Dog Bracing Made Simple

Bodhi is a survivor. She's a 14-year-old, lovable Cattledog and has been battling cancer for the last year and a half. She's been through two surgeries and two rounds of chemo, but nothing can keep her down. Literally. A few months ago, Bodhi was playing in the backyard when she made a quick turn and immediately yelped, falling to the ground in pain. Doctors determined that she had completely torn her back left ACL. She was unable to put any weight on it at all, with all movement excruciating. Bodhi need to be carried around everywhere, even outside to relieve herself. This was another obstacle to a dog who has already gone through so much. Because of Bodhi's cancer and her age, her oncologist recommended against surgery since it would require months of rehab. Out of options, the family considered putting Bodhi down. Then her chiropractor suggested a Hero Brace as an option. She had seen success for other clients and referred the family to Dr. Annette Richmond in Carmel, CA. Dr. Richmond examined Bodhi and created the cast for the brace. After three weeks, the brace for the ACL tear arrived. It only took a day or so for Bodhi to get used to the brace. Now she wears the brace from morning until just before bedtime and has about 80% of her mobility back. Bill, Bodhi's owner, reports that her attitude improved immediately, and her quality of life has returned. "Shortly after she started wearing her Hero Brace, she got her "silly" back and is thoroughly enjoying her golden years," Bill says. "I just wanted to say thank you for such a great product. I can't speak highly enough of the results."Bohdi has overcome so much in her dog life. We are happy to be a part of her survivor story. Go. Bohdi. Go

