CROC commonly treats IVDD patients in an attempt to restore as much normal bodily function as possible. Patients can present at a variety of stages in their disease progression, from experiencing slight back pain to complete paralysis. While no one can guarantee that your pet will regain 100% normal function, there’s plenty to be done to give them the very best chance of doing so. We’ll go over IVDD in depth so that you know exactly what to expect with your dog’s rehab journey from here on out. What is Intervertebral Disc Disease? While the spinal cord is mostly encased within the vertebrae, it is exposed in the Intervertebral Spaces and sits just above the Intervertebral Discs. This is why the spine is so flexible in so many different directions. Between each vertebra of the spinal column, there is a disc of semi-squishy material that helps absorb the impact of an animal’s daily life. The Intervertebral Disc is composed of a jelly-like inner material with a more rigid outer layer. With IVDD, this rigid outer layer of the disc starts to weaken and break down prematurely. Eventually, the outer layer breaks down enough that the disc ruptures and the jelly-like material herniates outside the rigid outer layer up, towards the Spinal Cord. This herniated material puts pressure on the spinal cord, restricting blood flow and damaging nerves. When the spinal cord is damaged, it can't transmit signals between the brain and body. In the best-case scenario, this results in mild to moderate neck or back pain and the dog can heal with strict cage rest and pain medications. In the worst-case scenario, this pressure causes pain AND blocks neurological signals traveling back and forth between the brain and the lower body, often causing partial or complete paralysis of the hind legs. Complete or partial loss of bladder and bowel control usually comes along with the paralysis/paraparesis. For the remainder of this article, we’ll be addressing the worst-case scenario since most of it still applies to best-care scenario as well. We describe the spinal cord as an unforgiving tissue, meaning that it does not tolerate or bounce back from injury very well and frequently requires quick (often expensive) diagnostics, treatments, or surgeries to have any chance of recovery. Failure to relieve significant pressure from the spinal cord in a timely manner will almost always result in permanent paralysis or paresis. Some patients with less severe disc herniation can recover to some degree without surgery, but there is no way to predict if your dog will recover without surgery. We do know that surgery increases chances that your dog will recover, but there are no promises there either. Who is at Risk for IVDD? Chondrodystrophic breeds (dogs with long bodies and short legs) like Dachshunds, Corgis, Shih Tzu, Basset Hounds, Cocker Spaniels, Pekingese, and mixtures of those breeds are at highest risk for developing IVDD. Anecdotally, CROC sees a significantly higher number of Dachshunds and French Bulldogs presenting with IVDD than any other breeds. Breed predisposition combined with body condition and lifestyle will determine risk factor for an individual dog. Diagnosing Intervertebral Disc Disease Many dog owners are not aware of IVDD until their dog suddenly can’t move their back legs. It is a common misconception that the paralysis is from an acute injury like a fall, rough play, or jumping down from furniture. In reality, the Intervertebral Disc had been degenerating for some time and then finally ruptured due to the extra stress on the disc from whatever activity the dog was engaged in. For the best chance at recovery, your dog should be seen by a Board-Certified Veterinary Neurologist as soon as possible. While radiographs (X-Rays) are helpful to rule out any fractures, identify narrowing disc spaces, and sometimes detect calcifications of the discs, these things frequently fail to correlate with the true location of the herniated disc. Therefore, radiographs are not sufficient to diagnose IVDD or Disc Herniation and Spinal Cord Impingement. Myelography, injecting a contrast agent and then performing radiographs, can provide more information but comes with significant risks that often outweigh the reward. Myelography and Computed Tomography (CT) have historically been used together to diagnose IVDD but have fallen by the wayside since they are not as effective as MRI. Magnetic Resonance Imaging (MRI) is the Gold Standard for diagnosing IVDD as it allows for detailed imaging of all soft tissue structures. While IVDD can go undetected with Myelography or CT, MRI has a diagnostic accuracy of 98-100%. Treating IVDD IVDD is staged according to its severity and while the earlier stages can recover without surgery, later stages have much lower rates of success. Surgical correction by a Board-Certified Veterinary Neurologist is considered Gold Standard treatment for IVDD , the goal being to relieve the pressure from the spinal cord as quickly as possible. There are several surgical options from which to choose from, but your Veterinary Neurologist should advise you as to the best option for your dog. This can be where things get challenging for pet parents. At this point, you’ve gone through the stress and expense of rushing your suddenly paralyzed pet to a specialist for an expensive MRI, but you’re not done yet. Unfortunately, surgery can’t be postponed. The sooner your dog gets surgery, and therefore gets that pressure relieved from their spinal cord, the better their chances of being able to walk again. Yet another aspect that can be difficult to swallow – even with timely surgery, there is no way to guarantee that your pet will regain the ability to walk or how long it will take. After surgery, your pet will likely need to be under strict cage rest for the first part of recovery and may be on multiple pain medications. Many IVDD patients are urine and fecal incontinent, meaning they will need to wear diapers to control the resultant mess. Some patients need to have their bladder manually expressed as they no longer have the ability to empty it themselves and it will continue to fill. If that’s the case with your pet, your Veterinary Neurology team should teach you how to safely do this at home. A regular schedule for bladder expressions is important to avoid infections or damage to the kidneys. As soon as your veterinarian deems it safe, starting Physical Rehabilitation Therapy as soon as possible will significantly increase your dog’s chances of walking. It’s important to note that your dog’s recovery will require a significant commitment of your time and energy. CROC will guide you through all the steps, stages, and details of this recovery but it will be up to you to follow through with the Prescribed Homecare between Rehab Sessions. Recovery from paralysis and spinal surgery requires patience and consistent participation for at least 6 months minimum. What Does Rehab for IVDD Look Like? The maximum healing of neurological tissue takes place over approximately 6 months. This means that we have 6 months from surgery to Rehab your pet to their maximum physical ability. Some pets will regain independent mobility before then, but it’s important to stick with the 6-month plan, as many pets quickly lose ground if they stop Rehab too early in the recovery process. Success of Rehab does depend on your pet’s condition at the time they start Rehab. Pet’s that don’t have any movement or feeling in their back legs will be at a greater disadvantage than those that are just weak and uncoordinated. IVDD patients begin their Rehab journey with target exercises intended to kickstart neurological activity. The nerves must be firing to be able to tell the muscles what to do. CROC often uses Electrostimulation Therapy (E-Stim) to help with this process. E-Stim uses low doses of electricity to stimulate nervous function but it doesn’t hurt. It can feel strange, like a tickle or in the best case, a big muscle twitch! Please note that E-Stim therapy requires us to shave small patches of your pet’s fur to allow electrical conduction through the tissues. We’ll also start simulating the body’s normal movement to help your pet “remember” what that feels like and to work on maintaining good Range of Motion in all the limbs. Once we start to see any sort of muscle contractions in the hind legs, we’ll step up our exercises to get that muscle moving as much as possible, while also stimulating more nerves and muscles to join in. We’ll practice weight bearing, essentially re-teaching your pet how to stand on their own. Many exercises for IVDD patients are focused on improving proprioception or knowing where your body is in space. Because of the damage to the spinal cord, IVDD patients often can’t feel their environment and have no sensations to tell them where their legs and feet are. This is important because if we can get your dog to the point of consciously controlled leg movement, they have to know where to move their legs in order to stand and eventually walk. This initial stage of rehab is frequently the hardest for pet parents. It can be discouraging to be a few weeks into Rehab without seeing obvious improvement. Meanwhile, us Rehabbers are getting super excited over the tiniest little muscle twitch or spontaneous kick or even a few seconds of weight bearing. We’re excited about these seemingly insignificant improvements because they are big indicators for what your pet will eventually be capable of, so hang in there! Hydrotherapy can be an exciting phase of their recovery. The buoyancy of the water allows for more movement with less effort, so we often see legs moving in the underwater treadmill before we see it on land. The underwater treadmill also allows them to feel the ground beneath them, so that continues to stimulate nervous function. Because they are walking in the water, instead of swimming in it, exercise in the Underwater Treadmill is low-impact, high resistance with slower, more controlled movements. Through their recovery process, CROC continues to challenge your pet with a variety of exercises while also treating any pain that your pet experiences. Thermotherapy and Therapeutic Massage help to relieve tense muscles and increase blood flow. Therapeutic Laser Therapy not only helps increase circulation to the tissues, but it also encourages healing at a cellular level. Veterinary Medical Acupuncture stimulates the nervous system while also releasing endorphins which helps with pain relief. What about Acute Non-Compressive Nucleus Pulposus Extrusion (ANNPE)? ANNPE is a form of IVDD that occurs as a result of excessive force or trauma such as intense exercise or a significant fall. That trauma tears the outer layer of the intervertebral disc, causing the inner gel-like substance to shoot out at high velocity and hit the spinal cord, essentially bruising the spinal cord. This is very painful! ANNPE typically occurs in young to middle-aged dogs and can happen with any breed. MRI is necessary to confirm ANNPE but it can be treated based on suspicion formed from medical history and exam findings. When presenting to your veterinarian, it is common for NSAIDs to be prescribed and ice packs should be applied to your pet's back right away. Activity at home should be restricted for 4-6 weeks, but Physical Rehabilitation with prescribed exercises should begin promptly, about 2 weeks after the incident. The sooner Rehab is started, the better chance your dog has at maximum recovery because like all IVDD cases, there is a 6 month window during which the greatest healing occurs. Between 6 and 12 months post-incident, some recovery can be possible, but minimal in comparison to the first 6 months. The mildest cases of ANNPE can sometimes recover after just 2 weeks of exercise restriction. The Rehab Treatment Plan for ANNPE is nearly identical to other IVDD cases. Safety for IVDD Patients Changing Habits:  While your dog may have had surgical correction, that doesn’t mean that they won’t