Fetell, M., Braunstein, N., Geba, G.P., Dakin, P., (2024). A phase III study to evaluate the long-term safety and efficacy of fasinumab in patients with pain due to osteoarthritis of the knee or hip. Osteoarthritis and Cartilage Open, volume 6, issue 4 . https://www.sciencedirect.com/science/article/pii/S2665913124001006 Bimonte, S., Cascella, M., Forte, C.A., Esposito, G., Cuomo, A., (2021). The Role of Anti-Nerve Growth Factor Monoclonal Antibodies in the Control of Chronic Cancer and Non-Cancer Pain. National Library of Medicine . https://pubmed.ncbi.nlm.nih.gov/34234542/ Dakin, P., DiMartino, S.J., Gao, H., Maloney, J., Kivits, A.J., Schnitzer, T.J., Stahl, N., Yancopoulos, G.D., Geba, G.P., (2019). The Efficacy, Tolerability, and Joint Safety of Fasinumab in Osteoarthritis Pain: A Phase IIb/III Double‐Blind, Placebo‐Controlled, Randomized Clinical Trial. National Library of Medicine . https://pmc.ncbi.nlm.nih.gov/articles/PMC6900077/

With the plethora of pet products available, it can be difficult to make choices for your pet. While CROC does not prescribe medications, our medical team is here to help you understand your options so you can work with your Primary Veterinarian to find what works best for your pup. The following information regarding these medications and supplements is sourced from our many years of Veterinary Medical education and experience. We have no affiliation with any company that produces the medications or supplements discussed herein. Prescription Pain Relief Adequan (Polysulfated glycosaminoglycan)  Adequan is a series of injections that stimulates cartilage healing, slows the progression of osteoarthritis, and decreases pain and inflammation. It begins with an initial series of 8 injections with one injection given every 3-4 days. Once that is complete, many pets can drop down to a maintenance schedule of one injection every 1-6 months. For larger dogs, this can be a costly investment to get started, but we have seen significant improvement for many dogs using this medication . If you have concerns about giving your dog injections, be sure to speak to your veterinarian for options like an in-person demo or having their staff perform the injections for you. You can also speak to the CROC team.  Non-Steroidal Anti-inflammatory Drugs (NSAIDs) Rimadyl (carprofen), Metacam (meloxicam), Deramaxx (deracoxib), and their generics are Non-Steroidal Anti-inflammatory medications that can be extremely helpful for managing pain and inflammation and since many generics exist, it can be easier to find one that fits your budget. They can have long term side effects to the liver and kidneys so regular bloodwork is strongly recommended to catch any change in organ function early. They must also be given with food! Some pets don’t tolerate these medications well and can have GI side effects like stomach ulcers and gastrointestinal bleeding, but these typically resolve when the medication is stopped and sometimes its just a matter of switching to a different NSAID. It is important to monitor your dog for any signs of vomiting, diarrhea, or dark stools while on these medications. Some pets REALLY like the taste of the flavored tablets so store these medications with caution, securely out of reach of your pet. These NSAIDs work similarly to human Advil (ibuprofen) but human medications like Advil are extremely dangerous for animals and should never be given to your dog. Galliprant (grapiprant)  Galliprant is a newer type of Non-Steroidal Anti-inflammatory that has less side effects than the more widely known NSAIDS listed above. It is reported to have less effects on liver, kidneys, and GI tract and can be safely used alongside a wider selection of other medications. Because it is newer and a more specific medication, it is generally more costly than the above listed NSAIDS that have been around longer.  Neurontin (gabapentin) Neurontin is a medication primarily used to treat nerve pain, though it can also help with anxiety. Many pets experience some level of drowsiness when they first start this medication, but they usually become accustomed to it and return to their normal energy level after some time. Besides temporary sedation when first started, other side effects are extremely rare. This medication is a good option for pets that cannot tolerate NSAIDS and it can also be used alongside NSAIDS and many other medications.  