A dog profoundly changed the course of her life. His name was Teddy and licensed physical therapist Karen Atlas adopted him unexpectedly. He had an injury that resulted in forelimb lameness. “I took him to several veterinarians to find out what I could do to help him,” said Atlas. “Every veterinarian we went to only gave us one option: crate rest and medication. Not satisfied with that answer and as a physical therapist, I knew more could be done.” In order to offer Teddy the best care she could, she took matters into her own hands. After more than 12 years treating humans, she changed careers. “Knowing I had a gap in my physical therapy education to treat animals, I sought out additional training specifically to learn how I could transfer my skillset and education from humans to animals,” she said. She enrolled in the Canine Rehabilitation Institute and earned her certification as a Canine Rehabilitation Therapist in 2008. “Teddy came into my life in an unexpected way and he forever changed my life in the most profound and wonderful way,” she said. Learning how to help Teddy gave her the ability to help many other animals. “The transition from human musculoskeletal and neuromuscular anatomy and function to animals is much less difficult [than] one might think,” she said. “Growing up, I have always had a deep affinity for and connection with animals, so being able to combine my passions has truly been a blessing.” In 2017, she opened up her own business and the schedule has been full from day one. Atlas Rehabilitation for Canines (ARC) in Santa Barbara, California has grown into a pioneering, state-of-the-art animal physical therapy clinic using the latest in physical therapy for animals, including manual therapy, customized therapeutic exercise, underwater treadmill, cold laser therapy, ultrasound, neuromuscular electrical stimulation (NMES), pulsed-electromagnetic field therapy (PEMF) and bracing.   “We’ve built trusted relationships within our community, which includes our referring vet clinics, animal welfare and shelter organizations, canine sports and performance groups, and canine law enforcement/search-and-rescue organizations,” she said. “We strive to get pets back on their paws faster and return them to a happy, healthy lifestyle after injury or surgery, and also help seniors live more comfortably in their golden years.” The clinic brings together experienced licensed canine physical therapists and veterinarians to offer comprehensive alternative care for animals. After the clinic receives a referral from a primary veterinarian, the onsite veterinarian meets with the client and pet to establish a veterinary-client-patient relationship. “After the initial exam, a physical therapist designs a customized treatment program to meet each pet’s needs,” she said. “Whether it is the sporting dogs/athletes whose handlers want a competitive edge, the search-and-rescue dogs that need some tune-ups as they train for future deployments, or the sweet, frosty senior faces that need some extra tender loving care for their aging joints and sore muscles, we consistently deliver high-quality care with positive results.” Some will even travel for hours from all over California for treatments at ARC. “No two dogs are the same, but we’ve had some impressive outcomes, including getting multiple paralyzed dogs back to full function — even after their veterinarian had given no hope and recommended euthanasia,” she said. “Our clients are very pleased with our effort, attention to detailed treatment plans, and the results. We are thrilled to be able to offer our services to the 805 community — and beyond. It's a true blessing.” Atlas said its their staff that really sets them apart. They have three veterinarians with 60-plus years of combined hands-on experience in client care, vet clinic ownership, mobile pet care and canine acupuncture. And between two physical therapists, they offer more than 30 years of combined experience as licensed professionals. “Our passion to provide innovative, alternative treatment options has brought clients to us from all over California,” she said. “Given the existence of animal rehab clinics across the state, for clients to travel so far to be treated by us, speaks volumes about our reputation. Our service is unique, not only to our local community, but in the state of California and beyond.” What it really comes down to is a love of animals and passion for helping dogs like Teddy who need help. Atlas has many inspirational stories about their work helping animals — like Lucas, the dog who was rescued after falling off of a cliff in Santa Barbara. ARC helped rehabilitate him so that he could walk again and he ended up finding a forever home. “We very often partner with local animal shelters and animal rescue organizations and provide discounted, and sometimes free, services to the underserved dogs looking for their forever home,” she said. “We also network with these organizations to actively help find homes once the dogs have completed their rehab with us.” ARC has made it part of their mission to work with the community. As another example, Atlas provided care for all the search-and-rescue (SAR) dogs that deployed for the Montecito debris flow tragedy in 2018. “The dogs — and their handlers — had impossible conditions to work in as they searched for survivors and victims in the days following the tragedy,” said Atlas. “After their shift, the dogs went through decontamination and headed over to my clinic where they received veterinary care — by volunteer veterinarians from Advanced Veterinary Services — while I provided body work and cold laser therapy so they would be ready to resume the next day. It was a true honor to serve these heroes.” At the center of ARC is a philosophy of service, compassion, empathy and teamwork. “I would describe my philosophy to be that of a servant leader and I truly believe we are better together,” she said. “My business culture is centered on serving others, and I start by modeling the behavior I would like to see throughout my clinic. You will frequently see me reaching for the poop bags and cleaners if that is what is needed to tend to a paralyzed, incontinent dog. I try to model how I would like my co-workers to treat each other and our clients. I was purposeful in developing a business model with limited hierarchy, as I seek to foster a spirit of service rather than competition. We are all on this journey together, and if we can realize that and help one another, life just works better.” Contact ARC at their website here.

If you ever wondered where stifle bracing started, Dr. Adrian was there from the beginning.  She has played an integral roll in the evolution of several braces and has worked with most manufactures helping dogs. Devoting her professional career to helping further canine physical therapy, she was the first person to earn a PhD in canine biomechanics from CSU Veterinary School. Below is an interview from dvm360 about her experiences with cruciate bracing. Dr. Adrian started working with Hero Braces in 2005 and has help us refine our brace designs to help thousands of dogs.  We appreciate her insight very much! Owners appreciate veterinarians that offer bracing for the dogs that cannot have surgery.

