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

This isn't just for athletes. While this article was originally written in the context of working & sporting dogs, it applies to all dogs & we hope that it can help every dog to have a better experience & higher quality medical care. Visits to the vet can be stressful but they don’t have to be! Couple this with the stress and anxiety you are feeling during the entire process and we now have the perfect storm brewing. Sadly, this scenario is very common amongst all dogs, but as highly trained, intelligent, and powerful animals, Canine Athletes have the potential to make this situation particularly dangerous for all involved. When dogs have not been socialized with strangers, conditioned to relax in new environments, or taught to allow touching of their body, we’re going to have a bad time at the vet. What Constitutes a “Bad Dog”? Growling Barking, whining, or howling Biting Jumping Leash chewing Reactivity towards other animals Inability to rest quietly in a kennel Inability to sit, lay down, or stay on command Refusing to be leash walked by a person other than their owner Refusing to be touched by a person other than their owner Refusing to be picked up by a person other than their owner How These Behaviors Affect Vet Visits Things get complicated. When a patient comes in that is growling, lunging, barking, or trying to bite at the veterinary staff, the veterinary team is now tasked with giving that dog the best exam, diagnostics, & treatment possible while making sure that they, the client, & the patient don’t get hurt. That’s a lot of pressure! An injured veterinary professional means many patients not getting the care they need or potentially the end of that veterinary professional’s career. All veterinary professionals are dedicated to the health and safety of their patients and clients, so if a client or patient has been injured on their watch, it is devastating for all involved. Hayden (pictured left) is being such a good boy, calmly allowing us to closely inspect his paw. If the veterinary team cannot safely approach or touch a dog without risking bodily injury, how are they supposed to provide good medical care? Examples include: If the veterinary team cannot touch your dog’s face, they cannot examine or treat your dog’s ears, eyes, nose, or teeth. If your dog cannot lay down and stay on command, performing radiographs will be significantly more difficult and potentially dangerous. If your dog is flailing or trying to bite, the radiographs may need to be reshot in order to get a diagnostic image, thus exposing your dog and the technicians to additional radiation. If your dog bites when its feet are touched, how will a veterinary team help them with a broken nail or avulsed paw pad? If your dog will not cooperate for a blood draw, the results of that bloodwork may be inaccurate due to poor sample quality or stress-related changes in the body. Dogs who can calmly and comfortably participate in their vet visit will get a more detailed examination, receive higher quality treatment, and heal better than a dog that cannot. When a dog cannot be handled safely, their exam and treatment is often rushed and/or shortened, skipping over things that have to be assumed to be okay and focusing only on the primary reason for the visit. For the Canine Athlete, this could mean that a career-ending condition isn’t diagnosed until it’s too late! It should be noted that friendly but overly excited dogs can also experience barriers to care. If they can't sit still long enough for examination and treatment, their quality of care will suffer the same limitations as a dog that bites. How Do These Behaviors Affect CROC Visits? When it comes to your Canine Athlete’s visit with the CROC Team, the ability to run our hands over all areas of the body is integral to maximizing their evaluation & follow-up sessions. Palpation is the most effective examination tool we have as professionals, especially for dogs with thick coats. We are frequently feeling all over every patient’s body to assess for any subtle changes because reduced range of motion, swelling, or muscle atrophy can be identified before a patient shows any obvious limping or pain. Please note: Limping IS a sign of pain! Do not ignore this crucial signal that your dog needs help! If a patient will not allow us to palpate a relaxed muscle, that will significantly reduce our ability to evaluate and treat that patient. In our earlier article, Canine Sports Medicine Part 1: Peak Performance & Injury Prevention, we discuss how vital massage and stretching is to restore lost range of motion and alleviate pain. If your dog is unhandleable or cannot relax and allow gentle touching, they are limiting the healing benefits of our touch. Bad behavior isn't limited to biting. This cutie pie (pictured right) is singing the song of his people while we're trying to treat his pain. His inability to calmly receive treatment ultimately reduces how much benefit he gets out of therapy. The CROC Team works with some of the most conditioned and capable Canine Athletes around and it is because those patients are happy to cooperate with us. Without their voluntary participation, our efforts to repair and recondition an injured working or sporting dog is severely inhibited. Make Vet Visits Easy Beginning as early in life as possible, your dog needs to be taught to tolerate handling & be comfortable around