Tramadol Tramadol is a synthetic opioid that has been commonly used to treat moderate to severe pain in dogs. Newer studies on this medication show that it may be less effective than previously thought, with only a small fraction of dogs getting any pain relief from it. Side effects from Tramadol include sedation, vomiting, diarrhea, constipation, and loss of appetite. Librela (bedinvetmab)   Librela is the newest Osteoarthritis treatment in the US; a once monthly injectable medication only for use in dogs. It must be administered by your veterinarian and may take up to 6 weeks for observable results. Librela is a monoclonal antibody (a protein that has been engineered to bind to a single target) that targets Nerve Growth Factor which helps reduce pain caused by Osteoarthritis. It can be extremely effective for the right patient but can have serious neurological and/or autoimmune side effects. To learn more, check out our article, A Look at Librela . Regenaflex K9 We recently became aware of this injectable medication and researched it thoroughly to see if it might be another good option for our patients. The lack of documentation on this product is highly alarming. This medication has not been FDA approved and lacks a non-proprietary drug name which is required for most drugs before they can be introduced to the US market. The manufacturer boasts that Regenaflex K9 can improve healing of a wide variety of conditions because it is made using tissues collected during a horse’s birth (likely umbilical cord and placenta) but there are no peer reviewed studies that prove efficacy or safety . The only study they have published lacks a date of completion/publication, involved just 25 dogs, and was uncontrolled, unblinded, and had very minimal objective assessment. This means that the placebo effect cannot be ruled out and it is completely unknown if any of the dogs suffered systemic side effects because they did not perform any labwork or imaging before or after injecting their test subjects. In addition, this study lasted just 60 days, meaning that there was no follow up to confirm that these dogs did not suffer long term side effects. Until it is FDA approved and peer-reviewed evidence of its safety and efficacy is made public, we strongly advise against use of Regenaflex K9 . A Note on Supplements Unfortunately, supplements are not regulated like medications are, so it can be difficult to choose a quality product. Supplements go to market without FDA oversight and cannot be removed from the market without the FDA proving that they are harmful. The company that makes the supplement is responsible for making sure their product is safe but they do not have to prove that it is effective. Generally speaking, companies that make both medications and supplements are more likely to have their supplement processes up to FDA standards. One thing you can look for is the National Animal Supplement Council (NASC) seal. To be permitted to use the seal on their product, a supplement company must adhere to NASC’s quality standards, pass random third party testing of their products to confirm they are accurately labeled, and pass a third party audit every two years. NASC does not verify efficacy or evaluate product studies. If you can find a product that has performed a random controlled clinical study, that would be ideal. Bonus points if they have multiple! It’s also important to keep in mind that supplements are intended to support health and wellness; not treat disease. Vitamins and supplements do not replace medical treatments or prescription drugs. If the patient is being fed an AAFCO approved diet that is appropriate for their age and breed, there is often no need for supplementation. In addition, the more supplements that a patient is on, the more likely they are to have an adverse reaction . About 10% of pet poison control cases are related to supplements. Supplements can have negative interactions with other supplements or medications that your pet is on, so you should always consult with your Veterinarian before giving your pet a new supplement. Make sure that you can accurately relay the brand, ingredients, and strength of the supplement so it can be adequately evaluated.  If you choose to use a supplement intended for humans, you’ll need to be extra wary. It’s not uncommon for human supplements to include ingredients that would be harmful to a pet. For example, a dog given a human supplement that has Vitamin D in it can overdose on Vitamin D since human dosage is higher. We often see CBD products, both pet and human products, that have ingredients in them that are extremely toxic to animals like xylitol.  Our Favorite Supplements  Joint supplements may be helpful to stimulate cartilage matrix production and inhibit enzymes that break down cartilage. Dasuquin Advanced with Egg Shell Membrane (made by Nutramax) is an excellent daily joint supplement that many of our team members choose to use for their own pets. It includes Chondroitin, Glucosamine, Omega-3 fatty acids, peptides sourced from egg shell membrane, and several herbal extracts all formulated to work together and maximize their impact. We like that Nutramax is made in the US, performs rigorous testing of all ingredients before they are accepted into their facility, has strict procedures for manufacturing, and frequently tests their products to confirm safety and accuracy. Dasuquin comes in a tasty, chewy treat, making it an easy addition to your daily routine but you will also need to make sure that it is stored correctly as some dogs like them a little too much and will eat the whole bag! Fish Oil added to your pet’s meals is another easy addition to help keep joints happy (and it helps their coat too!). Start with 500-600mg per day, then increase to 