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

Getting old is no fun! Although, dogs of any age can develop Osteoarthritis, especially if they've had an injury such as Cranial Cruciate Ligament Rupture (CCL/ACL) , a congenital issue like Hip Dysplasia , or participated in Canine Sports . Included below are some tips, tricks, warnings, and other info to help you keep your pup mobile and comfortable. Should you have any questions on any of this information or would like more details, feel free to ask the CROC team. We are here to support you and your best friend! Weight Management Keeping your dog at a lean body weight is the most important aspect of managing this condition. Fortunately, it’s also one of the easiest! Sometimes, it’s as simple as adjusting their meal portions. Other times, a complete switch to a new food is necessary. These days, there are a wide variety of AAFCO formulated Weight Management or Weight Loss diets readily available for purchase. Some are even specifically formulated for Senior Pets or for those needing extra Joint Support. Be sure to look for diets that are high in Essential Fatty Acids. Generally speaking, your goal Body Condition Score for an arthritic dog is a 4 out of 9, a little on the skinny side. If you'd like more information about managing your dog's weight, including tips on diet changes and safe exercise, be sure to read through our article Body Condition Score & Canine Weight Loss. Supplements We'll briefly cover our favorite supplements here and frequently used medications below, but to learn more about supplements, such as how to pick a quality product, visit our article Pain Meds & Supplements . Dasuquin Advanced with MSM is an excellent daily joint supplement that many of our team members choose to use for their own pets. It includes Chondroitin, Glucosamine, and other ingredients to support joint health and it comes in a tasty, chewy treat, making it an easy addition to your daily routine. Fish Oil added to your pet’s meals is another easy addition to help keep joints happy (and it helps their coat too!). Start with 500-600mg per day, then increase to 1000-1200mg per day. It is important to start slow with this as some pets may be sensitive and have GI symptoms if started too quickly. Myos Canine Muscle Formula is a supplement containing Fortetropin, a natural bioactive supplement made from fertilized egg yolk. Myos has been credited with improving muscle health, helping to reduce muscle loss (atrophy) and helping regain muscle after surgery or with other disease processes. It has also been shown to help skin, coat, cognitive, and bone health. Medications Adequan (Polysulfated glycosaminoglycan) is a series o f injections that stimulates cartilage healing, slows the progression of osteoarthritis, and decreases pain and inflammation. It begins with an initial series of 8 injections with one injection given every 3-4 days. Once that is complete, many pets can drop down to a maintenance schedule of one injection every 1-6 months. For larger dogs, this can be a costly investment to get started, but we have seen significant improvement for many dogs using this medication. If you have concerns about giving your dog injections, be sure to speak to your veterinarian for options like an in-person demo or having their staff perform the injections for you. You can also speak to the CROC team. Common NSAIDS - Rimadyl (carprofen), Metacam (meloxicam), Deramaxx (deracoxib), and their Generics are Non-Steroidal Anti-inflammatory medications that can be extremely helpful for managing pain and inflammation and since many generics exist, it can be easier to find one that fits your budget. They can have long term side effects to the liver and kidneys so regular bloodwork is strongly recommended to catch any change in organ function early. They must also be given with food! Some pets don’t tolerate these medications well and can have serious GI side effects like stomach ulcers and gastrointestinal bleeding. It is important to monitor your dog for any signs of vomiting, diarrhea, or dark stools while on these medications. Some pets REALLY like the taste of the flavored tablets so store these medications with caution, securely out of reach of your pet. Galliprant (grapiprant) is a newer type of Non-Steroidal Anti-inflammatory that has less side effects than the more widely known NSAIDS listed above. It is reported to have less effects on liver, kidneys, and GI tract and can be safely used alongside a wider selection of other medications. Because it is newer and a more specific medication, it is generally more costly than the above listed NSAIDS that have been around longer. Neurontin (gabapentin) is a medication primarily used to treat nerve pain, though it can also help with anxiety. Many pets experience some level of drowsiness when they first start this medication, but they usually become accustomed to it and return to their normal energy level after some time. Besides sedation, other side effects are extremely rare. This medication is a good option for pets that cannot tolerate NSAIDS and it can also be used alongside NSAIDS and many other medications. Tramadol is a synthetic opioid that has been commonly used to treat moderate to severe pain in dogs. Newer studies on this medication show that it may be less effective than previously thought, with only a small fraction of dogs getting any pain relief from it. Side effects from Tramadol include sedation, vomiting, diarrhea, constipation, and loss of appetite A Quick Note About Librela Librela (bedinvetmab) is the newest OA treatment in the US; a once monthly injectable medication only for use in dogs. It must be administered by your veterinarian and may take up to 6 weeks for observable results. Librela is a monoclonal antibody (a protein that has been engineered to bind to a single target) that targets Nerve Growth Factor which helps reduce pain caused by osteoarthritis. It can be extremely effective for the right patient, allowing dogs to return to their favorite activities while potentially reducing the need for daily medications. However, the adverse effects reported with this new medication are highly concerning and side effects are still being discovered. Due to potentially severe side-effects, we recommend that your pet be thoroughly evaluated before starting Librela. This should include bloodwork and radiographs at a minimum and may require evaluation with a neurological or orthopedic specialist. To learn more, visit out our article A Look at Librela . Dogs with neurological conditions, auto-immune conditions, breeding dogs, or dogs that are skeletally immature should not be given Librela. Librela does not cure OA. Dogs on Librela sometimes feel so good (since they can’t feel the pain) that they overdo it and cause further injury to themselves. It is best to introduce Librela alongside a structured exercise plan to avoid injury and only after thorough diagnostic screening to rule out auto-immune and neurological conditions. Other Options If the above options aren’t working well with your dog, be sure to speak to your regular veterinarian about other medication options for pain relief. While CROC does not prescribe medication, we do help you improve your dog's pain management plan as needed as part of their prescribed treatment plan at CROC. There are new medications coming out frequently that might be a better fit for your pet. Stem Cell Treatments are now available for pets and may be something that could potentially help your pet. There are also other, non-medication treatments which we will discuss below that might help reduce your pet’s pain Exercising at Home As part of your Consultation with us, you will have been provided with Veterinarian Prescribed Rehab Exercises (your Homework). These exercises will help keep your dog limber and improve their strength and stamina while maintaining their range of motion. Regular walks, tailored to your pet’s abilities are an important part of keeping those arthritic joints moving, reducing stiffness. Make sure to do shorter, more frequent walks instead of one long walk every day. Our article Motion is the Lotion discusses the importance of frequent but controlled exercise to maintain the joints' range of motion and musculature. There should never be sudden changes between inactivity & exercise. Always have your pet warm up before exercise & cool down after exercise. A void becoming the “Weekend Warrior” Over-exercising and acrobatic activities such as ball and Frisbee chasing are recipes for pain and stiffness later. Unfortunately, this also applies to rough play with housemates and other animal friends. Your dog may have once been the rough and tumble, go-go-go type, but it’s important to think of an OA dog as an antique luxury car. They’re still wonderful and should be taken out to enjoy the world, but great care should be applied when doing so. Regular maintenance and preparation will make all the difference for your dog’s experience. Osteoarthritis Flare-ups Flare-ups are common & can even be caused by changes in the weather. It can be tempting to call off therapy sessions when your dog is having an OA flare up, but more often than not, that's actually when they need Rehab the most! Don't forget that their treatment plan is geared towards treating the pain and inflammation associated with their osteoarthritis in addition to building muscle to better support the joints. Let us know when you see changes in your pet's symptoms and our Medical Team will adjust their therapy session to best address your pet's condition so they can go home feeling better than when they came in. The Problem with Swimming Swimming is frequently thought of as a low impact and helpful exercise for OA dogs, however it commonly causes significant abuse to the elbows, shoulders, and hip joints leading to inflammatory flare-ups. Opt instead for walking in warm water at your dog’s armpit level. Do this at very slow intervals to decrease the repetitive grinding of any arthritic joints. Swimming exercises typically do not help pets become better or stronger at walking outside of the water. To learn more about hydrotherapy, such as when swimming is appropriate and medical conditions that would make swimming unsafe, visit our article The Deep Dive into Swimming . Physical Rehabilitation Participating in Physical Rehabilitation Therapy at CROC allows your dog to get exactly the exercises and pain relief that they need on a regular basis to keep them comfortable and mobile, while also slowing the progression of their arthritis and atrophy. Our team closely monitors your pet’s abilities and adjusts their sessions as needed while also keeping you updated as your pet progresses. Therapy Sessions at CROC include multiple pain relief modalities like Thermotherapy, Cryotherapy, Laser Therapy , Therapeutic Ultrasound , PEMF, Electrostimulation , and Massage Therapy to be used as appropriate for your pet’s condition. Veterinary Medical Acupuncture is another option CROC offers to provide pain relief and increase circulation. Daily participation in at-home exercises wearing you down? Let us do some of that work for you & take your pet home feeling better than when you dropped them off! Regarding Chiropractics... We know this is a soft spot and that many people enjoy chiropractic for themselves. Human Chiropractic has been practiced since the late 19th Century but is still in contention regarding its efficacy today. In Veterinary Medicine, Chiropractic is a very controversial and divisive topic. We do not want to shame anyone for previous choices made with the intention of helping their pet. We do feel compelled as thoroughly educated Veterinary Medical Professionals to share our perspective. At CROC, we have treated multiple patients that were receiving chiropractic care and were in significant pain when they came to us, which resolved when chiropractic sessions stopped while proper Physical Rehabilitation Therapy continued. A good percentage of CROC patients arrive here after being referred by their veterinarian. Because of this, we have developed very close relationships with the local Neurological and Orthopedic Veterinary Specialists. CROC does not offer Chiropractic services because not a single one of these Board-Certified Specialists will support or recommend Chiropractic therapy for IVDD patients.  Even when consulting with Boarded Neurologists outside of Orange County, we have yet to find one that would approve of their spinal patients undergoing Chiropractic treatments. At this time, there are no Peer-Reviewed studies to substantiate claims that Chiropractic is an appropriate (or even safe) treatment for Veterinary patients. In addition, the American Veterinary Medical Association, America’s leader in advancing the science and practice of veterinary medicine to improve animal and human health, has not published any policies supporting Chiropractic. Reviewing Chiropractic on a basic level - Chiropractic treatment involves applying jarring and intense force on the body, which is also one of the worst things for a patient that has spinal instability or just had spinal surgery. The spine is particularly fragile under the forces of Chiropractic & there is a risk for severe pain & neurological injury. 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, we have a spine that is poorly cushioned by degraded intervertebral disks & surrounded by extra bone. Bone rubbing on bone & nerve impingement become chronic sources of pain & stiffness. Pain & 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 better and safer options for pain relief available. Environmental Modifications Use a good quality dog bed! Memory foam is an ideal material. Y our dog’s bed should be at least 1 1⁄2 times as long as your dog and at least 1-2 inches of thickness for every 40lbs of body weight. Encourage your dog to change position frequently, such as switching which side of their body they lay on. Laying in one position for extended periods of time will lead to significant stiffness and pain once they go to get up. Slippery, hard floors are tough on OA dogs.   Rugs, yoga mats, & the like are extremely beneficial to help keep your dog on their feet & avoid slips & falls. Be sure to keep your pet's nails short too! Doggie Doors need to be large enough for your dog to walk through  without having to stoop or crouch. The bottom lip must also be low enough for your dog to easily step over. Minimize how often your dog has to climb stairs, especially if they are shallow and tall. If you live in a home with multiple levels, you may need to carry your dog up and down the stairs. If you are unable to carry your dog, it may be necessary to contain your dog to one level of your home. Don’t allow your pet to jump on and off furniture or in and out of your car. Especially jumping down, these types of movements put extreme stress on the body and are a very common cause for injury. Use ramps whenever possible. Change the location of certain resources. Some dogs need to have their food, water, and bed close together to avoid over-exerting themselves to reach basic necessities. Others need these resources placed farther apart to encourage more movement during the day. Be sure to ask what would best suit your pet’s needs. Engage in activities that require more mental participation from your dog.   Whether it’s toys that have treat tucked inside or playing a game of hide and seek, mind games help keep your dog bright, engaged, and active even when their body may need a bit of a rest. Ask the CROC Team There are so many options to manage your dog's Osteoarthritis, it can be difficult to know which are the right options for your pet. The CROC team is always available to discuss your pet's case specifically and to help you find a management plan that fits your lifestyle and your dog's needs. Our arthritic pups got that way from a lifetime spent at our side, so it's only fair that we return their dedication by treating their aches and pains to the best of our ability.

