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Orthotics & Seating
Pressure Relief Seating
A surgeon's perspective on pressure relief seating — why protecting the skin matters for people who use wheelchairs, and why cushions and pressure care are prescribed by specialist teams.
For people who spend much of their day sitting because of a spinal condition, protecting the skin from pressure damage is a serious and important matter. Pressure injuries — sometimes called pressure sores — can be painful, slow to heal and occasionally dangerous, and good pressure relief seating is one of the main ways to prevent them. As a spinal surgeon I care about this because it affects my patients' health and wellbeing, but the assessment and prescription of pressure-relieving cushions and seating is carried out by tissue-viability specialists, occupational therapists and seating services — not by me. This page explains, from a surgeon's viewpoint, why pressure relief seating matters and who provides it.
For information only — not medical advice. The content on this page is patient education to help you understand a condition or treatment. It is not a substitute for personalised assessment by a qualified clinician. Always consult your doctor or specialist about your own symptoms, diagnosis, and treatment decisions.
Why pressure relief matters
When a person sits for long periods, particularly if they cannot easily shift their own weight or have reduced sensation, pressure over the bony parts of the pelvis and lower spine can damage the skin and underlying tissue. People with spinal cord injury and other conditions affecting sensation or movement are at particular risk. Pressure injuries can cause serious harm and are much better prevented than treated. Pressure relief seating — the right cushion and set-up, combined with movement and skin care — is central to that prevention, which is why it is taken so seriously.
What pressure relief seating involves
Pressure relief seating is more than just a soft cushion. It involves selecting a cushion designed to redistribute pressure appropriately for the individual, setting up the chair (including features such as tilt and recline that help offload pressure), and combining this with regular pressure relief movements and good skin care. The right cushion depends on the person's risk, body shape, posture and lifestyle, and is chosen through assessment rather than guesswork. It is one part of a whole approach to protecting the skin.
Who prescribes it
This is the work of specialist teams — tissue-viability nurses, occupational therapists, physiotherapists and seating services — who assess pressure risk, prescribe the appropriate cushion and seating, and educate and review over time. They have the expertise and the assessment tools to match the equipment to the person and to manage risk properly. My role, as a surgeon involved in someone's spinal care, is to be aware of their pressure risk and seating and to communicate with these teams; the pressure care itself belongs to them. I defer to their expertise in this area.
What the evidence shows
The evidence supports individualised pressure relief seating as part of pressure injury prevention. A randomised trial showed that skin-protection wheelchair cushions reduced the incidence of sitting-acquired pressure ulcers in at-risk elderly wheelchair users, and reviews of support surfaces and pressure-redistributing cushions support their role in prevention. Guidance on pressure ulcer prevention in wheelchair users emphasises appropriate cushions combined with repositioning and skin care. This evidence is why pressure relief seating is prescribed carefully by specialist teams.
What to expect
If you are at risk of pressure problems, your cushion and seating are assessed and prescribed by tissue-viability and seating specialists, who tailor them to you and review them over time, alongside advice on movement and skin care. Where I am involved in your spinal care, I will liaise with those teams so your seating and your spinal treatment work together, but the pressure care itself sits with the specialists.
Disclaimer. The information provided on this page is intended for educational purposes only and should not be considered personalised medical advice. Mr Madi is a spinal surgeon; pressure relief seating and pressure care are assessed and prescribed by tissue-viability specialists, occupational therapists, physiotherapists and seating services. Every patient is different, and pressure care needs depend upon an individual's diagnosis, skin, general health and personal circumstances. Decisions should always be made following consultation with your treating spinal surgeon, tissue-viability or seating specialist, therapist or healthcare professional.
Evidence & further reading
- —Brienza D, et al. A randomized clinical trial on preventing pressure ulcers with wheelchair seat cushions. J Am Geriatr Soc 2010. (PMID 21070197)
- —Geyer MJ, et al. A randomized control trial to evaluate pressure-reducing seat cushions for elderly wheelchair users. Adv Skin Wound Care 2001. (PMID 11905977)
- —Yang Y, et al. Wheelchair cushions and pressure ulcer prevention. 2020. (PMID 32573289)
- —Regan MA, et al. A systematic review of therapeutic interventions for pressure ulcers after spinal cord injury. Arch Phys Med Rehabil 2009. (PMID 19236976)
- —McInnes E, et al. Support surfaces for pressure ulcer prevention. Cochrane Database Syst Rev 2015. (PMID 26333288)
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Every patient is different. The information on this page is a starting point — Mr Madi will tailor any plan to your specific imaging, symptoms and goals.