1000-1200mg per day. It is important to start slow with this as some pets may be sensitive and have GI symptoms if started too quickly. We don’t have any specific brand to recommend but you can use the recommendations above to select a quality product. Myos Canine Muscle Formula is a supplement containing Fortetropin, a natural bioactive supplement made from fertilized egg yolk. Studies have shown that Fortetropin improves muscle health, reduces muscle loss (atrophy), and promotes muscle growth after surgery or other disease processes. It has also been shown to help skin, coat, cognitive, and bone health. We like this supplement for senior dogs and those recovering from surgery. As dogs age, they tend to lose muscle mass more quickly and it is more difficult for them to regain muscle. Dogs recovering from surgery typically require exercise restriction (remember that muscle atrophy begins after just 72 hours of inactivity) and they may have already been losing muscle before surgery. For example, if a dog is favoring a limb for weeks or months before surgery. Myos Muscle Formula comes in a powder that is sprinkled on their food and most dogs really enjoy it. It is very rich so if your dog has a sensitive stomach, we recommend starting slowly and working your way up to the recommended dose over several days/weeks. There are anecdotal reports of dogs with chicken allergies being able to tolerate this supplement if started on very low quantities that are slowly increased. While not yet NASC certified, as of October 2025, it is expected to complete the auditing process in 2026. We were able to secure a discount code for CROC patients! Use " CROC20" to get 20% off. In Summary While CROC does not prescribe medications, our medical team is here to help you understand your options so you can work with your Primary Veterinarian to find what works best for your pup. Before using Librela, your dog should be thoroughly evaluated to rule out any neurological or autoimmune conditions as Librela can significantly worsen these conditions and those side effects don’t always reverse when Librela is stopped. At this time, we strongly advise against the use of Regenaflex K9 because there are no peer-reviewed, controlled studies to prove safety and efficacy. We will continue to monitor this drug and update our recommendation as more information is made public. Because supplements are not regulated like medications are , it is necessary to research the company and make sure that you are purchasing a safe and effective product. Look for the NASC seal and efficacy studies! Always discuss new supplements with your Veterinarian before giving them to your dog. The more supplements and medications your pet is on, the more likely they are to experience an adverse reaction.

*** The tips and recommendations within this article may not be right for your dog. As all dogs are unique individuals, we recommend that you consult with your Veterinarian and/or schedule a Fitness Consultation with the Physical Rehabilitation Specialists here at Canine Rehabilitation of Orange County to discuss what is right for your dog.*** To help reduce your Canine Athlete's risk of injury, check out our first three Canine Sports Medicine articles! We understand that pet diets can be a highly contentious subject. The information included here is based on clinical studies & without influence by commercial or alternative dog food/supplement companies.  Proper nutrition is vital for the performance, recovery, and healing of the Canine Athlete's body. The type, quality, and amount of calories required will vary between dogs based on their activities, lifestyle, and any medical conditions. Sprinting dogs need more carbohydrates while endurance dogs need fat as the major fuel for exercise. Most athletes are kept lean to reduce strain of excess weight, so if more weight is desired, that weight should be gained in muscle rather than fat. Home-Cooked Diets High protein, non-commercial dog foods, typically including fresh, high quality meats and vegetables prepared at home, have become increasingly popular. Unfortunately, the majority of these diets are wildly unbalanced and lacking essential vitamins and amino acids that must be ingested as they cannot be made by the body. These nutritional deficiencies can lead to long term consequences. Calcium is often a problematic ingredient. Too little and a dog may become inappetent, weak, and potentially even have seizures. Too much and a dog may experience increased thirst and urination, inappetence, & bladder or kidney stones. To ensure that your Canine Athlete is getting all the nutrients they need, it is advised that home-cooked diets are supplemented with an AAFCO-approved commercial dog food for a minimum of 25% of a dog's meals. If possible, consult with a board-certified Veterinary Nutritionist to make sure your dog’s diet is balanced and complete. Our Gear & Resources page also includes links for fresh ingredient diets. All Meat Diets Like home-cooked diets, feeding primarily or only meat is not recommended due to nutritional deficiencies. While