rupture another disc in another part of their spine. At home, some simple changes can make all the difference to protect your dog’s spine. Remember that IVDD is a chronic disease; it never goes away. Many IVDD dogs regularly sprint across their home, launching themselves on and off furniture with delight. Unfortunately, that’s also one of the number one ways they herniate a disc! Jumping on and off furniture or running down the stairs, even jumping out of the car is extremely risky for IVDD patients, so we strongly encourage you to stop your pup from engaging in those activities. Rough play with housemates or any sort of acrobatic activities puts them in great danger, so great care must be taken in multi-pet households. Swimming: Sadly, swimming is NEVER appropriate for IVDD patients. There is a video viewable in our article, The Deep Dive into Swimming , that provides a visual 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. Swimming also puts immense strain and twisting movements on the spine which is probably one of the worst things for a patient that just had a spinal injury/surgery. Regarding Chiropractic... We know this is a soft spot and that many people enjoy chiropractic for themselves. Human Chiropractic has been practiced since the late 19th Century but is still in contention regarding its efficacy today. In Veterinary Medicine, Chiropractic is a very controversial and divisive topic. We do not want to shame anyone for previous choices made with the intention of helping their pet. We do feel compelled as thoroughly educated Veterinary Medical Professionals to share our perspective. At CROC, we have treated multiple patients that were receiving chiropractic care and were in significant pain when they came to us, which resolved when chiropractic sessions stopped while proper Physical Rehabilitation Therapy continued. A good percentage of CROC patients arrive here after being referred by their veterinarian. Because of this, we have developed very close relationships with the local Neurological and Orthopedic Veterinary Specialists. CROC does not offer Chiropractic services because not a single one of these Board-Certified Specialists will support or recommend Chiropractic therapy for IVDD patients.  Even when consulting with Boarded Neurologists outside of Orange County, we have yet to find one that would approve of their spinal patients undergoing Chiropractic treatments. At this time, there are no Peer-Reviewed studies to substantiate claims that Chiropractic is an appropriate (or even safe) treatment for Veterinary patients. In addition, the American Veterinary Medical Association, America’s leader in advancing the science and practice of veterinary medicine to improve animal and human health, has not published any policies supporting Chiropractic. Reviewing Chiropractic on a basic level - Chiropractic treatment involves applying jarring and intense force on the body, which is also one of the worst things for a patient that has spinal instability or just had spinal surgery. Your dog’s spine is particularly fragile and the force of Chiropractic can push your dog even closer to rupturing another disc. This is the normal healthy spine of a young dog. Notice that the vertebrae and the spaces between them are very well defined This is a senior dog with severe Spondylosis Deformans (spinal osteoarthritis). As intervertebral disks degrade, the spine starts to move abnormally and osteophytes (bone spurs) will form in an attempt to stabilize each joint. Eventually, osteophytes can become so severe that they bridge between each vertebrae. At this point, we have a spine that is poorly cushioned by degraded intervertebral disks and surrounded by extra bone. Bone rubbing on bone and nerve impingement become chronic sources of pain and stiffness. Pain and stiffness are common reasons that pet owners will pursue Chiropractic for their pet. Could you imagine applying jarring and intense force on a spine like this?!?! OUCH!!! If your dog is experiencing enough pain that you are exploring other treatments like Chiropractic, please check in with us or your regular veterinarian first. There are certainly better and safer options for pain relief available. The End Goal Ultimately, our goal is to try to get your pet as independently mobile as possible. We hope that your pet can regain the ability to walk or even run and regain control of their bowels and bladder. This isn’t possible for every patient and the ones that do… well, sometimes they learn how to do it in a different way than pet parents might have expected. Not all patients can regain conscious movement of their legs but instead learn something called a “spinal walk”. Spinal Walking is when a dog still doesn’t have sensation or proprioception in their back legs, but they develop a reflexive walk. Since the signals aren’t getting through the spinal cord to the brain (and vice versa), they are instead relying on more basic reflex signals to get their legs moving enough for them to be able to walk. This reflexive walk isn’t always pretty but it is functional. If we’re given the choice between paralysis and a goofy looking walk, we’ll take goofy any day of the week. What If They Still Can’t Walk? At CROC, we always want to give IVDD patients the full 6 months of treatment before throwing in the towel. If we’ve reached the 6-month mark and still haven’t seen significant improvement, that’s when we start looking at a Rear-Wheeled Cart, sometimes referred to as a Doggie Wheelchair. It’s important not to jump into using a cart too soon as once your dog starts getting around without using their back legs, that pretty much seals the deal that they never will. For more information regarding Rear Wheel Carts and what the process for getting one looks like, be sure to check out our in-depth articles, The Wheel Deal: Let's Talk About Carts and The Wheel Deal Part 2: You Got the Cart; Now What? Tools To Make Your Lives Easier We'll go over some basics for Recumbent Care here, but for a more detailed break down, visit our article Caring for the Recumbent Dog . We've also collected links and examples of the following tools on our Gear & Resources page. While your pet is re-learning to walk, they will frequently drag their hind legs, so it is key to protect their paws from the scuffing and abrasions that will happen. Plenty of dog booties are readily available for purchase, but our favorite is a rubber variety called Pawz. We like these best because they protect the paw while still allowing your pet to feel the textures of the ground and providing extra grip. With any dog booties, care should be given to appropriately size your pet’s paws and to only leave them on when your dog is on a surface that is harmful to their skin to rub on. Booties left on for too long can cause skin infections, reduced circulation, or worst case – be chewed off and eaten! Home modifications like adding rugs and ramps are quick and easy ways to help your dog get around the house more easily. Rugs and yoga mats make it easier for your dog to grip the floor, reducing their risk of falling. The softer surfaces also make abrasion wounds on their paws less likely, although rug burn is certainly a possibility for some dogs. Ramps can make obstacles like stairs less challenging, although care should still be taken to monitor your pet while using these. A good harness is a must! Your dog will depend on you for assistance, so your choice of harness makes all the difference in comfort for both you and your dog. Our favorite harness for IVDD dogs is called the Help ‘Em Up Harness. It was created to help owners better assist their dogs without hurting their own backs in the process. It comes in two pieces, one to go around the chest and one to go under and around the pelvis. In the early stages, your pet will need the back half, but as their coordination and strength improves, the back half of the harness will become less necessary. It is comfortable enough that your pet can wear it for extended periods, and it is more ergonomic for you and your dog than just lifting them or using a sling. If you are interested in purchasing this harness for your dog, be sure to speak to us as sizing and fitting your dog can be trickier than it might appear. Please note that this harness still needs to be removed each day and kept clean to prevent any abrasions or skin infections. You can learn more about this harness at The Help 'Em Up Harness. If your dog doesn’t have complete control of their bladder and bowels, diapers and belly bands become good options to help keep your dog and your home clean. Some dogs lose urinary control before fecal, so in those cases, belly bands are a nice alternative for male dogs over a full diaper. Just as with humans, good hygiene when using diapers and belly bands is a must! Dogs left in dirty diapers for too long are at risk for urinary tract infections and skin infections. It’s also important to note that dogs instinctively want to avoid their waste, so being stuck in it is not great for their mental health. Disposable and washable options are readily available for purchase online or at major pet stores. Just like us, dogs certainly benefit from a quality bed. Orthopedic Memory Foam beds are ideal. Your dog’s bed should be at least 1 & 1⁄2 times as long as your dog and at least 1-2 inches of thickness for every 40 pounds of body weight. Encourage your dog to change position regularly, such as switching which side of their body they lay on. Laying in one position for extended periods of time can lead to significant stiffness and possibly pain once they go to get up. Is There Anything Else? One of the best things you can do for your IVDD dog is keep them lean! We generally recommend a Body Condition Score (BCS) of about 4 out of 9. The less weight there is for them to haul around, the easier it will be to start lifting and moving their own body. Many IVDD dogs are also old enough to have developed arthritis, so all the more reason to reduce any extra work on their joints. For more information on the BCS and Weight Management, read our online article Body Condition Score & Canine Weight Loss. Some dogs will need medication to control their pain. CROC works closely with you to make sure your dog is on the right pain control regimen. Joint supplements are also helpful to support their joints as the front of their body takes on the extra load, compensating for the weaker back end. A supplement for muscle growth/maintenance called Myos Canine Muscle Formula may be helpful for the IVDD dog and is available online. To learn more, visit our Pain Meds & Supplements article. We cover commonly prescribed medications, side effects to watch for, and how to pick quality supplements. CROC strongly discourages the use of marijuana products for IVDD patients. While emerging research shows some promise for marijuana products in veterinary medicine, there is much more to be done and IVDD patients are already weak and have limited coordination, making them poor candidates for this treatment. Quality of Life We touch on this subject for your sake as well as your dog’s. Compassion fatigue is a prevalent concern for clients caring for IVDD dogs. The hope is that as your dog progresses through rehab, the amount of effort you will need to put into their care will decrease. For dogs whose paralysis is more advanced or who don’t have control of their bowels and bladder, the strain on you to keep them clean and safe, as well as the physical strain of carrying them around, is enough to wear down even the most dedicated owners. We bring this up because we want you to know that we are available to you as you navigate your pet’s condition. We frequently support our clients through the big decisions and help them to find the plan that works best for them while keeping quality of life as high as reasonably possible for all involved. If you are trying to decide whether or not to proceed with euthanasia, we suggest reading our Quality of Life article.