new people & situations. Anyone should be able to touch any part of your dog’s body, especially their mouth, eyes, ears, & paws. Practicing nail trims early on will make it easier to maintain your dog’s feet and help prevent torn or broken nails. Teach your dog to walk on a leash, sit, lay down, and stay regardless of who is handling them. You should be able to hand over the leash to a new person and know that your dog’s behavior will remain consistent. Train your dog to calmly ignore other dogs walking by rather than getting excited or aggressive. Even if you do not plan to use a crate at home, crate training is still super important! Your dog is likely to find themselves in a kennel at some point in their lives, so conditioning for this situation at a young age means it won’t be a big deal later. Vet visit stress can begin as soon as you get in the car, so practice loading your dog in the car, making sure that it’s a positive experience and that they go on car rides to go to many places, not just vet visits. Crates can be particularly helpful here since they give your dog their own comfy place to be in while preventing them from jumping all over the car or potentially interfering with your driving. Using a crate in the car can even save a dog’s life in the event of a car accident! If your dog gets car sick, ask your veterinarian about medications to help prevent nausea. If your dog only goes to the vet for vaccines, they learn that they get poked by needles every time they go there. Many veterinary hospitals are embracing “fear-free” techniques and suggest “happy visits”, where your dog visits the clinic to get a treat and some snuggles, then goes home. This exposure to the veterinary clinic and the people in it helps your dog remain calm and comfortable when visiting the clinic. Reina (pictured left) might look like a scary Malinois, but she's an excellent patient, allowing us to do whatever we need to help her as long as she also gets snuggles. If there is a special treat that your dog loves, try to reserve it specifically for important situations like vet visits so that you can provide extra motivation to be on their best behavior. Helping Adult Dogs with Fear Aggression & Anxiety It can be more difficult for adult dogs to create positive associations with vet visits, but it’s not impossible and there are other tools to make things safer for everyone. Anxiety or Sedation Medication You should still be working on calm, cooperative behavior and socializing regardless of your dog’s age, but anti-anxiety or sedating medications can make a world of difference for fearful or aggressive dogs. It can take some trial and error to find the right medication(s) and administration methods, but once you do, these medications can help reduce those feelings of fear and stress, thus resulting in a better, more willing patient that can be examined more closely and ultimately culminating in higher quality care. Some dogs do best with medications that start the day before a vet visit, while others benefit from injectable sedatives immediately upon arrival at the clinic. Oral medications are generally preferred over injectables so that the patient can be aware of their experience without feeling so afraid and because it can be risky to give injectable sedatives to a patient with an unknown medical status. Muzzle Training For safety reasons, muzzles are often required but trying to put a muzzle on a dog that wants to bite you is dangerous. That dog is also likely to be terrified, further reinforcing the idea that going to the vet is bad. But don’t let the negative stigma dissuade you! When introduced correctly, a muzzle can be a huge asset and make calmer, safer interactions possible. Pictured left, Nemo's muzzle allowed us to start treatment and once he learned that we're there to help him feel better and NOT to hurt him, he was much more tolerant of therapy! There are many types of muzzles so you will need to research which type and size would be best for your dog, with a wider variety of options available online than in your typical pet store. Many muzzles, if correctly fitted, allow the dog to pant and drink water while wearing them. The key to success is to train your dog to willingly wear the muzzle by creating a positive association & having them wear it in non-stressful situations. It’s often easiest to start by feeding high reward treats from within the muzzle (as if the muzzle was a cup) and slowly working towards putting the muzzle over the nose for a few seconds followed by a treat, and eventually getting to the point where your dog will wear the muzzle just as comfortably as a collar or harness. Once your dog is comfortable wearing the muzzle during their usual day to day activities, you can also put it on them before even stepping foot into the veterinary clinic, making the entire visit safer and more comfortable for everyone. Set Your Dog Up for Success! Being a tough, strong, impressive specimen of athleticism does not mean that your Canine Athlete should be a scared, reactive, or angry dog. Canine Athletes have so much time and effort invested in them to perform at their best, it behooves you both to ensure that they get the very best medical care possible so that they can continue their work or sport. Failure to thoroughly train & socialize your dog will negatively impact the quality of their medical care & life experiences for you both. Canine Rehab OC offers custom