You might have seen the abbreviation BCS on your pet's medical records or seen the charts on the wall at your Veterinarian's office, but what does it mean and where does your dog need to be? The Body Condition Score (BCS) is a scale used to describe body fat level & determine proper body condition in animals. The BCS is often used on a scale of 1 to 9 or 1 to 5. To provide as much information as possible, CROC utilizes a scale of 1 to 9, with 1 being extremely underweight and 9 being extremely obese. Since dogs come in all shapes and sizes, determining their BCS is more about evaluating certain parameters of their body condition instead of focusing on just the numbers on the scale. Some quick ways to assess your dog's BCS include: Does your dog have an hourglass shape when you stand behind/over them and look down at them? Do they have a tuck at their waist? Can you easily feel their ribs? If any of your answers to the above questions are “no”, there’s a good chance your dog needs to lose weight. Dog owners don’t always recognize when their dog is out of shape. Maybe that’s why approximately HALF of all dogs in the United States are overweight or obese ! An overweight dog is at severely increased risk for serious health concerns, with even just a few extra pounds contributing to: Shortened Life Span Diabetes Cancer Arthritis Heart & Respiratory Conditions Skin Infections Pancreatitis Increased Surgical & Anesthetic Risk and many more scary things! So my dog needs to lose weight.... Now what? Just like humans, weight loss for dogs really comes down to two things: food and exercise, with food being the easiest and quickest thing to change. For successful weight loss, a reduction of caloric intake is not optional. We know. We wish it worked differently too! Get Specific With What You’re Feeding Here’s where things can go sideways. Humans may or may not choose to count calories as a guide for what they’re eating, with some opting for other methods of keeping to a healthy regime (Do my pants fit? Cool or Yikes!). But when it comes to the long term management of your dog’s weight, it’s essential to establish a concrete benchmark for how much to feed, meaning we need to determine the number of calories your dog needs each day. Unfortunately, feeding guidelines on the average pet food package are generally too broad or vague and many owners end up over feeding. The feeding guidelines on pet food packages are loosely based on active adult dogs of all ages, breeds, & sexes. Spaying or neutering, as an example, reduces energy requirements by 20-30%, so if your pet is spayed or neutered, you can already be overfeeding by 20-30% or more. To determine the ideal caloric intake, we need to consider your dog’s Body Condition Score, muscle mass, lifestyle and any medical conditions. For at home calculating, you can use the Resting Energy Requirement (RER) Formula (or just ask us and we'll calculate for you!) . RER Formula Example Equation Using a 30lb Dog a. Start by taking your dog's weight in pounds & dividing by 2.2 to get your dog's weight in kilograms. 30lb divided by 2.2 = about 13.6kg Multiply weight in kilograms by 30. 13.6kg X 30 = 408 c. Add 70 408 + 70 = 478 d. You can then factor in Metabolic Energy Requirements (MER) based on things like weight loss or spayed/neutered. For healthy, intact (not spayed/neutered) adult: Multiply the RER by 1.8 478 X 1.8 = 860.4 calories per day For healthy, spayed/neutered adult: Multiply the RER by 1.6 478 X 1.6 = 764.8 calories per day For an overweight adult to lose weight: Multiply the RER by 1.0 478 X 1.0 = 478 calories per day These formulas provide an estimate, but every dog’s metabolism is different so be sure to monitor your dog’s weight as you adjust their diet. CROC weighs our overweight patients approximately every 2 weeks to make sure they are safely losing weight and if we need to make any changes to their weight loss plan. Another easy change is to start utilizing a diet formulated for weight loss. Many diets exist to help dogs feel fuller while eating less calories. Some even have extra benefits like joint support! Trick or Treat? Our bond with our dogs is priceless and every dog owner wants to see the joy and excitement a treat brings to their best friend. However, it’s easy to forget that those treats are also part of your dog’s daily caloric intake. Even if you’re following the above formula perfectly at meal times, any treats your dog gets throughout the day are adding to their caloric excess. This doesn’t mean that you can’t give any treats! What it does mean is that you must calculate the additional calories of the treats you are giving and feed that much less of your dog’s regular meal. While commercially prepared, AAFCO approved diets are nutritionally balanced to provide your dog with everything they need, treats are not!  The majority of your dog’s daily calories needs to come from a balanced diet to avoid any nutritional deficits that could then cause serious illness. Dogs also get the same joy and excitement from healthier or smaller treats. Many of our clients report success switching to fruits or veggies as treats. There are also commercially prepared low calorie treats readily available, some as low as 2-3 calories per treat. At the end of the day, there are many ways besides food to show our pups that we love them. Safely Increase Exercise Now that your dog’s diet has been addressed, it’s time to start adjusting their exercise routine. The most obvious and important activity for your dog’s weight loss is walking. The amount of walking your dog needs depends on their breed and general health, but unless recovering from life threatening trauma, all dogs need to move regularly. Our article Motion is the Lotion  discusses the importance of regular movement in maintaining your dog's musculature, range of motion, and comfort. Regular walks exercise your dog’s body & provide mental stimulation like the vital opportunity to sniff! If you’re already doing regular walks, try lengthening your walk by 10-20%. Remember to work in your Home Care exercises to improve coordination, stamina, and strength. Muscle burns more calories! Unless your dog has been trained and physically conditioned for sports or other vigorous exercise, you’ll need to avoid overly strenuous or repetitive exercise, or you will risk injury. Weather conditions, such as high heat, will also need to be kept in mind to avoid paw pad burns or heat stroke. Physical Rehabilitation is an excellent tool to safely exercise your dog and speed up their return to health. Hydrotherapy in an Underwater Treadmill Therapy is a great option for overweight pets since the buoyancy of the water reduces strain on their already overworked joints while providing resistance to build their muscle mass and improve their stamina. While swimming is often touted as a good low-impact exercise, it is not recommended for most compromised pets as it does not build muscle as effectively and puts excess strain on overworked joints. Read the Deep Dive into Swimming to learn more. Our Rehab Practitioners & Veterinarians will prescribe a weight loss exercise plan specifically for your dog to achieve maximum results while making sure your dog isn’t overworked or injured. On the topic of overworked joints, overweight pets often experience accelerated  osteoarthritis  formation and considerable joint pain due to the extra force applied to them daily. Rehab treatments like Laser Therapy can help reduce that pain and inflammation, therefore keeping your pet more comfortable as they work through their weight loss plan. Rule Out Medical Conditions If caloric boundaries have been established and strictly followed, your dog is getting regular and balanced exercise, but you’re still not seeing results, a visit to the vet could be in order to rule out medical reasons for your dog’s weight. Weight gain & lethargy can be symptoms of conditions like Hypothyroidism or Cushing’s, among many others. These conditions often occur in middle-age to older dogs and can be treated with medication once properly diagnosed. Other symptoms to watch for include frequent urination, hair loss or poor coat condition, weakness, and delayed healing. Keep Track! Sometimes, it feels like you're doing everything right, but your dog STILL isn't losing weight. Often, the devil is in the details! To help figure out the culprit, we suggest keeping a food diary to track everything your dog is eating. This goes beyond just what goes in the bowl day after day. Owners of CROC patients are welcome to bring their completed food diary in for discussion any time. We are here to help get your dog to optimal body condition! Your food diary should include treats, table scraps, supplements, random things they found outside - literally anything that goes into their mouth! Feel free to download & print our food diary form ---> We're here for you! Navigating your pet's healthcare isn't always easy but we're dedicated to our patient's best possible outcome. At any time during our patients' treatment plan, we are happy to reassess their diet and weight to ensure they are on the safest and most efficient path to healthy body condition.