not likely to be detrimental over short periods of time, extensive studies have shown that Canine Athletes perform better with a diet composed of 30% protein, 50% fat, and 20% carbohydrates. Carb-loading is a human sport principle that has been applied to Canine Athletes in multi-day events. Protein & carbs are given post-exercise as protein helps curb muscle loss & carbs replenish glycogen within the muscles to prevent the body from breaking down lean muscle. A plethora of studies have proven that this combination is best achieved with a commercial dog kibble. Grain Free Diets These diets were heavily marketed by boutique food manufacturers that lacked food laboratory feeding trials & research. It has become abundantly clear from overwhelming evidence that diets touted as high in legumes/pea proteins & grain free result in Cardiomyopathy, a serious & sometimes fatal heart condition. You can visit our Research & Trusted Sources page for links to peer-reviewed studies and published works from esteemed veterinary professionals. Grain free diets are, thankfully, becoming less popular as pet owners are in favor of safer, healthier alternatives. Look for wheat, corn, barley, oats, millet, or rice in the ingredients when selecting your Canine Athlete’s diet to ensure the formula is grain inclusive. Sporty Poops Even seasoned Canine Athletes can experience diarrhea related to competition stress or exercise. In humans, it’s referred to as “Runner’s Diarrhea”. Exercise can increase gut motility, making for loose and more frequent stool and stress or excitement can release hormones that loosen stool as well. The binding properties in supplements or commercial dog foods containing Chicory Root, Beet Pulp, or Psyllium Husk Fiber will help improve fecal quality. Canned pumpkin is also known to firm up softer stools & loosen hard stools. To balance bowel movements, use 1-2 tablespoons per meal for several days. Your Canine Athlete should have access to fresh water at all times, but hydration will be especially important if they are experiencing diarrhea on a big working/sporting day. When to Feed the Canine Athlete Food is fuel but when & how it's offered can affect performance. When feeding your Canine Athlete, do so with timing & frequency in mind to reduce fecal bulk while aiming to maximize metabolites. Field studies have proven that sprinting dogs running for less than 10 minutes in a single event benefited most from a 20% reduction in feed during the 24 hours prior to the event. It was previously common practice to "Carb Load" prior to burst exercise but that has been proven to be unhelpful for these Athletes. If Canine Athletes that participate in multiple bouts of exercise throughout the day are expected to perform again after 2-3 hours of rest, they benefit most from small amounts of carbohydrates immediately after exercise. However, if they are expected to perform within 2 hours of their initial event, food should be avoided to prevent regurgitation. During multi-day events or work assignments, carbohydrates should be provided within 30 minutes of the last exercise of the day in order to replenish glycogen in the muscle & reduce muscle break down. Gastric Dilatation & Volvulus (GDV) Due to high risks of GDV, it is not advised to feed large meals within 2 hours before or immediately after exercise, especially for large breeds with deep chests. Colloquially referred to as Bloat, a twisted stomach, or stomach torsion... GDV is life threatening if not identified and treated right away. It is most commonly associated with eating quickly or exercising on a full stomach of food/water. It initially begins with the stomach expanding to accommodate the food/water and dogs will display signs of discomfort like drooling, retching without producing anything, stretching, and restlessness.  As things worsen, the stomach can become so enlarged that it flips over on itself, which then cuts off vital blood supply to the stomach and spleen and interferes with circulation throughout the body . As the stomach continues to expand, this puts pressure on the diaphragm, making breathing difficult, further reducing oxygenation to the entire body. Abnormal heart beats are common as the lack of oxygen worsens and the stomach can sometimes rupture. Some dogs can be particularly stoic and not show any obvious signs of GDV until they have collapsed. Emergency medical care is required for this condition and at a certain point, surgery will be required for survival. GDV patients often go into shock and will need extensive care to stabilize them as they go into emergency surgery and will require hospitalization afterwards. While any breed or mix can experience GDV, Great Danes, Standard Poodles, German Shepherds, Irish Setters, Irish Wolfhounds, St. Bernards, Akitas, Weimaraners, & Boxers are most commonly affected. Middle aged and senior males are at the highest risk and there is an increased risk for dogs with deep chests, are fed once daily, or are related to a dog that has experienced GDV. Feeding from elevated food bowls, history of splenectomy, eating a diet with oils among the first four label ingredients, and stress are suggested as additional risk factors. There is a high rate of recurrence, so consistent and careful management will be required for any dog that has experienced GDV. Gastropexy, sometimes referred to as “tacking the stomach”, is a procedure in which the stomach is sutured to the abdominal wall to prevent the Volvulus (twisting) part of GDV, but it cannot prevent Dilatation (bloat).  