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Professional Version

Bovine Secondary Recumbency

(Downer Cow Syndrome)


Walter Grünberg

, DVM, PhD, DECAR, DECBHM, Faculty of Veterinary Medicine, Justus-Liebig-Universität Giessen, Giessen, Germany

Reviewed/Revised Jul 2022 | Modified Oct 2022

Bovine secondary recumbency is defined as the inability of cattle to rise and stand for a period of at least 12–24 hours, resulting from the delayed or unsuccessful treatment of a different primary cause of recumbency. "Downer cow syndrome" is a colloquial term that more broadly refers to the inability of cattle to rise and stand for a period of at least 12–24 hours for undetermined reason. Treatment is guided by the cause; supportive care is of major importance to improving the prognosis. Animal welfare considerations are paramount in guiding the overall management of affected cows.

Cattle can become recumbent for a variety of primary causes, including metabolic, traumatic, infectious, degenerative, and toxic disorders. If the primary cause of recumbency cannot be treated immediately or treatment is unsuccessful and cattle cannot stand for >24 hours, they are prone to develop secondary tissue damage from pressure-induced ischemic necrosis of muscles of the hind limbs and pressure damage to nerves of the fore limbs and hind limbs. This in turn can result in secondary recumbency. The affected animal will then remain involuntarily recumbent, even though the primary cause of recumbency may be resolved.

"Downer cow syndrome" is a poorly defined colloquial term referring to prolonged involuntary recumbency (usually lasting at least 12–24 hours) of unknown cause. The term does not differentiate between primary and secondary recumbency. Downer cows are generally further categorized as either alert or non-alert. An alert downer cow shows no signs of systemic illness or change in demeanor, and is able to eat and drink, as well as to maintain sternal recumbency. A non-alert downer cow shows altered mentation and signs of depression or lethargy, suggestive of systemic illness or central nervous disease.

Bovine secondary recumbency (downer cow syndrome) are most commonly observed in dairy cattle, primarily in periparturient and early-lactating cows.

Etiology and Pathogenesis of Bovine Secondary Recumbency

Primary causes for recumbency in non-alert downer cows include systemic illnesses and infectious diseases such as toxic mastitis Mastitis in Cattle With few exceptions, mastitis occurs when microbes enter the teat via the teat canal. Almost any microbe can opportunistically invade the teat canal and cause mastitis. However, most infections... read more Mastitis in Cattle or metritis Metritis in Production Animals In cows, metritis is a common polymicrobial disease, especially within the first 2 weeks after parturition. Acute puerperal metritis refers to a severe postpartum uterine infection that results... read more Metritis in Production Animals , right displaced abomasum or abomasal volvulus Left or Right Displaced Abomasum and Abomasal Volvulus in Cattle Abomasal displacement and volvulus are common disorders of high-producing dairy cattle. Clinical signs include anorexia and decreased milk production. With abomasal volvulus, clinical deterioration... read more Left or Right Displaced Abomasum and Abomasal Volvulus in Cattle , peritonitis Peritonitis in Animals Peritonitis is the inflammation of the serous membranes of the peritoneal cavity. It may be primary or caused by infectious or noninfectious agents. Signs include localized pain, depression... read more , ileus Acute Intestinal Obstructions in Large Animals Intestinal obstructions are functional or mechanical in nature and result in a decrease or absence of feces. Diagnosis is based on abnormal findings during examination via palpation per rectum... read more , and hemorrhagic bowel syndrome Hemorrhagic Bowel Syndrome Determination of the cause of intestinal disease in cattle is based on clinical, epidemiologic, and laboratory findings. Nonspecific therapy includes oral and parenteral fluid therapy to restore... read more Hemorrhagic Bowel Syndrome , as well as metabolic disturbances such as severe ketosis Ketosis in Cattle Ketosis is an elevated concentration of ketone bodies (acetone, acetoacetate, beta-hydroxybutyrate) in all body fluids. Key clinical signs of ketosis are vague but include anorexia, decreased... read more Ketosis in Cattle and hepatic lipidosis Hyperlipemia and Hepatic Lipidosis in Large Animals Hyperlipemia is the abnormal accumulation of lipids in blood, resulting from excessive mobilization of body fat in the face of pregnancy, anorexia, or dietary insufficiency. Lipid deposition... read more Hyperlipemia and Hepatic Lipidosis in Large Animals or liver failure.