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

As our four-legged friends become more and more integral parts of our lives, us humans are getting better at finding ways to keep them comfortable, mobile, and having fun despite physical limitations. Using a cart can allow an otherwise immobilized dog the chance to go on their favorite walks, play with their friends, even play fetch! Sometimes, these activities are the difference between a stimulated, happy pup and a depressed, lethargic one. Is Your Dog a Good Candidate for a Cart? Bella was given more time to be mobile and active after Degenerative Myelopathy made her rear legs too weak to walk or stand on her own. First, we have to point out that dog carts don’t function like a human wheelchair. When a human is in a wheelchair, they are usually sitting – a passive position that requires little effort to maintain. They are not holding up their own weight and depending on the type of wheelchair, they may not have to put in much physical effort to move the chair. For simplicity’s sake and since they’re the most common, we’ll be using a rear-wheel cart as the main subject of this article, though there are many configurations available. A rear-wheel cart requires the dog to be in a standing position & does not allow for them to sit or lay down. Imagine being a physically compromised human & being forced to stay on your feet all day without rest! ---- AND ---- A rear-wheel cart requires the dog to have the strength in the front half of their body to not only hold up their front half, but to also pull the weight of the rear half of their body AND  the weight of the cart. That’s quite a lot to ask of a weakened or injured pup! Well then, what’s the point? Rear-wheel carts are usually recommended for dogs that have normal strength and ability up front but whose back legs are too weak to walk or are being dragged. Dogs with Intervertebral Disc Disease (IVDD) or Degenerative Myelopathy (DM) who have no chance at regaining the ability to walk but are otherwise in good health are commonly referred for a cart. But even the perfect cart patient needs some preparation before they start using a cart. This is where rehab comes in. We’ve heard people say, “rehab can’t fix my dog’s legs so why do I still have to bring them?”. Firstly, we’ve had numerous patients come in for a cart fitting only for us to see that the dog still has a chance at walking again if the clients want to try. This is HUGE! If you take a dog that still has potential to regain the ability to walk & put it in a cart, you have sealed their fate & taken away that chance at independent mobility. If you haven’t seen it yet, we suggest watching the video about our patient, Nalu , as he was an exact example of this situation. If we hadn’t turned down the idea of a cart for him, he likely never would have walked again. Thanks to Rehab, he went back to running on hiking trails with his mom, his favorite activity! Secondly, remember how the dog has to remain standing and pull the weight of their body plus the weight of the cart? That’s going to take some serious strength and stamina to do comfortably. Rehab sessions for these patients are aimed at getting the front legs, neck, and back as strong as possible and building your dog’s cardiovascular stamina to meet the demand of using the cart. Not only that, but this extra strain on the front causes significant compensatory pain and possibly injury. Therapy can physically prepare & maintain your dog for the strain of using the cart while also keeping those overworked muscles & joints happy & comfortable. Purchasing Your Dog's Cart Example of a poorly constructed and ill-fitted rear wheel cart. At this point, we’ve established that our patient is a good candidate for a cart and they are being physically prepared for the cart. Now, we just need a cart! This is another spot where many pet parents get caught up and their dog suffers. Carts are quite the investment. Even the cheapest carts are several hundred dollars. But much like anything else, you get what you pay for and with a medical device, you never want to cut corners. Cheaper carts are often made with cheaper materials and in only a few cookie cutter dimensions but dogs come in all shapes and sizes! We have seen lower quality carts cause significant back pain because they were not properly fitted for the dog and serious skin injuries where poor craftsmanship caused damage from regular use. A properly fitted cart should allow the dog to stand in an ergonomic position, provide good support without injuring the body, and be as easy for the dog to use as possible. Barry's low quality, poorly fitted cart Barry getting measured by the CROC Team Barry's new custom built, high quality cart What DO we recommend then? CROC exclusively recommends Eddie’s Wheels and we can perform the measurements for you so you know that when you invest in your dog’s equipment, it will be custom built for your dog to use safely and comfortably for years to come. We’re so confident in their carts, that when our clients get their dog’s cart through our Cart Fitting process, we offer continuous support for the cart  long after the initial ordering process. Most of our clients never need this follow up support but sometimes a dog will need small adjustments as their condition or ability changes. We begin by meeting with our clients to make sure that their dog is a good candidate for a cart, then anywhere from 2-5 CROC team members are utilized to position, measure, photograph, and record all details required for the cart to be perfectly custom built. We send in our part and the client takes the rest and orders their pet’s cart directly through Eddie’s Wheels. Lead times vary, but it usually takes at least a couple weeks for the cart to be shipped. We don’t stop there though! Next, we have our clients bring in their cart at their dog’s next therapy session so we can put together any unassembled parts and make any small adjustments to ensure a perfect fit. Introducing a dog to a cart can be a delicate process. Dog’s generally don’t like the concept of something being stuck to them or “chasing” them and some can get spooked when a wheel hits a bump or a wall. We make sure your dog has a calm, positive introduction to the cart and then start acclimating them to being in the cart and walking with it. Then, we teach you how to use the cart at home. Unfortunately, because of how much effort is required for your dog to use their cart, they can’t just jump in and go back to their 2 mile long walks. Like any new exercise, they need to be slowly introduced to it and then gradually increase the length of time in the cart. This process starts with just a couple minutes at a time, a few times a day. Dogs that have been physically prepared in the weeks leading up to receiving their cart will move through this process much quicker. Often, dogs using carts benefit from continuing rehab therapy to keep the functioning limbs as pain-free and strong as possible. To learn more about life with a dog on wheels, check out our article The Wheel Deal Part 2: You Got the Cart; Now What? Ask the CROC Team There’s nothing quite like seeing a previously immobile dog absolutely take off in their brand new cart! They always seem so proud of themselves and their spirits instantly lifted. If you think your dog might benefit from a cart, give us a call to schedule a Cart Consult. We’ll go over all your options and give you the real facts about if your dog needs a cart, what kind, what the process will be, and how to set you both up for success.

The Iliopsoas (pronounced like ill-ee-oh-soh-az) is a grouping of muscles comprised of the Iliacus and Psoas Major, which originate in two different spots but then fuse into one common tendon way up in the groin and attach to the femur. Their job is to flex the dog's hip (bringing their knee forward and up to their belly), rotate the hip outwards, and stabilize the lower spine. Highly active or sporting dogs frequently experience Iliopsoas Injury since the activities they participate in are high intensity like jumping, sprinting, or rough play and are more likely to overstretch the Iliopsoas. Dog sports are very similar to human professional sports in that structured and staged exercises are done to work up to a certain level of ability. Human professionals also routinely warm up and stretch before exerting themselves to their full potential but this is all too often overlooked in our canine athletes. Just like us, if a dog’s body is not properly strengthened & cross-trained for these activities before attempting, they are more likely to overwork the body & incur an injury. 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 Tear/Rupture   (sometimes incorrectly referred to as an ACL) but a dog’s overall fitness level and lack of preparation for high intensity activity can also be primary causes. Even if they are otherwise very well-muscled & fit, a dog that has poor flexibility & core strength will be significantly more likely to experience Iliopsoas injury than a dog that has been cross-trained & warmed up before exercise. Symptoms of Iliopsoas Injury Signs and symptoms of Iliopsoas injury vary, with some being extremely difficult for dog parents or even veterinarians to notice. Sometimes, a mild change in the dog’s gait is the only outward sign. Dogs with significant injuries/pain often stand with their lower back rounded and their hind legs brought closer to their front legs in an attempt to avoid the painful stretch their normal posture requires. This injury is usually diagnosed by palpating the dog’s groin muscles along with evaluating symptoms, though it can also be identified via Ultrasound Imaging or Magnetic Resonance Imaging (MRI). Rehabbing Iliopsoas Injury Just like human medicine, Physical Rehabilitation is the treatment of choice for muscle strain. Previously, clients were advised to keep their pets on strict crate rest, but this is no longer recommended. Instead, treatment starts by managing the dog’s pain including pain in other areas of the body caused by compensating for this injury. Pain management is key, as a painful dog will not be able or willing to participate in the exercises necessary to recover. As part of your consultation, we will discuss all current medications that your dog is on and if their pain is not adequately managed, we will refer you back to your regular veterinarian to adjust their medication as needed. In addition to medications, Thermotherapy, Therapeutic Ultrasound , Therapeutic Laser , Massage, & Stretching are excellent modalities to relieve the pain your dog is experiencing. We will alert you to any signs of pain seen in clinic, but make sure to keep us updated on your dog’s comfort level at home with daily routines as well. Once we feel that your dog is comfortable enough to start exercises, we will create a customized plan of foundation exercises to carefully reintroduce the Iliopsoas to normal movements and functions. It might seem counterintuitive to work this injury, but specific exercises are integral to bring blood flow and movement back to this tight and overstrained muscle group. As your dog starts to tolerate more of these exercises, we will introduce more challenging exercises to strengthen not only the injured muscles, but also other supporting muscle groups. This balance is essential to return to normal function. Consistent rehab sessions are best, but the custom homecare plan we create for you & your pet to do at home is also an essential part of your dog’s optimal recovery. These controlled and measured exercises will help your dog get better, but if your dog is allowed to return to normal exercise, free play, or even their sport too soon, they are likely to quickly re-injure themselves and lose any progress gained by the previous weeks or months of therapy. Sticking to the prescribed exercises and patience with the process are a necessity. Remember that every dog is different in how their body heals, so the length of time required to heal from this injury is unpredictable. The goal is always to prevent injuries like this, but once they occur, we can help get your dog feeling and moving better, faster. If left untreated, Iliopsoas injuries can become a chronic source of lameness and pain, so professional rehabilitative services started directly after diagnosis are always recommended for this type of injury. Ask the CROC Team Think your pet might have an Iliopsoas Injury? Let’s get you in for a consultation to find out! Give us a call at (949) 444-2451 to schedule with our Certified Canine Rehabilitation Practitioners and Veterinarians so we can get your best friend back to doing what they love most.

