Although there is no clear optimal positioning or turning frequency in bed, the evidence suggests avoiding the 90° lateral position because of high pressures and PU risk over the trochanters. During sitting, pressures are linearly redistributed from the sitting area during recline and tilt; however, reclining carries with it an increased risk of shear forces on this skin. The evidence does not support conclusive guidelines on positioning or repositioning techniques for PU prevention in bed or during sitting. We conclude that PU risk is highly individualized, with the SCI population at a higher risk, which demands flexible PU prevention strategies for bed/seated positioning and pressure relief maneuvers. Education has and will remain our most powerful ally to thwart this pervasive public health problem.

reflexes throughout. Past medical history was significant for an episode of diplopia and visual loss in her 30s, which was diagnosed as optic neuritis and treated with steroids. An MRI at that time was inconclusive. Considering multiple sclerosis versus lumbar stenosis, an MRI of her low back and brain was ordered. Setting: Tertiary care outpatient clinic. Results or Clinical Course: Lumbar spine imaging revealed mild lumbar spondylosis at L5-S1 and no evidence of stenosis. Neuroimaging revealed classic distribution of demyelinating lesions and high T1 black holes with enhancing lesions characteristic of multiple sclerosis. Full workup including B12, TSH, RPR, HIV, ACE and RF were all negative. Neurology indicated the history may be compatible with relapsing MS dating back for 15 years, which was undiagnosed. Patient was started on steroid therapy and subsequently improved. Conclusions: This is the second case of MS presenting with back pain seen in the literature; most recently there was a similar case last year in Spain. In this case, it is possible that MS may have triggered some kind of pain cascade within the spine or that her findings on MRI (spondylosis) though mild, could have caused low back pain superimposed on MS. We offer this case report as an example of careful history taking and physical examination as they can help explain atypical presentations for well-known diagnoses. Further studies can explore how many patients with MS report low back pain as a presenting symptom.