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If your pet is unable to rise, stand, or walk, they are considered a recumbent patient or sometimes referred to as a “down dog”. If your dog can rise and stand but can’t walk, they’re considered non-ambulatory. Either way, caring for a dog that cannot move about on their own is a challenging endeavor which can be more difficult due to your dog’s size, temperament, and level of debilitation. Depending on their diagnosis, you may be responsible for some or all of your dog’s most basic bodily functions – eating, drinking, urinating/defecating, maintaining Range of Motion, minimizing muscle atrophy, preventing bed sores, and even providing mental stimulation. If your pet is expected to get better, these responsibilities may be temporary, but other conditions may require you to continue providing this level of support for the remainder of your pet’s life. While the information in this article is focused on recumbent pets, it can also be applied to veterinarian-directed crate rest, regardless of your pet’s mobility status. Conditions commonly in need of recumbent/non-ambulatory care include: Intervertebral Disc Disease (IVDD) Fibrocartilaginous Embolism (FCE) Acute Non-Compressive Nucleus Pulposus Extrusion (ANNPE) Degenerative Myelopathy (DM) Geriatric Onset Laryngeal Paralysis & Polyneuropathy Geriatric Sarcopenia Until your dog can resume independent mobility, you’ll need to make some adjustments at home in order to keep them safe, clean, and comfortable so we’re sharing all the best tips and tricks for creating a recovery pen for your dog with real life examples and options to fit your dog’s size and medical condition. Why Does Your Dog Need A Recovery Pen? The short answer is that it will help your dog recover faster, reduce risk of complications, and make it easier for you to properly care for them. The purpose of the recovery pen is to limit your pet’s activity, reduce overexcitement or stress, & provide a clean, comfortable environment that maximizes healing. If your dog is allowed to be more active than their condition allows, they are likely to re-injure themselves or otherwise worsen their condition. Similarly, if they don’t have enough room to move and stretch, they can quickly lose muscle mass and range of motion that are integral for any chance of recovery. If they cannot reposition themselves on their own, they are at risk for complications like decubital ulcers aka “bed sores” which can severely impact their health and ability to recover. If your dog is incontinent, you’re going to want to make cleaning up as fast and simple as possible to reduce the burden of care on you and reduce your dog’s risk of skin and urinary tract infections. Preventing free access to your home helps avoid serious safety hazards. Sometimes, other pets in the household can be a danger to your recumbent dog, whether it's an unintentional jostle or outright aggression. If your dog is recovering from a spinal injury, a fall down the stairs or even just traversing the furniture can mean the difference between permanent paralysis and successful recovery. If you have to clean up potty accidents all over the house, you are likely to develop compassion fatigue much more quickly, reducing your ability to effectively care for your pet, your family, and yourself. Influential Factors The reason for and severity of your dog’s loss of mobility will directly influence how you’ll need to prepare their recovery pen, as well as how that space might evolve in the coming days, weeks, or months. These questions will help guide you through the process: Is your dog expected to get better? Can they keep themselves upright, sit, or stand? Do they make any attempts to walk? Can they eat and drink on their own? Can they control when and where they urinate or defecate? How much supervision are you able to maintain? Does your dog respect boundaries like baby gates or pens? Keep your answers in mind as we delve into the details. Other influential factors to consider include your dog’s breed, age, body weight, if they’ve had surgery, and your physical capability to care for them. Early vs. Late Stages of Rest If your dog is expected to get better, your recovery pen will need to be modified as their abilities and needs change. The goal is to maximize safety and comfort while still providing enough space to encourage movement as appropriate. Early Rest is generally considered the period of time when your pet is the most delicate and/or debilitated. During this stage, the recovery pen will be small and require that you can move your pet in and out of it in a manner that is safe for you and your pet. Late Rest can vary pending your pet’s condition and your veterinarian’s recommendations, but this typically begins a few weeks after your pet’s initial injury or surgery. You should not switch to a late rest recovery pen until your veterinarian advises you to do so. During this stage, your pet is likely making more attempts to move and we want to encourage them to continue doing so while preventing potential complications from over activity. Recovery Pen Basics Your dog’s recovery pen will be their own little world for most of the time and they will use this space for eating, drinking, rest, and eventually, attempts at walking. Regardless of the stage of rest, your pet’s recovery pen should always: Rest on a flat, level surface Be in a temperature controlled space Be lined with easily cleaned materials that provide good traction & padding Have clean water available in a bowl that can’t be spilled Securely contain your recumbent pet while keeping other pets & small children out Be located in a spot that is neither too isolated, nor too overstimulating Include some element of privacy for your dog Be kept clean, dry, & free of pet waste Have a floor level entry so your pet doesn’t have to step over anything Allow you to easily get your pet in & out without twisting or pulling on their body Early Rest Pen NO walking space! Just large enough that your pet can lie fully stretched out, sit, stand, turn around, and eat/drink with ease but no larger. Late Rest Pen Slightly expand upon the Early Rest Pen to add a standing area just large enough for your pet to take 2-5 steps away from their bed, but no larger. While expandable pens work well for most pets, special considerations may need to be made for some pets. If your dog is an escape artist, you may need to utilize a crate instead of a pen and then use a larger crate once they have entered late stage rest. Giant breeds may benefit from a small recovery room instead of trying to squish them into a pen that is too small or short. Should that be the case, ensure that all furniture is removed and that the doorway can be securely closed or blocked off. Recovery rooms are only appropriate for dogs that are too large to use a pen & should still follow all of the rules for a typical recovery pen. Linings, Layers, & Linens When lining your pet’s recovery pen, it's a good idea to utilize multiple layers of varying materials, especially since many recumbent pets have some form of incontinence. All layers should be chosen with consideration for your pet’s comfort and safety, their stage of recovery, as well as ease of cleaning or replacement. Protective Layers This first layer is intended to prevent any damage to your floor and stop the pen from sliding around. Commonly used materials include plastic sheeting, rubber/yoga mats, and waterproof blankets. Absorbent Layers If there is any chance your dog will urinate, defecate, vomit, or spill water in their recovery pen, absorbent layers are a must. Options vary widely depending on budget and what is easiest for you to use. If you don’t mind frequent washing and drying, thick towels or blankets may work well for you. Alternatively, disposable potty pads make for quick and easy clean up, are available in a variety of sizes, and can be purchased in bulk. If your pet has trouble controlling their bowels or bladder, be prepared to change linings out multiple times a day regardless of what material you’ve chosen or if your pet is wearing a diaper. Early Rest Bedding Because early rest pens should only be wide enough for your pet to lie fully stretched out, the entire floor of the pen can be considered a bed and should be relatively level. Because early rest pens should only be wide enough for your pet to lie fully stretched out, the entire floor of the pen can be considered a bed and should be relatively level. At this stage, our primary goal is to ensure there is enough padding to support your pet’s body & protect them from injury if they roll over or stumble. At minimum, bedding should be 1-2 inches thick for every 40 lbs of body weight. Since there should be no room inside the pen for your pet to get off the bedding, you are free to make the bed as thick as is needed for comfort and safety. Additional padding around the edges of the pen is strongly recommended to keep your pet from getting stuck up against a wall. The easiest way to do this is to place rolled towels or crib bumpers around the inner perimeter of the pen. Similarly, rolled towels or bolster pillows can be placed directly against the body to prevent pets from rolling over or otherwise changing position. Insufficient padding can result in stiffness, soreness, facial injuries, & decubital ulcers (bed sores). In addition, pets that get stuck between their bed & the pen wall frequently panic & injure themselves. Late Rest Bedding & Walking Area Late rest patients still need a bed area that adequately cushions their body and is large enough for them to lay fully outstretched upon, but now that movement is encouraged, we’ll need to add room for them to walk around inside their pen. First and foremost, there should be minimal height difference between your pet’s bed & walking area. This is to ensure they can get on and off with ease and reduce risk of falling. Generally speaking, beds should be no more than 2 inches high for small dogs or 4 inches high for large dogs. For the walking area, you’ll need to provide a soft layer that provides good traction on top of the protective and absorbent layers. Avoid anything that wrinkles easily or slides. Common materials include terry towels, fleece blankets, low pile rugs with rubber backing, and yoga mats. Special Considerations for Linings & Bedding If your pet is frequently soiling their dog bed, it can be helpful to wrap the inner filling in plastic, then put the outer bed covering back on. It’ll be much easier to clean, especially if you have more than one cover for the bed. Even soft materials can still cause injury Be mindful that soft materials can still cause injury. Skin abrasions and excessively worn toenails can occur if your pet is dragging themselves across carpet or rough towels. Blankets and towels with holes can be a serious safety concern. It’s not uncommon for animal toes and nails to get stuck in those holes and as the pet tries to get free, that fabric can get twisted around the toe and cut off circulation. For this reason, it's best to avoid knit/crochet blankets and replace any towels or blankets that have torn. If your pet tends to chew up bedding, you will need to find alternative ways to provide adequate padding while preventing your pet from eating anything they shouldn’t. Sometimes, it’s enough to have the layers laid flat and extended beyond the walls of the bed so that there are no edges for your pet to grab. As long as your method is equally safe & comfortable, you’ve succeeded! It can take a little trial and error to find what works for you and your pet. You might try out different beds or layer materials in a different order than our examples. If you’re not sure about an alternative option, reach out to us or your veterinarian first. What else goes in the Recovery