Passive Range of Motion for a Dog Who Can't Get Up: Which Joints, How Many Repetitions, and When to Stop

Move every joint of each leg that is not moving on its own, from the toes up to the hip or shoulder, slowly, to the point of mild resistance and never past it. That much the veterinary handouts agree on. They do not agree on the dose: we read nine of them and found repetitions from 2 to 20 per joint or per limb and sessions from two to five a day. The only dose reported in a randomized trial is fifteen repetitions at the hip, stifle, hock and toes, twice a day, in small dogs (20 kg or less) after back surgery. If nobody wrote a number on your discharge sheet, take that one to your surgeon and ask whether it fits your dog. Stop for pain, swelling, heat, or a joint that is moving less than yesterday. And know what it is for: range of motion is meant for the joints. In the one trial where every dog had it, weight and thigh circumference fell anyway, and no trial has shown that it makes him walk sooner.

Start with your hands, before you read any numbers#

Put him on his side and hold the paw of the top back leg. Bend the hock slowly, then the knee, then bring the thigh forward, and feel for the point where the joint stops going easily. Then do the same on his other side, and compare. That is the whole technique, and it is also the only instrument you will have for the next few weeks. A joint that moved to a certain point on Monday and stops shorter on Thursday is telling you something, and nobody but the person doing the exercises will notice.

Passive range of motion means you move the joint and he does not. It exists for the dog whose legs are not moving on their own: after disc surgery, during a spinal injury managed without surgery, in degenerative myelopathy, after some orthopedic operations. The handouts' reasoning is that a joint that is never moved stiffens, and that the exercises give it the motion walking would have. We found no measurement of how fast that happens in dogs, so treat it as the working theory rather than a result.

Here is what the handouts are trying to give you, and what they leave out.

How many repetitions, how many times a day? Ten sources, seven repetition counts#

On 5 October 2026 we searched for owner-facing range-of-motion instructions from veterinary hospitals, specialty practices and clinical reference sources and kept every one that gave a repetition count; the list is a convenience sample, not a census, plus the one trial protocol. This is what each one says.

And the panel that wrote the ACVIM consensus on thoracolumbar disc disease, surveying the published protocols, said this: reported frequency ranges from one to five times a day for at-home exercises, "but frequency commonly is not specified."^[11]

That is the finding of this page: the dose is not standardized, and the ACVIM panel says frequency is commonly not specified at all. If your discharge sheet says only "do range of motion," it has left out the one part that decides how much of it happens, and a task with no number can quietly become zero while everyone believes it is being done.

Read the table again for what agrees. Most sources that describe the movement say slow and gentle, and most of the ones that say how far say to the point of resistance and no further; the exceptions are below. The sessions cluster at two to four a day. The disagreement is in repetitions and holds, and it is wide: the knee-surgery sheet is written for a dog who is already walking and adds a stretch hold, while the paralyzed-dog sheets are keeping joints moving that are not moving at all.

What we would do, and this is our reading, not a published rule: if your surgeon gave you a number, use theirs. If they did not, start from the trial protocol, fifteen repetitions at the hip, stifle, hock and toes twice a day (the protocol's wording does not settle whether that is fifteen per joint or fifteen passes of the whole sequence, so ask), because it is the only dose on the table that every dog in a randomized trial received, in dogs of 20 kg or less after back surgery, and ask whether it fits yours. Then ask at the next call or recheck whether it should be more. Write down the answer.

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Which joints, in what order, and how far?#

The trial moved the hip, stifle, hock and toes of the back legs. Its dogs had disc disease in the middle of the back, which is our reading of why the front legs were left out.^[1] The Partner Emergency and Specialty Center sheet lists all six large joints: carpus, elbow and shoulder in the front leg, hock, stifle and hip in the back.^[3] If his neck is the problem and all four legs are weak, all four get the exercises. Dallas Veterinary Surgical Center adds that the legs that are moving normally should be worked too.^[4]

Putting the sheets together, a session looks like this.