Degenerative Myelopathy is a debilitating disease that causes progressive paralysis in dogs. The paralysis is due to the degeneration of the dog’s spinal cord, a process similar to the human affliction, Lou Gehrig’s Disease. This disease frequently leads to euthanasia or eventually death and there is no cure. However, there are things you can do to maintain your dog’s Quality of Life for as long as possible. We're very lucky to spend so much one-on-one time with our DM patients that we develop very close bonds with them. Apache, pictured here, was a much loved and very missed DM patient. Diagnosing Degenerative Myelopathy The diagnosis of Degenerative Myelopathy can be a shock to pet parents as dogs generally don’t show any signs of being at risk for the disease until symptoms appear around 8 to 14 years of age. The first symptom is usually scuffing of the hind paws or loss of coordination in the hind limbs However, this can be a sign of several other disease processes like Intervertebral Disc Disease , Spinal Tumors, and even Osteoarthritis , among many others, so it’s important to investigate all possibilities early on. DM is usually a diagnosis of exclusion, meaning that all other potential causes have been ruled out, leaving DM as the most likely cause. To do this, a thorough Neurological exam is to be performed as well as Radiographs and Bloodwork to get the most obvious answers out of the way. Further diagnostics may include MRI, CT scan, or spinal fluid analysis. There is a genetic test available for pet owners to purchase online through the Orthopedic Foundation for Animals at https://ofa.org/degenerative-myelopathy/ . This test is not used for diagnosis, but it can provide insight as to your dog’s genetic risk for DM. Dogs that have one copy of the gene are classified as Carriers and while it is still possible for a Carrier Dog to develop DM, they are significantly less likely to do so. Dogs with two copies of the gene are classified as At-Risk. They can only be interpreted as At-Risk as not all At-Risk dogs go on to develop DM. However, a dog showing signs that then tests as At-Risk can then be more easily diagnosed with DM and therefore given appropriate treatment. Once purchased, the OFA Genetic Test is shipped to your home where you will then use the included Foam-Tipped Applicator Card to collect a DNA sample from your dog. You can do this yourself at home, no vet visit required. Once collected, samples make their way to the University of Missouri College of Veterinary Medicine where they are processed by the Small Animal Molecular Genetics Lab. When results are available, the OFA will report to you. As of May 2025, the cost for this test is $65.00. While any breed or mixture of breeds can be affected, these breeds were proven to have genetic predisposition for Degenerative Myelopathy: American Eskimo Dogs Bernese Mountain Dogs Borzoi Boxers Cardigan Welsh Corgi Pembroke Welsh Corgi Chesapeake Bay Retrievers German Shepherd Dogs Golden Retrievers Great Pyreness Kerry Blue Terriers Poodles Pugs Rhodesian Ridgebacks Shetland Sheepdogs Soft Coated Wheaten Terriers Wire Fox Terriers What to Expect Patients in the earlier stages of DM will still be able to walk, albeit with progressively less coordination. They frequently struggle to rise on their own and will begin losing muscle mass in their hind limbs. Loss of strength and coordination in their hind limbs almost always leads to knuckling or dragging their paws, leading to abrasion wounds and worn down toenails. As the disease continues to take hold, DM dogs eventually lose all voluntary movement of their hind limbs. They will also lose control of their bladder and bowels. They will no longer be able to walk but some will try to drag themselves around, which comes with its own set of problems. Paralysis continues to ascend up the body, eventually affected the front legs and diaphragm. When Degenerative Myelopathy reaches the point where it affects the diaphragm, and therefore the pet’s breathing, there are no further options to maintain Quality of Life and euthanasia is strongly recommended. Dogs left to experience the final stages of the disease will experience great suffering and a slow, stressful death because they will struggle to breathe right up until the moment that they just can’t anymore. Ideally, a DM patient would have a kind and humane goodbye before their breathing is affected. Fortunately, there are a lot of options and tools available to you to maintain good Quality of Life for your pet for as long as possible. Life expectancy from time of diagnosis ranges from 6 months to 2 years. W hat Can We Do About It? Caring for the Degenerative Myelopathy patient will change as their symptoms progress, but there are things you can do! The good news with DM is that if your pet is otherwise well managed, it is a painless disease up until it affects breathing. We have even seen dogs with a history of chronic pain no longer feel that pain as DM moves up the body. More Good News! – You’re in the right place! With the help of Rehab at CROC, London's symptoms slowed down enough to buy an extra 2 years with her family. Physical Rehabilitation has been proven to be the most effective treatment to slow DM's progression. Underwater Treadmill Hydrotherapy (not swimming ) has specifically been shown to maintain their strength, stamina, and coordination for as long as possible and slow the progression of the paralysis. Other Rehab Treatments such as Laser Therapy help relieve pain, like muscles in the front of the body becoming sore from overcompensating for the weaker back legs. For Physical Rehabilitation to have the most beneficial effect on your dog, they will need consistent and frequent therapy. We have seen DM patients lose significant ground with even a short vacation (1 week!) from rehab. Rehab cannot completely stop the progression of DM, but it can greatly increase the quality time you get with your pet. Tools To Make Your Life Easier Typical nail wear and abrasions from scuffing/knuckling. These can become quite painful and even get infected! We've gathered links and examples of these items on our Gear & Resources page! While your pet is still fully ambulatory on their own, it is important to protect their paws from scuffing and abrasions. Plenty of dog booties are readily available for purchase, but our favorite is a rubber variety called Pawz. We like these best because they protect the paw while still allowing your pet to feel the textures of the ground and providing extra grip. With any dog booties, care should be given to appropriately size your pet’s paws and to only leave them on when your dog is on a surface that is harmful to their skin to rub on. Booties left on for too long can cause skin infections, reduced circulation, or worst case – be chewed off and eaten! Adding rugs and ramps is a quick and easy way to help your dog get around the house more easily. Rugs and yoga mats make it easier for your dog to grip the floor, reducing their risk of falling. The softer surfaces also make abrasion wounds on their paws less likely, although rug burn is certainly a possibility for some dogs. Ramps can make obstacles like stairs less challenging, although care should still be taken to monitor your pet while using these. There will come a time where these obstacles are no longer safe for your dog to work around or over and should instead be avoided. A good harness is a must! Your dog will continue to depend on you for assistance more and more as DM progresses, so your choice of harness makes all the difference in comfort for both you and your dog. Our favorite harness for DM dogs is called the Help ‘Em Up Harness . It was created to help owners better assist their dogs without hurting their own backs in the process. It comes in two pieces, one to go around the chest and one to go under and around the pelvis. In the early stages, your pet may not need the back half, but as their coordination and strength wanes, the back half of the harness will become your best friend. It is comfortable enough that your pet can wear it for extended periods and it is more ergonomic for you and your dog than just lifting them or using a sling. If you are interested in purchasing this harness for your dog, be sure to speak to us as sizing and fitting your dog can be trickier than it might appear. Please note that this harness still needs to be removed each day and kept clean to prevent any abrasions or skin infections. As your dog loses the ability to control their bladder and bowels, diapers and belly bands become good options to help keep your dog and your home clean. Some dogs lose urinary control before fecal, so in those cases, belly bands are a nice alternative for male dogs over a proper diaper. Just as with humans, good hygiene when using diapers and belly bands is a must! Dogs left in dirty diapers for too long are at risk for skin and urinary tract infections. Always change soiled diapers promptly. It’s also important to note that dogs instinctively want to avoid their waste, so being stuck in it is not great for their Quality of Life . Disposable and washable options are readily available for purchase online or at major pet stores. Some owners will pursue Rear Wheel Carts (sometimes referred to as a wheelchair) for their DM dog. Not all dogs are good candidates for this and it’s quite the investment so it’s important for pet parents to approach this with realistic expectations. DM dogs that are good candidates should be fitted for a custom-built cart while they can still use their back legs. When their cart arrives, they can get used to the cart by using it as support for their back legs, still moving their back legs and propelling themselves forward. As back leg function lessens, their hind limbs can be propped safely up and off the ground using either the padded bar or padded loops included in the construction of the cart. For more information, be sure to read our article The Wheel Deal: Let's Talk About Carts and The Wheel Deal Part 2: You Got the Cart; Now What? Is There Anything Else? One of the best things you can do for your DM dog is keep them lean!  We generally recommend a Body Condition Score of about 4 out of 9. The less weight there is for them to haul around, the less strain is imposed on their already weakened body. Many DM dogs are also old enough to have developed arthritis, so all the more reason to reduce any extra work on their joints. For more information, visit our article Body Condition Score and Canine Weight Management . While there are no medications to directly treat DM, your pet may likely benefit from treating any other sources of pain and inflammation like arthritis. Joint supplements are also helpful to support their joints as the front of their body takes on the extra load. There are no clinically proven medications or supplements to treat Degenerative Myelopathy. For more information on pain medication and supplements, including how to choose quality products and minimize risk of side effects, check out our article, Pain Meds & Supplements . CROC strongly discourages the use of marijuana products for DM patients. While emerging research shows some promise for marijuana products in veterinary medicine there is much more to be done and DM patients are already weak and have poor coordination, making them poor candidates for this treatment. Quality of Life We touch on this subject for your sake as well as your dog’s. Compassion fatigue is a prevalent concern for clients caring for DM dogs. As your dog’s DM progresses, the amount of effort you will need to put into their care will drastically increase. Especially when their paralysis becomes more advanced or they lose control of their bowels and bladder, the strain on you to keep them clean and safe, as well as the physical strain of carrying them around is enough to wear down even the most dedicated owners. We bring this up because we want you to know that we are available to you as you navigate your pet’s condition. We frequently support our clients through the big decisions and help them to find the plan that works best for them while keeping quality of life as high as reasonably possible for all involved. At any time during your pet’s DM journey, we completely understand and support humane euthanasia as an option. When deciding “when it’s time”, it’s always best to go even weeks too early than a day too late. Make sure to be realistic with your resources, your time and energy, and frequently check in with yourself. Are you still enjoying your dog’s company? Are they happy and still enjoying their favorite activities? At any point, are you building resentment for the amount of work your dog now requires? It is important to note that for any end of life evaluation, the fact that an animal continues to eat is NOT significant enough to delay euthanasia if other aspects of their life are filled with suffering. If you would like more information about how to properly evaluate quality of life for you and your pet and what to do next, check out our Quality of Life article. You are also welcome to reach out to us for assistance. Overall, Degenerative Myelopathy is an awful disease to contend with, though there are certainly worse. There's a lot to consider when deciding how to move forward once your dog has been diagnosed, but having realistic expectations for yourself and your dog can help make the process a bit easier to manage. The CROC team is here to support you and offer advice at any time during your pet's DM journey but it's also a good idea to find support with your regular veterinarian and anyone else in your household.