Pen? Food bowls can be removed as needed, but water should always be kept available. It’s best to secure all bowls by surrounding them with towels or using bowls that can be clipped to the side of the pen. Some pets benefit from having their bowls slightly elevated off the ground, but always ask your pet’s veterinarian or Rehab specialist before doing this to ensure it is appropriate for your pet and to confirm what height is safest. Regardless of the method you choose, just make sure it’s easy for your pet to access & that any spills are cleaned up quickly. While you might be inclined to include your pet’s favorite toys, take care with what you choose to add and when. Toys can bring your pet joy, but they can also be a tripping hazard or encourage more activity than is safe. If your pet has a delicate spinal condition, such as Intervertebral Disc Disease, no tug toys or vigorous toy shaking should be permitted. As with any pet, be mindful of leaving toys unattended with your pet. Life in the recovery pen can get boring, especially if you’re not around to keep your pet company. If there’s a risk your pet might eat their toy, only give it to them when you are available to supervise. Emotional Wellbeing Pets experience significant distress when their mobility is compromised and for some pets, this can be compounded by being confined. Fortunately, there’s a lot you can do to make the experience more pleasant for your dog and promote the relaxation and rest they need to heal. Start Positive Your dog is an emotional creature and looks to you for guidance on how to respond to new things. Seeing your furry best friend struggle with pain or lack of mobility can instill feelings of sadness and frustration for you, but we can’t overstate how important it is for you to keep your attitude positive when around your pet. When you introduce your pet to their recovery pen, make sure it’s a good experience! Use their favorite bed or blankets. If you can time the introduction to align with their next meal, have that waiting in the pen for them. Spend some time with them as they check out their new space and calmly use lots of praise to help them understand that this is a good thing. Visit with them often and don’t make a big show when you walk away from the pen. Just calmly go about your day so you don’t emphasize that you’re leaving. If your dog is particularly food motivated, it might be helpful to give them a little snack every time you put them back in the pen. Just make sure that you never reward anxious behavior (such as whining or barking) and always include those calories when measuring their food for the day as any excess body weight will drastically impact your pet’s ability to get back on their paws. If you’re not sure how much they can have, ask the CROC team or your primary veterinarian. Pen Location & Privacy The location of your pet’s recovery pen can have a huge impact. You don’t want to leave your pet feeling isolated from the family but you also don’t want them to get overly excited from too much going on around them. The goal is for your pet to rest, which requires a calm, peaceful environment that promotes as much sleep as possible. If your pet is the type to follow you around the house wanting to be involved in everything you’re doing, they’ll probably appreciate their pen being in the area where you and your family spend the most time. Some even appreciate having multiple pens around the house so that you can bring them along to whatever area you’ll be in. If your dog is more aloof or nervous, they might do better in a quieter part of the house where they don’t feel so overstimulated & exposed. Keeping the TV or music playing at low volume can help drown out any noise that might overexcite your pup, like the doorbell or other dogs barking nearby. If your pup is doorbell reactive, you may want to put up a “shhh, please don’t ring the doorbell” sign at your front door. Even if your pup is shy in nature, make sure to visit with them often so you can make sure they have everything they need and don’t feel completely alone. Dogs are social animals after all, even if some are more introverted than others! As den animals, most dogs appreciate some semblance of privacy. Covering part of the pen with a bed sheet or blanket can help them feel like they have a little den of their own to retreat to. Choosing a spot with a consistently comfortable temperature also goes a long way to helping your pet relax, so make sure to avoid drafty areas or places that warm up with a lot of direct sunlight. Mental Stimulation Since your pet can’t burn through pent up energy with exercise, this energy can manifest as anxiety and frustration. Keeping their brain busy not only helps release that excess energy, but it's also a significant contributor to cognitive & emotional health for all dogs. You can provide mental stimulation with new toys, games, food puzzles, and teaching or practicing tricks that require minimal movement. Delivering their meals to them in novel ways is a super easy way to do this and can be as simple as freezing it inside a kong toy, using a snuffle mat, or making them work through a food puzzle to get it. If the weather allows and your dog can remain calm, some dogs really appreciate some supervised time in a pen outside to get some fresh air and sunlight. Just make sure that the outdoor pen follows the same rules as the recovery pen and your pet is not left out in overly hot, cold, or wet weather. Questions? The CROC Team is always happy to help you with your pet’s recovery pen! Remember that every pet is different and it might take you a little bit to find the exact configuration that works best for you and your pet. The goal is to make sure your pet only moves as much as is safe and they are comfortable enough to rest so they can heal. Feel free to share pictures of your recovery pen so that we can provide more detailed recommendations.