1. Position. Him on his side, the leg to be worked on top. The Cohn and Côté sheet has you kneel or sit beside his belly, between the front and back legs, facing his tail for the back legs.^[7] North Downs adds the instruction that matters most after back surgery: support the spine and prevent unnecessary movement of it.^[8] One hand steadies the limb above the joint; the other moves the limb below it. Only one joint moves at a time.
2. Massage first, if you have been shown how. North Downs puts massage before the stretching exercises because it helps the muscles warm up.
3. Toes first, then up the leg. North Downs starts by gently flexing each toe, then the hock and knee, then the hip.
4. Each joint: bend, then straighten. Slowly, until you feel mild resistance, then back. The Cohn and Côté sheet says one full bend or straighten may take 10 to 30 seconds the first time, coming down to 5 to 10 seconds with practice. Do not bounce at the end.
5. Then the bicycle. Partner, Dallas and the Veterinary Surgical Centers sheets all describe cycling the whole leg through a pedaling motion, as if he were walking.^[5] It is a compound movement, not a substitute for the joint-by-joint work.
6. Turn him, and do the other side. The Cohn and Côté sheet has the dog come up onto his chest before being rolled onto the other side. After spinal surgery, turn him the way your surgeon showed you, with the lifting rules for a fresh back in force. Fitting the session into the turns you are already doing is our suggestion, not a source's; it saves one handling.

How far is far enough? Nearly every sheet that gives an answer says the first resistance. Veterinary Specialty Center: flex and extend the joint to its limit "until there is resistance," and "nothing should be forced." (The same sheet adds that stretching scar tissue and contracted muscle is the goal and "will not be comfortable for your pet at first," which is the surgeon's call for a particular dog, not yours.)^[9] Cohn and Côté: "until you meet mild resistance."^[7] North Downs: never stretch the leg too far. One sheet goes further: the Madison TPLO sheet says to bend to the first sign of discomfort, go a little further, and hold.^[10] That sheet is for a dog recovering from knee surgery who is already walking, and we would not carry its instruction over to a dog who is paralyzed. A dog with little or no feeling in his legs may not be able to tell you when "a little further" became too far.

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When should it not be done, and when should it stop?#

This is the part the handouts say least about, so here is all of it.

Before you start. Brooks, writing on Veterinary Partner, puts the exception in one clause: passive flexion and extension and light massage are very good for the paralyzed limbs "as long as there are no dislocations or healing fractures."^[6] The Cohn and Côté sheet: if severe pain is present, do not attempt the exercises, and contact the veterinarian about pain control. The ACVIM consensus table puts the start of range of motion and massage at 24 to 48 hours after disc surgery.^[11] None of the owner sheets we read gives a special rule for a spine that was stabilized with implants, or for a fracture repair. We read that as a question for the surgeon, not a gap for us to fill. If he had anything more than a decompression, ask before the first session.

During a session. The Cohn and Côté sheet lists the signs of discomfort: raising the head, shaking the leg away, vocalizing. If you see them, stop and let him rest for several seconds before trying again. North Downs: if he becomes restless, painful or yelps, stop and try again later in the day. The Partner Emergency and Specialty Center sheet: do not force the movement if he shows any pain.

Resistance is not always pain. Here the sources point in different directions, and it is worth knowing why. Veterinary Specialty Center says that as a pet becomes stronger it may start to resist the exercises, and that this "is not only expected, but it should be encouraged." Madison says a dog who is very resistant should have his therapy reduced.^[10] Both can be right. A leg that starts pushing back against your hand, steadily and without signs of distress, may be a leg whose muscles are coming back; a dog who turns his head, pulls away or cries is a dog in pain. Telling those apart at home is hard, and if you cannot, describe what you are seeing to the clinic.

The signs that are a call, not a pause. Our list, drawn from what the sheets describe and not from any single source: a joint that is newly swollen or hot; a joint that moved easily yesterday and today stops short; crying out at a movement that did not hurt before; or a leg that had started moving on its own and has stopped. Any of these on a dog after spinal or orthopedic surgery is the same-day phone call.

More is not automatically better. One study in rats looked at heavy daily stretching after spinal cord injury and found it made recovery worse: rats stretched for 30 minutes a day, five days a week for eight weeks, walked worse than unstretched rats, and lost knee range of motion from week four.^[12] That is rats, not dogs, and far more stretching than fifteen gentle repetitions. We cite it for one reason only: it is a reason not to invent a bigger dose of your own because the dog is not improving fast enough.

