Traditionally, the downer cow has been considered a metabolic problem. This viewpoint cannot account for the pelvic limb predilection of the condition. Whatever the primary cause of recumbency, all recumbent animals are susceptible to pressure damage. The extensive literature on pressure damage in human beings and horses is reviewed. Miscellaneous causes of and contributing factors to bovine recumbency are reviewed. Concepts and details of diagnosis, prevention, management, and therapy are discussed.