A first lactation, two month fresh Holstein presented to the Cornell University Hospital for Animals for inability to rise. On physical exam she was bright and alert. She was placed in a floatation tank for presumptive neuromuscular injury. Every third day she was walked out of the float tank and into a stall, to assess whether she could rise on her own. If unable to rise, she was raised with hip lifters and then walked into the tank. Once up she was able to remain standing and walk without any obvious signs of lameness. The primary causes of downer cows are numerous. All recumbent cows, regardless of the inciting cause are subject to pressure damage. This is termed secondary recumbency and is the unifying factor in downer cow syndrome. Treatment of downer cows involves first treating the initial cause of recumbency, if possible, and then attempting to decrease pressure damage. Treatment of downer cows is labor intensive, thus diagnosis of the cause of recumbency is important so labor expenditures can be focused on those animals with a reasonable prognosis of survival.