When it ends. The ACVIM table gives a duration of 10 days to 6 weeks, or until the dog walks or moves normally. Southwest Veterinary Surgical Service, on its neck surgery page, says the massage and range-of-motion exercises "may be helpful until he or she is walking again."^[13] The Cohn and Côté sheet: a few days or several weeks, and "your veterinarian can make this determination." The logic holds across all three. These exercises stand in for movement the leg cannot make. Once he is using a leg himself, the walking does the job, and the exercises for that leg can be tapered at the surgeon's say. For a disease that only goes one way, such as degenerative myelopathy, there is no end date, and the exercises become part of the day.

“Because your dog can't tell you how much pain he or she is in.”

Does it work? What it can do, and what it cannot#

Be clear about what has been tested, because the honest answer changes what you should expect.

We found no test of passive range of motion against nothing in dogs. In Zidan's randomized trial, every dog had passive range of motion every 12 hours; the trial compared that basic programme against the same plus an intensive one (supported standing, electrical muscle stimulation, balance work, underwater treadmill). Thirty non-ambulatory dogs of 20 kg or less finished it. The intensive programme did not change gait scores at 14 days or any secondary measure at 42 days, and the authors report no adverse events associated with rehabilitation.^[1] A 2023 evidence review in Veterinary Evidence asked directly whether passive range of motion speeds recovery after disc surgery, appraised five studies, and found no study that investigated it on its own; its strength of evidence was rated weak.^[14] The one randomized trial we found with an arm that had no rehabilitation, Bennaim and colleagues in 32 dogs after disc surgery, tested a rehabilitation bundle rather than range of motion alone, and found no difference in the time to supporting weight, to first limb movements, or to walking. The groups were 11, 11 and 10 dogs and the paper calls itself preliminary, so that is a null result too small to rule anything in or out.^[15]

Weight and thigh girth fell anyway in the one trial that gave it to everyone. In the same trial, with every dog receiving the exercises twice a day, 24 of the 30 dogs lost weight during the 14 days in hospital, and thigh circumference followed the same pattern; most regained it after going home.^[1] Weight and girth are not direct measures of muscle, and there was no group without the exercises, so the trial cannot say what would have happened otherwise. What it does show is that thin thighs in the first weeks do not by themselves mean the exercises were done wrong. Moving a joint is not the same as working a muscle. Our page on muscle wasting in one back leg covers what does rebuild it.

What the evidence shows about the joint is indirect. In ten Labrador Retrievers with osteoarthritis and restricted joints, owners did ten passive stretches with a ten-second hold, twice a day for 21 days, and goniometer measurements showed a significant increase in range of motion.^[16] That is a small study of arthritic dogs, not paralyzed ones, and we read the abstract only. It is still the most direct evidence we found that owners' hands, twice a day, change what a dog's joint can do.

So the case for doing the exercises rests on three things, and it is a reasonable case. In the one trial where every dog had it, in 30 dogs of 20 kg or less after back surgery, the authors report no adverse events associated with rehabilitation. That is not a safety study of range of motion, and it does not cover large dogs. It is meant to keep the joints moving while the nerves recover, so that the leg has its range when it can work again; that is the handouts' reasoning, not a measured result. And the ACVIM panel, having reviewed the two randomized rehabilitation trials it found, still says the available evidence supports basic exercises as standard components of postoperative care in all dogs, on moderate-level evidence, and recommends a basic protocol including passive range of motion and massage on low-level evidence.^[11] Do it, at the dose your surgeon gives you. Just do not expect it to set the date he walks. That is not what it is for.

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What to buy, if anything#

Nothing is required. The exercises need two hands and a floor. Carpet that can be kept clean works, and so does a folded duvet under him and a cushion under your knees.

The surface is the one thing worth a decision. Two cautions pull in opposite directions: a padded mat is not needed if clean carpet is already there, and the mat's own listing says results are best on flat, hard floors and that on carpet the tiles can shift at the joins, so lay it on the hard floor, not over the carpet. The Cohn and Côté client sheet is the only one of the owner handouts in our table that specifies one, and it says carpet is well suited so long as it can be kept clean, so the free option is fine by its own standard. Its other option is "a rubberized, padded mat that is at least twice as long and twice as wide as the length of the pet," with a large foam cushion or foam rubber sheet as padding for pets with thin or fragile skin.^[7] It also has you kneeling beside him for every session. The sheet gives three sessions a day, and the ACVIM table allows up to six weeks; by our arithmetic, three a day for 42 days, that is up to about 125 sessions on your knees on whatever floor you have.