Getting old is no fun! Although, dogs of any age can develop Osteoarthritis, especially if they've had an injury such as Cranial Cruciate Ligament Rupture (CCL/ACL) , a congenital issue like Hip Dysplasia , or participated in Canine Sports . Included below are some tips, tricks, warnings, and other info to help you keep your pup mobile and comfortable. Should you have any questions on any of this information or would like more details, feel free to ask the CROC team. We are here to support you and your best friend! Weight Management Keeping your dog at a lean body weight is the most important aspect of managing this condition. Fortunately, it’s also one of the easiest! Sometimes, it’s as simple as adjusting their meal portions. Other times, a complete switch to a new food is necessary. These days, there are a wide variety of AAFCO formulated Weight Management or Weight Loss diets readily available for purchase. Some are even specifically formulated for Senior Pets or for those needing extra Joint Support. Be sure to look for diets that are high in Essential Fatty Acids. Generally speaking, your goal Body Condition Score for an arthritic dog is a 4 out of 9, a little on the skinny side. If you'd like more information about managing your dog's weight, including tips on diet changes and safe exercise, be sure to read through our article Body Condition Score & Canine Weight Loss. Supplements We'll briefly cover our favorite supplements here, but to learn more about supplements, such as how to pick a quality product, visit our article Pain Meds & Supplements . Dasuquin Advanced with MSM is an excellent daily joint supplement that many of our team members choose to use for their own pets. It includes Chondroitin, Glucosamine, and other ingredients to support joint health and it comes in a tasty, chewy treat, making it an easy addition to your daily routine. Fish Oil added to your pet’s meals is another easy addition to help keep joints happy (and it helps their coat too!). Start with 500-600mg per day, then increase to 1000-1200mg per day. It is important to start slow with this as some pets may be sensitive and have GI symptoms if started too quickly. Myos Canine Muscle Formula is a supplement containing Fortetropin, a natural bioactive supplement made from fertilized egg yolk. Myos has been credited with improving muscle health, helping to reduce muscle loss (atrophy) and helping regain muscle after surgery or with other disease processes. It has also been shown to help skin, coat, cognitive, and bone health. Medications Adequan (Polysulfated glycosaminoglycan) is a series o f injections that stimulates cartilage healing, slows the progression of osteoarthritis, and decreases pain and inflammation. It begins with an initial series of 8 injections with one injection given every 3-4 days. Once that is complete, many pets can drop down to a maintenance schedule of one injection every 1-6 months. For larger dogs, this can be a costly investment to get started, but we have seen significant improvement for many dogs using this medication. If you have concerns about giving your dog injections, be sure to speak to your veterinarian for options like an in-person demo or having their staff perform the injections for you. You can also speak to the CROC team. Common NSAIDS - Rimadyl (carprofen), Metacam (meloxicam), Deramaxx (deracoxib), and their Generics are Non-Steroidal Anti-inflammatory medications that can be extremely helpful for managing pain and inflammation and since many generics exist, it can be easier to find one that fits your budget. They can have long term side effects to the liver and kidneys so regular bloodwork is strongly recommended to catch any change in organ function early. They must also be given with food! Some pets don’t tolerate these medications well and can have serious GI side effects like stomach ulcers and gastrointestinal bleeding. It is important to monitor your dog for any signs of vomiting, diarrhea, or dark stools while on these medications. Some pets REALLY like the taste of the flavored tablets so store these medications with caution, securely out of reach of your pet. Galliprant (grapiprant) is a newer type of Non-Steroidal Anti-inflammatory that has less side effects than the more widely known NSAIDS listed above. It is reported to have less effects on liver, kidneys, and GI tract and can be safely used alongside a wider selection of other medications. Because it is newer and a more specific medication, it is generally more costly than the above listed NSAIDS that have been around longer. Neurontin (gabapentin) is a medication primarily used to treat nerve pain, though it can also help with anxiety. Many pets experience some level of drowsiness when they first start this medication, but they usually become accustomed to it and return to their normal energy level after some time. Besides sedation, other side effects are extremely rare. This medication is a good option for pets that cannot tolerate NSAIDS and it can also be used alongside NSAIDS and many other medications. Tramadol is a synthetic opioid that has been commonly used to treat moderate to severe pain in dogs. Newer studies on this medication show that it may be less effective than previously thought, with only a small fraction of dogs getting any pain relief from it. Side effects from Tramadol include sedation, vomiting, diarrhea, constipation, and loss of appetite A Quick Note About Librela Librela (bedinvetmab) is the newest OA treatment in the US; a once monthly injectable medication only for use in dogs. It must be administered by your veterinarian and may take up to 6 weeks for observable results. Librela is a monoclonal antibody (a protein that has been engineered to bind to a single target) that targets Nerve Growth Factor which helps reduce pain caused by osteoarthritis. It can be extremely effective for the right patient, allowing dogs to return to their favorite activities while potentially reducing the need for daily medications. However, the adverse effects reported with this new medication are highly concerning and side effects are still being discovered. Due to potentially severe side-effects, we recommend that your pet be thoroughly evaluated before starting Librela. This should include bloodwork and radiographs at a minimum and may require evaluation with a neurological or orthopedic specialist. To learn more, visit out our article A Look at Librela . Dogs with neurological conditions, auto-immune conditions, breeding dogs, or dogs that are skeletally immature should not be given Librela. Librela does not cure OA. 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. Other Options If the above options aren’t working well with your dog, be sure to speak to your regular veterinarian about other medication options for pain relief. We discuss pain medications in greater detail in our upcoming article Pain Meds & Supplements . While CROC does not prescribe medication, we do help you improve your dog's pain management plan as needed as part of their prescribed treatment plan at CROC. There are new medications coming out frequently that might be a better fit for your pet. Stem Cell Treatments are now available for pets and may be something that could potentially help your pet. There are also other, non-medication treatments which we will discuss below that might help reduce your pet’s pain Exercising at Home As part of your Consultation with us, you will have been provided with Veterinarian Prescribed Rehab Exercises (your Homework). These exercises will help keep your dog limber and improve their strength and stamina while maintaining their range of motion. 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. Our article Motion is the Lotion discusses the importance of frequent but controlled exercise to maintain the joints' range of motion and musculature. There should never be sudden changes between inactivity and exercise. Always have your pet warm up before exercise and cool down after exercise. A void 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 an OA 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. Osteoarthritis flare-ups are common and can even be caused by changes in the weather. It can be tempting to call off therapy sessions when your dog is having an OA flare up, but more often than not, that's actually when they need Rehab the most! Don't forget that their treatment plan is geared towards treating the pain and inflammation associated with their osteoarthritis in addition to building muscle to better support the joints. Let us know when you see changes in your pet's symptoms and our Medical Team will adjust their therapy session to best address your pet's condition so they can go home feeling better than when they came in. Swimming  is frequently thought of as a low impact and helpful exercise for OA dogs, however it commonly causes significant abuse to the elbows, shoulders, and hip joints leading to inflammatory flare-ups. Opt instead for walking in warm water at your dog’s armpit level. Do this at very slow intervals to decrease the repetitive grinding of any arthritic joints. Swimming exercises typically do not help pets become better or stronger at walking outside of the water. To learn more about hydrotherapy, such as when swimming is appropriate and medical conditions that would make swimming unsafe, visit our article The Deep Dive into Swimming . Physical Rehabilitation Participating in Physical Rehabilitation Therapy at CROC allows your dog to get exactly the exercises and pain relief that they need on a regular basis to keep them comfortable and mobile, while also slowing the progression of their arthritis and atrophy. Our team closely monitors your pet’s abilities and adjusts their sessions as needed while also keeping you updated as your pet progresses. Therapy Sessions at CROC include multiple pain relief modalities like Thermotherapy, Cryotherapy, Laser Therapy , Therapeutic Ultrasound, PEMF, E-Stim, and Massage Therapy to be used as appropriate for your pet’s condition. Veterinary Medical Acupuncture is another option CROC offers to provide pain relief and increase circulation. Daily participation in at-home exercises wearing you down? Let us do some of that work for you and take your pet home feeling better than when you dropped them off! Regarding Chiropractics... We know this is a soft spot and that many people enjoy chiropractic for themselves. Human Chiropractic has been practiced since the late 19th Century but is still in contention regarding its efficacy today. In Veterinary Medicine, Chiropractic is a very controversial and divisive topic. We do not want to shame anyone for previous choices made with the intention of helping their pet. We do feel compelled as thoroughly educated Veterinary Medical Professionals to share our perspective. At CROC, we have treated multiple patients that were receiving chiropractic care and were in significant pain when they came to us, which resolved when chiropractic sessions stopped while proper Physical Rehabilitation Therapy continued. A good percentage of CROC patients arrive here after being referred by their veterinarian. Because of this, we have developed very close relationships with the local Neurological and Orthopedic Veterinary Specialists. CROC does not offer Chiropractic services because not a single one of these Board-Certified Specialists will support or recommend Chiropractic therapy for IVDD patients.  Even when consulting with Boarded Neurologists outside of Orange County, we have yet to find one that would approve of their spinal patients undergoing Chiropractic treatments. At this time, there are no Peer-Reviewed studies to substantiate claims that Chiropractic is an appropriate (or even safe) treatment for Veterinary patients. In addition, the American Veterinary Medical Association, America’s leader in advancing the science and practice of veterinary medicine to improve animal and human health, has not published any policies supporting Chiropractic. Reviewing Chiropractic on a basic level - Chiropractic treatment involves applying jarring and intense force on the body, which is also one of the worst things for a patient that has spinal instability or just had spinal surgery. The spine is particularly fragile under the forces of Chiropractic and there is a risk for severe pain and neurological injury. This is the normal healthy spine of a young dog. Notice that the vertebrae and the spaces between them are very well defined. This is a senior dog with severe Spondylosis Deformans (spinal osteoarthritis). As intervertebral disks degrade, the spine starts to move abnormally and osteophytes (bone spurs) will form in an attempt to stabilize each joint. Eventually, osteophytes can become so severe that they bridge between each vertebrae. At this point, we have a spine that is poorly cushioned by degraded intervertebral disks and surrounded by extra bone. Bone rubbing on bone and nerve impingement become chronic sources of pain and stiffness. Pain and stiffness are common reasons that pet owners will pursue Chiropractic for their pet. Could you imagine applying jarring and intense force on a spine like this?!?! OUCH!!! If your dog is experiencing enough pain that you are exploring other treatments like Chiropractic, please check in with us or your regular veterinarian first . There are certainly better and safer options for pain relief available. Environmental Modifications Use a good quality dog bed! Memory foam is an ideal material. Y our 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 OA dogs. Rugs, yoga mats, and the like are extremely beneficial to help keep your dog on their feet and avoid slips and falls. Doggie Doors need to be large enough for your dog to walk through without having to stoop or crouch. The bottom lip must also be low enough for your dog to easily step over. Minimize how often your dog has to climb stairs, especially if they are shallow and tall. If you live in a home with multiple levels, you may need to carry your dog up and down the stairs. If you are unable to carry your dog, it may be necessary to contain your dog to one level of your home. Don’t allow your pet to jump on and off furniture or in and out of your car. Especially jumping down, these types of movements put extreme stress on the body and are a very common cause for injury. Use ramps whenever possible. Change the location of certain resources. Some dogs need to have their food, water, and bed close together to avoid over-exerting themselves to reach basic necessities. Others need these resources placed farther apart to encourage more movement during the day. Be sure to ask what would best suit your pet’s needs. Engage in activities that require more mental participation from your dog. Whether it’s toys that have treat tucked inside or playing a game of hide and seek, mind games help keep your dog bright, engaged, and active even when their body may need a bit of a rest. Ask the CROC Team There are so many options to manage your dog's Osteoarthritis, it can be difficult to know which are the right options for your pet. 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. Our arthritic pups got that way from a lifetime spent at our side, so it's only fair that we return their dedication by treating their aches and pains to the best of our ability.