Regardless of the initial cause of recumbency, all affected cattle develop pressure-induced secondary damage to muscles and nerves of the pelvic limbs, especially when lying on a hard surface. The hind limb muscles of the limb the animal is lying on are compressed by the physical pressure from the animal's own body weight. The muscles and nerves of the forelimbs are damaged when cows remain in lateral recumbency on a hard surface for a matter of hours or longer.

With prolonged recumbency the lymphatic and venous drainage to muscle is decreased because of sustained pressure with no decrease in arterial blood flow. The net result of pressure-induced changes in blood flow is an increase in interstitial fluid volume and pressure within the muscle, because the fascia around each muscle cannot expand sufficiently to accommodate the increase in interstitial volume. In severe and prolonged cases of recumbency, the increase in intramuscular pressure is visible as a firm swelling of the muscle. The resulting compression of muscles, nerves, and blood vessels within an enclosed compartment induces ischemic pressure damage of muscle and nerves, also named compartment syndrome. The severity of pressure damage to the muscles depends on regional anatomical factors (bones), the duration of compression, and the surface on which the animal is kept.

Pressure myopathy Traumatic Myopathies in Cattle Muscle damage commonly accompanies bovine secondary recumbency. Tearing of adductor or semitendinosus/membranosus muscles may arise as animals weakened by hypocalcemia attempt to rise. Additionally... read more in downer cows is often complicated by damage to and functional loss of the sciatic nerve and its peroneal and tibial branches. The sciatic nerve may be damaged by direct compression against the caudal femur, secondary swelling of the surrounding muscles, or both. The extent of damage to the sciatic nerve is thought to be a critical factor for recovery of downer cows. Damage to the peroneal branch of the sciatic nerve results from direct pressure on the nerve as it crosses over the lateral condyle of the femur. Necropsy of affected cows may show extensive necrosis of the caudal thigh muscles.

Additional complications of prolonged recumbency include acute mastitis, decubital ulcers, and traumatic injuries to the limbs (eg, laceration and rupture of muscles and tendons, fractures of long bones, or joint dislocations) from struggling and efforts to rise. Renal failure may occur in patients displaying severe and prolonged myoglobinuria, resulting from an obstruction of renal glomeruli by large amounts of myoglobin entering the kidneys.

Clinical Findings of Bovine Secondary Recumbency

Downer cow syndrome is most commonly observed in periparturient dairy cows. Affected cows may have altered mentation of varying severity and be found in lateral recumbency with obtundation and a rapid, shallow pulse, which may indicate an unresolved metabolic problem such as hypocalcemia or hypomagnesemia. Inquiries into the severity and duration of parturition, the duration of recumbency, and whether the cow was observed standing after parturition may provide valuable hints to identify the primary cause of recumbency.

Altered mentation in affected cows may also be the result of toxemia, which is commonly due to genital tract or mammary gland infection. Other cows found in involuntary sternal recumbency may appear bright and alert—the most typical demeanor of the true problem downer cow. If the animal is young or not pregnant, the cause is likely to be either physical trauma (e.g., fracture) or a rare condition, either of which requires careful, detailed examination.

The environment of the animal can have a bearing on the cause of recumbency. If the footing is slippery, musculoskeletal injury must be considered. This is much less likely in cows that are kept in open space with a dirt or well-bedded surface.

The positioning of the hind limbs may indicate the cause of the recumbency. Limbs splayed out behind the animal may indicate obturator nerve paresis or paralysis, rupture of adductor muscles, hip dislocation, or fracture of the femur or tibia. Fracture should be suspected whenever the upper limb is extended sideways in such a manner that a crease is formed in the skin.

Physical Examination

The objective of the physical exam in a downer cow is to determine the current status of the animal rather than only to assess the primary cause for the recumbency. In cows that are involuntarily recumbent for >24 hours, secondary damage should be not only considered but expected.

The examination should be preceded by determination of the patient's signalment, including age, stage of lactation, body condition, and production type; and by acquisition of a concise history relevant to the case. The history should include information about the circumstances under which the animal became involuntarily recumbent, in cases of periparturient animals the nature of parturition, the duration of the recumbency, prior treatment, and treatment response. A herd history may be relevant in herds with higher incidence rates of downer cow syndrome.

