Nonambulatory cattle, commonly known as downer cows, are a significant economic concern in today’s dairy and beef cattle industries. Persistent recumbency in cattle may result from an array of metabolic, infectious, toxic, degenerative, neoplastic and traumatic disorders. A thorough physical examination is crucial for a veterinarian to create a feasible list of differential diagnoses. Often times, a definitive diagnosis may not be generated, but management and treatment of a downer cow generally remains the same. Secondary pressure ischemia and subsequent myopathy are rapid sequelae of prolonged recumbency and may decrease the likelihood of survival. It is important for the clinician to determine a prognosis, taking into account the degree of secondary myopathy, and make an educated decision whether treatment is warranted. If treatment seems practical, several therapeutic measures may be implemented, including the newest approach to physical therapy in the downer cow, which includes the use of a flotation tank system.