pressure-injury prevention and skin care in SCI
Sit still long enough and most people feel an ache that makes them shift in their seat — a quiet, automatic signal that the skin and tissue over a bony spot are being squeezed and starved of blood. After a spinal cord injury, that warning signal is gone: the person cannot feel the pressure and often cannot shift their own weight to relieve it. So tissue over a bone can be silently crushed for hours until it dies, forming a pressure injury (also called a pressure ulcer, pressure sore, or bedsore). Preventing these is one of the most relentless daily disciplines of life with SCI.
A pressure injury is localised damage to skin and the tissue beneath it, caused by sustained pressure (or pressure plus shearing, the dragging force when sliding across a surface) over a bony prominence — the tailbone, the sitting bones, the hips, the heels. The pressure pinches off blood flow; without oxygen the tissue breaks down, sometimes from the bone outward so that a small surface wound hides a much larger cavity beneath. After SCI, three factors stack up: no sensation to warn of trouble, no ability to fidget and redistribute load, and often poorer tissue and circulation. Prevention is built on a few non-negotiable habits: regular weight shifts (leaning, tilting, or push-ups every so often while sitting, turning regularly while in bed), a properly fitted support surface and wheelchair cushion, keeping skin clean and dry (moisture from sweat or incontinence weakens it), good nutrition, and daily skin inspection — often with a mirror — to catch the first red, non-blanching patch before it breaks open.
This matters because pressure injuries are common, costly, slow to heal, and dangerous: a deep one can take months to close, can become infected down to the bone, and is a frequent cause of hospital readmission and a known trigger of autonomic dysreflexia. The cruel arithmetic is that they take seconds of unrelieved pressure to start and months to heal, so prevention is overwhelmingly cheaper and kinder than treatment. Teaching the person and their helpers to make skin protection a reflex — pressure relief on a schedule, a daily skin check — is one of rehabilitation's highest-value lessons.
A wheelchair user with a C7 injury sets a phone reminder to shift his weight every twenty minutes — leaning side to side and tipping forward — and checks his skin with a long-handled mirror each night. He catches an early red mark over a sitting bone and offloads it for a day, and it never becomes a wound.
Scheduled weight shifts and a daily skin check catch trouble before tissue breaks down.
A pressure injury can start in seconds to hours of unrelieved pressure but take months to heal, and the worst damage is often deep against the bone while the skin still looks nearly intact. That asymmetry is why prevention — relief and inspection — vastly outweighs any treatment.