The physical examination begins with a visual examination of the patient from a distance to determine respiration rate and type, and to assess demeanor and mentation, appetite, extent and type of mobility while recumbent, the position of the limbs, and the presence of swellings or wounds. The area surrounding the recumbent animal should be inspected for signs of unsuccessful attempts to rise, and to determine whether the recumbent cow was able to tilt herself (or was tilted) from one side to the other.

The next step is a general physical exam to determine hydration status (based on eyeball recession or skin-tenting duration), both body surface temperature and rectal temperature, heart rate, pulse strength, jugular fill, and capillary refill time, which could indicate varying extents of hypovolemia or hypovolemic shock. The abdomen should be palpated and auscultated to identify abnormal content or motility of the digestive tract or abnormal muscle tone of the body wall that may suggest an acute abdomen. In female recumbent cattle, inclusion of the mammary gland in the exam is imperative. A toxic infection of the udder caused by an organism such as Escherichia coli or Klebsiella pneumoniae can be a primary cause of recumbency. However, such an infection may be precipitated by the recumbency, especially if the cow is bedded on an unsanitary surface and the udder is engorged and remains unmilked.

Vaginal exploration is mandatory in every peripartum, recumbent cow. Damage to and infection of the wall of the vagina is common. Metritis and an associated toxemia can contribute to postpartum recumbency.

Rectal exploration is essential for differential diagnosis. For convenience, it is advisable to combine the rectal exam with the musculoskeletal examination of the hind limbs (see below). Before initiating the rectal exploration, the tone of the tail and anal sphincter should be assessed. Decreased or absent tail and sphincter tone suggest damage of the nerve bundle extending from the caudal end of the spinal cord, a condition termed cauda equina syndrome. In cases of suspected cauda equina syndrome, particular attention must be paid to the size and tone of the urinary bladder during rectal exploration because this syndrome can be associated with paralysis of the urinary bladder. At least small amounts of fresh feces should always be present in the bovine rectum. Palpating the bony circumference of the pelvis to identify fractures, swellings, or dislocations is easily done in nonpregnant animals; it may be challenging, however, with a pregnant or freshly postparturient uterus in the pelvic cavity. In these cases, having an assistant move the pelvic wings from outside in a rocking motion while the pelvis is palpated transrectally will allow determination of the presence of crepitation or abnormal motility in the pelvis in the case of a pelvic fracture. Palpation of the obturator foramen on both sides of the bottom of the pelvis may reveal the presence of the head of the femur in one of the foramina in cases of a ventral or caudoventral dislocation of the hip. Palpation of the obturator foramen is easily done when the uterus is small; in late pregnant or periparturient cows with a large uterus, this examination is better conducted transvaginally. The abdomen should be further explored rectally to rule out abnormalities of the digestive tract or signs of peritonitis.

The extent of uterine involution should be appropriate for the number of days postpartum. Ballottement of uterine fluid or lack of tonicity should be noted. Unexpected anomalies may be palpated. Adhesions, lumps of necrotic fat, and enlargement or turgidity of the cervix or vaginal wall are all sequelae of a difficult birth.

Next follows an in-depth examination of the musculoskeletal system. With the cow in sternal recumbency, the back should be firmly palpated from the neck to the tail to identify swellings, painful areas, possible misalignment, instability, or abnormal motility of the vertebrae. The patient should then be rolled into lateral recumbency with an assisting person keeling on the neck, and fore limbs and hindlimbs of the upper side then carefully examined from toe to hip or shoulder. Examination should confirm the musculoskeletal integrity of the limb with normal mobility of joints, and should identify painful areas, swellings, or open lesions.

Muscle bellies must be deeply palpated to identify swelling, edema, or abnormal firmness that may indicate compartment syndrome. The nerve supply down to the lower limb should be tested by stimulating the flexor-withdrawal reflex, first by pricking the skin above the coronary band on the dorsal and plantar/palmar side with a hypodermic needle. If the animal does not respond, an electric cattle prod should be briefly held to the distal limb to determine whether the stronger stimulus can elicit a response. This test with a stronger stimulus enables differentiation between decreased and absent sensitivity in the leg. The cow should then be rolled back into sternal recumbency and into lateral recumbency of the other side to repeat the examination on the contralateral side.