We’ve recommended a Help 'Em Up Harness for your dog. What is it, why do you need it, and why can’t you just use a regular harness? Unlike a regular harness you might buy from a pet store or online which might be comparable to clothing, the Help 'Em Up harness is a medical device , like crutches or a wheel chair. You’d want your crutches to be designed in a way that is comfortable for you to use, will withstand day to day wear and tear, and will not cause injury to other body parts during use. Using the Help 'Em Up Harness makes it much easier to help Nalu stay on his feet during an exercise meant to challenge his balance and stamina. Why This Harness? This harness is a fantastic tool to help your dog be more mobile. Whether old age and weakness is making getting in and out of the car more challenging, or they have a neurological condition requiring that they relearn how to walk again, your dog needs physical assistance. The thought behind assisting them to do normal activities rather than just carrying them everywhere is a sort of “use it or lose it” concept. They can’t ever regain strength if they’re not using those muscles. They won’t get the chance to regain neurological function if the opportunity to get those nerves firing isn’t there. The hope is, that by assisting your dog to do basic things, like walking or using the stairs, they can eventually regain the ability to do it on their own. So where does that leave you and your dog? You can physically lift and hold them in the positions, postures, and paw placements necessary for these activities - prepare for your own back pain! You can use a towel, leash, or sling to hold your pet up. These are appropriate tools for short term but they don’t disperse your dog’s weight in a comfortable way and aren’t the most comfortable for you to use every day either. There’s often too many straps to easily manage, you have to remember to grab it before any activity, they can impede your dog’s normal range of motion, and they put most if not all of your pet’s weight on their belly – ouch! The Help 'Em Up is designed to be easy for you to use and fitted for your dog’s anatomical needs. The padding is strategically placed so that your dog’s body weight is evenly dispersed under their chest and hips, instead of their neck or belly while also allowing your dog to move their legs normally. They even have pieces specifically designed for male dogs to be able to urinate while still getting the support they need to stand. No more pee covered slings or towels! But why does it have to be this harness specifically?  Over the years, we have seen countless attempted knock offs of this device. We understand; they’re not cheap and pet parents are trying to do the best they can for their pups while keeping themselves afloat; it’s a delicate balance. Unfortunately, we’ve yet to see a knock off that offers the same benefits and we’ve seen many that are dangerous to use. Some of the knock offs we have seen put dogs at risk for a dislocated hip or a slipped disc! Yikes! While we do offer a service to custom fit a Help 'Em Up Harness for your dog, the cost of this service only covers the expense to provide it (meaning we make no money by offering it) and we do not receive any sort of kick back from the makers of the harness. We recommend this product exclusively because it is the best we have found and tested. Common Conditions that Benefit from a Help 'Em Up Intervertebral Disc Disease (IVDD) Fibrocartilaginous Embolism (FCE) Geriatric Onset Laryngeal Paralysis & Polyneuropathy (GOLPP) Degenerative Myelopathy (DM) Osteoarthritis (OA) Hip Dysplasia Post-Op Amputation Most recovering recumbent patients Proper Use of the Help 'Em Up You might ask, " why is a harness fitting appointment necessary? ". The Help 'Em Up can be a bit tricky to fit to your pet the first time and improper use can cause skin irritation or failure to support your pet as intended. There are many adjustment points and this device needs to be well-fitted to your pet. Using the size chart to pick out your pet's harness can be deceiving as well as we have found that they often need a slightly different size from what the chart indicates. These harnesses are also unable to be returned, to us or the manufacturer. By letting CROC Professionals take care of this for you, you'll know that your pet is comfortable and well supported in their new harness the first time around. It is important for the harness to be snug. You should not see huge gaps between your pet and the harness. The Help 'Em Up is designed to be worn all day, but it must still be cleaned on a regular basis. Harnesses left on 24/7 and unwashed can cause skin infections/abrasions, especially for pets with urinary or fecal incontinence. If you notice that your pet's skin is irritated from the harness, remove the harness and wash it before putting it back on your pet. It is machine washable and we recommend placing it in a garment bag or large pillow case tied up before machine washing it. Ask the CROC Team If you have questions about using a Help 'Em Up with your dog, feel free to reach out to us! We’d love to help make sure that your dog is properly outfitted with the correct components, as several different combos of the harness and accessories exist, and that they are properly sized and fitted. We also help with adjustments later on as the buckles can move a bit over a longer period of time or your pet may need different settings as their body changes.

If your pet is unable to rise, stand, or walk, they are considered a recumbent patient or sometimes referred to as a “down dog”. If your dog can rise and stand but can’t walk, they’re considered non-ambulatory. Either way, caring for a dog that cannot move about on their own is a challenging endeavor which can be more difficult due to your dog’s size, temperament, and level of debilitation. Pending the reason for your dog’s condition, you may be responsible for some or all of your dog’s most basic bodily functions – eating, drinking, urinating/defecating, maintaining Range of Motion, minimizing muscle atrophy, preventing bed sores, and even mental stimulation.  We’re diving into all the basics you’ll need to know as you care for your pet at home, as well as common problems so you’ll know what to watch out for, why it happens, how to prevent them, & what to do if they occur.  While the information in this article is focused on recumbent pets and particularly those that suffer from neurological conditions, it can also be applied to any pet with compromised mobility. Conditions commonly in need of recumbent/non-ambulatory care include: Intervertebral Disc Disease (IVDD) Fibrocartilaginous Embolism (FCE) Acute Non-Compressive Nucleus Pulposus Extrusion (ANNPE) Degenerative Myelopathy (DM) Geriatric Onset Laryngeal Paralysis & Polyneuropathy Geriatric Sarcopenia Nutrition & Body Condition The recumbent dog’s body condition can be tricky to maintain and there may be some trial and error to meet their nutritional requirements. To set your pet up for success, you will need to adjust their diet to match their activity level and rehabilitation needs.  Why Nutrition Matters Dogs that aren’t moving on their own quickly begin to experience muscle atrophy, where the muscle wastes away from disuse. Inactivity also means that they are prone to gaining weight in the form of fat. More weight to haul plus weaker, wasting muscles is not an equation for recovery. However, inadequate nutrition can be just as harmful. The body cannot heal or build muscle if we don’t give it the building blocks it needs to do so. In addition, muscle and fat act as cushioning for the body. The more that is lost, the more prominent skeletal features become, and the higher the risk for decubital ulcers (bed sores). Lastly, if your pet has lost bowel control, diet can mean the difference between a quick clean up or a bath and full bedding swap out. Everything your pet eats, including treats, table scraps, dental chews, and anything else in addition to their regular food must be factored into their daily caloric allowance and nutritional requirements. Pro tip: All calories count! Treats are not nutritionally balanced to provide your dog with everything they need, so the majority of your dog’s calories need to come from an AAFCO approved diet to avoid any nutritional deficits that could cause serious illness. As nutrition is part of your pet’s Rehab Consultation, the CROC medical team will provide you with a clear outline of how much food and water your dog will require each day and how many feeding sessions to split that amount into. On occasion, we will recommend adding a veterinarian prescribed muscle building supplement to a patient’s diet, as it can help prevent muscle loss and promote muscle growth. Visit our article Body Condition Score & Canine Weight Loss to learn more about maintaining your pet's weight. You can also reach out to your primary veterinarian or a veterinary nutritionist for guidance and prescription diets.  How to Feed Your Pet If your pet is unable to eat or drink on their own, they may require hospitalization for intravenous fluids and possibly even a feeding tube. Sometimes, when patients are otherwise stable, owners can be taught how to feed their pet using the feeding tube and can continue to do so at home with the goal being that the dog will eventually be able to eat on their own so the feeding tube can be later removed. If your dog is able to swallow or chew, then you may be able to hand or syringe feed them at home, but refer to your veterinarian to ensure your pet’s safety. If your dog is able to eat and drink on their own, your job is to make sure that they can access food and water easily. Some pets may need different bowls or extra bowl stabilization if incoordination or weakness makes it difficult to reach or use their bowls without spilling. If your pet is up to the challenge, offering their meals in food puzzles, snuffle mats, or frozen lick mats can have the added benefit of mental stimulation, which can help release pent up energy & boost your pet’s mood.   Hydration Monitoring your dog’s hydration is especially important. There are a couple simple observations you can make to assess if your dog is well hydrated.  Gum Color & Moisture While some dogs have extra pigment that can make this observation more difficult, the hydrated dog will have wet gums of a nice bubblegum pink color. Dry gums are an easy indicator that your dog is experiencing dehydration. If your dog’s gums are dry and pale in color, you should contact your veterinarian right away , as your dog may need more urgent veterinary care. Skin Turgor Gently pinch the skin (gentle enough that this should not hurt) in between your dog’s shoulder blades and pull it away from the body, then quickly release. In a well hydrated dog, the skin should snap right back against the body immediately. If the skin is slow to return to position, your dog is dehydrated.  If your dog’s skin is slow to return to position AND their gums are pale/dry, absolutely contact your veterinarian immediately as your dog will need more advanced care right away . Urine Color Monitoring the color of their urine can help indicate hydration but is not always a reliable indicator on its own, so it is best to use this only in conjunction with the above methods. Darker, more concentrated urine can indicate dehydration, but it can also indicate other serious conditions so you should always consult with your veterinarian. What Goes In Must Come Out We won’t sugarcoat it. Loss of bladder and/or bowel control is no fun for you or your dog. Your dog has a strong instinct to relieve themselves away from their resting area and no one likes cleaning up soiled bedding. Over the years, we’ve discovered some of the best methods and products to keep this aspect as easy as possible.  