Supplements Canine Athletes are more likely to develop chronic joint pain due to early or chronic osteoarthritis associated with their lifestyle. Long-chain Omega 3 Fatty Acids and other nutraceuticals can help reduce inflammation and improve mobility in joints affected by osteoarthritis. The most common source for these are commercial diets with Palmitic, Oleic, Linoleic, Alpha-linoleic, & Arachidonic acids as these are all Omega 3 or 6 Fatty Acids associated with mitigating inflammation & joint disease. Protein powders for dogs also exist! Supplements like Myos Muscle Formula (Fortetropin) have been proven to help enhance muscle growth & in addition to supporting the Canine Athlete’s peak fitness, it can also be used to restore muscle lost to injury or disease. Myos Muscle Formula can sometimes be quite rich for sensitive stomachs, so we recommend introducing this supplement slowly and over several days to weeks. For more information on these supplements and how to choose quality products, check out our Pain Meds & Supplements article. Hydrating Your Hound When we humans sweat, we lose water & electrolytes that require replenishment. Since dogs sweat very little & only from their feet, they lose the most water when panting. Replenishing lost electrolytes is good for us, so should Canine Athletes be given electrolytes on working days? No! If you add electrolytes to your dog’s water, the charge of the electrons will pull water from the tissues in the body into the intestines. This means taking hydration away from the muscles & other organs needed for their current activities & only contributes to their overall dehydration. Instead, fresh water without any additives should be available to your Canine Athlete at all times. Canine Rehab OC offers custom Fitness Plans by appointment. If you are interested in a comprehensive exam, clinically-proven therapies, and prescribed exercises for your Canine Athlete, check out the New Patient  section of our website to learn how to get started. Want to learn more about how to support your Athlete? Canine Sports Medicine events are coming to Canine Rehab OC soon and we'd love to see you there! These events include demonstrations courtesy of Dogtor Wilbur and a 30+ page Canine Sports Medicine booklet for each attendee. If you are part of a local Dog Sports group and interested in setting up an event, reach out to us ! We love getting involved in the dog community and helping as many families as possible. This article is Part 4 of our 5 part Canine Sports Medicine series! Other articles include: Part 1: Peak Performance & Injury Prevention Part 2: Cross-Training Part 3: Common Conditions & Injuries Part 5: Bad Dogs, Bad Medicine  (Effects of Behavior on Quality of Care)

*** The tips and recommendations within this article may not be right for your dog. As all dogs are unique individuals, we recommend that you consult with your Veterinarian and/or schedule a Fitness Consultation with the Physical Rehabilitation Specialists here at Canine Rehabilitation of Orange County to discuss what is right for your dog.*** To help reduce your Canine Athlete's risk of injury, check out our first two Canine Sports Medicine articles! It doesn't matter if your dog just dabbles in dock diving on the weekends or if they are a full-time TSA Officer. Dogs live to please us, sometimes to their own detriment, so it's up to us humans to keep them safe and physically sound. We're digging into injuries commonly experienced by Canine Athletes in hopes that they can be avoided or identified so your dog can continue to perform and thrive in their work. Cranial Cruciate Ligament Rupture Often compared to the human Anterior Cruciate Ligament (ACL), rupture of the Cranial Cruciate Ligament (CCL) is the most common injury in pet and sporting dogs . While dogs do not have an ACL, the CCL is also a stabilizing ligament between the femur and tibia. In young dogs, rupture typically occurs with fast & forceful movements but in older dogs, rupture occurs over time with chronic wearing away & fraying of the ligament. Careful conditioning helps reduce, but not eliminate, the risk of injury by keeping the muscles, tendons, & ligaments flexible, supple, & balanced. Cross Training to avoid injury involves slow, controlled exercises & a focus on enhancing stabilizing structures like the Patellar Tendon. Check out our Cranial Cruciate Ligament (CCL) article to learn more about this condition, how to minimize risk, and treatment options. Iliopsoas Injury The Iliopsoas (pronounced ill-ee-oh-soh-az) is a grouping of muscles in the groin that flexes and rotates the dog’s hip in