Pressure relief is the single most critical element in wound care and mobility management for people living with spinal cord injuries. Each transfer we make—whether from wheelchair to bed, toilet, car, or another surface—requires intention, care, and awareness. These everyday movements may seem routine, but over time they play a significant role in protecting (or compromising) our skin integrity.
Why Pressure Relief Matters
Medical professionals and researchers consistently identify unrelieved pressure as the primary cause of pressure ulcer development. Other contributing factors include:
- Shear and friction
- Moisture
- Poor nutrition and hydration
- Immobility
- Psychological, social, and economic factors such as depression, substance use, limited resources, and non-compliance with preventive care
Every person with an SCI is at risk for pressure ulcers. In fact, most individuals will experience at least one serious pressure wound during their lifetime. These wounds can lead to prolonged hospitalizations, delayed return to community life, reduced quality of life, and loss of self-esteem.
A Personal Reminder
Speaking from experience—after years of diligently guarding my skin since my injury—I can tell you that pressure wounds can develop when you least expect them. Living an active lifestyle is not the problem. I still want to work, play, and live fully. Yet I developed a Stage 3 pressure injury that abruptly limited many of my daily activities. Now, every transfer and position change feels calculated and cautious.
Pressure sores are not just skin issues. They can cause pain, infection, sepsis, autonomic dysreflexia (AD), and increased spasticity. In severe cases, complications can be life-threatening. This makes prevention—and early treatment—essential.
Common Areas Where Pressure Ulcers Develop
Pressure wounds most often occur over bony prominences, where there is minimal muscle or fat padding. These areas are under the most pressure when sitting or lying down, especially in a wheelchair or bed.
Common locations include:
- Tailbone or buttocks (sacrum and ischium)
- Hips (trochanters)
- Lower back
- Heels, feet, and ankles
- Back of the thighs
- Pelvic floor
Practical Reminders for Pressure Wound Prevention
Even if we know the basics, reminders are valuable. Prevention requires consistency and attention to detail.
Change positions frequently
- In a wheelchair: perform pressure reliefs every 15 minutes
- In bed: reposition at least every two hours
Use proper equipment
- A well-fitted wheelchair cushion
- Mattress overlays or air mattresses
- Pillows or foam wedges to protect bony areas
Check your skin daily
- Watch for redness, warmth, swelling, blisters, cracks, or bruising
- Use a mirror or ask for assistance to inspect hard-to-see areas
Keep skin clean and dry
- Clean gently with mild soap and water
- Pat dry—do not rub
- Moisturize as needed
- Avoid talcum powder and alcohol-based products
Support your body from the inside
- Eat a balanced diet rich in protein, vitamins, and minerals
- Stay hydrated
- Avoid smoking and limit alcohol
- Consult a dietitian if needed
Manage other health conditions
- Keep blood sugar controlled if diabetic
- Treat infections promptly
- Follow wound care recommendations
- Maintain regular follow-ups with your healthcare team
Don’t Forget Your Equipment
Regularly inspect all surfaces you sit or lie on—wheelchairs, cushions, mattresses, and transfer equipment—to ensure they are in proper working condition. Worn or malfunctioning equipment can silently increase pressure and risk.Our health is ultimately our responsibility. Protecting our skin takes ongoing diligence, awareness, and self-advocacy. Staying active is important—but staying intact is essential. With thoughtful transfers, proper equipment, and daily attention, we can reduce risk and preserve both mobility and quality of life.