Using a Tarsal Brace with Graduated Articulation Most would agree that as practitioners we need to protect the Achilles tendon injury/repair early on and then slowly load the Achilles Tendon over time. That said, it is difficult to find a consensus on how to implement these needs. Below is a jumping-off point, a work in progress, based on my experiences and the knowledge gained from research of my peers. Please leave comments on how you think we should make it better. Partial Achilles Tendon Rupture or Post -Operative Arthrodesis Day 0 -Impression/casting at the time of diagnosis of a partial tear or end of surgery. Custom Orthotic will be taking the place of Bivalve Cast/Splint in 2-3 weeks. Weeks 0-2 -After Casting/Impression is performed place in Bivalve cast/Splint with dorsiflexion of toes, if possible at 45 degrees. Tarsus will typically be at 135 degrees extension. Recheck the bivalve cast weekly. Weeks 3-7  Sutures removed at 10-14 days post-op if used. Fit orthotic to pet. Orthotic is non-articulating. Wear in place of cast 24/7. Owner/practitioner to check 3-4 times a day for pressure sores. Begin rehab therapy. Continue rechecks every two weeks with Surgeon/RDVM. Weeks 8-11  -Cut brace to allow 15 degrees of articulation if a partial tendon rupture. Continue rehab in the clinic and at home. Weeks 12-16:  Pet out of brace or using as a “Sports Brace,” times of high activity. The pet needs to have sufficient strength to maintain a normal standing angle in Hock. The pet should be challenged with the rear leg in a “Three-legged Stand.” Typically 135 Degrees of extension. NOTE: Time intervals are stated as a guide. Some pets will need more or less time as they heal. This is where the “Art” of being a Practitioner is applied. Items to consider: Normal Range of Motion of the Tarsus. Flexion is 40 Degrees, and Extension is 170 Degrees in a relaxed pet. The normal Standing angle of the Tarsus for Tarsal Arthrodesis is 135 Degrees. According to Millis and Levine: Early partial weight-bearing and joint movement creates stress to promote parallel collagen alignment and increase tendon strength. The Hero Brace Tarsal Orthotic may help bypass or relieve weight-bearing forces to the healing tendon, much like incorporating a walking ring into a cast or external fixator. References: Small Animal Surgery 3rd Edition.  Fossum  pgs 1322-1324 Veterinary Surgery Small Animal 2nd Edition. Johnston and Tobios Vol 1 pgs 1204-1209 Small Animal Orthopedics and Fracture Repair 4th Edition. Brinker, Piermattei and Flo pgs 674-678 Canine Rehabilitation and Physical Therapy. Millis and Levine 2nd Edition pg 573 “Calcaneal Tendon Tears in Dogs” Four Leg Rehab Inc Newsletter March-April 2012 Vol1 : Issue 1. Laurie Edge Hughes “Post-Operative Management of Tendon Repairs” Four Leg Rehab Inc Newsletter May-June 2012 Vol 1 : Issue 2. Laurie Edge Hughes Copyright Paul Brumett DVM, CCRP, cAVCA

Not sure bracing fits into your practice? Initially a skeptic, Dr. Beck shares how her veterinary practice has grown to use bracing. 100% of my professional time is devoted to healing animals.  You could say I come by it naturally.  My father and I are both veterinarians. I took it a step further and am a certified canine rehabilitation therapist. Our private practice still believes surgery, with rehab, is the best way to treat orthopedic injuries. AND not all dogs can have surgery. My first experiences withe bracing were in 2010.  Initially, I was skeptical about bracing for cranial cruciate disease (torn ACL). After bracing many patients I have found it extremely useful when used in combination with rehabilitation therapies. I have had many cases where bracing has made a dramatic difference in a pets life. One patient tore both CCLs in the course of two years and chose to brace one leg and rest for the other (conservative management).  While both knees are now stable, the braced knee has better range of motion and less scar tissue that the knee that went unstabilized (no surgery, no brace).  I think that speaks to the biomechanics of the brace in preventing tibial thrust. I had a 150 lb. Boerboel dog tear both cruciates within 30 minutes of each other.  He had surgery on one knee and the other knee was braced. Otherwise he would not be able to walk and he was certainly to large for his mom to carry. I had a labrador retriever patient that lived on the second story apartment building with no elevator.  Bracing allowed her to use the stairs without pain, and she could still go for walks with her mom in downtown Omaha..  This treatment certainly made life easier for her mom! The Brace Honestly, I think what makes Hero Braces exceptional is their customer service. I feel like Ben, the orthotist, has a deeper understanding of the needed fit and support because he is an amputee and wears a prosthesis everyday. I have always believed that the more empathy you can have for your patients, the higher quality care you can provide them. The Hero Braces are very high quality and durable for all the wear and tear a dog can do. Dogs do very well with the application of the braces, and most owners do a great job monitoring the leg for  any changes from the brace. Michelle Beck, DVM CCRT

Super excited about the research coming out on the Hero Brace. Special thanks to Dr. Kelly at Online Pet Health for the interview on the research presented by Kiki Haeusler at the IAVRPT at the University of Cambridge in August of 2022.  