Fitness Plans by appointment. Have Your Athlete Evaluated If you are interested in a comprehensive exam, clinically-proven therapies, and prescribed exercises for your Canine Athlete, check out the New Patient section of our website to learn how to get started. Looking For More? Want to learn more about how to support your Athlete? Canine Sports Medicine events are coming to Canine Rehab OC soon and we'd love to see you there! These events include demonstrations courtesy of Dogtor Wilbur and a 30+ page Canine Sports Medicine booklet for each attendee. If you are part of a local Dog Sports group and interested in setting up an event, reach out to us! We love getting involved in the dog community and helping as many families as possible. This article is Part 5 of our 5 part Canine Sports Medicine series! Other articles include: Part 1: Peak Performance & Injury Prevention Part 2: Cross-Training Part 3: Common Conditions & Injuries Part 4: Nutrition for the Canine Athlete

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

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

The tips & recommendations within this article are made for dogs that are free from any health concerns & 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 house pet. 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 & 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. 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! 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. 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. Start light! 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. Massage both sides of your dog's body. Do your best to massage each side 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 & 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 & 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 held 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 & make sure stretches are performed slowly & 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! Each stretch should be performed 4-5 times & held for 30 seconds to the point of initial discomfort. 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. *** Reminder *** The stretches discussed below are only indicated for dogs that are physically sound & may not be right for your dog. Canine Rehab OC offers custom Fitness Plans by appointment. Have Your Athlete Evaluated If you are interested in a comprehensive exam, clinically-proven therapies, and prescribed exercises for your Canine Athlete, check out the New Patient section of our website to learn how to get started. Looking For More? Want to learn more about how to support your Athlete? Canine Sports Medicine events are coming to Canine Rehab OC soon and we'd love to see you there! These events include demonstrations courtesy of Dogtor Wilbur and a 30+ page Canine Sports Medicine booklet for each attendee. If you are part of a local Dog Sports group and interested in setting up an event, reach out to us! We love getting involved in the dog community and helping as many families as possible. This article is Part 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)

Degenerative Myelopathy is a debilitating neurological disease that causes progressive paralysis in dogs due to degeneration of the 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, Geriatric Onset Laryngeal Paralysis & Polyneuropathy, 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, & therefore the pet’s breathing, there are no further options to maintain Quality of Life & 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 & 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. What 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 & 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 & abrasions from scuffing/knuckling. These can become quite painful & even get infected! We've gathered links and examples of these items on our Gear & Resources page! We also recommend checking out our article Recumbent/Non-Ambulatory Care for more detailed information. While your pet is still fully ambulatory on their own, it is important to protect their paws from scuffing & 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 & 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! Our favorite harness for DM dogs is called the Help ‘Em Up Harness. 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. The Help 'Em Up Harness 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 & bowels, diapers & belly bands become good options to help keep your dog & 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! 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. Dogs left in dirty diapers for too long are at risk for skin & urinary tract infections. Always change soiled diapers promptly. Pro Tip! If your pet's diaper keeps falling down (especially common with short tailed dogs) try Baby Pacifier Clips! Anchor the clips to the top of your pet's harness, then run the straps under the rest of the harness to clip them to the top of the diaper. We find that metal clips work best! 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 & 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. 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. The less weight there is for them to haul around, the less strain is imposed on their already weakened body. 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. We're Here For You 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.