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 & supplements is sourced from our many years of Veterinary Medical education & 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! It is important to monitor your dog for any signs of vomiting, diarrhea, or dark stools while on these medications. 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. 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 & 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. Librela 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 & 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. The company that makes a supplement is responsible for making sure their product is safe but they do not have to prove that it is effective. Supplements go to market without FDA oversight & cannot be removed from the market without the FDA proving that they are harmful. 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! Vitamins & supplements do not replace medical treatments or prescription drugs. It’s also important to keep in mind that supplements are intended to support health and wellness; not treat disease. 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 w/ Egg Shell Membrane Dasuquin (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, & frequently tests their products to confirm safety & 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 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 Myos 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), & 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 starting Librela, your dog should be thoroughly evaluated to rule out any neurological or autoimmune conditions as Librela can significantly worsen these conditions & 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 & efficacy. We will continue to monitor this drug & update recommendations as more information is made public. Because supplements are not regulated like medications are, it is necessary to research the company & make sure that you are purchasing a safe & effective product. Look for the NASC seal & efficacy studies! Always discuss new supplements with your Veterinarian before giving them to your dog. The more supplements & medications your pet is on, the more likely they are to experience an adverse reaction.

Librela 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, & maintenance of nerve tissues in the body. The dog’s pain stops when the nerves don't work & can no longer send pain signals to the brain. What Librela Can’t Do 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. It does not cure Osteoarthritis 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. 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 This includes 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/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: Knuckling Dragging paws Inability to walk Generalized weakness Inability to control bladder and/or bowels Stumbling 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 & 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 “Librela has accumulated 20 times more reports [of adverse effects] than the highest-ranking comparator drug (Rimadyl)”. 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. 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). 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. “RPOA is characterized by an accelerated deterioration of joint structures, leading to severe pain and functional impairment."³ 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 & 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 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. Studies have shown that NSAIDs are equally effective at treating osteoarthritis pain when compared to Librela. 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 & 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) & 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 Dogs with neurological or autoimmune conditions should never be given Librela. While Librela can be a very effective method of pain relief, it is not well studied & serious side effects are still being discovered. Studies show that well established drugs like Rimadyl or Metacam are equally effective at treating pain & 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 & safe exercise are still integral to your dog’s comfort & mobility. 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. Before starting Librela, your dog should be thoroughly evaluated & have comprehensive bloodwork & 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/

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, & 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 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. This is the most severe stage of MPL. 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 & it’s easy to miss how quickly the treats & 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 entire 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. If your dog has MPL, they are also more likely to develop a CCL injury. 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. 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 & 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 & 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, & 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 luxation 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. 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. 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. 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 & reduced range of motion is the most common post-operative complication that we treat. Muscle contracture is very painful & 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 & 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 young, 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 & 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 & 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 & medications might be appealing solutions, they will not resolve your pet’s condition & 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 & 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. The CROC Team is Here for You! 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. 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.

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, & 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 Reluctance to use stairs Thigh muscle atrophy Enlarged shoulder muscles Pain Difficulty rising, laying down, or sitting Radiographs (x-rays) are the easiest way to assess a dog for Hip Dysplasia, but proper positioning & 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 & 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 & 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) 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. If Hip Dysplasia is diagnosed at a very young age, this surgery can be performed to improve joint stability & reduce osteoarthritis formation for both hips at once. 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 functions 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 & side effects are still being discovered. Due to potentially severe side-effects, we recommend that your pet be thoroughly evaluated before starting Librela. Dogs with neurological conditions, auto-immune conditions, breeding dogs, or dogs that are skeletally immature should not be given Librela. A thorough evaluation 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. 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. 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. Generally speaking, your goal Body Condition Score for a dysplastic dog is a 4 out of 9, a little on the skinny side. 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 & 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 & helpful exercise for Hip Dysplasia dogs, however it commonly causes significant abuse to the elbows, shoulders, & 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. To learn more, check out our Medical Library article, The Deep Dive into Swimming. Swimming exercises typically do not help pets become better or stronger at walking outside of the water. 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 & 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, Pulsed Electromagnetic Field Therapy, Electrostimulation Therapy, 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 & 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 & 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- & post-operative Total Hip Replacement radiographs! We wish her well on her recovery journey! <3 the CROC Team