If you decide to buy a surface, the one we looked at is the ProsourceFit exercise puzzle mat. It is a gym floor, not a pet product: six interlocking 24-inch tiles of half-inch EVA foam, $29.99 sold by Amazon.com on 5 October 2026.^[17] Four of them make a 4 × 4 ft padded square, which meets the sheet's size rule (twice the dog's length and width) for a dog up to about 24 inches long, though these are foam tiles, not the rubberized mat the sheet names; a dog 30 inches long, Labrador-sized, needs nine tiles, so two packs. We have not used it, and we cannot read its reviews from here. What it is bad at: the tiles are separate pieces, so urine runs into the joins and under the mat, and for a dog who leaks it needs a washable pad on top, as the pressure-sore page explains. Half an inch of foam is a working surface for a short session, not a bed for a dog who lies there all day. If you already have clean carpet and a thick cushion, you do not need it.

What we could not find#

• A study in dogs comparing passive range of motion with no passive range of motion. Not for disc disease, and not for anything else we searched. The evidence review we cite says the same.
• A shared dose. Eight of the ten sources give a repetition count, and those eight give seven different ones. The trial dose is the only one used in a randomized trial, in which the authors report no adverse events associated with rehabilitation; that is not the same as a safety study.
• An owner handout that addresses spinal stabilization or a fracture repair specifically. Veterinary Partner names healing fractures and dislocations as exceptions; nothing we read went further.
• Large dogs. The trial enrolled dogs of 20 kg or less. No sheet distinguishes a 9 kg dachshund from a 40 kg shepherd, beyond the size of the mat.
• Normal joint angles we could verify. The goniometry study of Labradors that published normal values is behind a paywall, and we will not print numbers we could not read at source.
• How quickly an unmoved joint stiffens in a dog. We found no figure for days to stiffness that we could check at source.

What to do this week#

The delay is the injury, and with range of motion the delay does not look like waiting. It looks like a plan that says "gentle exercises" and a household where, as can happen with any task that has no number, the sessions fade after the first few days.

Today, write the dose down where the bladder times go. Four lines: which legs, which joints, how many repetitions, how many times a day. If your surgeon gave you numbers, they go there. If not, write the trial's, fifteen repetitions at the toes, hock, knee and hip, twice a day (and ask whether that means per joint or per pass), and mark it "ask the surgeon: does this fit my dog?" (the trial was dogs of 20 kg or less after back surgery). Add a fifth line for the stop signs: swelling, heat, crying out, a joint moving less than yesterday. Tick each session when it is done. Then, at the next call, ask the surgeon three questions: is this the right number, are there any joints I should not move, and when do we stop. The back-surgery recovery page covers the rest of that recheck, and the feeding page uses the same sheet for water.

He cannot tell you a hip is getting stiff. Your hands can, if they are there twice a day and someone is writing it down.