In alert downer cows, if the physical examination to this point has not revealed an apparent cause for recumbency, motor activity should be tested by stimulating the recumbent animal to make an attempt to rise. Several simple but effective techniques can be tried for this purpose. In one method, the clinician, while standing, presses their feet under the cow below the scapulohumeral joint. They then deliver a sharp blow by driving their knees into the muscle mass below and caudal to the scapula. It is important not to use this method on the thoracic wall unprotected by the muscle mass, because it could fracture the ribs. If the animal has difficulty rising, an assistant should use both hands to grab the root of the tail and lift. Damage could result if any other part of the tail is grabbed for this lifting maneuver. The sound of a cow's own calf bawling with hunger could motivate a recently calved cow to rise. The calf is best restrained close to the cow but out of the cow's sight.

The motion, weight bearing, and positioning of the limbs during the attempt to rise must be observed closely. Abnormal weight bearing, positioning, and posture of a limb can provide valuable information for locating a specific lesion. If the attempt to rise is unsuccessful and lacking diagnostic value, the cow should be rolled onto the opposite leg and the procedure repeated. In cases of unilateral nerve, muscle, tendon, bone, or joint trauma, a recumbent cow may be able to rise only if the unaffected limb is underneath it.

Whenever the circumstances permit to do so safely, the patient should be lifted using a device suitable for this purpose, with the objective of completing the motor function examination. If hip clamps are used, they should not be too tight, and the cow should be lifted slowly so that circulation of the limbs can be reestablished. The device should be raised until the cow is lifted enough that its hind feet just touch the ground. Often, the cow will hang with the limbs slightly flexed. This slight flexion should not be confused with unilateral flexion, which indicates peroneal paralysis. Next, two assistants—one on each side of the cow and facing the hind limbs—should press the shoulders into the paralumbar fossa. The lifting device should then be lowered slowly while the assistants try to force the hind limbs into a weight-bearing posture and to manipulate the stifle and hock to decrease the flexion. As soon as the two limbs are supporting any weight, the device should be lowered 1–2 in. This process may have to be repeated several times.

In this part of the exam, particular attention should be paid to the contributing effort the cow makes while lifted, to the amount of weight bearing by each individual limb, and to hints of possible proprioceptive deficits suggestive of specific nerve lesions. Regardless of whether the cow stands, while it is lifted its limbs can be manipulated and palpated for crepitation, and the skeleton in the pelvic area can be evaluated for possible asymmetry.

Asymmetrical position of the greater trochanter of the femur of both sides, combined with abnormal motility of the trochanter while moving the corresponding limb, suggests a dislocated hip. If the affected limb appears shorter than the contralateral limb and the greater trochanter does not move while the affected leg is being moved, there may be a fracture of the femoral neck or proximal femur.

Diagnosis of Bovine Secondary Recumbency

  • Physical examination

  • Serum biochemical analysis, urinalysis

Diagnosis of fractures, joint lesions, and nerve injuries is based primarily on the findings of the physical examination. Although radiography is of little additional value in the field, ultrasonography conducted by an experienced clinician can assist the diagnosis of fractures of long bones of the upper limb, as well as lesions of joints and tendons.

Blood samples are not usually taken when treating routine cases of periparturient hypocalcemia. However, hypocalcemia, hypophosphatemia, and hypokalemia should be assumed to be present in previously untreated recumbent periparturient cattle. Determining the biochemical status of cattle unresponsive to calcium therapy in particular will help to guide treatment and prognosis. Hypokalemia and hypophosphatemia have been suggested as potential causes for downer cow syndrome in cows with normal mentation. Alert downer cows may have normal serum concentrations of calcium, potassium, magnesium, and phosphorus, particularly if previously treated with intravenous or oral fluids.

Examination of fresh urine may reveal a dark discoloration consistent with myoglobinuria, resulting from the excretion of large amounts of myoglobin through the kidney after severe muscle damage. Milder cases not yet resulting in discolored urine may yield a positive result for hemoglobin (that is not differentiated from myoglobin) and protein on the urine stick.

Downer cows commonly have increased serum CK, AST, and LDH activity to a varying extent, which may indicate the presence and severity of muscle trauma. Although acute muscle trauma (eg, from slipping) can be a primary cause of downer cow syndrome, prolonged recumbency alone and the ensuing secondary muscle tissue damage are sufficient to explain increased activity of these enzymes.