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 & 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 guarantees 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. Prompt surgical correction by a Board-Certified Veterinary Neurologist is considered Gold Standard treatment for IVDD. The goal of surgery is 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 to relieve pressure off 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. Check out our articles regarding Recumbent Care for tips & tricks to help you support your pet's recovery. How to Set Up a Recovery Pen Recumbent/Non-Ambulatory Care 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 & spinal surgery requires patience & 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! 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 their 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. The initial stages of rehab are 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. To learn more, visit our Rehabbing Recumbency article 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 & 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 & twisting movements on the spine which is 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 & 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 & 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 & 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, the spine is poorly cushioned by degraded intervertebral disks & surrounded by extra bone. Bone rubbing on bone & nerve impingement become chronic sources of pain & stiffness. Pain and stiffness are common reasons that pet owners will pursue Chiropractic for their pet. Could you imagine applying jarring & 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 & 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 & still haven't seen a 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 start using a cart too soon! Once a dog starts getting around without using their back legs, they often lose motivation to try, pretty much sealing the deal that they will never regain independent mobility. For more information regarding Rear Wheel Carts & 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 & 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. Protect Paws 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! Improve Traction 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. Home modifications like adding rugs & ramps are quick & easy ways to help your dog get around the house more easily. Use a Harness 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. Use Excellent Hygiene Practices If your dog doesn’t have complete control of their bladder & bowels, diapers & belly bands become good options to help keep your dog & 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 & 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. Pro Tip! If your pet's diaper keeps falling down (especially common with short tailed dogs) try Baby Pacifier Clips! Anchor the clips to the top of your pet's harness, then run the straps under the rest of the harness to clip them to the top of the diaper. We find that metal clips work best! Provide Extra Plush Bedding 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 & 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. We're Here For You The impact of IVDD on the lives of pets and their families can't be overstated. With so many variables, big decisions, and modifications to lifestyle and home environment, it's easy to get overwhelmed. We're dedicated to supporting the best possible recovery for our patients and with more than 10 years rehabbing IVDD patients, we've found the safest and most effective approach to their treatment. Owners of CROC patients are encouraged to reach out to us with any questions regarding their pet's care so that we can work together to optimize results.

The tips & recommendations within this article are made for dogs that are free from any health concerns & 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 puts 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 & 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 & 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, & 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 & customized Fitness Plan that maximizes your athlete's safety & performance, 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. Have Your Athlete Evaluated If you are interested in a comprehensive exam, clinically-proven therapies, and prescribed exercises for your Canine Athlete, check out the New Patient section of our website to learn how to get started. Looking For More? Want to learn more about how to support your Athlete? Canine Sports Medicine events are coming to Canine Rehab OC soon and we'd love to see you there! These events include demonstrations courtesy of Dogtor Wilbur and a 30+ page Canine Sports Medicine booklet for each attendee. If you are part of a local Dog Sports group and interested in setting up an event, reach out to us! We love getting involved in the dog community and helping as many families as possible. This article is Part 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)

Research and innovations in Veterinary Medicine, such as preventative care, nutrition, and new treatments for previously life-threatening conditions, has significantly increased the average lifespan of our pets. With more pets living longer, we’re also seeing a higher prevalence of age-related cognitive changes that are not caused by other medical conditions. As our four-legged friends get older, their bodies will become weaker and less able to repair itself which sadly, also includes their brain function. Sometimes referred to as “Doggie Dementia” or compared to human Alzheimer’s Disease, Cognitive Dysfunction Syndrome (CDS) can be heart-breaking to watch as it takes hold of our pets. There are some treatments for CDS that may be helpful, but it is a condition that has only more recently become a focus of research and many treatments are still in development. What happens to a dog with CDS? Neurons serve to conduct information in the brain and throughout the body. As a dog ages, these neurons begin to waste away, making the ability to learn and recall memories more difficult. CDS is typically progressive and irreversible. As the dog’s brain