Sources#

1. Zidan N, Sims C, Fenn J, Williams K, Griffith E, Early PJ, Mariani CL, Muñana KR, Guevar J, Olby NJ. "A randomized, blinded, prospective clinical trial of postoperative rehabilitation in dogs after surgical decompression of acute thoracolumbar intervertebral disc herniation." Journal of Veterinary Internal Medicine. 2018;32(3):1133-1144. doi:10.1111/jvim.15086 — full text and Supplementary Data 2 read via Europe PMC (PMC5980307) on 5 October 2026. "All dogs had passive range of motion (PROM) exercises performed every 12 hours"; the basic group received that care and the intensive group "the same treatment as well as a staged progression through supported standing, neuromuscular electrical stimulation (NMES), weight shifting and balance board exercises and underwater treadmill (UWT) work." Supplementary Data 2: "Fifteen repetitions of passive range-of-motion (PROM) exercises were performed putting the hip, stifle, hock and digits through a full range of motion every 12 hours starting 48 hours postoperatively"; "Between weeks 2 and 6, owners were instructed to perform PROM exercises twice a day." Inclusion weight ≤ 20 kg; 30 dogs completed; "no adverse events associated with rehabilitation"; mean change in open field score by day 14 6.13 (basic) vs 5.73 (intensive), treatment effect −0.4; "Twenty-four of 30 dogs lost weight during their 14-day hospitalization"; thigh circumference mirrored weight.
2. Animal Clinic of Billings. "Dog Spine Surgery Recovery Resources." animalclinicofbillings.com — read 5 October 2026: move each limb "in flowing, circular, forward to backward movements"; "Repeat for 10-15 repetitions, several times daily."
3. Partner Veterinary Emergency and Specialty Center. "Home exercises for the neurologic patient." partnervesc.com — read 5 October 2026: "the carpus/wrist, elbow and shoulder in the forelimb; and hock/ankle, stifle/knee, and hip joints in the hind limb"; individually or "as a compound movement (think of a bicycle pedaling type movement)"; "Do not force the movement if your pet is displaying any pain"; "Perform 10-20 repetitions two to three times daily."
4. Cichocki B, Franks J. "Care for paralyzed pets." Dallas Veterinary Surgical Center. dvsc.com — read 5 October 2026: "Gently move the limbs through range of motion 10-15 repetitions 3-4 times a day"; "bicycle movements with one limb at a time ... as if your dog were walking"; "Make sure to rehab all limbs that are moving normally."
5. Veterinary Surgical Centers. "Post-operative instructions: intervertebral disc disease." vscdsurgerycenters.com — read 5 October 2026: "Perform passive range-of-motion exercises 3-5 times daily for 5-10 minutes each session ... gently flex and extend your pet's hind limbs in a bicycling motion."
6. Brooks W. "Physical therapy for paralyzed dogs." Veterinary Partner, Veterinary Information Network; published 25 August 2003, revised 18 August 2026. vin.com — read 5 October 2026: "As long as there are no dislocations or healing fractures, passive flexion and extension and light massage are very good for the paralyzed limbs"; "This is repeated for about five to 10 minutes two to three times daily."
7. Cohn LA, Côté E. "How to perform range-of-motion exercises." Client education sheet from Clinical Veterinary Advisor: Dogs and Cats, 4th edition. Elsevier, 2020; as distributed by a veterinary practice. PDF — read 5 October 2026: "Each exercise usually is performed 15-20 times each session"; "between 5 and 10 minutes ... 3 times a day (about every 6-10 hours)"; one full extension or flexion "will likely take from 10 to 30 seconds the first time ... 5-10 seconds should eventually be typical"; "until you meet mild resistance"; discomfort signs "raising the head, shaking the leg away, or vocalizing"; "If severe pain is present, do not attempt these exercises"; started "within 1-3 days of injury/surgery"; "a rubberized, padded mat that is at least twice as long and twice as wide as the length of the pet"; kneel or sit beside the belly; duration "a few days or several weeks ... Your veterinarian can make this determination"; "even once a day is better than none."
8. North Downs Specialist Referrals. "Canine pelvic limb physiotherapy." ndsr.co.uk — read 5 October 2026: massage before stretching "helps the muscles warm up"; toes first, then hock, knee and hip, then cycling; "hold in place for 5 seconds, relax the leg and repeat up to 5 times"; around 20–30 minutes three to four times daily; stop if the pet "becomes restless, painful or yelps"; "Never stretch your pet's leg too far"; "support the spine and prevent unnecessary movement."
9. Veterinary Specialty Center (Bannockburn, Illinois). "Passive range of motion." Surgery handout. vetspecialty.com — read 5 October 2026: "a series of ten repetitions," starting with fewer and working up; "2-3 times daily"; lying on the side with the affected limb up; "Flex and extend the joint to its limit until there is resistance ... nothing should be forced"; resistance as the pet becomes stronger "is not only expected, but it should be encouraged."