Interpretation of enzyme activities requires taking into consideration the time lapse between occurrence of the suspected muscle trauma and blood sampling, in particular for CK. Increased serum CK activity is a specific indicator of muscle damage. CK activity peaks shortly after the start of muscle damage but declines noticeably within 4 hours because of the short half-life of this enzyme. Repeated blood samples obtained at early stages of recumbency may be useful to differentiate between acute (primary) and sustained (secondary) muscle trauma. Very high but rapidly declining CK activity suggests an acute trauma, while elevated values with moderate change over time are more suggestive of ongoing secondary pressure damage.

A number of blood biochemical parameters have been studied for their prognostic value in downer cows. These parameters indicated that AST activity is the most suitable prognostic indicator in recumbent cattle, with higher AST activity indicating a poorer prognosis. The serum concentrations of phosphorus, magnesium, sodium, bilirubin, glucose, and urea are not appreciably different between recovering and non recovering cows.

Parameters determined in CSF from recumbent cows were also studied for their prognostic value. Animals with elevated total nucleated cell counts and/or protein concentration >0.4 g/L in CSF were found to have notably lower short-term survival rate.


Ischemic necrosis and rupture of muscles of the thigh region are common necropsy findings in downer cows. Hemorrhage and rupture of adductor muscles may be evident if the animal “spread-eagled” itself while struggling to rise on a slippery surface such as wet or icy concrete. Traumatic and inflammatory injuries to sciatic and peroneal or tibial nerves are also found in downer cows. Damage to intrapelvic nerves, such as the sciatic and obturator nerves, account for most cases. Decubital injuries to the lateral aspect of the stifle can be associated with damage to the peroneal nerve.

Treatment of Bovine Secondary Recumbency

  • Correction of primary disease including hypocalcemia, other electrolyte abnormalities

  • Excellent nursing care, pain management, hydration

  • Daily assisted attempts to rise; use of a flotation tank as indicated

  • Attention to animal welfare concerns

Treatment of downer cow syndrome is guided largely by the findings of the physical exam and the suspected or confirmed primary and secondary causes. In addition to addressing etiologic causes of the recumbency, the treatment plan must aim at preventing predictable secondary disturbances (such as inflammation) or metabolic disturbances (such as ketosis or electrolyte imbalances that may result from anorexia).

State-of-the-art pain management and maintenance of adequate hydration are of paramount importance as supportive care measures that will help to maintain or stimulate voluntary feed intake. NSAIDs are indicated in most cases of involuntary recumbency to alleviate pain, discomfort, and secondary inflammation in damaged muscle tissue. Large single doses of steroids have been advocated on the basis of empirical evidence in animals with (suspected) fresh nerve trauma.

Recumbent cows with decreased or no feed intake may develop secondary energy and mineral deficiencies reflected in ketonuria, hypokalemia, or hypophosphatemia. Minerals like potassium, phosphorus, and calcium, as well as propylene glycol, can safely and effectively be administered orally as drenches. Monitoring the hydration status is an important part of downer cow management.

Recumbent cattle should be examined and, if alert and responsive, stimulated to rise or hoisted daily to determine whether the ability to rise or bear weight has changed. If there is no sign of improvement within 7 days after a cow has been moved to a place that has good footing and serum electrolyte abnormalities have been corrected, the prognosis is poor.

Some recumbent cattle appear to lose interest in trying to stand; these cattle may benefit from use of a specially designed flotation tank that has a volume of ~2,500–3,000 L. Alert downer cows are loaded into the flotation tank by being dragged on a mat into the empty tank. Doors are then put in place, and the tank is filled with lukewarm water. Both cold and hot water should be avoided, because they can induce hypothermia or hyperthermia. Cattle should be encouraged to stand after the water reaches the level of the scapulohumeral joint. Cattle that can support their own weight should be permitted to stand for 6–8 hours; however, the water in the tank should be removed as soon as the cattle exhibit trembling. The water in the tank must be maintained at approximately skin temperature to prevent hypothermia. This can be done either by circulating the water through a heating system or by regularly adding warm water to the tank. Cattle that remain standing should be encouraged to walk slowly from the tank on a nonslip surface. Cattle able to walk out of the tank after the first flotation treatment are 4.8 times more likely to survive than those that do not walk out of the tank. Cattle that stand on all four limbs during the first flotation treatment are 2.9 times more likely to survive than those that had an asymmetrical stance or were unable to stand. Reported success rates in returning recumbent cattle to normal ambulation range from 37%–46%.

