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Pressure Issues After Spinal Cord Injuries

UPMC Content 3

The Problem with Pressure

You need adequate blood circulation to keep your cells alive. When circulation is cut off — as it is when you sit or lie in one place for a while — the cells cannot get blood and oxygen. They die and sores may develop.

Pressure can come from outside the body. The pressure of your weight pushes your bones onto blood vessels and cuts off circulation. Cells can die in 30 minutes if they do not have proper circulation.

Pressure Releases

You should do pressure releases every 15 minutes, and hold the position for between 30 and 60 seconds. This will take the pressure off your tailbone and other bones that you sit on.

Releases may include:

  • Leaning side-to-side
  • Bending your chest to your knees
  • Using powered seating systems

Work with your rehabilitation team to determine the best releases for you.

Positions and Turning

Changing your body posture and position will take pressure off bony areas. There are different things you can do, depending on whether you are in a bed or a wheelchair.

In Bed

  • Change your position according to your skin's tolerance level. Sleep on your stomach, if possible.
  • Use an alarm clock to wake you for turning. Turning in your sleep may become automatic after a while.
  • Get someone to turn you if you cannot do it yourself.
  • Consider getting a specialized mattress.

In A Wheelchair

  • Check your posture. Make sure your ankles, the sides of your knees, and your hip bones are not leaning against the wheelchair.
  • Make sure the foot pedals on the wheelchair are adjusted for your height.
  • Sit up as straight as possible in the wheelchair.
  • Always use a well-maintained cushion.


Avoid problems by:

  • Checking your skin for redness or chafing after wearing new clothing.
  • Buying jeans with low profile seams. Consider removing back pockets.
  • Buying jeans and slacks a size larger than what you would normally buy.
  • Wearing socks that are not too tight or too loose.
  • Making sure your shoes fit correctly.

Dealing with Pressure Sores

There may be early warning signs that pressure is causing damage. These signs include redness and firmness. You should check for them when you do your skin checks.

There are four stages of pressure sores, which are also known as decubitus ulcers. The deeper the pressure sore, the more serious the problem.

Stage 1 Warning Signs

  • An area of redness that does not fade or blanch.
  • The skin is intact.

Stage 2 Warning Signs

  • The skin is broken.
  • It may look like a scrape, blister, or shallow crater.

Stage 3 Warning Signs

  • A deeper crater.
  • It goes all the way through to soft tissue.

Stage 4 Warning Signs

  • The deepest stage of a pressure sore.
  • It goes all the way to the muscle, bone, or tendon.

Unstagable pressure ulcers are covered by thick yellow slough or a scab. Pressure ulcers that have a deep purple or maroon color may be a deep tissue injury that has not yet opened on the surface of the skin.

Treating Pressure Sores

Pressure sores can be treated. Successful treatment, however, depends on finding them early and removing the cause.

Treatment includes:

  • Removing all pressure
  • Staying off the pressure sore
  • Keeping the area clean and dry

Do not:

  • Massage the area
  • Clean the wound with any solution, unless prescribed by a doctor
  • Dry the wound with a heat lamp or hair dryer
  • Put sugar, vitamins, or antacids into the wound
  • Use antibiotic ointments in the wound, unless prescribed

You may need surgery or a specialist to help with treatment. Pressure sores take a long time to heal, and the skin will still have scar tissue.

Expert Care for a Brighter Outlook on Living

If you've had a stroke, transplant, or severe injury, inpatient physical rehab can help you restore function.

The UPMC Rehabilitation Institute offers expert inpatient and transitional rehab care for a range of health concerns, including:

We can start your rehab while you're still in the hospital.