addition to stabilizing the lower spine. It is comprised of two separate muscles; the Iliacus and Psoas major which originate in different spots on the spine and pelvis but fuse into a common tendon on the femur. Highly active or sporting dogs are frequently affected by this type of injury since the activities they participate in are high intensity like jumping, sprinting, or rough play. Injury to this muscle group usually happens when it is overstretched during activity & if left untreated can become a chronic source of lameness & pain. There are some conditions that can make your dog more likely to experience an Iliopsoas injury like Hip Dysplasia , Intervertebral Disc Disease , or Cranial Cruciate Ligament Rupture but a dog’s overall fitness level & lack of preparation for high intensity activity can also be primary causes. Thermotherapy, massage, & stretching are particularly effective to reduce risk of this injury. Check out our Iliopsoas Injury  article to learn more about this condition, how to minimize risk, and treatment options. Repetitive Motion Injury The dog equivalent to human Tennis Elbow or Swimmers’ Shoulder, the repetitive movements, even low-impact ones, gradually wear down & inflame the soft tissues & joints . This condition is common in Search & Rescue dogs but can occur in any working or competing canine. Even dogs at home that pace along the backyard fence are at risk! This type of injury is preventable & the likelihood of occurrence can be reduced by taking breaks, cross training, training for good ergonomics, & practicing “opposite” movements. Soft Tissue Shoulder Injury The most common shoulder injuries in working dogs are Medial Shoulder Instability & Biceps Tendinopathy. Both can occur as Repetitive Motion Injuries. Medial Shoulder Instability  is the result of the degeneration or breakdown of stabilizing structures within the shoulder. This injury is chronic & progressive in nature; as the shoulder joint becomes increasingly unstable, arthritis will develop and luxation (dislocation) of the shoulder joint can occur. This injury is common in water sports, like swimming and dock diving, as well as frequent jumping down or even poor landings in fly sports. Mild shoulder lameness is usually the first sign, followed by pain on extension of the shoulder joint.  Biceps Tendinopathy involves the Biceps brachii muscle, which is responsible for extending & stabilizing the shoulder, as well as flexing the elbow. When the tendon that attaches the biceps brachii muscle tears or becomes strained, dogs become lame, painful, & have reduced range of motion in the shoulder. Strains or low grade tears require significant amounts of rest since this is an exceptionally slow healing and frequently recurring injury. Severe tears/ruptures require surgery & sadly, retirement from most sporting activities. A good warm up routine, cross training, & regular breaks can help prevent these injuries. No-pull harnesses are also known to exacerbate shoulder injury because of where they apply pressure to the shoulder, thus their use should be avoided. Check out our Gear & Resources page for examples of harnesses we like. Carpal Strain High impact and repetitive activities create weakness and excess laxity of the carpus (your dog’s wrist). It happens most often with jumping down activities like jumping out of vehicles or off of furniture, but it can also happen when a dog pushes off a surface with too much force or with frequent ball play. The force of falling and the impact on the ground are initially absorbed by your dog’s front legs with the biggest impact on the carpus. Flyball athletes often experience this injury just from the force of slamming into the ball box at the end of the course. This is a cumulative injury, adding up over time, and permanent damage can result. Compensation for carpal pain and referred pain are common, as is osteoarthritis formation. Regularly practicing balance work and using cross-training to strengthen the ligaments and tendons of the forepaw may help reduce injury to the carpus. In situations where jumping down is not strictly necessary, such as when a ramp or stairs can be used, it’s best to utilize those tools to minimize impact forces whenever possible. If your Canine Athlete must jump down from things, do what you can to make the landing surface “impact friendly”. Metacarpophalangeal-Interphalangeal Joint Disease The CROC Team refers to this as “Polar Bear Paw” because bony changes within the carpus, metacarpals, and phalanges cause the front paws to resemble that of a polar bear. This is a repetitive motion injury often associated with frequent games of fetch, acrobatic movements with hard landings on the front paws, and dogs that live exclusively on hard surfaces like tile and concrete . Most of the cases we see are dogs that repetitively run along a fence or property line. Their intense speed followed by abrupt, sideways stopping results in chronic abuse to the tiny joints within the paw, causing osteoarthritis formation and thickening of those joints. These permanent changes often cause pain, reduced range of motion and loss of flexibility within the paw and toes.  