Hobbling may be considered in cows suspected to have obturator or sciatic nerve damage, to prevent overabduction that can lead to muscular damage. Ropes should never be used for this purpose. A soft, nylon strap may be wrapped twice around the middle of each metatarsus, allowing a distance of at least 3 feet between the legs.

Assisting Cows to Rise

The value of hip clamps is controversial. Their proper use requires experience, skill, and a delicate touch. Continual use causes trauma and pain that is counterproductive. The forelimbs support 60% of a cow’s weight; therefore, the use of a canvas sling under the sternum is almost mandatory for consistent success. A chest band is required to prevent the sling from slipping backward. Suspending the sling from the tine at one end of a forklift and the hip clamps from a tine at the other end minimizes trauma. If a forklift is not available, a T-bar suspended by a pulley from an overhead beam (or a tripod for animals at pasture) will serve. The jaws of the clamps must be well protected with synthetic foam or rubber secured in place with a wrap of duct tape.

Moving Recumbent Cows

Moving a downer cow requires rolling her into lateral recumbency. The cow can then be slid over dry straw for a short distance by pulling on a rope attached to a lower forelimb and a halter rope. Transportation over longer distances can be accomplished using a suitably prepared farm gate hauled by tractor. The longest dimension of the farm gate is closely applied to the back of the cow still in lateral recumbency. A tarpaulin is placed on the gate to protect the cow from contact with the ground. Dry straw is spread on the tarpaulin, and the cow is rolled over onto the makeshift stretcher. The halter should be tied to the gate to minimize struggling, and a sack placed over the eyes to minimize alarm while the cow is being moved. The tail is best tied to the hock of the upper limb. Once moved, the cow should be restored to sternal recumbency. A few cows, particularly if <12 hours postpartum, will rise immediately after being moved to a location with good footing.

Dragging a recumbent cow over the floor without protection for body and skin or carrying the cow while it is hanging on hip clamps is inadmissible because these procedures are likely to inflict additional physical damage and pain on the animal. Moving injured cows in such a manner not only is illegal in many countries but also hurts the production animal industry through negative publicity.

Supportive Care of Recumbent Cows

Recovery from downer cow syndrome strongly depends on the quality of patient management and nursing care. Moving the cow to a site with an earthen floor improves the changes of resolution considerably. The optimal site depends on climatic conditions. If the weather is warm and dry, grassy pasture is best, but a ready means to lift the cow is essential. In less ideal weather conditions, a shelter with a roof and other protection should be provided. Hay barns and implement sheds can provide the necessary protection, and it may be possible in such structures to install a pulley system to lift the cow.

Protection from the elements is essential. Rain and wind can decrease body temperature considerably and worsen shock if present. A windbreak of straw bales is essential. Straw bedding should be provided to help insulate the cow from the ground. A recumbent cow does not require a warm environment; in a cold environment, however, an inactive animal can gradually succumb to hypothermia.

Lateral recumbency must be avoided. If it occurs, immediate correction is required to prevent bloating, regurgitation, and aspiration of gastric contents, as well as pressure lesions to the brachial plexus and radial nerve. The cow should be rolled into sternal recumbency. To maintain this posture, however, the limb the cow was lying on should be drawn from under the body. For example, a cow presented in lateral recumbency on the right side should be rolled into sternal recumbency on the left side. To maintain sternal recumbency, some animals may require support under the shoulder; straw bales can be used for this purpose. Tilting the recumbent cow in 6- to 8-hour intervals from one side to the other is labor-intensive but of paramount importance to limit secondary pressure damage to muscle and nerves. This repeated tilting defines state-of-the-art nursing care for downer cows.

Attempting to stabilize a recumbent cow on a concrete surface is highly undesirable but sometimes unavoidable. Until the transport of the recumbent cow onto a softer surface with more grip can be arranged, the cow's rear legs should be hobbled to prevent slipping and splaying during an attempt to rise. A common approach is to bed the cow on a layer of least 10 inches of dry straw sitting on top of >6 inches of wet, sticky bedding (feces). If the concrete beneath the wet layer becomes exposed by the cow's movements, more must be added. Although the footing is good with such a manure pack, the cow's skin may become soiled with urine and feces. A deep bed of sand (> 25 cm) is more effective for housing a recumbent cow. A sand bed usually drains well, and good hygiene can be maintained if voided feces are removed several times a day.

