Preventing Pressure Injuries in Seating: 10 Key Tips for Therapists

When we think about pressure injuries, beds get most of the attention. But for many individuals, particularly those who are seated for long periods, the chair is the primary risk zone.

Poor posture, lack of tilt, unstable cushions, and incorrect seat sizing all contribute to pressure injury development. The 2025 International Pressure Injury Guidelines now place greater emphasis on seating as a high-risk environment for skin breakdown, especially over the ischial tuberosities and sacrum.

In this blog, we’ll explore how to prevent pressure injuries in seating by focusing on posture, pressure redistribution, correct use of tilt-in-space, and the importance of choosing the right cushion and cover.

Why Seating is a High-Risk Position

According to the 2025 Guidelines, sitting is a primary risk factor for pressure injuries because:

  • Up to 75% of body weight is concentrated through the pelvis in seated positions
  • Bony areas such as the ischial tuberosities, sacrum, and posterior thighs are common sites of breakdown
  • Sliding and poor posture lead to shear, which deepens tissue damage

Seating for long periods without pressure relief can cause damage to the skin and deeper tissue within 1–2 hours, especially in individuals with limited mobility.

10 Tips to Prevent Pressure Injuries in Seating

1. Start with a Seating Assessment

You need a full picture before recommending any seating.

  • Look at posture, pelvic alignment, and balance
  • Check skin condition and injury history
  • Assess mobility, sitting time, and ability to move
  • Include cognitive and sensory needs

Tools like the Purpose T Tool can help identify pressure injury risk level and risk factors.

Click here to access the Purpose T Tool

2. Choose the Right Cushion

Not all cushions are the same.

  • Look for gel, air, or foam cushions that spread pressure
  • Pick one that allows immersion and envelopment to reduce peak pressures
  • Avoid stacking cushions as it raises seat height, makes transfers harder, reduces stability, blocks immersion, and increases the risk of slippage and shear

3. Use Tilt-in-Space Chairs

Tilt-in-space is more than a comfort feature.

  • Tilting reduces pressure on the pelvis and spine
  • Helps shift weight without slumping
  • Reduces the risk of shear during recline

4. Avoid Slumped Postures

When clients slide down or lean to one side, risk goes up.

  • Use contoured back supports to align the spine
  • Ensure correct seat depth and height
  • Add lateral supports for trunk stability if trunk control is poor

Poor posture/sacral sitting = higher pressure on the sacrum.

5. Offload the Heels and Support the Feet

The feet play a big role in posture and heels are high-risk for pressure injuries.

  • Use footrests or leg supports to keep the body stable
  • Make sure heels are offloaded, especially in high-risk users
  • Avoid dangling feet that cause pressure on the Achilles tendon and risk of contractures developing

Proper support improves posture and reduces heel pressure and shear.

6. Use Modular, Adjustable Seating

  • Modular chairs let you adjust the fit as needs change
  • Add lateral supports if the trunk collapses
  • Include headrests when neck control is limited

7. Use Stretchable, Breathable Covers

Skin needs to breathe.

  • Choose covers that reduce heat and wick away moisture
  • Avoid non-breathable vinyl or thick fabrics on seated surfaces
  • Make sure the client sinks properly into the cushion

Helps prevent moisture build-up and skin damage.

8. Encourage Movement

Even with good seating, skin needs full pressure relief or offloading.

  • Aim for small weight shifts every 15–30 minutes
  • Use tilt-in-space for offloading every 1–2 hours
  • Limit long periods of sitting if the client is high risk

Motion boosts blood flow and relieves pressure.

9. Keep Records and Review Often

Good seating needs follow-up.

  • Document seating setup and changes
  • Include skin check results and comfort feedback
  • Update the plan after hospital visits or changes in care

Share updates with the care team and carers.

10. Train Carers on Equipment Use

If seating is used wrong, it can cause more harm than good.

  • Show how to use tilt, recline, and leg rests
  • Teach signs of poor posture and pressure damage
  • Guide carers on cushion checks and skin care

Education helps keep clients safe between reviews.

Final Thoughts: Smart Seating Protects Skin

Pressure injury prevention in seating requires more than just a cushion. It’s about the right chair, configured correctly, used actively as part of a pressure care plan.

By selecting clinically appropriate seating solutions, like the Configura Chair, and following the latest 2025 Guidelines, healthcare teams can reduce skin breakdown risk while improving posture, safety, and comfort.

Want the Full Clinical Guide?

This blog is a quick guide. For in-depth clinical advice, based on RESNA standards and the 2025 Guidelines, download the whitepaper Preventing Pressure Injuries in Seating below. 

 


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