Therapeutic Laser is an immensely helpful tool to accelerate healing and relieve pain, but as it has become more popular, low quality devices have flooded the market. So how do you know if your dog is getting the real deal or just a flashing red light? Do any of these devices actually work? Read on to find out! How Does Therapeutic Laser Work? In order to distinguish snake oil from legitimate medical treatment, you’ll need a good understanding of what Laser Therapy does to the tissues it is applied to. Laser Therapy involves applying that focused light into the tissues to achieve Photobiomodulation (the alteration of cellular function). Laser stands for: Light Amplification of Stimulated Emission of Radiation When Photobiomodulation is achieved, healing is accelerated, circulation is improved, & inflammation is reduced, all of which decreases pain & stiffness. Pain relief from Laser Therapy may be dramatic & substantial, lasting for hours, days, or weeks. The primary effects of Photobiomodulation are increased circulation, the release of more oxygen from the bloodstream, and enhanced utilization of that oxygen to increase ATP production. Adenosine triphosphate (ATP) provides energy to drive and support living cells. Mitochondria are a likely site for the initial effects, leading to increased ATP production, modulation of reactive oxygen species, and induction of transcription factors. These effects lead to increased cell proliferation and migration, modulation of cytokines levels, growth factors and inflammatory mediators, and increased tissue oxygenation. Cell permeability is also enhanced/increased. In short, Photobiomodulation can help with tissue repair, most notably in patients with chronic pain and/or injury. Studies have also shown that Laser Therapy promotes accelerated nerve regeneration & improved functional recovery of peripheral nerves. What Does Laser Therapy Feel Like? Laser Therapy is commonly described as a very soothing, warm sensation. Since our lasers are Class IIIb devices, your pet’s skin will get warm during the treatment. Many patients feel a significant reduction in pain after the first treatment, but some patients need multiple treatments to start feeling the effects. Most owners report their pets are relaxed or even sleepy after laser therapy. The effect of Laser Therapy treatments is cumulative, so patients that get successive treatments will benefit more than a patient that only gets one treatment every once in a while. Classes of Laser Devices Before pursuing Laser Therapy for your dog, find out what class of Laser Device will be used. This is one of the easiest ways to confirm that your dog will be getting safe and effective treatment. The wavelength that the Laser Device emits determines its ability to penetrate and achieve photobiomodulation, but also the potential hazards of using a device. Class I & II These are considered safe for everyday use such as barcode scanners and laser printers and pose no more hazard than regular light. Because they are such low power devices, they would take an extremely long time to achieve Photobiomodulation, if they can even manage to penetrate deeply enough into the tissues, therefore they are not utilized for therapeutic purposes. Class IIIb Sometimes referred to as “Cold Laser” this is the best studied and most commonly utilized class. They can heat tissues and materials but are considered a low risk for burns. This class can cause eye injury and depending on the device’s power level, protective eyewear may be recommended. Because they are powerful enough to achieve Photobiomodulation while being a relatively safe device, they are the device of choice for human Physical Therapists and Veterinary Physical Rehabilitation Practitioners, including the CROC Team. Class IV This powerful class of lasers deliver treatment more quickly than lower classes, but they also have a much higher risk for injury and must be used with extreme care. Protective eyewear is required as any eye exposure will cause significant injury. In addition to therapeutic purposes, this class also includes surgical lasers used to cut soft tissues. Why Does the Class Matter? The power required to effectively penetrate the tissues can only be produced by Class IIIb & IV lasers, but these devices can only be purchased and utilized by licensed medical professionals because they can be hazardous when used incorrectly. Lasers that are available over the counter (typically Class I) are generally safe enough for someone without medical training to use, but this also means that they often do not provide any benefit as they are too weak to achieve Photobiomodulation. We have met with many pet families who were sold expensive over the counter lasers to use on their pets. By an overwhelming majority, their feedback was that they spent hours applying these devices to their pets but saw no improvements in their pet’s comfort or mobility. They have been extremely frustrated and their faith in Therapeutic Laser as a modality completely undermined. Unfortunately, this also means that many patients who would greatly benefit from a medical grade Therapeutic Laser never get that opportunity for pain relief and healing. Contraindications Because Therapeutic Laser alters and accelerates cellular function, it can be problematic in certain situations. Growing Animals If Therapeutic Laser is applied to a puppy’s growth plates, it can cause those cells to stop growing. The rest of the puppy’s growth plates will remain open and continue to grow like normal while the lasered growth plate closes prematurely, causing permanent skeletal deformity. Pre-Existing Cancer Cancer cells are cells that replicated incorrectly from normal cells, then continued to proliferate. Therapeutic Laser stimulates cellular function and increases blood flow to support those cells so if it is used on cancerous cells, it can encourage those cells to spread and proliferate more quickly. For this reason, any lumps or bumps on your pet should be examined before Laser Therapy commences. Pregnant Animals Pregnant animals are chock full of rapidly reproducing cells growing new life in their wombs, but those new cells are also extremely sensitive to the effects of laser. Risks include deformities or even miscarriage, and due to these risks, there are limited studies as to safety of Laser Therapy in pregnant animals, therefore it is avoided as much as possible. End of Life Care If a senior dog is suffering from pain that cannot be adequately controlled with medication, other modalities should be considered in conjunction with pain medication. During a dog’s senior years, it’s important to start prioritizing quality of life over length of life. These modalities include Thermotherapy, Massage, Stretching, Acupuncture, and Laser Therapy. If the dog in this example also has a history of cancer, Laser Therapy should only be pursued with the understanding that it can increase the risk of cancer returning or spreading and that choosing to move forward with Laser Therapy is choosing to address the pain the dog is definitely feeling now rather than worrying about the possibility of future cancer. These are tough decisions and should only be made after thorough discussion with your dog’s medical team. Key Takeaways Lasers that are safe enough for anyone to buy are not powerful enough to make any real impact on your pets comfort or mobility. Class IIIb & IV Therapeutic Lasers used by licensed medical professionals to achieve Photobiomodulation offer significant healing & pain relief effects. If Laser Therapy has been recommended for your pet, be sure to ask what class of device will be used to ensure your pet receives effective treatment. Pets that receive Laser Therapy on a regular basis will benefit more than pets that only get Laser Therapy occasionally. Laser Therapy should not be used on pregnant animals, animals with open growth plates, or those with a history of cancer or untested masses. In special circumstances, such as end of life care, Laser Therapy is a viable & effective pain relief option as long as it is understood that it may increase risk of cancer returning or spreading. Questions? If you have any questions about Laser Therapy or any other aspect of Physical Rehabilitation Therapy, you are welcome to reach out to the CROC Team. We are happy to share our knowledge and help you to make educated decisions for your pet’s medical care.