Potty Pads & Easily Washable Bedding Invest in some quality potty pads! These are excellent for containing any mess and easy to throw away and start fresh. Bigger is better because the more pads you have to use to cover an area, the more edges there are where urine or feces can leak through. Since your dog will be spending a lot of time in one area, they will need plenty of soft, cushioned bedding and that bedding is likely to become soiled at some point. Make your life easier and choose bedding/padding that can be layered and is easy to clean! For a more detailed breakdown and real life examples on this aspect of your pet’s care, visit our article How to Set Up a Recovery Pen . Diapers & Belly Bands Diapers are great for female dogs with fecal or urinary incontinence, but are really only helpful for males with fecal incontinence. Disposable or reusable versions are readily available for purchase. Getting the right fit can be tough and your dog’s tail may complicate things. Even with the perfect fit, diapers tend to slide down and fall off, especially as they become full, which can be frustrating. Pro Tip - If you’re battling falling diapers, have your dog wear a comfortable harness & use pacifier clips to hold their diaper in place. Wrap the loop around the harness & attach the clips to the diaper’s edge that sits over your dog’s back. Metal clips tend to work best.  Belly bands are super helpful for male dogs that have bowel control but are urinary incontinent. These wrap around the dog’s abdomen to hold an absorbent material over the penis so that urine is contained within the band. These come in both disposable and reusable versions. We find that the reusable ones tend to stay on better and are often more cost effective. We’ve prepared links for many of these items on our Gear & Resources  page. Pro Tip - Line your pet's reusable belly band or diaper with human menstrual or incontinence pads! It's super easy to switch out pads rather than having to wash the band/diaper every time your dog urinates. Regardless of what type of diaper or belly band you choose to use, you must be extremely careful to use them properly or you risk injury and infection . Just like human babies, your dog’s diaper needs to be correctly sized and changed promptly once it has been soiled. All areas of skin that come into contact with the diaper must be closely monitored. The skin around the groin area is particularly sensitive so a soiled diaper (bacteria) that is too tight (abrasive/cuts off blood flow) and is left on for too long (prolonged exposure to moisture) is the perfect storm for painful, infected wounds. Incontinent dogs are already at a higher risk for Urinary Tract Infections, but sitting in a dirty diaper will exponentially increase that risk. When Possible, Get Outside If your veterinarian deems it safe to do so, try to help your pet urinate and defecate outside as often as possible. It can be emotionally helpful to give them a break from the monotony of life in the recovery pet in favor of some sunlight and fresh air. Even if you are manually expressing your pet’s bladder, try to do it outside where your pet would normally potty whenever you can. Your pet will always prefer to eliminate in a separate space from their den area Washing Up Regular, prompt changing of bedding and diapers/belly bands is a great place to start, but you’ll need to address their skin and coat as well. If your dog has a long/thick coat, shaving the hair around their anus & genital area, aka a Sanitary Trim, makes clean up much easier! Unscented baby wipes work well in a pinch but soapy washcloth is often more effective. Frequent wiping or washing can irritate your pet’s skin so we recommend using an oatmeal or sensitive skin pet shampoo to prevent overly dry skin. Pro Tip - If you intend to use wipes on a regular basis, make sure to buy wipes that are formulated specifically for dogs, as their skin pH is different from ours. Sometimes, a complete bath may be necessary. If so, just make sure your dog cannot slip or fall in the bath and that they are thoroughly dried after. Skin that is allowed to remain dirty and/or moist for too long is likely to develop a rash or infection.  Pro Tip - “Waterless” shampoo, often sold as a blue liquid spray product, can be somewhat helpful for very minor messes, but doesn’t actually wash your pet’s skin or coat since there’s no rinsing after! It does not replace actual bathing, can create skin irritation with frequent use, & can even stain your pet’s coat blue. Keep in mind that dogs have a primal need to maintain some level of cleanliness and for their den to be free of waste. Dogs that are left in dirty bedding/diapers can develop significant stress, anxiety, and even depression. None of these are conducive to healing, so remember that keeping your dog clean and comfortable will also help keep their mental state healthy which will help support their physical recovery and Quality of Life . Neurogenic Bladder & Urinary Tract Infections Dogs with spinal cord injuries often experience urinary dysfunction as well and the more time the pet spends unable to urinate normally, the higher their risk for developing Urinary Tract Infections (UTI). For some patients, the bladder becomes flaccid and the pet urinates involuntarily, however that doesn’t mean they are completely emptying their bladder. Often, the bladder remains partially filled and requires manual expression to completely empty, else “old” urine is left to sit and the bacteria within it will proliferate. Other patients may have too much urinary sphincter tone, preventing the bladder from emptying. These pets must receive timely medical intervention or serious complications like kidney damage, bladder rupture, or even death can result.  Depending on your pet’s needs, your veterinarian may teach you how to express your pet’s bladder so that you can do it as often as needed at home but you should never attempt to do this without instruction from your pet’s veterinarian . If you believe for any reason that your pet may be unable to urinate & you are unable or have not been instructed how to express their bladder, you should seek veterinary care immediately. Keeping your pet clean and dry will go a very long way to help reduce risk, but you should remain vigilant for common signs of UTI. These signs include: Excessively stinky urine, especially a fishy odor Urine that is darker in color Pink tinged or bloody urine Discharge from the urethra Pain while urinating Excessive licking of penis/vulva Increased thirst UTI is diagnosed via Urinalysis and if possible, it’s best to have a Culture & MIC performed as well, as this specifically identifies the type of bacteria that caused your pet’s infection and the antibiotic that is mostly likely to kill it. You should never assume that your pet’s UTI is gone just because they finished a course of antibiotics.   Should your pet be diagnosed with a UTI, always be sure to completely finish the prescribed course of antibiotics AND have a follow up Urinalysis performed to ensure no infection remains.  Their symptoms may have improved enough for you to believe they’ve been cured but the initially prescribed course of treatment isn’t always enough to completely eradicate the bacteria that caused the infection. If any of that bacteria remains when you’ve finished giving antibiotics, it will repopulate and your pet’s symptoms will return. Worse yet, the bacteria that survived and repopulated is significantly more likely to be resistant to first line antibiotics, meaning that your pet will require stronger medications that may have more side effects for a longer period of time to be cured of their UTI.  Protecting Skin & Paws Urine Scald When the skin is exposed to urine for a prolonged period of time, the ammonia and other components of urine will damage the skin’s protective barrier, causing it to become raw and painful. Urine scald is 100% preventable by ensuring that your pet’s skin & coat is kept clean & dry. The longer the skin remains moist and exposed to irritants, the weaker it becomes, the higher your pet’s risk for infection and open wounds. Accidents or soiled diapers must be addressed promptly and the skin should be allowed to breathe on a regular basis. Urine scald is easily identified, as the skin becomes very obviously inflamed and the pet’s coat develops staining and odor that are difficult to remove. Many pets will begin licking the area in an attempt to remove the source of their discomfort, which can also result in staining of the coat and introduce infection.  If your pet develops Urine Scald that doesn’t quickly resolve from improved hygiene practices, your pet may also need oral and/or topical medication to address infection and pain. If your pet’s coat is particularly long or thick, shaving or trimming it back can be immensely helpful to make clean up faster and easier in addition to allowing more air flow to reach the skin, helping to keep it dry. Sometimes, an e-collar (the cone of shame!) may be necessary to prevent your pet from licking the skin while it heals. Failure to treat and prevent urine scald can also contribute to our next topic, Decubital Ulcers. Decubital Ulcers (aka Bed Sores) More commonly referred to as Bed Sores or Pressure Sores, Decubital Ulcers are painful wounds and a serious concern for the Recumbent Dog. If the body remains in one position for too long, the soft tissues in the areas where bones are most prominent will experience too much pressure and too little circulation. These tissues then begin to break down, forming open wounds. Combine open wounds with urinary/fecal incontinence and we’ve got a recipe for a nasty infection. If allowed to continue, these wounds can become so deep that they expose muscle, tendon, or even bone.  Common Decubital Ulcer Locations Decubital ulcers are most likely to form on the bony parts of the body that experience the most pressure when laying on their side. Commonly affected areas include ankles, hips, elbows, shoulders, and eyebrow area, but these can occur anywhere that experiences prolonged pressure. Early stages can look like patches of hair loss or pink skin. If pressure is not relieved, the skin will begin to break down. You may also see redness, swelling, and discharge from the developing sore. Decubital ulcers that are allowed to worsen can eventually become full thickness wounds that expose muscle, tendon, or even bone. Decubital Ulcers can be very difficult to heal once they form, but they are very preventable! Make sure your dog has plenty of cushy padding (see our Recovery Pen  article) and most importantly, that they are repositioned every 4 hours if they cannot do so themselves. If your dog urinates or defecates on themselves or their bedding, they should be washed promptly and their bedding should be changed out right away. Again, make sure they are thoroughly dried before being returned to their resting place. Skin that is kept moist for a prolonged period will also be more fragile. If your dog cannot reposition or roll themselves over to their other side, you will need to reposition them every 4 hours.   When repositioning your pet, make sure to rotate between multiple positions and regularly switch sides of the body. Use rolled up towels or limb spacer pillows to help support your pet’s body and prevent them from rolling over. Not all positions are appropriate, so be sure to consult with your Rehab specialist for specific recommendations. If deemed safe for your pet, sternal positioning is a great alternative to always laying on their side & makes it easier for them to eat, drink, & interact. When laying your pet on their side, make sure to provide extra cushioning between their legs so that they are parallel to each other. This will help prevent decubital ulcers & overly tight muscles that could hinder their return to mobility. Abrasions If your dog is dragging themselves around, they are at high risk of developing wounds, even if it's on a soft surface. If your pet’s veterinarian has deemed it safe for your pet to drag themselves around, you’ll need to protect the areas of their body making the most contact with the ground to avoid injury. There is a common misconception that it is safe for dogs to drag themselves on soft surfaces like carpet, but we see many patients that are allowed to do so develop abrasions over their pubic bone or paws and they often present with excessively worn toenails that bleed. Drag bags are a great tool for these situations and can help contain any mess that results from a slipped diaper. When assisting your dog with a sling or Help ‘Em Up Harness , you’ll still need to mind their feet. There are many different booties on the market, and like us, every dog’s feet are unique so you may need to try a few different kinds to find which ones work best for your dog. As with anything you put on or around your pet, take care to ensure your pet doesn’t eat them and that they are not left on for too long.  