BONDAGE BASICS

BONDAGE BASICS

These pages are devoted to bondage safety and risk awareness-based education for new, experienced, and aspiring rope tops and bottoms. These safety basics apply to everything from bedroom bondage to suspension, shibari, and kinbaku to Western style. Articles range from very beginner (perfect if your bondage skills begin and end with tying your shoes) to advanced (including addressing some extremely common myths about bondage safety).

Formerly known as Remedial Ropes, remedialropes.com

  • Always have a method of quick release available. A pocket knife is not a good tool for this purpose.

    More great info on this topic can be found on Frozen Meursault’s site!

    Paramedic Shears

    • Readily available online or at your local drugstore.

    • These have a blunt side used under the bondage (against the skin) that helps prevent cutting/poking.

    • Try yours out on the rope or bondage implement you plan to use! They can have a surprisingly difficult time getting through many bondage materials (including rope, especially synthetics). Quality varies wildly.

    Rescue Hook

    • Available online – just search for “Benchmade Rescue Hook.”

    • Multiple styles are available. Many people prefer a “5” as they can hang it from a DM kit or even a necklace to have it on hand.

    • These work well for cutting material under tension (load-bearing lines especially). Keep in mind that cutting rope that is under load is often unsafe (see below for details).

    • Rescue hooks do not work well with cutting the rope that has any slack.

    Quick release snaps

    • Available at Home Depot (or online, of course!)

    • Don’t use these for load-bearing (or potentially load-bearing) bondage.

    • These can be handy to use with bondage that ties someone in a laying position to a bed, for example – they will release instantly when the quick release is activated.

    • Remember that if you want your bondage to be more difficult to escape, you should place these out of your partner’s reach!

    Notes on cutting rope

    • Always remember that your rope is much more replaceable than your partner!

    • In many situations, cutting the rope may not be the safest option.

    • When someone needs to be out of bondage immediately, cutting rope should always be available. Reasons for this could include:

      • The onset of sharp, shooting pains or other signs of nerve injury in a bound limb

      • Panic/anxiety

      • Muscle spasm

      • Asthma attack

      • Nausea/vomiting

      • Factors outside the scene. (Mother-in-law knocking on the bedroom door! House on fire! You get the idea.)

    • Remember that quickly moving limbs that have been tightly bound, especially in a restrictive or strenuous position, can cause further injury.

    • Support limbs as rope is cut to allow them to move to a neutral position SLOWLY.

    • If you buy rope from Twisted Monk, they will replace it if it is cut off in an emergency!

  • Bondage tops are responsible for educating their rope partners about warning signs and communication methods before tying them up. Bottoms should also take the initiative to get educated about bondage safety! For even more bottoming resources and education, check out this site.

    Health negotiation

    • Before starting a bondage scene, ask and share about underlying medical conditions that affect bondage, including joint injuries, seizures, asthma, breast implants, diabetes, nerve injury/damage, etc.

    • This should include asking about conditions predisposing the bottom to nerve damage. Those include pre-existing peripheral neuropathy (nerve damage) from diabetes, peripheral vascular disease, and previous traumatic nerve injury.

    • Health history questions aren’t just for bottoms – if the top has a history of any conditions that could lead to alteration in consciousness (seizures, diabetes, etc.), this is also critical to disclose, particularly if you will be tying in private.

    • Consider asking about your health insurance status. It is not fun to think about, but what would happen if someone got hurt? Do they have insurance? Who would be financially responsible?

    • Asking, “do you have any medical problems” will primarily result in a knee-jerk “no.” Better starting questions are “tell me about your health” and “what medications do you take?”

    • Discuss the possibility of rope marks.

    Scene negotiation

    • Negotiation is about finding out limits and finding out turn-ons and sweet spots!

    • Consider using a paper negotiation form (or FetLife fetish lists) as a starting point.

    • Negotiation is not just the top asking the bottom questions – bottoms can (and should!) ask their top questions as well!

    • Some good questions to start with are:

      • What is your experience level with bondage?