Caroline Adrian is a PT, PhD, and CCRP, and the new leader of Canine IQ and most recently at VCA Veterinary Specialists of Northern Colorado in Loveland, CO, where she was the Director of Rehabilitation Services for all VCA Hospitals. In 2005, Dr. Adrian met Hero's founder, Ben Blecha, through his uncle and co-founder, Dr. Wayne Watkins. Dr. Adrian was impressed with the unique Hero design and how it was based on established, biomechanical concepts. She was also impressed with how Ben made sure his designs 'worked' before ever introducing them to the public. Dr. Adrian stresses that it is the proper stability-providing, biomechanical design that allows the brace to be truly effective. A stifle orthosis may be used as an alternative to surgery when surgery isn't an option due to concomitant medical reasons or when finances are a concern. A Hero Brace can allow a dog to perform at any level, even when a meniscal tear is present. In her experience, she's noticed that other braces steer you away from a bracing option when a meniscal tear is involved. Dr. Adrian likes how simple the casting process is for the Hero Brace; the fact that it's done while the dog is side-lying and that it only takes 20-30 minutes in the clinic. She appreciates that the entire process is quick and simple: from talking with the client, to evaluating the dog, to casting and mailing the brace. She admires how Ben and the Hero team are extremely responsive to any questions or concerns, and she thinks the videos and learning tools online are most beneficial and easy to follow. Because of the accurate design, she likes that the brace itself is easy for clients to use with minimal complications and/or adjustments needed. She is glad that her clients are satisfied with the product and see positive results immediately with their dog after the first fitting! Dr. Adrian's patient, Sadie, sustained a CCL rupture in July 2013. Surgery was not an option as Sadie had several other issues, including polyarthritis, and had been on steroids long-term. Her owner, Cindy, recently sent Dr. Adrian an email to thank her for recommending a Hero Brace. From: Cindy Leary Sent: Wednesday, November 12, 2014, 3:59 PM To: Carrie Adrian Subject: Re: Sadie with new knee brace Hey, Carrie....How are you? Sadie is handling her new "knee" fairly well. The other day I took her for a walk with the leash out of our back gate, which she hasn't been out of since her accident. We walked all along the breeze stone path, and it's all open acreage back there and very rugged; she pulled like crazy to get back there. Just seeing her reaction and happiness to her old stomping grounds was everything. She wears the brace for around 3 hours at a time and doesn't really pay any attention to it. SO upset at myself for not doing this sooner! Thanks for everything…..Cindy Dr. Adrian is proud to be able to offer Hero Braces to her clients, "Hero Braces are a viable, beneficial option for a cranial cruciate ligament rupture (+/- meniscal involvement) – even bilateral ruptures." She also recommends Hero Braces to fellow physical therapists, CCRPs, and veterinarians for their patients, "IT WORKS!" Dr Carrie Adrian, PT, PhD, CCRP, began her career in animal physical therapy in February 2000 at Alameda East Veterinary Hospital in Denver, CO. She received her PhD in Canine Biomechanics, the first degree of its kind in the country, from Colorado State University, with a research focus related to electromyography and the canine cruciate ligament. Dr. Adrian is so well respected in the field of canine rehabilitation that she has actually helped "write the book". She has authored several chapters in textbooks used by many entering the field. She is widely sought to speak at many conferences as an authority on topics such as rehab bracing and biomechanics.