Amputations are never a pleasant option and obviously we’d all prefer to keep our legs but, there are situations where this is the best option for a patient to live longer or more comfortably. We often see dogs that required amputation due to trauma, cancer, or congenital defects and each of these situations need unique approaches for optimal recovery. Generally speaking, most dogs do quite well post-operatively, but all of them can benefit from rehabilitation therapy. While dogs still have the 3 remaining legs, they’re not much different from human amputees in that there are significant changes to how they do even the most basic things and it is of utmost importance to keep the functioning legs at their best. How did your dog become a Tri-Pawd? Birth Defects Dogs with congenital defects have spent their entire life up until amputation compensating for the affected limb. While their body still has to make up for this limb, its also had time to build muscle in the functional limbs and to adjust balance to remain upright and mobile. Dogs in this situation often arrive at amputation when prosthetics are not appropriate or not financially possible and the leg has become more of a hindrance than a help. The musculature of the affected limb is often atrophied and depending if and how the dog uses the limb, wounds and infection are a chronic problem. Rehab helps these cases keep the three remaining legs as strong and sound as possible, as they are likely to have compensatory repercussions like arthritis or muscle fatigue from having to make up for the lost leg. These patients usually recover from amputation quite well since they’re already accustomed to relying on their stronger legs and now they are free from the dead weight and chronic wounds associated with the deformed leg. Traumatic Injuries Dogs that lose a limb due to trauma are a bit more complicated. Up until that point, they have been fully mobile with all four legs but now they’re suddenly depending on three to get the same job done. There is usually little to no preparation for these patients and it is crucial to get them into rehab therapy as soon as they are healed enough to participate. Therapy for these patients usually entails teaching them how to correctly stand and walk as well as overall strengthening while soothing the now overworked muscles and joints. Just like us, poor posture can significantly affect how the body feels and operates. Cancer Dogs that lose a limb to cancer are often at the greatest disadvantage. Not only are they suddenly having to depend on three legs, but more often than not, they are senior pets with decreased muscle mass, likely arthritis, and overall poorer body condition from cancer and/or chemo as well as any other medical conditions they might have developed over their lifetime. Again, getting them into rehab right away can give them a better chance, but these patients have the longest road ahead of them. Goals are similar to the other cases in that we are focused on building muscle and soothing the overworked remaining legs, but special care is given to ensure these patients aren’t over-exerted. Too much too soon can quickly wear them out and make their creaky joints even more painful. Variables Affecting Successful Recovery For all amputees, the leg in need of amputation is a significant variable. Dogs carry approximately 70% of their weight on their front legs, so patients that require a front limb amputation are most at risk for compensatory injury. However, since dogs come in all shapes and sizes, sometimes the leg in question isn’t the problem. For example, heavier bodied dogs like English Bulldogs or longer bodied dogs like Dachshunds can have a particularly difficult time recovering from an amputation, and even more so if it’s a front leg. Dogs that are long and heavier bodied, like a Bassett Hound, are essentially twice as disadvantaged. Cases like this can be ethically challenging for all involved and thorough consideration for Quality of Life post-operatively is a must. Whether there is time to prepare for amputation or not, weight management is the other huge variable for how these patients recover. Your dog’s skeletal and muscular systems are only built to carry and propel their lean weight. Now we’ve removed a leg and the remaining three are operating at 133% of their normal workload so any additional weight is even more of a burden than it would be for a normal dog. Factor in front vs rear limb and if there are any other comorbidities like osteoarthritis , and your dog could be set up for failure. Even a perfectly healthy, younger dog that undergoes a leg amputation will be putting extra wear and tear on their remaining legs, so as your Tri-pawd ages, it will become even more important to manage their weight, treat their pain, and keep them as strong as possible. Rehabbing the Tri-Pawd For our amputee patients, we focus on making sure they are at a healthy weight, that any sources of pain are well managed, and that the remaining legs are well equipped to take on the extra strain of Tri-pawd life by teaching them better ergonomics and improving overall strength and stamina. Generally speaking, once sutures are removed, therapy can begin but if your pet has other injuries or conditions, they may need further care before it’s safe to begin treatment. Thermotherapy and Therapeutic Massage helps to improve blood flow to overly strained muscles, helping to reduce tension and pain. Stretching is extremely important for the Tri-Pawd to retain full Range of Motion of their remaining limbs but should only be done as prescribed and after Thermotherapy and Massage. Laser Therapy and Acupuncture are excellent tools for pain relief and improved circulation. Pain relief is important but the body will not improve without exercise! Hydrotherapy using an Underwater Treadmill is particularly effective to help teach better ergonomics since their speed is controlled by both the treadmill belt settings and the resistance of the water. The buoyancy and warmth of the water helps reduce strain on sore joints and muscles. Take note that Hydrotherapy in an Underwater Treadmill is recommended, but due to less benefit and higher risks, swimming is not. Our article The Deep Dive Into Swimming  provides a visual and more detailed explanation for this, but we’ll briefly explain here too. When dogs swim, they generally paddle fiercely with their front legs while keeping their back legs tucked up alongside their body. This type of movement means they are over-working their front legs and barely working the back legs. If they do kick their back legs, it is generally in a quick, spastic movement that does not encourage muscle building but does apply more stress to the limb. Since the Tri-pawd is already experiencing extra strain on their 3 remaining limbs, they should not be subjected to the additional stress from swimming. Target Exercises also provide an incredible impact on their recovery since we are improving their strength, stamina, and balance while also teaching them how to safely navigate obstacles common to daily life. Things to Do at Home Changes to their home environment are in order as well. Stairs and slick floors are especially dangerous for your pup, especially in the early stages of recovery. It is best to avoid these at first, then slowly introduce them in a controlled manner where you can slow them down and support them using a harness. Remember that a slip and fall on stairs or hard floors could seriously injure your already compromised pet. If your dog enjoys high impact exercise or wrestling with other dogs, these activities will also need to be restricted until your pet has been cleared to resume. Unfortunately, there are some cases where these activities will never be safe to resume. Extra supportive orthopedic foam beds (Big Barker is our favorite!) ensures a comfortable resting place that also avoids any undo pressure on overworked joints and insulates from cold flooring that can cause stiff muscles and joints. The addition of rugs or yoga mats around the house makes a huge difference in your pet’s ability to safely traverse their home. Even after they have learned to use stairs or traverse slick floors, it’s still a good idea to use a harness ( Help ‘Em Up is our top pick) to provide support as needed. Your pet is at higher risk to trip or slip and injure themselves but you can safely offer assistance with a harness whereas a collar will provide zero support and is more likely to cause additional injury. Special Considerations for Tri-pawds Because the leg opposite from the amputation is now the only one supporting that half of the body, you'll want to take great care to avoid any unnecessary risks that could cause injury or infection to that leg. If your Tri-pawd needs injections or an IV catheter placed, you may need to ask your veterinary team to use a different leg since this one doesn't have back up. This is particularly true for intravenous chemotherapy treatments. If you notice anything off with the remaining leg, even if it seems small, make sure to have your primary veterinarian check it out right away! Some Tri-pawds may require long term pain medications to address compensatory pain. Many benefit from dietary supplements to support muscle growth and joint health. To learn more about commonly prescribed pain medications and how to choose quality supplements, check out our article Pain Meds & Supplements . To Summarize Many Tri-pawds go on to live fulfilling lives with their families and yours can too! It’s likely to be a big adjustment at the beginning but once the basic activities of daily life are mastered and your pet’s body condition maximized, you and your pet can still enjoy good quality time together. Rehab is particularly helpful in the beginning but remember that your dog’s body will now be experiencing more wear and tear than a dog with four legs. For this reason, we recommend circling back to Rehab as your Tri-Pawd ages to help keep them strong and comfortable for as long as possible. We’re here for you and your Tri-Pawd now and in the future, so don’t ever hesitate to reach out to us!