function continues to decline, subtle behavior changes can become extremely disruptive or even dangerous for them or their families. Common Behavior Changes The abbreviation DISHAAL can help summarize the types of behavior changes commonly observed in dogs with CDS, but it's important to note that some of these changes can also be caused or associated with other medical conditions. Disorientation Staring at walls or corners Getting trapped behind furniture that they previously navigated with ease Struggling to get around commonly used doors Getting lost in familiar surroundings No longer responding to previously stimulating things like doorbells or food containers being opened Interactions Spends more or less time with family or other pets in the home Unable to recognize family members New or increased aggression Easily irritated Sleep-Wake Cycles Sleeping more during the day Waking up in the middle of the night without cause & often paired with pacing, whining, barking, or howling House Soiling Failing to alert family when they need to go Begins urinating and/or defecating in places they previously understood were off limits which may even occur right after being outside Activity Restless behaviors such as wandering, pacing, or whining Less interest in activities they previously enjoyed such as play time, walks, or meals. Anxiety New or worsened separation anxiety New phobias Signs of anxiety can include: Shivering Licking Drooling Pacing “Wide-eyed” or “whale eye” appearance Learning Difficulty responding to previously understood commands Inability to learn new things Who is affected by CDS? According to a study done by Texas A&M College of Veterinary Medicine & Biomedical Sciences, “approximately 28% of 11- to 12-year-old dogs and 68% of 15- to 16-year-old dogs have CDS” and a similar study found that "22.5% of dogs over the age of 9 years show cognitive impairment”. Any breed of dog can be affected by CDS but there is a slightly higher risk for smaller dogs since they tend to live longer than large dogs. How is CDS diagnosed? Cognitive Dysfunction Syndrome is a diagnosis of exclusion; meaning that all other possible causes are ruled out before concluding that CDS is the reason for your pet’s behavior changes. There are many conditions that can share symptoms & behavior changes with Cognitive Dysfunction Syndrome. Limited by Pain A dog that is painful from Osteoarthritis or a soft tissue injury may not want to play like before. They may not respond to doorbells anymore because it hurts to get up and run to the door. They may become cranky or even aggressive because being touched by you or jostled by another pet in the home might be painful. They may not make it outside to potty because it’s too painful to traverse stairs or a doggie door. Decreased range of motion usually occurs alongside orthopedic and soft tissue conditions, further limiting their mobility and increasing the level of pain they experience. To learn more, check out Motion is the Lotion. Blindness A dog that is losing vision can appear confused and lost. They may struggle to recognize family members until they can pick up a familiar scent or hear a familiar voice. Dogs losing vision often rely on a consistent home environment and will memorize the layout of rooms and furniture to avoid collision. Even just moving some furniture around can make a blind dog completely lost in their own home. They may avoid going on walks or have separation anxiety because without their human to keep them safe, they are lost anywhere outside their home. Neurological Conditions A dog suffering from a neurological condition, such as Intervertebral Disc Disease, may stumble and struggle to navigate previously simple obstacles like furniture, stairs, or doggie doors because they cannot move their body like they could before. They may start having accidents in the house because the nerve signals that control their bladder and bowels may be disrupted. It’s not uncommon for dogs to develop anxiety or restless behaviors just because they are frustrated that they cannot do what they used to. Benign or Cancerous Tumors Masses, both cancerous and benign, are always going to be high on the list as a rule out for CDS symptoms. Even if a mass isn’t malignant, it can still cause problems just by being there. For example, if a mass is located in the brain or near the spinal cord or major nerves, severe neurological issues can occur as the nerves are impinged upon and will progressively get worse as the mass grows. To rule out these conditions, your veterinarian will begin with a thorough physical exam. There are some simple observations and manipulations that can help your veterinarian identify potential orthopedic or neurological conditions. Routine comprehensive bloodwork & urinalysis is always recommended for seniors because it gives a quick snapshot of the bodily functions & can identify subtle changes before symptoms develop. Radiographs (X-rays) are extremely helpful to get a general look at the organs, identify boney changes, and reveal any internal masses. If your dog is painful or agitated, sedating them for their radiographs is a kindness! Not only will they be less stressed, but since they won’t be fighting the positioning, the images will be of better quality and they are less likely to injure themselves or their medical team. Depending on the physical exam findings, your veterinarian may recommend further diagnostics/treatment. For example, if a heart murmur is discovered or structural changes to the heart are identified in radiographs, an echocardiogram would provide more information as to the overall heart function and if medications are recommended. If severe periodontal disease is found, it may explain any difficulty with eating or pain related behavior changes and an anesthetic dental cleaning with extractions may be warranted to address pain and infection. If diabetes is revealed, dietary changes and additional lab work will be required as insulin dosages are established. Because some conditions are best managed with more specific training, equipment, and medications, your vet may recommend that your pet be evaluated by a veterinary specialist such as a neurologist, orthopedic surgeon, or internist. How is CDS treated? The primary focus should be to address any other conditions