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. Don't have time to read the entire article? Watch our CCL Summary Video: 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, like the dog pictured right, 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, & Mastiffs are predisposed, but any dog can be affected. Anecdotally, CROC has seen a high incidence of CCL disease in Labradoodles, Goldendoodles, & 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. 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. 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. This pictured healing surgery site may look okay, but a major infection was brewing beneath! 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. Walks are typically restricted to slow & short outings, but can be increased each week as your surgeon recommends. Your surgeon may provide instructions for low-impact exercises as your pet heals. This may include Passive Range of Motion or standing exercises. 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. Muscle atrophy & 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. Pictured on the right, this dog's right leg is adequately muscled, but their left leg is severely atrophied. 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. Medications & Supplements We'll briefly touch on the most common options below, but for more detailed information, make sure to visit our article Pain Meds & Supplements. Dasuquin Advanced with MSM is an excellent daily joint supplement that includes Chondroitin, Glucosamine, and other ingredients to support joint health. Fish Oil added to your pet’s meals is another easy addition to help keep joints happy (and it helps their coat too!). Myos Canine Muscle Formula is a natural bioactive supplement made from fertilized egg yolk credited with improving muscle health, helping to reduce muscle loss (atrophy) and helping regain muscle after surgery or with other disease processes. Adequan (Polysulfated glycosaminoglycan) is a series of injections that stimulates cartilage healing, slows the progression of osteoarthritis, and decreases pain and inflammation. For larger dogs, this can be a costly investment to get started, but we have seen significant improvement for many dogs using this medication. Rimadyl (carprofen), Metacam (meloxicam), Deramaxx (deracoxib), and their generics are Non-Steroidal Anti-inflammatory Drugs (NSAIDs) that can be extremely helpful for managing pain and inflammation. 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! Galliprant (grapiprant) is a newer type of NSAID that is reported to have fewer effects on liver, kidneys, and GI tract and can be safely used alongside a wider selection of other medications. Neurontin (gabapentin) is a medication primarily used to treat nerve pain, though it can also help with anxiety. Drowsiness is common at first, but most pets return to their normal energy level after some time. Besides sedation, other side effects are extremely rare. Tramadol is a synthetic opioid that has been commonly used to treat moderate to severe pain in dogs but newer studies show that it may be less effective than previously thought. Librela (bedinvetmab) is a once monthly injectable medication that targets Nerve Growth Factor which helps reduce pain caused by Osteoarthritis. 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. Side-effects & adverse reactions from Librela are still being discovered. In the short time it has been on the market, there have been significant reports of neurological and autoimmune complications with this drug, only some of which appear to be reversible. The CROC Team has seen many of these cases first hand so we strongly urge you to learn about the potential risks, explore alternatives, and have your pet thoroughly evaluated before beginning this medication. We've compiled more information, including recent peer-reviewed studies, in our article A Look at Librela. What About Rehab? Remember that Rehab can't fix a CCL rupture, but initiating Rehab after surgery can improve recovery by addressing muscle atrophy, increasing range of motion, promoting healing, & 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. Because every case is different, recommended commencement of therapy can range from 2-8 weeks after 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. Recovery takes more than just the “feel good” treatments. Your dog’s comfort & mobility 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 & 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 & 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 to keep your pet comfortable & active is to maintain a lean body weight & 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 & 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. To Summarize CCL ruptures are painful & 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 & a certified veterinary rehab specialist is likely to give your dog the best results. While braces & medications might be appealing solutions, they will not resolve your pet’s condition & could potentially make it worse. With surgery & 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. Still Have Questions? Our team of licensed veterinary professionals at Canine Rehab of Orange County is happy to consult with you and help find the best options for you and your dog. CCL injuries are among the most common conditions that we see! 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.