To prevent this injury, try to prevent repetitive, high impact activities and focus on building strength in the forearms and paws to support the joint. This might mean mixing in other games besides fetch or in the case of fence running, training to modify your dog’s behavior. Adding softer surfaces with better traction can also be helpful. For example, you can add grass outside and rugs or yoga mats inside. Dental Injuries Canine Athletes can experience premature wear, chips, fractures, & even lose teeth. Tennis balls are known to be extremely abrasive, wearing through enamel & down into the pulp of the tooth. As the tooth is worn away, it can be extremely sensitive and painful to eat, drink, or even pant. Tennis balls are so abrasive, that many veterinarians can look at a dog’s mouth and extrapolate that the patient is a “ball dog” from the pattern of wear on the teeth.  Frisbee dogs often experience chips & fractures when catching hard frisbees. In such an intense and fast-paced sport, Canine Athletes are often so focused on making the jump and catching the frisbee, that no attention is given as to how that frisbee is caught. Even in minor cases of damage to the enamel, that still opens up the tooth to more significant dental disease. Dogs performing bite work, like Police K9's, often fracture or lose teeth during their work. We’ve all heard of Police K9's getting titanium implants and seeing those impressive silver chompers! Fractured teeth are extremely painful and invite infection to quickly take hold. They often cannot be salvaged, thus requiring extraction. Having a healthy tooth knocked out of their mouth is exactly as painful as you’d imagine.  Regardless of your Canine Athlete’s profession, make sure to have their teeth examined by a Veterinarian on a regular basis & use softer, less abrasive balls, frisbees, & other toys whenever possible. Generally speaking, if you cannot make a dent in it with your thumb nail, that object is a risk for chips and fractures. In addition, the Veterinary Oral Health Council is a great resource for safe and effective dental care. Cuts, Abrasions, & Avulsions Canine Athletes are often so focused on their work that they are completely unaware of these small injuries until all the excitement dies down. Proprioceptive exercises can help with some of these, but more than anything, your attention to the environment and your dog’s body will make the biggest difference in your dog’s safety . Torn toenails can happen to any dog but can be avoided by ensuring your dog’s nails are kept at an appropriate length and are free of any cracks or flaking. Pay attention to the surfaces that your dog will be performing on. Some dogs can be prone to paw pad avulsion (tears of the paw pad) just from too much intense exercise on concrete and we are all very aware of the painful burns dogs can experience just walking on asphalt. If your dog is too weak, tired, or spatially unaware to properly lift their paws over obstacles, they are likely to incur abrasions on the top of their paws. If your Canine Athlete is expected to perform on sharp, abrasive, or particularly hot/cold surfaces, they may benefit from booties to protect their paws. Most injuries of this type are not severe and can benefit from rest and standard wound care. For deep cuts or serious abrasions that keep bleeding after rest and compression, a vet visit is likely necessary for suturing or bandaging. Improper bandaging technique can result in permanent damage to or even complete loss of the limb. It sounds extreme, but it is sadly a very common occurrence and is a devastating result of good intentions. You should never attempt to bandage your dog’s legs or paws without veterinary medical supervision. When to Call the Professionals Even with all the training and conditioning in the world, accidents still happen. Sometimes rest and stopping all activities for several days is all it takes to recover. However, depending on the severity of the injury, your dog may need medical attention. Some injuries and conditions require prompt veterinary care to avoid long term pain or loss of mobility, so it's always best to have your Canine Athlete examined sooner rather than later. If there are clicking sounds, swelling, instability, limping, or pain, it’s important to speak to your Veterinarian right away. After speaking with your Veterinarian, formal Physical Rehabilitation services should be considered if: Activity is Limited Rehab can help your Canine Athlete stay conditioned while they recover by providing safe and controlled exercise. The body heals during periods of rest, so taking a break from sports is integral to recovery. The problem is that when the body stops working, its strength, flexibility, and stamina will decline. In as little as 72 hours, muscles that you've worked very hard to build can begin to atrophy, or waste away! Veterinary Physical Rehabilitation specialists have the medical knowledge to safely exercise your dog and help them heal better and faster than they would have without therapy. Once your dog is recovered enough to return to work, if their physical conditioning has not been maintained, they will have to slowly ease back into their work or risk re-injury. If their physical fitness has been safely maintained during their recovery period, they will be able to return to work sooner and be less likely to suffer a subsequent injury. Limb Use is Reduced Limping means pain!  