What is a pressure injury?
A pressure injury (also called a bedsore) is damage to the skin and underlying tissue caused by staying in one position too long. Pressure reduces blood flow, which can lead to skin breakdown and wound formation.
Why it matters for SCI
- After a spinal cord injury, you may not feel pain or pressure in parts of your body
- You may not notice when skin is being damaged
- Pressure injuries can develop in hours without proper relief
- Preventing pressure injuries is critical to staying healthy and independent
High-Risk Areas After SCI
Pay close attention to:
- Tailbone (sacrum)
- Sitting bones (ischial tuberosities)
- Hips
- Heels
- Ankles
- Elbows
Pressure Relief in Sitting (Wheelchair)
How often?
- Every 15–30 minutes
- Hold for 30–90 seconds
Methods (based on your ability level)
- Side-to-side weight shift: Lean to one side to unload the opposite hip
- Forward lean: Lean forward to take pressure off sitting bones
- Seated push-up: Push through armrests to lift your body
- Tilt/recline (power or tilt-in-space wheelchair users): Use tilt to at least 45 degrees if possible. Stay in that position for at least 2 minutes.
Pressure Relief in Bed
How often?
- Reposition at least every 2 hours (or more often if needed)
Recommended positions
- Back lying (supine): Float heels using a pillow under your legs. Keep pressure off the tailbone if possible.
- 30° side-lying position: Slight turn, not directly on your hip. Place a pillow/wedge behind your back. Also place a pillow between knees and ankles.
Follow a consistent rotation schedule between positions (for example: back → left side → back → right side → and repeat as directed by your care team). This helps ensure no single area of skin is under pressure for too long and reduces risk of pressure injury.
Avoid
- Direct pressure on hips for long periods
- Heels resting directly on the mattress for prolonged periods
- Wrinkled bedding or objects under your body
Skin Checks
- Check your skin at least 2 times per day (morning and night recommended). You can use a mirror, phone camera, or help from a caregiver as needed.
- Look for: Redness or discoloration, darkened areas (especially in darker skin tones), warmth, swelling, blisters, or open skin
Important Tips
- Do not rely on pain as a warning sign
- Always complete full pressure reliefs, even if you feel fine
- Use a proper wheelchair cushion and mattress
- Keep skin clean and dry (especially with sweating or incontinence)
- Be cautious with transfers to avoid shear and friction
- Watch for moisture from bowel and bladder programs
When to Contact Your Healthcare Provider
- Redness that does not go away within 15–30 minutes after pressure relief
- Any open area, blister, or skin breakdown
- Increased warmth, swelling, or drainage
Your rehabilitation team will continue to guide you in selecting the most appropriate wheelchair positioning strategies, pressure-relieving techniques, and specialized seating or cushion systems based on your individual needs, skin risk, and functional level. These recommendations may change over time as your recovery, mobility, and tolerance improve.
If you notice any changes in your skin, comfort, ability to tolerate positioning, or if you have questions about your equipment or pressure relief routine, contact your healthcare team promptly so adjustments can be made as needed.