Shear Facts about Pressure Injuries

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We know that life on wheels can be complicated. One complication no one wants is pressure injuries (also known as pressure sores). Knowledge is power when it comes to protecting your bum. The first thing to know is that pressure, friction, and shear all play a role in annoying pressure injuries.

Pressure is pretty much what it sounds like – a perpendicular force against a surface. A certain amount of force against a small surface results in higher pressure than that same force distributed over a large area. Makes sense, right? But when it comes to bones, skin, and soft tissue, shear and friction share the stage with pressure.

When our pelvic bones or tailbones – or any other bones – press against our chairs or our beds, our skin, muscles, and fat feel the squeeze. Shearing is the stress that results from how our tissues are compressed. Our skin doesn’t get the oxygen it needs, which over time damages the walls of our capillaries. The reduced blood flow eventually results in fluid leaking into the surrounding tissue and – voila – the dreaded pressure injury surfaces.




At first glance, friction is a no-brainer. When our skin doesn’t slide effortlessly with the rest of our body, it creates friction and can contribute to pressure injuries. It can also make irritated or inflamed skin worse. But friction also contributes to shear. After all, our bodies are made up of layers, and there’s a layer of muscle and a layer of fat between skin and bone. If our skin is in one place and our tissues are moving in another direction, that creates additional shear.

Pressure, friction, and shear are realities of life on wheels. Every time we bend, rotate, lean, or reach, we stress our skin and tissues. The same holds true for transfers – whether the transfer is DIY or with the help of someone else. Even riding in the car or sitting on another type of seat can take its toll because of uneven pressure distribution.

man shown getting from his sailboat to his wheelchair by using arms to transfer his body wieight

Be careful of Shear on skin when making transfers. Image of Alan on his sailboat via PushLivingPhotos.com

We each have a game plan to reduce the likelihood of getting pressure injuries or to deal with them once we have them, but some common strategies – like lubricants and dressings – can actually increase friction. What’s the answer? We’ve compiled a dozen shear do’s and don’ts – and have found one fantastic product – to keep those pressure injuries at bay.

A Dozen Shear Do’s and Don’ts

Reducing shear, pressure, and friction can help you avoid pressure injuries, or help in keeping pressure injuries from getting worse.

  • Avoid angles. Shear stress is made worse when the bed is in any position other than completely flat or when a chair’s backrest is at an angle. You can thank gravity for that.
  • Avoid a fashion faux pas. Rough fabrics create additional friction, and ultra-smooth fabrics can cause you to slide. Find your inner Goldilocks and wear fabrics that are just right. While you’re at it, skip embellishments that press on your skin and clothes that bunch up in awkward places.
  • Spread it around. The larger the area across which pressure is applied, the less shear stress.
  • Check from head to toe. Every day’s to-do list should include checking for pressure injuries. The top danger zones are where bones press against tissues (spine, tailbone, hips) and where tissues press against surfaces (heels, ankles, back of the head).
  • Act quickly. If you see signs of a pressure injury, start treating it immediately. Signs to watch for are redness, warmness, skin texture that’s hard or spongy, or breaks in the skin.
  • Wash gently. Forgo the loofa and instead use a soft sponge or washcloth.
  • Dry thoroughly. If a towel isn’t enough, try a blow dryer on the cool setting.
  • Check your chair’s fit. If your weight changes, gauge whether or not your chair still fits. Even if your weight is stable, check once a year to make sure all’s well.
  • Stay cushy. Get a proper cushion and a good clinical accessement as to what works best with your body– and a low-friction cushion cover – can do wonders to prevent pressure injuries.
  • One, two, three, shift. Three or four times each hour, slightly shift position in your chair to ease the pressure. In bed, change position every couple of hours.
  • Watch the transfers. You need balance and strength to lift yourself completely; if you’re dragging, you’re shearing. You or your caregivers should use transfer aids; dragging is a no-go.
  • Nighttime comfort. Liberally use pillows and foam or other pressure reducing surfaces to cushion spots that are subject to pressure.

GlideWear: Shear Prevention 101*

GlideWear is one of the most useful new products on the market to address shear. It’s fashionable, comfortable, and puts your mind at ease.

GlideWear Skin Protection Underwear is made from a silky, breathable fabric blend that prevents moisture and heat build-up while reducing friction and shear. GlideWear Underwear are available in men’s (catheter fly) and unisex (no fly) in sizes from small to 5X.

Clinical case studies have found that GlideWear Underwear’s dual-ply textile acts as strategic friction reduction. In one instance, a paraplegic man had an open pressure injury for more than 13 years. Within three months of starting to wear GlideWear, the wound surface area decreased about 90 percent; in addition, the wound dressing lasted longer, meaning that he saved a significant amount of money.

In another instance, a man with incontinence associated dermatitis had an open wound for more than a year. Within one week of wearing the underwear, the skin healed, and he didn’t have a recurrence for five months. In a third instance, a Paralympian who used a variety of seat surfaces had a pressure injury surgically closed – but it looked as though it was going to open back up. GlideWear healed the signs of skin trauma and hasn’t had a recurrence in more than six months.

The right underwear in the right fabric can make a huge difference in your health and in your life. GlideWear is the ticket to fewer pressure injuries and greater peace of mind.

 

*Tamarack, the manufacturer of GlideWear and a sponsor of Push Living, provided free products for us to review.

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