This isn't just for athletes. While this article was originally written in the context of working & sporting dogs, it applies to all dogs & we hope that it can help every dog to have a better experience & higher quality medical care. Visits to the vet can be stressful but they don’t have to be! Couple this with the stress and anxiety you are feeling during the entire process and we now have the perfect storm brewing. Sadly, this scenario is very common amongst all dogs, but as highly trained, intelligent, and powerful animals, Canine Athletes have the potential to make this situation particularly dangerous for all involved. When dogs have not been socialized with strangers, conditioned to relax in new environments, or taught to allow touching of their body, we’re going to have a bad time at the vet. What Constitutes a “Bad Dog”? Growling Barking, whining, or howling Biting Jumping Leash chewing Reactivity towards other animals Inability to rest quietly in a kennel Inability to sit, lay down, or stay on command Refusing to be leash walked by a person other than their owner Refusing to be touched by a person other than their owner Refusing to be picked up by a person other than their owner How These Behaviors Affect Vet Visits Things get complicated. When a patient comes in that is growling, lunging, barking, or trying to bite at the veterinary staff, the veterinary team is now tasked with giving that dog the best exam, diagnostics, & treatment possible while making sure that they, the client, & the patient don’t get hurt. That’s a lot of pressure! An injured veterinary professional means many patients not getting the care they need or potentially the end of that veterinary professional’s career. All veterinary professionals are dedicated to the health and safety of their patients and clients, so if a client or patient has been injured on their watch, it is devastating for all involved. Hayden (pictured left) is being such a good boy, calmly allowing us to closely inspect his paw. If the veterinary team cannot safely approach or touch a dog without risking bodily injury, how are they supposed to provide good medical care? Examples include: If the veterinary team cannot touch your dog’s face, they cannot examine or treat your dog’s ears, eyes, nose, or teeth. If your dog cannot lay down and stay on command, performing radiographs will be significantly more difficult and potentially dangerous. If your dog is flailing or trying to bite, the radiographs may need to be reshot in order to get a diagnostic image, thus exposing your dog and the technicians to additional radiation. If your dog bites when its feet are touched, how will a veterinary team help them with a broken nail or avulsed paw pad? If your dog will not cooperate for a blood draw, the results of that bloodwork may be inaccurate due to poor sample quality or stress-related changes in the body. Dogs who can calmly and comfortably participate in their vet visit will get a more detailed examination, receive higher quality treatment, and heal better than a dog that cannot. When a dog cannot be handled safely, their exam and treatment is often rushed and/or shortened, skipping over things that have to be assumed to be okay and focusing only on the primary reason for the visit. For the Canine Athlete, this could mean that a career-ending condition isn’t diagnosed until it’s too late! It should be noted that friendly but overly excited dogs can also experience barriers to care. If they can't sit still long enough for examination and treatment, their quality of care will suffer the same limitations as a dog that bites. How Do These Behaviors Affect CROC Visits? When it comes to your Canine Athlete’s visit with the CROC Team, the ability to run our hands over all areas of the body is integral to maximizing their evaluation & follow-up sessions. Palpation is the most effective examination tool we have as professionals, especially for dogs with thick coats. We are frequently feeling all over every patient’s body to assess for any subtle changes because reduced range of motion, swelling, or muscle atrophy can be identified before a patient shows any obvious limping or pain. Please note: Limping IS a sign of pain! Do not ignore this crucial signal that your dog needs help! If a patient will not allow us to palpate a relaxed muscle, that will significantly reduce our ability to evaluate and treat that patient. In our earlier article, Canine Sports Medicine Part 1: Peak Performance & Injury Prevention, we discuss how vital massage and stretching is to restore lost range of motion and alleviate pain. If your dog is unhandleable or cannot relax and allow gentle touching, they are limiting the healing benefits of our touch. Bad behavior isn't limited to biting. This cutie pie (pictured right) is singing the song of his people while we're trying to treat his pain. His inability to calmly receive treatment ultimately reduces how much benefit he gets out of therapy. The CROC Team works with some of the most conditioned and capable Canine Athletes around and it is because those patients are happy to cooperate with us. Without their voluntary participation, our efforts to repair and recondition an injured working or sporting dog is severely inhibited. Make Vet Visits Easy Beginning as early in life as possible, your dog needs to be taught to tolerate handling & be comfortable around new people & situations. Anyone should be able to touch any part of your dog’s body, especially their mouth, eyes, ears, & paws. Practicing nail trims early on will make it easier to maintain your dog’s feet and help prevent torn or broken nails. Teach your dog to walk on a leash, sit, lay down, and stay regardless of who is handling them. You should be able to hand over the leash to a new person and know that your dog’s behavior will remain consistent. Train your dog to calmly ignore other dogs walking by rather than getting excited or aggressive. Even if you do not plan to use a crate at home, crate training is still super important! Your dog is likely to find themselves in a kennel at some point in their lives, so conditioning for this situation at a young age means it won’t be a big deal later. Vet visit stress can begin as soon as you get in the car, so practice loading your dog in the car, making sure that it’s a positive experience and that they go on car rides to go to many places, not just vet visits. Crates can be particularly helpful here since they give your dog their own comfy place to be in while preventing them from jumping all over the car or potentially interfering with your driving. Using a crate in the car can even save a dog’s life in the event of a car accident! If your dog gets car sick, ask your veterinarian about medications to help prevent nausea. If your dog only goes to the vet for vaccines, they learn that they get poked by needles every time they go there. Many veterinary hospitals are embracing “fear-free” techniques and suggest “happy visits”, where your dog visits the clinic to get a treat and some snuggles, then goes home. This exposure to the veterinary clinic