All of these items are found on our Gear & Resources  page, but we’re always happy to provide personalized recommendations to CROC clients. For more information about getting your recumbent pet up and moving, including choosing the right gear for your circumstances, visit our upcoming article Rehabbing the Recumbent Pet . How to Lift & Carry Your Dog  If your dog can’t walk because of a spinal injury, it is imperative that you lift and carry them in a specific manner so as to avoid any further injury or pain. The most important thing is to make sure their spine remains parallel to the ground at all times. This is most easily accomplished using both arms to do the “lamby lift”or using a Help ‘Em Up Harness . Both methods provide equal support under the chest and pelvis and keep the pet’s legs directly underneath them. You should never pick up your pet by their armpits or allow their spine to twist or hang in any direction. Put them down in the same manner, keeping their spine parallel to the ground. Harnesses & Slings A good harness will be one of the most important things to help you safely move and restrain your dog, but it can be tough to pick the right one out of the millions of options because many aren’t made with ergonomics or safety in mind. Look for one that has a Y-shaped front and the leash attachment point should be on your dog’s back. Be sure to avoid harnesses with a strap horizontal in front of the chest, step-in style harnesses, and “no-pull” harnesses or those with a section that tightens with pressure. Our favorite harness for dogs that are unable or struggle to walk on their own is the Help ‘Em Up Harness  because it supports the entire body - no sling required - and it’s more comfortable for long term use. It can be tricky to find the right size and then adjust all the straps to fit your dog, but check in with our team and we can help you with that! Our Gear & Resources page also includes examples of traditional harnesses that we've found work well for our patients. A sling can be as simple as a towel or a neck tie but dog specific slings are also available online or in big box pet stores. No matter what you use, just make sure that it is made with soft material & does not inhibit movement - if your dog can move their back legs even a little, we don’t want anything getting in their way! Some male dogs can find it difficult or impossible to urinate with certain slings, so you may need to try one that sits farther forward or backward on their belly. That’s another reason we like the Help ‘Em Up! Almost all sizes have the option of a U-band for male dogs that cannot comfortably urinate with a sling. Lastly, make sure you choose a sling with handles that can be adjusted to your height. Your ergonomics matter too! Collars can be worn as an accessory to hold identification tags, but should never be used to move the recumbent pet or any pet with a history of or predisposition to spinal injury. When using a harness and/or sling to move your dog outside to potty, follow the same rules as when lifting them. Support the entire body and keep their spine parallel to the ground - do not allow their spine to twist in any direction. Walk slowly and allow them to move their legs/paws as much as they are able. Even if their legs aren’t moving at all, as long as their feet are protected from injury, just the act of imitating walking is very helpful in working towards recovery. To learn more about getting your pet moving and additional gear to make life easier, visit our upcoming article Rehabbing the Recumbent Pet . Quality of Life for All We touch on this subject for your sake as well as your dog’s. Compassion fatigue is a prevalent concern for clients caring for recumbent dogs. Especially if 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 journey, we completely understand and support humane euthanasia as an option. When deciding “when it’s time”, it’s always best to go weeks or even months too early than a day too late. Make sure to be realistic with your resources (finances, 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 a significant enough reason 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, please feel free to reach out to us for assistance or read our article discussing Quality of Life . We're here for you & your dog Overall, caring for the recumbent/non-ambulatory dog is a tall order. There's a lot to consider when deciding how to move forward, but having realistic expectations for yourself and your dog can help make the situation a bit easier to manage. The CROC team is here to support you and offer advice at any time during your pet's journey but it's also a good idea to find support with your regular veterinarian and others within your household.

Please note: This article does not replace your veterinarian’s medical advice or prescribed veterinary medical physical rehabilitation, but it can help you with the basics you’ll need to know to understand and support your pet’s journey towards mobility. If you haven’t already, we recommend that you start with our other articles discussing recumbent care: If your pet is unable to rise, stand, or walk, they are considered a recumbent patient or sometimes referred to as a “down dog”. If your dog can rise and stand but can’t walk, they’re considered non-ambulatory. Either way, caring for a dog that cannot move about on their own is a challenging endeavor which can be more difficult due to your dog’s size, temperament, and level of debilitation. Not all hope is lost though! With the right care at the right time, many pets regain some amount of independent mobility.  Your Pet’s Diagnosis Physical Rehabilitation for the recumbent or non-ambulatory dog will look different for every condition and patient. What may work well for one diagnosis may be extremely harmful to another, so the more information about why your pet is down the better. Getting your pet up & moving is a necessary part of their recovery, but doing so incorrectly, too much, too soon or too late can completely derail their progress. There is no one size fits all recovery plan, so you should always refer to the treatment plan prescribed to your pet by the CROC team or your veterinarian. Generally speaking, our goal is to help your dog regain the muscular strength and neurological function to be able to get up and walk on their own again. Some conditions will recover faster or better than others and some will never recover despite our best efforts. Results & the time it takes to achieve them can’t be predicted or guaranteed. For dogs experiencing Neurological conditions like Fibrocartilaginous Embolisms or Intervertebral Disc Disease , there’s a good chance we can improve function and mobility with dedicated, consistent therapy that begins promptly. For dogs experiencing progressive conditions, like Degenerative Myelopathy or Geriatric Onset Laryngeal Paralysis & Polyneuropathy , we know that we will not be able to restore function but we can slow down the effects of these conditions and help patients maintain comfortable mobility longer than without therapy. Once they are Recumbent, it’s time to pay close attention to Quality of Life for everyone involved. Timing Can Make or Break Recovery! Waiting too long to start Rehab is the most common reason a patient does not achieve optimal results.  Starting therapy too soon could risk further injury to your pet, but starting too late is highly likely to delay or prevent their recovery. The longer your pet remains inactive, the more muscle mass and flexibility they will lose and the more likely they are to gain weight - all major contributors to poor recovery. For patients affected by neurological conditions like Intervertebral Disc Disease , there is a very limited window of time (around 6 months from symptom onset for most patients) to encourage the nerve tissues to heal and the longer those patients wait for therapy, the lower their odds of recovery. The sooner we start, the more time we have to get those nerves firing again and the more likely that pet is to regain function. However, unstructured activity, over-activity, or in appropriate activity can worsen your pet’s condition & potentially significantly impact their ability to recover. For this reason, it’s imperative that your pet’s therapy is closely monitored by credentialed and experienced Physical Rehabilitation specialists, especially in the early stages of their recovery. Patients that begin Rehab at the earliest safe opportunity recover better & faster than those that wait. own content We understand that the idea of challenging your pet’s body after everything they’ve been through can be nerve wracking and we agree that everyone should be cautious with their care. We are proud to say that we are the most accomplished, licensed, certified, & skilled Physical Rehabilitation specialists in Orange County, with more than 10 years experience treating medically fragile patients. You can trust in our expertise as we evaluate your pet’s case and determine the earliest safe opportunity for your pet to begin Rehab. Their prescribed therapy plan will evolve as their medical condition changes to prioritize their safety while maximizing recovery. Don’t wait to get your pet’s Rehabilitation journey started! We recommend that you call us as soon as you think your pet might need therapy, even if your veterinarian hasn’t mentioned it as an option yet or you’re not sure that it will be necessary. It’s super easy to book a Consultation several weeks in advance and cancel if your pet doesn’t end up needing therapy, but waiting until the last minute may mean losing weeks that could have been spent recovering just waiting for the next available Consultation appointment. We never want patients to wait any longer to get started than they absolutely have to and once you have completed the Consultation with our medical team, our schedule for therapy sessions is very accommodating. Effort Rehabbing the recumbent/non-ambulatory pet is rarely an easy or quick process, but can be highly successful and rewarding in many cases. More often than not, you get out what you put in. Recumbent pets will require more time and attention than when they were able bodied and be reliant on you to fulfill their basic needs, often for an extended period of time. To give your pet the best chance at regaining independent mobility, consistency is key, so you should be prepared to commit to the treatment plan for weeks to months. Work smart, not hard! The right tools can make it much easier to commit to longer term care & after more than a decade of rehabbing recumbent pets, we’ve tried out a wide variety of equipment. Check out our Gear & Resources  page to see our favorites! Your pet may need round the clock supportive care at home in addition to multiple therapy sessions each week. Our medical team also prescribes a custom homecare program complete with recommendations for massage, PROM, stretching, target exercises, nutrition plans, home modifications, and if appropriate, alterations to your pet’s medication regimen. It is integral to your pet’s recovery to adhere to that prescribed homecare program every day if you want your pet to achieve the best possible recovery. Skipping the “homework” or only partial compliance will significantly impact how much progress your pet will make. Your pet’s recovery journey may take several months. If you are unable to perform your pet’s prescribed treatment plan for any reason, let us know so that we can better assist you and your pet. If your schedule makes it difficult to stick to your pet’s homework, we also encourage clients to book extra appointments so that our medical team can perform those tasks for you and help keep your pet’s progress on track. Ultimately, just do your best to stick to the treatment plan and keep your expectations realistically aligned with the amount of effort and consistency you are able to maintain. Before We Jump In… The following techniques should not be attempted without being prescribed by a veterinarian as some of these may be harmful for your dog depending on their condition or if performed incorrectly. Many of the therapies described below cannot be legally performed by anyone other than licensed and experienced veterinary professionals. Keep Them Limber You know how after a long drive, you get out of the car and your body aches from sitting for so long? Recumbent dogs feel something very similar but on a larger scale. Their muscles simultaneously tighten and shrink from disuse and their joints become stiff and achy. Since they cannot move their body as they normally would, that task now falls to you. Thermotherapy Stiff and atrophied dogs need some loosening up before they can stretch and move. Thermotherapy therapy, or 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. Chronic injuries heal more quickly, joints experience a greater range of motion, and flexibility is maximized.  