If there is lameness, limping, or changes in your dog’s gait or stance, your dog is in pain! Dogs will deliberately try to minimize use of a painful limb, so don’t ignore this crucial signal. In addition, when a dog minimizes use of one limb, that means they are transferring the load to the other 3 legs. At this point, the entire body becomes imbalanced and failure to resolve this imbalance promptly can result in even more pain and potentially additional injury. This imbalance may initially present as tension of the neck and back muscles as the body compensates. Long term imbalance will put excess wear and tear on the healthy limbs which can accelerate Osteoarthritis or Cranial Cruciate Ligament rupture . The sooner your Athlete’s lameness is diagnosed and treated, the less strain is put on the rest of the body. Pain is Not Well Managed No one can perform well while  in pain and sometimes prescription medications aren’t enough to control pain. There are many options for prescription pain relief and its not uncommon for some trial and error to be required to find the right medications for your pet. To learn more about commonly prescribed medications, side effects to watch for, our favorite supplements and how to pick quality products., visit our Pain Meds & Supplements article. Canine Rehab of OC’s Veterinary Medical Physical Rehabilitation specialists utilize therapies originating from human Physical Therapy that have been modified and clinically-proven to be effective and safe for dogs. Laser Therapy , Acupuncture, Electrostimulation, & Therapeutic Ultrasound may be helpful options. Physical Rehabilitation should only be provided by licensed and certified Veterinary Medical Physical Rehabilitation professionals, as some therapies can be dangerous if used inappropriately.  Chiropractics, in particular, are not recommended for use in animals. There are no peer-reviewed studies to support the safety or efficacy of Chiropractic and we frequently treat dogs that have suffered permanent injury as a result of Chiropractic treatments. If you are not convinced that Chiropractic is harmful and wish to pursue forceful spinal manipulations, we strongly recommend meeting with a Veterinary Neurologist first to confirm that your dog does not have any spinal abnormalities that could be made worse by applying force to their spine. Radiographs (x-rays) of the spine can help rule out conditions like Spondylosis or Intervertebral Disc Disease; both conditions that would be made significantly worse and more painful with the application of Chiropractic manipulations, potentially even resulting in temporary or permanent paralysis.  When looking for Rehab services for your athlete, look for providers with any of the following certifications: Certified Canine Rehabilitation Practitioner (CCRP) Certified Canine Rehabilitation Therapist (CCRT) Certified Companion Animal Rehabilitation Therapist (CCAT) Certified Canine Rehabilitation Veterinary Technician (CCRVT) Mobility is Compromised If your Canine Athlete is having difficulty getting around on their own, Physical Rehabilitation will be necessary to heal faster, get stronger, & restore mobility. Treating pain is always the top priority, but medication will not strengthen the body; only exercise will do this! Pending the severity of your dog’s condition, they may need to completely cease all work/sports activities and instead focus that energy on Rehab in hopes that they can recover enough to safely return to their sport of choice. The right exercise at the right time coupled with therapies to promote healing and reduce pain, will give your Canine Athlete the best chance of recovery. Canine Rehab OC offers custom Fitness Plans by appointment. If you are interested in a comprehensive exam, clinically-proven therapies, and prescribed exercises for your Canine Athlete, check out the New Patient  section of our website to learn how to get started. Want to learn more about how to support your Athlete? Canine Sports Medicine events are coming to Canine Rehab OC soon and we'd love to see you there! These events include demonstrations courtesy of Dogtor Wilbur and a 30+ page Canine Sports Medicine booklet for each attendee. If you are part of a local Dog Sports group and interested in setting up an event, reach out to us ! We love getting involved in the dog community and helping as many families as possible. This article is Part 3 of our 5 part Canine Sports Medicine series! Other articles include: Part 1: Peak Performance & Injury Prevention Part 2: Cross-Training Part 4: Nutrition for the Canine Athlete Part 5: Bad Dogs, Bad Medicine  (Effects of Behavior on Quality of Care)