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

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 is an acronym for L ight A mplification of S timulated E mission of R adiation and Laser Therapy involves applying that focused light into the tissues to achieve Photobiomodulation (the alteration of cellular function). When Photobiomodulation is achieved, healing is accelerated, circulation is improved, and inflammation is reduced, all of which decreases pain and stiffness.  Pain relief from Laser Therapy may be dramatic and 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 and improved functional recovery of peripheral nerves. What Does Laser Therapy Feel Like? 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. 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.  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 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 During a dog’s senior years, it’s important to start prioritizing quality of life over length of life. 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. 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 Class IIIb and IV Therapeutic Lasers used by licensed medical professionals to achieve Photobiomodulation offer significant healing and pain relief effects. Lasers that are safe enough for anyone to buy are not powerful enough to make any real impact on your pets comfort or mobility. 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 and effective pain relief option as long as it is understood that it may increase risk of cancer returning or spreading. If you have any questions about Laser 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.

While this article was originally written in the context of working and sporting dogs, it does apply to all dogs and we hope that it can help every dog to have a better experience and get 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”? Inability to sit, lay down, or stay on command Growling Barking, whining, or howling Biting Jumping 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 Inability to rest quietly in a kennel Leash chewing Reactivity towards other animals How These Behaviors Affect Vet Visits 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 examination, diagnostics, and treatments possible while making sure that they, the client, and the patient don’t get hurt. Great example of a very good pupper calmly allowing close inspection of their feet! 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.   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? Bad behavior isn't limited to biting. This cutie pie 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. 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 and 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. 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 and be comfortable around new people and situations. Anyone should be able to touch any part of your dog’s body, especially their mouth, eyes, ears, and paws. Reina might look like a scary Malinois, but she is an excellent patient and allows us to do whatever we need to help as long as she also gets pets. 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. 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. Train your dog to calmly ignore other dogs walking by rather than getting excited or aggressive. 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. 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. 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. For safety reasons, muzzles are often required but trying to put a muzzle on a dog that wants to bite you is dangerous and that dog is 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. 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. 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! The key to success is to train your dog to willingly wear the muzzle by creating a positive association and 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 you step foot into the veterinary clinic. 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 and socialize your dog will negatively impact the quality of their medical care and life experiences for you both. Canine Rehab OC offers custom Fitness Plans by appointment. If you are interested in a comprehensive exam, clinically-proven therapies, and prescribed exercises for your Canine Athlete, check out the New Patient  section of our website to learn how to get started. Want to learn more about how to support your Athlete? Canine Sports Medicine events are coming to Canine Rehab OC soon and we'd love to see you there! These events include demonstrations courtesy of Dogtor Wilbur and a 30+ page Canine Sports Medicine booklet for each attendee. If you are part of a local Dog Sports group and interested in setting up an event, reach out to us ! We love getting involved in the dog community and helping as many families as possible. This article is Part 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

*** The tips and recommendations within this article are made for dogs that are free from any health concerns and may not be right for your dog. As all dogs are unique individuals, we recommend that you consult with your Veterinarian or schedule a Fitness Consultation with the Physical Rehabilitation Specialists at Canine Rehabilitation of Orange County to discuss what is right for your dog.*** What does weight lifting have to do with playing tennis? Human athletes cross-train to ensure they are in peak physical condition and ready to perform at their best. They know that weight training and targeted exercises translate to bigger wins and reduced chances of injury. That’s why olympic swimmers can be found cycling and basketball players will practice pilates. Using low-impact, targeted exercises, cross-training will improve your Canine Athlete’s balance, endurance, flexibility, and strength in the same way as their human counterparts.  Balance Balance is the ability to maintain uprightness and avoid falling, so we begin our work here before moving our focus to coordination and strength. You can’t focus on getting stronger if you keep falling over! Balance work also increases core strength; a weak core can cause hyper-mobility of the spine and predispose your dog to significant back injuries and chronic pain. Poor core strength will also put excess force onto the limbs, increasing risk of compensatory injury. The goal with balance work is to gradually increase the challenge of each movement. If your dog is unsteady at a certain level and cannot hold a balance pose for extended periods of time, continue to train and repeat the exercise until it is no longer difficult for at least 5 sets of 15 seconds.  Proprioception The foundation of good agility, proprioception is the brain’s awareness of the body’s position in space. Improving proprioception enhances your dog’s speed and precision of limb movement. Poor proprioception can mean the difference between 1st and 2nd place, but it might also be the variable saving your dog from serious injury. One paw in the wrong spot could lead to a nasty fall off an obstacle and potentially months to recover before they can resume their favorite activity. Strength In order to gain strength, exercises must be challenging enough to require cellular adaptation but not so difficult that the body has to modify or compensate in a counterproductive way. It takes an average of 8-12 weeks of strength training to achieve measurable outcomes. Remember that rest & recovery is vital as strength training too frequently can result in overly fatigued muscles, followed by catabolizing (breaking down) of the muscle tissue. At least 48 hours between strength training sessions is necessary for recovery , with the average Canine Athlete strength training just 1-2 times weekly. It’s also important to keep in mind that fast movements do not enhance muscle mass but slow, controlled movements do! A Quick Word on Overtraining The buildup of lactic acid is proof of muscle strengthening occurring but it can also result in Delayed Onset Muscle Soreness (DOMS). Sore and tight muscles can delay performance reaction times, so cross-training should be avoided in the two days prior to a competition or performance. Varied training will help decrease the risk of exhaustion and soreness, but it’s important not to overtrain your Canine Athlete. An example workout week might look like 1-2 days of cardio, 1-2 days of strength training, and 3 days of target training for the sport or job your dog participates in.   If you note that your Canine Athlete stretches a lot the day after a workout or event, they are likely experiencing DOMS and would benefit from a good massage and stretching session. The application of Cryotherapy can help reduce inflammation and swelling in acute phases of tissue trauma (occurring immediately after an activity/injury) by reducing blood flow to the area, therefore reducing pain. Cold packs can be made at home using a sealable bag with three parts water to one part running alcohol. Wrap the cold pack in a thin towel and apply to your dog for 15 minutes, but no longer than 20 minutes. Target Exercises for the Canine Athlete The following target exercises can be helpful for working and sporting dogs, but please use your best judgement before attempting them with your Canine Athlete as these exercises may not be right for them. For a comprehensive and customized Fitness Plan, schedule a Fitness Consultation with our Veterinary Physical Rehabilitation team. We always recommend checking with your Rehab Team or Primary Veterinarian before beginning any new exercise regimen with your dog. We strongly recommend using a harness during exercise so you have better control of your dog and can catch them more easily if they stumble. If your dog has not been properly warmed up for exercise, check out Part ONE of our Canine Sports Medicine series first! Step Up & Step Down Your dog will be standing still for this exercise. Have your dog step up a single stair, curb, or other raised surface & leave their back legs on the lower surface. While in this position, gently push one area of the body & then another. Vary the speed & direction of each push. Push enough to challenge your dog’s balance but not enough to make them take a step or fall. For a Step Down, have your dog stand with their back legs on the higher surface & their front legs on the lower surface, then repeat gentle pushing to challenge balance. For increased challenge, add a three legged stand or an unstable surface like a fitbone, or wobble board. Three Legged Stand Your dog will be standing still for this exercise. Lift one of their legs off the ground. When holding a front leg, bring the leg forward, holding the underside of the paw above the big pad. When holding a back leg, bring the leg backward by holding it at the ankle & pulling up & back so that the paw pads face up. Support the paw lightly so that your dog cannot use your hand to support their weight. For increased challenge, combine this exercise with a Step Up or Step Down, add an unstable surface, or for even more challenge, lift up a front leg on one side & a back leg on the other. Figure 8's Using a leash and harness, slowly walk your dog in a large, wide figure 8 pattern. It can be helpful to have objects for your dog to walk around. This exercise can be included as part of your dog's regular walks. Canine Rehab OC offers custom Fitness Plans by appointment. If you are interested in a comprehensive exam, clinically-proven therapies, and prescribed exercises for your Canine Athlete, check out the New Patient  section of our website to learn how to get started. Want to learn more about how to support your Athlete? Canine Sports Medicine events are coming to Canine Rehab OC soon and we'd love to see you there! These events include demonstrations courtesy of Dogtor Wilbur and a 30+ page Canine Sports Medicine booklet for each attendee. If you are part of a local Dog Sports group and interested in setting up an event, reach out to us ! We love getting involved in the dog community and helping as many families as possible. This article is Part 2 of our 5 part Canine Sports Medicine series! Other articles include: Part 1: Peak Performance & Injury Prevention Part 3: Common Conditions & Injuries Part 4: Nutrition for the Canine Athlete Part 5: Bad Dogs, Bad Medicine  (Effects of Behavior on Quality of Care)

*** The tips and recommendations within this article are made for dogs that are free from any health concerns and may not be right for your dog. As all dogs are unique individuals, we recommend that you consult with your Veterinarian or schedule a Fitness Consultation with the Physical Rehabilitation Specialists at Canine Rehabilitation of Orange County to discuss what is right for your dog.