Thermotherapy 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. Your dog should be in a relaxed position and heat should be applied for about 10-15 minutes. Cryotherapy (cold therapy) may be more appropriate for your pet so you should always refer to your pet’s prescribed treatment plan before proceeding. Wrap the heat pack in a pillow case or thin towel before putting it on your dog. Massage can be performed simultaneously while stretching and passive range of motion exercises should follow immediately after heating. Beware of Burns ! Always check that the heat pack is at a safe temperature before applying it to your pet! If you cannot comfortably hold the heat pack to your inner arm or neck, it’s too hot! Therapeutic Massage When your pet’s soft tissues are tense from inactivity, overexertion, or pain, blood flow is restricted which then deprives the cells within those tissues of vital oxygen. Reduced oxygenation reduces the metabolic removal of waste products and further impairs performance and healing. Lack of use causes your pet’s muscles, tendons, & ligaments to become short & tight, progressively limiting their range of motion. Massage Therapy relieves tension while restoring circulation and oxygenation to the tissues, thereby improving your pet's comfort and making it easier for them to participate in the exercise necessary for recovery. Muscles with good circulation will perform better, maximizing your pet's ability to increase their strength and stamina. Tendons and ligaments that are warm and relaxed will stretch farther and be less prone to injury. To top it off, massage releases endorphins that further promote your pet’s physical and emotional recovery. Your pet will need massage techniques specifically prescribed to them to avoid injury or other complications with their recovery. Refer to your pet’s prescribed treatment plan before proceeding. Tips to Maximize the Magic of Massage Less is more! The most effective massage is soothing and gentle, using slow kneading and gliding strokes similar to swedish tissue massage. This soft approach allows your dog to truly relax into the massage instead of bracing or tensing up in response. Choose a quiet, comfortable space with minimal distractions and make sure you are calm and relaxed before beginning.  One hand massage is less intimidating than two hands. To avoid feelings of being grabbed, be sure to use a flat, open hand and start the massage without using your thumbs.  If your dog is not used to having their body touched, start with light stroking, then work up to gliding and kneading. If they are particularly fussy and try to move away, let them! You are asking your dog to trust you with their weakened and/or painful body, so don’t make them feel trapped. Try again later with a lighter approach. The more you practice this type of touching, the easier it will become. The shoulders and neck are often the easiest areas to start with. Your dog’s muscles should not feel tight or banded in a relaxed state. If you can strum the muscle like a guitar string, there is tension and pain in that muscle. Do your best to massage both sides of your dog's body equally. To learn more, check out our video How to Massage a Dog . Passive Range of Motion & Stretching Beginning with thermotherapy and therapeutic massage to relieve tension and increase circulation will help make Passive Range of Motion (PROM) exercises and stretching more comfortable and more effective. Attempting to skip thermotherapy & massage can, at best, be ineffective at treating your dog’s condition, & at worst, cause pain or even injury.  Your pet will need PROM & stretching techniques specifically prescribed to them to avoid injury or other complications with their recovery. Our team provides all clients with a custom Treatment Plan to follow at home that has been prescribed to best address the pet’s specific needs. By following a customized Home Care Plan, you’ll know that the stretches and exercises within are not only safe for your dog, but also handpicked as the most beneficial for their recovery. PROM exercises involve moving your pet’s joints back and forth several times within its range of available movement. This promotes blood flow to the soft tissues and acts to lubricate the joint in order to maintain your pet’s overall range of movement. Stretching returns tight muscle fibers to their natural, elongated state to restore and maximize range of motion. Both assist in preventing tension and improving flexibility, which can then translate to an increase in your dog’s strength, stamina, and comfort. For stretching to be physiologically beneficial, start with warm, relaxed muscles and make sure stretches are performed slowly and held for a longer period of time. 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 during PROM or stretching, 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. 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.  All movements should be smooth & performed while stabilizing and supporting the joints. Apply gentle pressure to the muscles to manipulate your dog’s body into each stretch; NEVER pull! “If my pet doesn’t have feeling in their legs, is thermotherapy, massage, or stretching still necessary?” YES! Lack of sensation does not negate the need to keep your pet’s tissues healthy. For example, you can’t feel your liver but as a vital organ, it's important that we support liver health and function. The better your pet’s tissues are supported, the more likely they are to regain function. Avoiding Muscle Contracture Thermotherapy, Massage, Passive Range of Motion, and Stretching is a lot to get done every single day (and often multiple times a day) but the alternative is far worse. When a dog’s leg experiences long periods of disuse, the muscles not only waste away, but also contract and tighten, locking the dog’s leg into one position. This process is called Muscle Contracture & is both painful & difficult to reverse, so the goal is to avoid it entirely by keeping your dog flexible & moving. Once Muscle Contracture takes hold, it will take several months of intensive Physical Rehabilitation to have any chance at reversing it and there is no guarantee that it will be reversible. If your pet is already compromised by a neurological condition or poor musculature, Muscle Contracture will be a significant hindrance and may ultimately prevent your pet’s recovery. Change Requires Challenge Rest and pain relief are not enough for recovery! Thermotherapy, Massage, Stretching, and Range of Motion are passive treatments that improve comfort, maintain flexibility, and prepare the tissues for work, but when it comes to muscle and nerve function, it’s a “use it or lose it” situation. We know what some of you are thinking - “How am I supposed to exercise a dog that can’t walk?” Exercise comes in many forms and the custom treatment plan we prescribe to your pet will include several Target Exercises that are meant to safely maximize the function your pet still has and encourage the return of function they lost. Often, exercises for recumbent pets don’t appear to be exercise at all, when they are in fact powerful contributors to your pet’s recovery. Many are intended to “remind” the body how it’s supposed to work. The connection may be interrupted, but keeping the functioning nerves firing and trying to connect the tissues to the brain encourages nerve tissue to repair and regrowth. Even if a pet can’t move its legs or feel their feet on the ground, the nerves in their feet are still receiving information & trying to communicate that information to the brain. Other exercises are intended to harness the power of reflexive movement. Think of how your foot will curl if the underside is lightly tickled. You didn’t consciously tell your foot to do that, but those muscles were still activated and the movement happened without you even thinking about it. The same concept applies to your dog! With the right approach, we can stimulate your pet’s nerve function AND activate their reflexes to encourage muscle contraction, which can then later translate into kicking, standing, preventing falls, and hopefully walking. Of course, actively using muscles in the way we usually associate with exercise will always result in better and faster muscle growth, but any movement is better than none. While there’s no way to guarantee it, this reflexive movement can eventually become conscious movement for some patients. For recumbent/non-ambulatory dogs that are expected to make any kind of recovery, the first stages of exercise often appear tedious and insignificant. We start by re-teaching the dog to be able to lay sternally, where its legs are underneath them and their head is up, and after that, sitting up. These might seem like simple things, but strength, stamina, proprioception, and balance are crucial to be able to do these simple things and when we start, your dog may have very little strength, stamina, or balance and they may not have any proprioception at all. Once they are able to sit unassisted, we start working on standing. Your dog has likely spent a noteworthy amount of time just laying down, not supporting their own weight, so we have to retrain the body to be able to hold itself up again. This is where weight management plays a huge role in the level of difficulty your dog experiences during recovery. Getting to the point of standing may take weeks to months and during that entire time, you will still be responsible for all the movement and maintenance that your dog cannot do on their own and we will be working/supporting all aspects of your dog’s body to encourage healing and recovery. Fortunately, while conscious movement is the best case scenario, it isn’t always required for walking. Not all patients can regain conscious movement of their legs but many instead learn something called a “spinal walk”. Spinal Walking is when a dog still doesn’t have sensation or proprioception in their legs, but they develop a reflexive walk. Since the signals aren’t getting through the spinal cord to the brain (and vice versa), they are instead relying on more basic reflex signals to get their legs moving enough for them to be able to walk. This reflexive walk isn’t always pretty but it is functional and if we’re given the choice between paralysis and a goofy looking walk, we’ll take goofy any day of the week! Electricity, Needles, Lasers, & Sound Waves We utilize a mixture of clinically proven therapy modalities to help our patients feel better and recover faster. Our facility is outfitted with a variety of medical grade equipment including two Class IIIB Therapeutic Lasers, a Transcutaneous Electrical Nerve Stimulation (TENS) unit, a Neuromuscular Electrical Stimulation (NMES) unit, and a Therapeutic Ultrasound machine. For your pet’s safety, these medical devices should only be used by experienced veterinary professionals. Electrostimulation Neurological injury or disease are the most common reasons for pets to be recumbent or non-ambulatory as they interfere with nerve signal transmission & can result in phantom pain, incontinence, incoordination, weakness, and/or paralysis. Your pet cannot regain their ability to walk if their muscles aren’t working, & muscles won’t move if nerve signals to initiate movement aren’t getting delivered. Electrostimulation involves shaving small patches of your pet’s fur to place small, sticky electrodes over areas where motor nerves enter the muscle or the muscle belly itself, then introducing gentle electrical currents to help the nerves "practice" transmitting signals again. The more the neural pathways "practice", the more likely they are to heal or regenerate, potentially restoring your pet's mobility . E-stim also causes involuntary muscle contraction, helping to maintain musculature, improve circulation, & relieve tension. Voluntary movement will always be superior to the involuntary movement made by E-stim, but some movement is better than none.  