and the people in it helps your dog remain calm and comfortable when visiting the clinic. Reina (pictured left) might look like a scary Malinois, but she's an excellent patient, allowing us to do whatever we need to help her as long as she also gets snuggles. If there is a special treat that your dog loves, try to reserve it specifically for important situations like vet visits so that you can provide extra motivation to be on their best behavior. Helping Adult Dogs with Fear Aggression & Anxiety It can be more difficult for adult dogs to create positive associations with vet visits, but it’s not impossible and there are other tools to make things safer for everyone. Anxiety or Sedation Medication You should still be working on calm, cooperative behavior and socializing regardless of your dog’s age, but anti-anxiety or sedating medications can make a world of difference for fearful or aggressive dogs. It can take some trial and error to find the right medication(s) and administration methods, but once you do, these medications can help reduce those feelings of fear and stress, thus resulting in a better, more willing patient that can be examined more closely and ultimately culminating in higher quality care. Some dogs do best with medications that start the day before a vet visit, while others benefit from injectable sedatives immediately upon arrival at the clinic. Oral medications are generally preferred over injectables so that the patient can be aware of their experience without feeling so afraid and because it can be risky to give injectable sedatives to a patient with an unknown medical status. Muzzle Training For safety reasons, muzzles are often required but trying to put a muzzle on a dog that wants to bite you is dangerous. That dog is also likely to be terrified, further reinforcing the idea that going to the vet is bad. But don’t let the negative stigma dissuade you! When introduced correctly, a muzzle can be a huge asset and make calmer, safer interactions possible. Pictured left, Nemo's muzzle allowed us to start treatment and once he learned that we're there to help him feel better and NOT to hurt him, he was much more tolerant of therapy! There are many types of muzzles so you will need to research which type and size would be best for your dog, with a wider variety of options available online than in your typical pet store. Many muzzles, if correctly fitted, allow the dog to pant and drink water while wearing them. The key to success is to train your dog to willingly wear the muzzle by creating a positive association & having them wear it in non-stressful situations. It’s often easiest to start by feeding high reward treats from within the muzzle (as if the muzzle was a cup) and slowly working towards putting the muzzle over the nose for a few seconds followed by a treat, and eventually getting to the point where your dog will wear the muzzle just as comfortably as a collar or harness. Once your dog is comfortable wearing the muzzle during their usual day to day activities, you can also put it on them before even stepping foot into the veterinary clinic, making the entire visit safer and more comfortable for everyone. Set Your Dog Up for Success! Being a tough, strong, impressive specimen of athleticism does not mean that your Canine Athlete should be a scared, reactive, or angry dog. Canine Athletes have so much time and effort invested in them to perform at their best, it behooves you both to ensure that they get the very best medical care possible so that they can continue their work or sport. Failure to thoroughly train & socialize your dog will negatively impact the quality of their medical care & life experiences for you both. Canine Rehab OC offers custom Fitness Plans by appointment. Have Your Athlete Evaluated 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. Looking For More? 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 5 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 4: Nutrition for the Canine Athlete

We understand 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. 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! 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 can cause inappetence, weakness - even seizures. Too much can cause increased thirst & 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. Click Below to Learn More 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 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. These diets were heavily marketed by boutique food manufacturers that lacked food laboratory feeding trials & research. 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 & 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 Early Signs of GDV Include: drooling retching without producing anything stretching 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 & spleen & 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 & at a certain point, surgery will be required for survival. GDV patients often go into shock & will need extensive care to stabilize them as they go into emergency surgery & 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 & senior males are at the highest risk. Risk increases if your dog is deep chested, fed once daily, or 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. Have Your Athlete Evaluated 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. Looking For More? 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 & 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. Check out our other 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. Cranial Cruciate Ligament (CCL) rupture is the most common injury in both pet & sporting dogs. 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 This injury 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. Mild shoulder lameness is usually the first sign, followed by pain on extension of the shoulder joint. MSI is common in water sports, like swimming & dock diving, as well as frequent jumping down or even poor landings in fly sports. Biceps Tendinopathy 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 & 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 & 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, & dogs that live exclusively on hard surfaces like tile & 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 & focus on building strength in the forearms & 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. 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. Tennis Ball Mouth 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. 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 & 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 & 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 & 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. 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. Qualifications to Look For 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) Canine Rehab OC offers custom Fitness Plans by appointment. Have Your Athlete Evaluated 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. Looking For More? 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)