your pet is afflicted by as your pet’s symptoms may be significantly improved upon doing so. There is currently no cure for CDS, and potentially helpful treatments are limited but research is ongoing. It may be worth trying the following treatments as they may help improve symptoms and/or slow CDS progression. Early research indicates that diet & exercise have the biggest impact on your pet’s brain function. There are a few commercial diets available with promising feedback from owners of CDS patients such as the prescription formulas Purina Veterinary Diets NeuroCare and Science Diet B/D, as well as the over-the-counter formula, Purina Pro Plan Bright Mind. These diets include various combinations of antioxidants, fatty acids, and medium-chain triglycerides, which preliminary evidence indicates are likely to support brain health. If your pet is unable to make a diet switch, these nutrients can also be found in over-the-counter supplements, but be sure to evaluate these products carefully since supplements are not regulated like food or medication is. Our article on Pain Meds & Supplements includes tips on picking quality products and choosing the right medications for your pup. Providing more mental stimulation can help reinvigorate brain function. Brain games that require a bit of problem solving can help exercise a “weak” brain. Examples include: Wrapping a favorite toy in a blanket or towel & inviting your dog to find it Placing high value toys or treats around a room for them to seek out Kong toys (freeze for more of a challenge), puzzle feeders (available in varying difficulty), & snuffle mats. Frequent cycling of toys; you can buy new ones or just switch them out every week, so they feel “new”. Variety is key! Teaching new or practicing old tricks. If new tricks are too difficult, practicing old tricks still gets the brain working. Increased & varied exercise is also very stimulating when done with care & this is where Rehab can be an excellent tool! At CROC, we frequently treat senior and geriatric pets with a wide spectrum of medical conditions, so our team is very comfortable handling dogs that need extra gentle care. Your pet will get calm and supportive interaction with a new group of people who will help them as novel exercises are introduced. Our approach addresses your dog’s entire body, not just the presenting complaint. In this case, it means that your pet’s diminished strength or Osteoarthritis pain will be treated, often with modalities like Therapeutic Massage and Laser Therapy, alongside provision of mentally stimulating exercises. Teaching your pet to safely navigate our obstacle course will be a workout for their brain and their body, which will hopefully equate to a brighter and more confident demeanor at home. Unique experiences, like Hydrotherapy in our Underwater Treadmill, offer immense mobility benefits as well as tactile, auditory, and visual stimuli in a safe manner. Acupuncture is sometimes used for CDS patients since it can stimulate neurological function as well as relieve pain with minimal risk. To top it off, all CROC patients are prescribed “homework” consisting of massage, stretching, and exercises to do at home, further stimulating brain function as well as supporting the aging body. Our article, Motion is the Lotion, discusses how regular movement is integral to reducing pain and stiffness. What else can you do at home? When we humans reach our golden years, we often look to make our home safer and more comfortable. The same can be said for our silver-faced pups and even more so for dogs affected by CDS. Ensure that your dog has a quiet and cozy “safe place”, similar to a den. A good quality bed is a must! Orthopedic memory foam is best since dogs at this age are almost guaranteed to have osteoarthritis and the discomfort that accompanies it. Some dogs just want a comfy bed to snuggle up in while others prefer a crate to use as a private space. Make sure your home has flooring with good traction. Hard floors are very popular these days and while they’re great for keeping clean, many older dogs struggle with slick floors. A senior pup that is weak and contending with arthritis is more likely to slip and injure themselves. Placing rugs or yoga mats around your home can make it easier for your dog to safely navigate the house. If there are stairs, balconies, or similar obstacles in the home, pet/baby gates can be a literal lifesaver. For dogs with diminished vision, keeping the home environment consistent can help them avoid walking face first into walls or furniture. As a dog loses their vision, they often memorize the layout of their home & other commonly visited places, allowing them to get around even as they become blind. Sometimes, they can be so skilled at this that you could be fooled into thinking they can see! In these cases, rearranging furniture can have them completely lost in their own home, so if your dog’s vision is worsening, try to keep this in mind. They may also need better lighting, especially to get outside to go potty when the sun is down. Turning a dim room’s light on or even just using a flashlight to guide your dog can make a huge difference in their ability to make it outside to relieve themselves. Blind dogs may struggle to recognize their own family, so voices and smells become more important than ever. Make sure your blind dog knows you are approaching them before touching them, so they aren’t frightened by sudden contact. When dogs are in a state of high anxiety or fear, a calm & patient family member can be a huge comfort. For example, should your dog have an accident in the house, do your best to keep any frustration to yourself and instead give your pet gentle support. Dogs can feel frustration & even embarrassment in these situations because they know that what they did goes against a lifetime of training, but their body failed them in some way they couldn’t control. Helping your dog make it to the yard and making sure they are clean will go a long way toward bolstering their confidence. If your dog becomes stuck behind furniture or seems lost in their home, announcing your approach as you come to aid them can help reduce fear. Try talking to them in steady and mellow tones to let them know it’s okay and you’re there to help them. Visit our Gear & Resources