E-Stim can be combined with PROM or target exercises for greater effect or used to amplify other treatments such as with Electroacupuncture. Replicating normal limb use or additional tactile stimulus, like tickling the toes, can be particularly helpful to maximize nerve activation & retrain muscle fibers. Acupuncture Acupuncture originates from Traditional Chinese Medicine & the concept of Qi. It is believed that placing needles in specific points along the body's Meridians unblocks disruptions to Qi flow that might cause illness. Modern science found that modifying this technique to stimulate specific nerves & muscle groups initiated endorphin release, increased blood flow, & increased nerve activity resulting in pain relief & improved healing. It can also be combined with E-Stim to enhance the benefits of both modalities as the acupuncture needles allow gentle electrical currents to bypass the skin, giving direct access to the nerves & muscle beneath. Many animals tolerate Acupuncture quite well. The needles used are sterile and extremely thin, so while the tissue's response to the needle can feel a little funny at first, it is generally not painful. The biggest factor for success is a pet's ability to sit still so that we can safely place the needles & keep them in place for the duration of the session. Plenty of pets relax or even fall asleep once they recognize the comfort that Acupuncture provides. Laser Therapy Laser is an acronym for L ight A mplification of S timulated E mission of R adiation and Laser Therapy involves applying that focused light into the tissues to achieve Photobiomodulation (the alteration of cellular function). Photobiomodulation can help with tissue repair, most notably in patients with chronic pain and/or injury. S tudies have also shown that Laser Therapy promotes accelerated nerve regeneration and improved functional recovery of peripheral nerves. Pain relief from Laser Therapy may be dramatic & substantial, lasting for hours, days, or weeks. Therapy is commonly described as a very soothing, warm sensation. Many patients feel a significant reduction in pain with just one treatment, but some patients need multiple treatments before they start feeling the effects. The effects of Laser Therapy treatment are cumulative, so patients that get successive treatments will benefit more than a patient that only gets one treatment every once in a while. It’s important to note that we exclusively utilize veterinary medical grade Class IIIb "Cold" Therapeutic Lasers to maximize efficacy & safety. Lasers of this caliber are not available for purchase by the general public & the devices that are readily available do not have enough power to achieve the same results. Check out The Low Down on Laser  for more information. Therapeutic Ultrasound We typically think of Ultrasound as the diagnostic imaging machine doctors use to see inside the body, such as during pregnancy. Therapeutic Ultrasound is not for diagnostic imaging but uses the same technology to create heat deeper into the soft tissues than external sources, like heat packs, can reach, thus facilitating tissue healing & reducing pain. Ultrasound is particularly useful for patients that have developed Muscle Contracture. Tissues that are warm are better oxygenated & more flexible, allowing for optimal stretching that makes it possible to safely regain range of motion more quickly. Ultrasonic waves can't travel through air, so it is best to shave off a small patch of fur at each area to be treated & apply a generous amount of ultrasound jelly. Treatment lasts several minutes for each area & causes a painless, warming sensation. Many patients relax & snuggle while they wait. For most cases, stretching & exercise commences immediately after treatment. Underwater Treadmill Hydrotherapy Once we’ve utilized our other modalities to prepare your pet’s body and deemed it safe for them to participate, initiating Underwater Treadmill Hydrotherapy is immensely helpful in supporting their return to mobility. In addition to providing low impact, high resistance exercise, the buoyancy the water provides gently lifts your pet’s body, allowing them to move more than they could on land. The more movement they can manage, the more their muscles can regrow and the more their nerves can heal or regenerate. Patients often start to demonstrate regained strength & coordination in the water long before they do on dry land. Many patients that don't like baths or swimming find Hydrotherapy in our Underwater Treadmills enjoyable thanks to the gentle introduction to the water. Your dog will walk onto a dry treadmill belt, then warm water slowly & quietly rises to their customized specifications. Throughout your dog’s Rehab journey, we'll alter the water level, belt speed, duration, & reps to perfectly tailor their hydrotherapy session & maximize their recovery. Pro Tip: Swimming is NOT safe or effective therapy for most recumbent/non-ambulatory patients! Swimming requires fast, intense motion that causes the spine to move in a twisting motion, overworks some muscle groups while underutilizing others, and can be very hard on your pet’s joints - all things your pet needs to avoid if they are to recover . Using an Underwater Treadmill provides a controlled hydrotherapy environment that encourages the slow, deliberate movement required to safely build muscle and improve coordination without causing excess strain to any other areas of the body, making it the safest option for fragile patients. Check out our article, The Deep Dive into Swimming  for more details. A New Set of Wheels Some clients elect to pursue a cart (sometimes referred to as a wheelchair) for their dog, but this option is highly dependent on the individual dog’s condition.  Pro Tip: We strongly advise against the use of a cart for any dog that has the potential to regain mobility, as it is likely to prevent recovery. If it is not possible to pursue physical rehabilitation therapy or your pet’s prognosis for return to independent mobility is poor, a cart may be a good option. Not all dogs are good candidates for this and it’s quite the investment so it’s important for pet parents to approach this with realistic expectations.  Carts for animals do not work the same way as a wheelchair for humans & require significant physical strength & stamina from the dog. While using a cart, dogs are forced to rely on the functional parts of their body to move their entire body weight AND the weight of the cart with fewer opportunities to rest as, unlike human wheelchairs that allow the user to sit and recover, dogs are unable to sit or lay down until removed from their cart . This means that cart candidates must be physically fit enough to withstand the challenge. Dogs that are good candidates should be fitted for a custom-built cart. Barry was professionally measured by the CROC Team & his rear wheel cart was built specifically for his body shape & size. This cart is a popular online purchase, but comes in a limited range of sizes. It rarely fits well & can result in pain & even injury. Dog bodies come in every shape, size, and proportion, so their medical devices should be chosen with great care and/or custom made for them. The only company we recommend for carts is Eddie’s Wheels whom we regularly collaborate with by performing cart measurements and providing long term cart support to the pets we measure. Over the years, we have seen many other carts and found serious flaws in all of them, with some even causing severe pain for the dog using it. For this reason, we recommend approaching To learn more about carts for dogs Visit our articles The Wheel Deal: Let’s Talk About Carts  & The Wheel Deal Part 2: You Got the Cart; Now What? . Keep Them Healthy Lean! It’s important to find and maintain just the right balance of nutrition and exercise so that your pet has enough fuel for healing and exercise without adding unnecessary weight. 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 less strain is imposed on their already weakened body. Many recumbent 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 & Canine Weight Loss . Pain Medication & Supplements Since there are many reasons a dog may become recumbent, it can be difficult to recommend any medications or supplements across the board but it is important to treat any sources of pain as pain will inhibit your pet’s ability to heal. CROC does not prescribe medications, but we can help evaluate your pet’s current pain management plan  and give you the information you need to discuss it with your regular veterinarian. Check out our article Pain Meds & Supplements  to learn more. Medical Marijuana & CBD CROC strongly discourages the use of marijuana products for canine patients. While emerging research shows some promise for cannabis based treatments in veterinary medicine, there is still much more to be done to prove safety and efficacy. The lack of regulation is highly concerning as there have been countless reports of harmful, even life threatening, ingredients being used in products marketed for pets . Lethargy and incoordination are common side effects of marijuana so recumbent and non-ambulatory patients that are already weak and have diminished coordination make poor candidates for these products. Cannabis products marketed for pets are not currently regulated in California & multiple incidents of harmful, even life threatening, ingredients in these products have been reported. Chiropractic Manipulation We know this is can be a soft spot and that many people enjoy chiropractic for themselves. 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. Human Chiropractic has been practiced since the late 19th Century but is still in contention regarding its efficacy today. 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.  CROC does not offer Chiropractic services because not a single one of the many Board-Certified Specialists we’ve consulted with will approve or recommend Chiropractic therapy. 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. At this time, there are no Peer-Reviewed studies to substantiate claims that Chiropractic is an appropriate or safe treatment for Veterinary patients. If your pet has a spinal condition such as Intervertebral Disc Disease , the force of Chiropractic can cause serious injury up to and including permanent paralysis. 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 and osteophytes (bone spurs) will form in an attempt to stabilize each joint. Eventually, osteophytes can become so severe that they bridge between each vertebrae. At this point, we have a spine that is poorly cushioned by degraded intervertebral disks and surrounded by extra bone. Bone rubbing on bone and nerve impingement become chronic sources of pain and stiffness. Pain and stiffness are common reasons that pet owners will pursue Chiropractic for their pet. Could you imagine applying jarring and intense force on a spine like this?!?! OUCH!!! If your dog is experiencing enough pain that you are exploring other treatments like Chiropractic, please check in with us or your regular veterinarian first. There are certainly better and safer options for pain relief available. We're here for you & your dog Overall, caring for the recumbent/non-ambulatory dog is a tall order. There's a lot to consider when deciding how to move forward, but having realistic expectations for yourself and your dog can help make the situation a bit easier to manage . The CROC team is here to support you and offer advice at any time during your pet's journey but it's also a good idea to find support with your regular veterinarian and others within your household.