*** Canine Athletes and Working dogs are the epitome of fitness for their species. K9 officers, service dogs, and sporting participants use their speed, precision, and exuberance to complete their physically demanding work. With years of training and financial investment poured into these dogs, it is essential to ensure that each athlete is conditioned and prepared for the tasks at hand to help them safely continue their sport or work for as long as possible. Canine Sports Medicine Human professional athletes have entire teams of medical and fitness professionals specialized in sports medicine to help them perform at their best and reduce their odds of injury; your Canine Athlete should too! Canine Sports Medicine is a branch within Veterinary Medicine that addresses the prevention, diagnosis, and treatment of injuries sustained by working and sporting canines. While risk of injury can never be completely eliminated, Canine Athletes that participate in structured and targeted work as part of their training are significantly less likely to be injured and will recover more quickly if they sustain an injury when compared to non-conditioned dogs. A Canine Sports Medicine performance plan consists of prescribed stretches, exercises, nutrition and supplements, and medications (only as needed) in order to optimize the physical potential of the Canine Athlete. Physical therapy techniques are administered to treat injuries and restore tissue loss or offset bodily imbalances to prevent injury and promote proper ergonomics.  Who Needs to Be Involved in My Canine Athlete’s Performance Plan? It might sound silly, but as a finely tuned “machine”, anyone that interacts with your Canine Athlete on a regular basis should be included in their performance plan . In the household, everyone should know what the Canine Athlete can and cannot eat and when - don’t let the kids feed them then take them to run around outside immediately after. Your dog walker or pet sitter should be well aware of your Canine Athlete’s daily exercise routine in order to maintain physical conditioning, but also to ensure that your Canine Athlete is not overworked in your absence. Your groomer should know if trimming nails in a particular way interferes with your Canine Athlete’s performance or that jumping down from a tub or table should not be allowed. Your trainer and your veterinary medical team should be very well versed in your Canine Athlete’s performance plan. Deviations from the plan could mean that your dog is not adequately prepared for the work they are facing or that your veterinary medical team misses something because it is not a typical issue for a housepet.  A Memo on Muscles A muscle’s job is to move joints, protect the body from harm, and to work alongside the neurological system to maintain balance and coordination. Muscles can’t push; they move joints exclusively by contracting and pulling, so muscles are attached on each side of a joint in order to pull it into various directions. When muscles contract, the muscle fibers shorten, causing the joint to flex or “close”. To extend or “open” the joint, muscles on the other side of the joint will contract. If muscles are overworked or have extensive tension due to repetitive movement, the muscle fibers will get progressively tighter, thereby reducing the joint’s range of motion (the totality of movement a joint is capable of doing) . Overly tight muscles also negatively impact flexibility and the muscle’s ability to absorb stress and impact. These conditions make for the perfect opportunity to rupture the Cranial Cruciate Ligament (CCL), often compared to the human Anterior Cruciate Ligament (ACL). CCL rupture is the most common canine injury and can be devastating for the Canine Athlete. Joint disease and joint injuries almost always start out as overly abundant muscle tension. Releasing that tension will help keep the body healthy, active, flexible while reducing strain from stress forces and preventing poor ergonomics. Pre-Workout Considerations: Thermotherapy, Massage, & Stretching No professional human athlete runs onto the field without a pre-game plan because properly warmed up muscles, tendons, and ligaments will perform better, fatigue less, and be less likely to experience a strain, sprain, or rupture . Muscles will be less likely to cramp and will recover more quickly if they are heated, massaged, stretched, and lightly exercised using activities that complement the activity they are about to participate in. Thermotherapy Heat therapy reduces inflammation and pain while increasing blood flow and improving the extensibility of tendons and ligaments. When properly warmed up, these tissues are more likely to stretch rather than strain or rupture. The metabolic rate of cells within heated tissue is improved, increasing oxygenation and better cellular recovery from lactic acid build up or toxic wastes that accumulate during and after exercise. Chronic injuries heal more quickly, joints experience a greater range of motion, and flexibility is maximized.  Heating in Canine Sports is typically provided via microwavable heat packs applied directly to the patient. For optimal penetration into the muscles, ligaments, and tendons, apply moist heat rather than dry. Canine Athletes should be in a relaxed position and heat should be applied for about 10-15 minutes. Always check that the heat pack is at a safe temperature before applying it to your dog! If you cannot comfortably hold the heat pack to your inner arm or neck, it’s too hot! Wrap the heat pack in a thin towel before putting it on your dog. Stretching and passive range of motion exercises should follow immediately after heating. Alternative thermotherapy modalities can include Therapeutic Ultrasound, warm water baths, and infrared heat lamps.  Massage Overexertion, compensation for other issues, previous injuries, fear, and age-related muscular changes often result in muscle and soft tissue tension. When tissues are tense, blood flow is restricted, depriving the cells within those tissues of vital oxygen. Reduced oxygenation will also reduce the metabolic removal of waste products and further impair physical performance. This inevitably leads to a vicious cycle of pain, inflammation, muscle tension, followed by even more pain.  Tips to Maximize the Magic of Massage Less is more! The most effective massage for muscle tension and fatigue is soothing and gentle, using slow kneading and gliding strokes similar to swedish tissue massage. This soft approach allows your dog to truly relax into the massage instead of bracing or tensing up in response. Choose a quiet, comfortable space with minimal distractions and make sure you are calm and relaxed before beginning.  One hand massage is less intimidating than two hands. To avoid feelings of being grabbed, be sure to use a flat, open hand and start the massage without using your thumbs.  If your dog is not used to having their body touched, start with light stroking, then work up to gliding and kneading . If they are particularly fussy and want to walk away, let them! You are asking your dog to trust and let go of their tension, so don’t make them feel trapped. Try again later with a lighter approach. The more you practice this type of touching, the easier it will become. The shoulders and neck are often the easiest areas to start with. Your dog’s muscles should not feel tight or banded in a relaxed state. If you can strum the muscle like a guitar string, there is tension and pain in that muscle. Do your best to massage both sides of your dog's body equally or you risk injury to the side that was not prepared for activity. Temporal Mandibular Joints This is the joint where the jaw attaches to the skull. Bite work, heavy chewing, & ball/frisbee activities increase tension of the muscles that attach the jaw to the skull. Osteoarthritis, inflammation, and pain can develop here, so it's a great place to massage. Neck & Base of the Skull This area absorbs a lot of force, especially with turning, twisting, & jumping down activities. All Canine Athletes can benefit from massage here. Shoulders & Chest The front legs are attached to this body exclusively by muscle and connective tissue between the trunk and shoulder blades. There are no boney attachments to the trunk! This allows your Canine Athlete to be fast, flexible, and agile, but it also means that the health of these tissues is absolutely vital for mobility. Dogs that do a lot of vertical leaps or swimming tend to gather excess tension and stiffness in this area. Many of these tissues connect to the cervical vertebrae, so any tension in these tissues can also translate into neck pain. Work your way from the neck down their trapezius, then move forward to the front of the chest, massaging the pectorals all the way down to the armpit area. Elbows & Upper Arm The Triceps muscles are the main antigravity muscles of the front leg & are stronger than the Biceps, though both are responsible for upper arm movement along with the brachiocephalic muscle. These muscles are prone to soreness from overuse & should receive extra attention , especially if the elbow’s range of motion is reduced. Metatarsals, Carpi, Forearms, & Front Paws Movement of front paws is facilitated by many tendons and ligaments from the elbow down to the toes. Along with the elbows, the carpi (analogous to the human wrist) experience a lot of strain over the life of an average pet dog, but Canine Athletes in particular will be testing the limits of these joints. Jumping down is the top reason for excess strain and injury to the carpal joints. For a thorough massage, feel for tight, banded tissues along the forearm and massage down the leg all the way to the toes. Make sure to massage both the top and bottom (or front and back depending on your dog's position) of the forearm. The digital flexors of the paw and carpus are located on the back side of the forearm, so soft kneading here can be very helpful to reduce tension. The metatarsals are the bones above the toes, but below the carpus. This location benefits from gentle massage at the area just above your dog's biggest paw pad. Mid-Trunk Compensation for any kind of forelimb discomfort will show up as tension from the base of the neck down the length of the longissimus dorsi and iliocostal muscles, which run down each side of the spine all the way to the pelvis. This leads to mid-back pain & limited, stiffer movements of the trunk. All Canine Athletes benefit from massage in this area. Athletes that do a lot of twisting movements (or ill pets that have been coughing) benefit from light massage along the ribs as well, working from front to back. Hips & Thighs The Quadriceps (the main muscles of the thigh) flex the hip, move the leg forward, & act as stabilizers to balance the body during side to side movement. The Sartorius muscle runs along the front of the thigh and is responsible for lifting the leg off the ground. When standing, it extends & stabilizes the stifle (knee). The Canine Athlete often experiences tension in this area. Overworking the hip flexor, hip dysplasia, or any change in gait can result in banding of the Sartorius muscle which can be very painful & may result in serious injury if not corrected. Several muscle groups are responsible for extending the legs backward to drive the body forward. As primary muscles for locomotion, all dogs benefit from regular massage in this area.  Stifles (Knees) The Stifle is a hinge-type joint designed to move backward and forward. There is very little flesh to massage, but small movements along the inside and outside of the Stifle can ease tension & increase circulation. The Patella (kneecap) is help in place by the Patellar Tendon, which can become banded, swollen, or painful from overuse , potentially pulling the patella outside of its normal position. Tarsi, Metatarsal, & Rear Paws Below the Stifle, the Tarsus joint is the Canine equivalent of the human ankle, & below the Tarsus are the Metatarsals. This area is stabilized almost exclusively by tendons & is a major shock absorber during exercise & play. Just like the front legs, try to massage all the way down the leg to the toes and paw pads. Stretching & Passive Range of Motion Passive Range of Motion (PROM) exercises involve moving the joint back and forth several times within its range of available movement. This promotes blood flow to and from the joint and acts to lubricate the joint. Active dogs benefit from PROM exercises for their shoulders, elbows, carpi (wrists), hips, and stifles (knees). Stretching returns tight muscle fibers to their natural, elongated state. Tension is prevented or eased by stretching and flexibility is improved, which can then translate to an increase in your Canine Athlete’s speed, endurance, and agility. For stretching to be physiologically beneficial, start with warm, relaxed muscles and make sure stretches are performed slowly and held for a longer period of time. Ideally, your dog should go on a short walk or have several minutes of light activity before stretching as blood flow is reduced to tissues that have been inactive.  