page for links and examples of helpful tools like harnesses, diapers, booties, and more. The Help 'Em Up Harness can be particularly helpful in assisting large dogs outside to potty or on walks. If your dog is waking up during the night and pacing, whining, or howling, exercise and pain management may be enough to prevent this behavior, but sometimes prescription medications may be necessary. Make sure your dog is safely exercised every day and provided with adequate mental stimulation so that any excess energy is spent before bedtime. Rehab can be an immense help here! If physical and mental exercise isn’t sufficient, your dog may benefit from anti-anxiety medications or calming pheromones. You will need to discuss this with your veterinarian and finding the right medication, the right dosage, and/or the right combination of medications can take some trial and error. Try to be patient with your pup during this process & keep in mind that the first, even second or third plan, may not be the right one for you & your pet. Possible Safety Concerns Senior dogs can become less tolerant of certain interactions just because of pain or loss of vision, but dogs with CDS are often also contending with confusion, inability to recognize four- and two-legged family members, and increased anxiety. It’s important to acknowledge that your dog may not only become a danger to themselves, but can also become a danger to others. Imagine going to pet your dog on an area of their body that you didn’t know was painful and your dog doesn’t realize who you are. A dog that is painful, scared, and surrounded by people they don’t recognize has a much higher likelihood of biting someone. It’s important to watch for any signs of fear aggression towards humans, especially children, as well as other pets they may share their home with. Some dogs are genetically predisposed to have a high prey drive, but have learned to live with the family cat, then one day they no longer remember the cat as belonging to their family so those genetics to hunt and chase kick in. Or they may prefer to avoid other dogs but made friends with their housemate, only to start fights with them once they can’t recognize them anymore. Some of these things can be prevented despite your dog’s CDS. If your dog doesn’t recognize or no longer has tolerance for furry housemates, they may need to be kept separate using baby/pet gates. Children should be closely supervised or, if children are just visiting, it may be safest to keep your dog in another room during their visit. Best vs Worst Case Scenario In a perfect world, no dog would suffer from CDS but since we cannot prevent it, we just have to do our best to manage. In the best-case scenario, your dog’s CDS symptoms are mild and easily manageable. They do not cause any significant impact to your or your dog’s life, nor are there any increased safety concerns. The worst-case scenario is a sad one, but it is one that some pet owners face. If a CDS patient is suffering from their symptoms or is becoming a danger to themselves or others, euthanasia may be recommended. If your dog is living in a constant state of fear and anxiety despite your efforts, it’s time. If your dog is constantly soiling themselves, causing them to feel shame and you resentment, it’s time. If your dog is injuring you or other people, it’s time. You & your pet should enjoy your time together. When your dog’s quality of life is declining or you are suffering from compassion fatigue, it’s a good time to speak with your veterinarian & make plans for the wellbeing of all involved. If things can be done to support good quality of life for you and your pet, that’s great! Of course, we want every good moment with our pet that we can get! But if you have exhausted your financial, time, or energy resources and still struggle to enjoy life with your pet, it’s okay to consider euthanasia. To learn more about evaluating Quality of Life for you and your pet, visit our in-depth article here. Lean On Your Veterinary Team Whether it’s our Rehab Team or your Primary Veterinarian, we veterinary medical professionals work in this field because we truly care about the health and wellbeing of your pet. We see ourselves in you & consider each patient as if they were our own beloved pet, drawing on a wealth of knowledge & experience to help guide you. We have all the tips and tricks to help keep life easy and pleasant for you and your pet, but we also have the compassion to support you when hard decisions need to be made. Our Rehab Team is happy to assist you both on this journey and hope to help you maximize the best parts of your relationship with your dog.

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. Dogs are emotional creatures so creating a positive environment for them to learn in is a huge contributing factor for your dog’s success. 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. 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 & 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. You want to start the training session in a calm, but encouraging energy so that your dog feels relaxed and confident. 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! 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. 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. 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 & calmly continue. 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 The first few sessions in the cart should only last about 5 minutes (unless directed otherwise by CROC) each & 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. 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 & 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 your dog is only moving backwards, this is often a sign that they are 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 & 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. 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. You dog cannot defend themselves like a fully ambulatory dog can, so be very careful about which animals are allowed to interact with your wheeled dog. 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. 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 & bolts are secure & that the wheels are spinning easily & 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!