Sacrum and coccyx

Specific risks

Seated surfaces and activities that cause increased pressure, shear and friction to the sacrum and coccyx are:

  • spending prolonged periods of time sitting up in bed
  • poor posture. A posterior pelvis tilt and kyphotic posture will result in increased body weight to the sacrum and coccyx.
  • cushions in particular ‘bottoming out’
  • backrests
  • any other seating surfaces such as sports chairs, car seats, flooring/ground surfaces, other chairs (e.g., dining, lounge or outdoor), tub transfer benches or static shower chairs
  • transfers that contact the rear wheel of a manual wheelchair
  • sliding down or forward in the wheelchair, in bed or in a sling
  • bulky clothing such as low waistbands and incontinence pads
  • inadequate frequency or quality of pressure relief
  • muscle wasting or weight loss
  • These areas should be assessed by palpating for ‘boggy’, soft, or tender areas.

Management of breakdown

  • Review and identify causative factors such as the mattress, cushion, showering aids, other seated surfaces, transfers, clothing, muscle bulk, care routines and continence management.
  • Sitting may be possible if there is no contact with all of these:
    • backrest
    • sling
    • cushion
    • showering and toileting aids including toilet seat, shower commode aperture, or tub transfer bench
  • Avoid transferring and sitting in the car until the wound is healed and a return to sitting program has been completed.
  • Review and consider using a commode seat design with a rear-opening aperture.
  • Review the wheelchair set-up and posture.
  • Sitting in a wheelchair may be possible with custom seating. Rehabilitation Engineering Centre, Surgical Treatment and Rehabilitation Service (STARS) can be consulted for advice.

The contact details are:

email: STARS_REHABENG@health.qld.gov.au or
phone: (07) 3647 6070

Stage 3 or 4 pressure injuries may require a surgical consult.

Contact the following services within the Queensland Spinal Cord Injuries Service to refer a person for a review of a wound:

For urgent consultation

On-call Consultant Spinal Injuries Unit,
Princess Alexandra Hospital Ipswich Road,
Woolloongabba, Queensland.
Switch: (07) 3176 2111
Ask for the SIU Registrar on business days or an on-call SIU Consultant during after-hours for the Spinal Injuries Unit.

For a review at the Spinal Injuries Unit outpatient department

Referrals can be faxed through the central intake hub on 1300 364 248.

To link with community services

Contact Spinal Outreach Team at 3176 9507 or spot@health.qld.gov.au

Check out other pressure injury locations and learn how to manage them.