It is best for your dog to be laying down but they must be relaxed and muscle groups being stretched should not be weight bearing or engaged in any sort of work. If a muscle is not relaxed when being stretched, there is a higher risk of injury to the muscle fibers or cells (pulling a muscle). Slowly moving the limbs to their maximum reach reduces risk of monosynaptic stretch response, which will tighten the muscle fibers and contract the muscles in reaction to moving the limb too quickly. All movements should be smooth and performed while stabilizing and supporting the joints. Apply gentle pressure to the muscles to manipulate your dog’s body into each stretch; NEVER pull! There are different types of stretching but passive stretching, where you move your dog’s limbs for them, is the most beneficial for easing tension, increasing blood flow, and elongating the soft tissues.  Each stretch should be performed 4-5 times and held for 30 seconds to the point of initial discomfort. Reminder that these stretches are indicated for dogs that are physically sound and may not be right for your dog . Canine Rehab OC offers custom Fitness Plans by appointment. If you are interested in a comprehensive exam, clinically-proven therapies, and prescribed exercises for your Canine Athlete, check out the New Patient section of our website to learn how to get started. Want to learn more about how to support your Athlete? Canine Sports Medicine events are coming to Canine Rehab OC soon and we'd love to see you there! These events include demonstrations courtesy of Dogtor Wilbur and a 30+ page Canine Sports Medicine booklet for each attendee. If you are part of a local Dog Sports group and interested in setting up an event, reach out to us ! We love getting involved in the dog community and helping as many families as possible. This article is Part 1 of our 5 part Canine Sports Medicine series! Other articles include: Part 2: Cross-Training Part 3: Common Conditions & Injuries Part 4: Nutrition for the Canine Athlete Part 5: Bad Dogs, Bad Medicine (Effects of Behavior on Quality of Care)

Congratulations on ordering your pet’s new, custom-built cart! There’s some pretty important details you’ll need to familiarize yourself with in order for your dog to get years of safe and comfortable use out of their cart. Most importantly, this is not a process that can be rushed! Jumping ahead too quickly can cause serious injury to your dog or make them too afraid of their cart to continue using it. Preparing Your Dog & Your Home Ideally, dogs who will be needing a cart will have Physical Rehabilitation Therapy beforehand to prepare their body for the physical demands of cart use. This is not a passive device like a human wheelchair. A human can pause and just sit and rest when they get tired. Your dog cannot and is stuck in a standing position as long as they are in their cart. Building up their strength and stamina before cart use can help them adjust to this new activity more quickly and ultimately set them up for better success long term. Dogs that are unable to participate in Physical Rehabilitation Therapy before getting their cart can still do well, but they will need much smaller increments of time and distance as they become accustomed to exercising in their cart. In addition, you may want to prepare your home for your dog’s new cart. Obstacles like furniture, doorways, and even small bumps on the floor are likely to be challenging for your dog to navigate at first.  As they are learning to use their cart, hitting obstacles that cause sudden stops can be scary and obstacles that cause them to feel trapped can be frustrating. Dogs are emotional creatures so creating a positive environment for them to learn in is a huge contributing factor for your dog’s success. Flat open areas, free of furniture and tight spaces, are the perfect environment for practicing in the cart. Hard, smooth floors like tile, laminate, or concrete are the easiest to roll on with textured flooring like carpet being more difficult especially as your dog is still adjusting to their new device. It may also be helpful to be able to temporarily put other pets away while they’re practicing in their cart, so having a safe space for other pets is optimal. Without a careful introduction, some animals can view the cart as something terrifying or dangerous attached to their housemate and may act aggressively towards your wheeled pet out of fear. Good Vibes Only! As mentioned above, dogs are emotional creatures and positive reinforcement is the most effective training tool. We’re working together to train your dog to properly use their cart. We are asking them to be strapped into a moving, metal contraption that is going to “chase” them everywhere they go; some calm confidence is definitely needed here! To assist with this first introduction (and to make any remaining adjustments), we will have you schedule one last Cart Fitting appointment at CROC at no charge. During this appointment, we will introduce your pet to their new cart in a calm and positive environment. We teach them that the cart is not scary, what it’s like to get in/out, and how to make it move with them. We let them make their first, sometimes awkward, steps in the clinic where we can help them learn how to maneuver it where they want to go and what it’s like when they inevitably hit an obstacle. Some dogs are chomping at the bit to run right from the get-go and couldn’t care less about any speed bumps. Others are more reserved and need a lot of encouragement to take even a few steps. The shy pups can quickly shut down out of anxiety and refuse to walk any further, especially if they hit an obstacle. By having them go through this initial experience at CROC, we can ensure that their first time in their wheels is a positive experience , making your first time using the cart at home a smoother, easier process. While you might feel excited or even anxious about your dog’s first few times in the cart, you must focus on the task at hand. If you are anxious about the cart, your dog will be too! You want to start the training session in a calm, but encouraging energy so that your dog feels relaxed and confident. Even just having the cart nearby for them to inspect and do normal daily activities next to can help desensitize your pet and any housemates, so they feel that it is a safe thing to have near. Your confidence truly rubs off on them! Even if they show some initial signs of being nervous or fearful, it’s super important that you reassure them and calmly continue. When you’re ready to get started, be sure you have any and all tools you might need close at hand. You will want to have your dog harnessed and leash and you may want a bag of treats to encourage them with. Make sure you read the instructions included with your dog’s cart and are familiar with how to load/unload your dog into the cart so you can make your dog’s experience smooth and fear-free. You don’t want to panic or become frustrated. Move too quickly and your dog may become scared. Move too slowly, and they may be too excited or frustrated to stay still long enough for you to finish loading them in. It’s okay if you’re nervous! Sometimes you just have to “fake it until you make it” for your dog’s sake. Listen to Your Dog These first few sessions in their cart should only last about 5 minutes (unless directed otherwise by CROC) each and happen a few times each day, with plenty of time to rest in between sessions. Be sure to monitor for signs of fatigue. Dogs that lower down onto their front legs are trying to lay down, so it’s important to give them a break when they ask for it. If your dog hesitates to walk, try to encourage them to take a few more steps before calling it quits. If the session has come to a complete halt, it may be best to recognize that your dog needs a break and try again later, keeping things positive and light the entire time. Over time, you can start increasing their cart sessions by 5 minute increments every few days to a week, as long as they are able to finish the session without being exhausted. If you increased your dog’s cart session and they are totally wiped out exhausted at the end, it’s recommended to revert to shorter sessions for a bit longer before attempting to increase again. If you find that your dog is only wanting to move backwards, this is often a sign that your dog is not strong enough to pull their cart forward as pushing backwards is much easier. For the best chance of successful cart use in this situation, your dog will need additional physical conditioning to become strong enough to pull themselves and the weight of the cart forward. If this is happening with your dog, follow up with the CROC team so that we can work together to create a plan to help your dog get rolling. Suggested Safety Measures Use extreme caution around stairs and pools A fall down the stairs or into a pool can cause serious injury or death. Ideally, these risky areas would have a physical barrier preventing your dog from getting to them. Use caution around other animals Not all animals are comfortable around carts and may even be terrified, making your dog a target for attack. You dog cannot defend themselves in the way that a fully ambulatory dog can, so please be very careful about which animals are allowed to interact with your wheeled dog. When allowing your wheeled dog to play with other animals, it is best to prevent overly rough play, as most wheeled pets have conditions that can be worsened by the impact and twisting of rough play. Practice good hygiene Keeping your dog’s cart clean and well maintained is imperative for comfortable, long term use. Your dog is able to urinate and defecate while in their cart and while it’s not common that the cart becomes soiled, be sure to watch for it and wipe down as needed. The pelvic support area can get dirty just from regular use, so make a good habit of cleaning it regularly and allowing it to dry fully before resuming use. Abrasions and worn nails are frequently seen when a dog's feet are not adequately protected. Protect those paws Depending on your dog’s condition, they may or may not have some use of their affected limbs. We always want to encourage whatever independent movement your dog can manage, so if they are able to move their legs with the support of the cart, you should let them do so. Either way, you will need to protect their paws from scuffing or dragging on the ground. If they are able to move their legs in any meaningful way, you may want to keep some booties on hand, such as Pawz, or keep them on soft surfaces like grass. Please note that even carpet can cause burns from frequent rubbing. If your dog does not have the ability to move their legs, please take care to use the included supportive pieces on your cart to hold their paws up off the ground. Some carts will have a padded bar along the back for the legs to rest on and others will have dedicated stirrups to secure their feet safely up and away from dragging. Visit our Gear & Resources page for examples and links to booties we like. When in Doubt, Call CROC! When we suggest a cart for your pet and begin preparing them, we use our Veterinary Physical Rehabilitation experience to ensure that your pet is a good candidate, that they get the right cart and the right fit and we stand behind our work. Therefore, patients who have undergone CROC’s Cart Fitting process are extended long-term support for their cart. You are welcome to call with questions any time or even schedule a follow up fitting if something seems off down the line. Some pets will need minor adjustments to their cart as they age or as their condition changes to ensure that the cart remains ergonomic and comfortable. On a regular basis, you will need to check that all screws and bolts are secure and that the wheels are spinning easily and evenly. More frequent maintenance checks should be performed for dogs that are particularly active in their carts. Unfortunately, CROC cannot offer any support for carts obtained outside of our guidance, even if they are obtained through Eddie’s Wheels. We know that the circumstances leading up to needing a cart are typically challenging and exhausting, but now that you've got some wheels, we hope that you and your dog get as much joy and freedom from your new cart as possible!