The downer cows most difficult to treat are those that do not try to eat. A cow that salivates on its feed will not eat it later. Rather than being offered large amounts of feed, the cow should be tempted with sweet hay. Any hay not accepted should be cleared away every 30 minutes. Placing bitter-tasting weeds such as ivy or dandelion in the cow's mouth may provoke salivation and an interest in eating. Some cows accept lettuce and cabbage leaves. In extreme cases, the cow can be drenched with rumen contents.

Prevention of Bovine Secondary Recumbency

Effective strategies to prevent milk fever are important to decrease downer cow syndrome. All dairy cows should be monitored closely around calving for early signs of parturient paresis Parturient Paresis in Cows Parturient paresis (milk fever, hypocalcemia, paresis puerperalis, parturient apoplexy) is a disease of adult dairy cows in which acute hypocalcemia causes acute to peracute, afebrile, flaccid... read more Parturient Paresis in Cows .

The critical issue seems to be the length of time (several hours) from when clinical signs of milk fever begin until treatment. Every cow that has been successfully treated for hypocalcemia should, if necessary, be moved to a location with good footing and remain there for 48 hours. Straw over sand provides good insulation and good footing.

Injuries from slipping frequently occur on concrete floor with insufficient grip. Overcrowding and an unrelaxed or even stressed attitude of the cows in the herd will further increase the risk of slipping injuries. Texturing or grooving the surface of the concrete, as well as calmly handling the herd, can improve the situation.

Animal Welfare Considerations of Bovine Secondary Recumbency

Although it is possible for a cow to rise after being recumbent for >14 days, the cow should not be unmonitored during this period. As long as the cow looks bright, occasionally struggles to rise, and continues to eat and drink, recovery is a possibility. However, if the cow becomes listless, shows no interest in feed, or has decubital lesions or starts to lose condition, euthanasia on humane grounds must be considered, irrespective of how long the cow has been recumbent. Euthanasia should also be considered if it is apparent the animal owner is not able or willing to provide the required basic nursing and veterinary care. A cow that has decubital lesions, a poor appetite, or shows signs of wasting is unsuitable for salvage slaughter. Attempting to transport recumbent animals except for the purpose of providing veterinary care is illegal in many countries and considered an act of cruelty.

Key Points

  • Bovine secondary recumbency is a complication of a primary recumbency of >24h duration that was not treated or was unsuccessfully treated and has resulted in an inability to rise or stand due to secondary muscle and nerve damage. "Downer cow syndrome" is a colloquial term and more broadly refers to prolonged inability to rise in cattle for an undetermined reason.

  • The condition is most commonly observed in dairy cattle in the periparturient period, frequently as a complication of periparturient hypocalcemia or calving paralysis that was unresponsive to treatment.

  • Pressure damage on muscle and nerve tissue is considered the most important causative factor.

  • A thorough physical examination of the recumbent cow to identify all relevant primary and secondary causes contributing to recumbency is the basis for successful treatment

  • State-of-the-art nursing and supportive care greatly increase the chances for a positive outcome.

For More Information

  • Dairy Australia video: Caring for the Down Cow

  • Dairy Australia video: Assessing the Down Cow

  • Dairy Australia video: Lifting With a Hip Clamp

  • Puerto-Parada M, Bilodeau M-E, Francoz D, et al. Survival and prognostic indicators in downer dairy cows presented to a referring hospital: A retrospective study (1318 cases). J Vet Intern Med. 2021;35(5): 2534–2543. Published online 2021 Aug 13. doi: 10.1111/jvim.16249

  • Poulton PJ, Vizard AL, Anderson GA, Pyman MF. Importance of secondary damage in downer cows. Aust Vet J. 2016;94(5):138–144. doi: 10.1111/avj.12437

  • Stojkiv J, Weary DM, von Keyserlingk MAG. Nonambulatory cows: Duration of recumbency and quality of nursing care affect outcome of flotation therapy. J Dairy Sci. 2016;99(3):2076–2085. doi: 10.3168/jds.2015-10448

  • Ontario Association of Bovine Practitioners. Considerations for Developing a Down Cattle Protocol. 2019. Accessed June 27, 2022.

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