10. Madison Veterinary Specialists. "TPLO/TTA rehabilitation home care instructions." mvsvets.com — read 5 October 2026: flex "until the first signs of discomfort are noted, go a little further and hold for a 5-7 count"; "2-5 repetitions, 2-3 times daily"; if very resistant, activity or therapy "should be reduced"; if painful, "discontinue the exercises and contact our office."
11. Olby NJ, Moore SA, Brisson B, Fenn J, Flegel T, Kortz G, Lewis M, Tipold A. "ACVIM consensus statement on diagnosis and management of acute canine thoracolumbar intervertebral disc extrusion." Journal of Veterinary Internal Medicine. 2022;36(5):1570-1596. doi:10.1111/jvim.16480 — full text read via Europe PMC (PMC9511077) on 5 October 2026. Section 10.1: two RCTs show intensive in-hospital rehabilitation "does not improve the recovery of ambulation compared to a control population receiving only basic rehabilitation in the form of passive range of motion (PROM) and assisted walking"; evidence "does support inclusion of basic exercises as standard components of routine postoperative care in all dogs regardless of severity. Supported by moderate-level evidence." Section 10.2: "At a minimum, a basic rehabilitation protocol can be recommended to include cryotherapy, PROM, massage, assisted standing and walking ... Supported by low-level evidence"; "Reported frequency of exercises ranges from 1 to 3 times per day while hospitalized ... and 1 to 5 times per day for at-home exercises, but frequency commonly is not specified." Table 9: range of motion and massage, initiation 24 to 48 h postop, duration 10 d to 6 wk or until ambulation or normal mobility.
12. Caudle KL, Atkinson DA, Brown EH, Donaldson K, Seibt E, Chea T, Smith E, Chung K, Shum-Siu A, Cron CC, Magnuson DS. "Hindlimb stretching alters locomotor function after spinal cord injury in the adult rat." Neurorehabilitation and Neural Repair. 2015;29(3):268-277. doi:10.1177/1545968314543500 — abstract read via Europe PMC on 5 October 2026: daily stretching 30 min/day, 5 days/week for 8 weeks; stretched animals had "significant deficits in knee passive range of motion starting at week 4"; "Stretch-based therapy significantly impaired functional recovery." Rats, not dogs.
13. Southwest Veterinary Surgical Service. "Ventral cervical slot." swvetsurgery.com — read 5 October 2026: "muscle massage and passive range-of-motion exercises may be helpful until he or she is walking again."
14. Wallace A. "Do passive range of motion exercises lead to quicker postsurgical recovery of canine IVDD?" Veterinary Evidence. 2023;8(4). doi:10.18849/ve.v8i4.670 — full text read on 5 October 2026: five studies appraised; no study "found that directly investigated this PICO question"; none "investigated the effects of PROM exercises alone on recovery"; strength of evidence "Weak."
15. Bennaim M, Porato M, Jarleton A, Hamon M, Carroll JD, Gommeren K, Balligand M. "Preliminary evaluation of the effects of photobiomodulation therapy and physical rehabilitation on early postoperative recovery of dogs undergoing hemilaminectomy for treatment of thoracolumbar intervertebral disk disease." American Journal of Veterinary Research. 2017;78(2):195-206. doi:10.2460/ajvr.78.2.195 — abstract read via Europe PMC on 5 October 2026: 32 dogs; photobiomodulation (11), physical rehabilitation with sham photobiomodulation (11), sham only (10); time to grades B, C and D "did not differ among groups."
16. Crook T, McGowan C, Pead M. "Effect of passive stretching on the range of motion of osteoarthritic joints in 10 labrador retrievers." Veterinary Record. 2007;160(16):545-547. doi:10.1136/vr.160.16.545 — abstract read via Europe PMC on 5 October 2026: owners "performed 10 passive stretches for a hold of 10 seconds twice daily" over 21 days; "the passive stretching had significantly increased the range of motion of the joints." Full text not read.
17. Amazon listing B0B1LQCLNS, "ProsourceFit Exercise Puzzle Mat 1/2-inch, EVA Interlocking Foam Floor Tiles ... 24 Sq Ft - 6 Tiles." amazon.com — read via the Amazon Creators API on 5 October 2026: $29.99 In Stock sold by Amazon.com; Amazon Resale $27.29; "Each tile measures 24 in x 24 in x 1/2 in"; "Includes 6 tiles with end borders"; "Foam may compress slightly under heavy objects"; "Best results on flat, hard surfaces"; care with warm water and dish soap; limited lifetime warranty on manufacturer defects. No star rating or reviews returned.

This article is educational and does not replace the discharge instructions from the hospital treating your dog. Which joints to move, how often and when to stop are your surgeon's call, not ours.