      • What are the places you do and don’t want me to touch you?

      • What type of bondage scene energy or mood were you thinking of? Sexy, casual, platonic, playful…?

      • What do you enjoy about bondage?

    During a bondage scene

    • Avoid gags unless you know each other well and have another communication method (non-verbal safe signal, drop ball, etc.).

    • Go slow with new partners, check in often, and pay attention to emotional reactions.

    • The main predictor of a bad bondage outcome is the bottom’s subjective experience in the bondage. COMMUNICATE and check in often.

    • Bondage tops should empower their bottoms to communicate if they need the bondage modified/removed.

    Reading body language in scene

    • Of course, this varies by individual, but some general guidelines exist.

    • Tension

      • This manifests as scrunched-up shoulders, holding breath, furrowed eyebrows, etc.

      • Generally, increasing tension is an indication to check in, help them relax, and remind them to breathe.

    • Arousal

      • Signs include flushing, increased skin temperature, dilated pupils, faster breathing, increased blood flow to genitals, etc.

      • Keep in mind that genital response is not consent.

    • Moving toward or away

      • Sticking out your butt or tucking it in is an obvious example

    Safewords

    • Until you’ve negotiated otherwise, “no” means “no,” and “I need untied” means to untie them!

    • Safewords are a communication tool that can enhance your play.

    • A common element of power exchange and bondage is the “fantasy of non-consent” – wanting to be able to say “no, don’t, stop” – but not wanting your partner to stop.

    • In many public playspaces, safewords are part of the rules.

    • Some people don’t use safewords (usually within long-term relationships with established trust) or only use them sometimes.

    • You are responsible for empowering your partner to communicate (through a safeword or just plain using their words).

    • Tops can/should be empowered to use safewords as well – they are not just for bottoms!

    Verbal safewords:

    • Common verbal safewords include yellow (generally means “slow down”), red (typically means “stop” or “stop that specific thing/activity”), and “safeword” (generally means “stop everything, we’re done”). These are used differently by different people, so be sure to clarify the definition you’re using!

    • Consider using a verbal safeword that will work with the scene's energy – “mercy,” “uncle,” etc.

    • It may work for you to have a safeword as a backup (“if I say “red,” that means everything stops and you untie me right away”), but to communicate specifically in plain language (“my left arm just started going numb”) most of the time. This is much more valuable information than a vague “yellow.”

    • Check-in with a number system from 1 to 10.

    • As a bottom, it is beneficial to give your top a “two-minute warning” that you will need to be out of bondage (vs. waiting until it’s a matter of OH, MY GOD, GET ME OUT NOW!). This is not always possible, but try to monitor your body so you can communicate when you’re nearing (not at) the end of your tolerance.

    Non-verbal safewords

    • Many people have an easier time using a non-verbal safeword.

    • Examples of non-verbal safewords include opening and closing the hands, “tapping out,” stomping feet, or dropping an object in the hands.

    • An excellent non-verbal check-in is to tell the bottom that if you put your fingers in their hand, they should squeeze your fingers as a “green” (indicating that they are good and play should continue). This will also allow you to assess for possible nerve damage (inability to grip can be a sign of nerve damage and should prompt you to untie the limb immediately, but keep in mind that weakness is usually a late sign of damage).

    Use of safewords

    A critical negotiation point to consider is whether you (and your partner) will use safeword if needed. This is not always known and may vary unpredictably from scene to scene.

    Some players are totally empowered, can monitor themselves and communicate clearly in the middle of any scene, and have no issues communicating clearly in the moment.

    Reasons a player doesn’t/won’t/fails to use safewords include:

    • Taking pride in not using a safeword

    • Going non-verbal

    • Getting high on endorphins or emotionally so in the moment they forget limits/lose the ability to monitor their physical status

    • Being afraid that they’ll embarrass their partner or their partner won’t want to play with them again if they safeword.

    • A freeze or fawn response

  • Always start with intention. Why bondage? What will you do after your partner is tied up (if anything)?

    Consider what type of bondage scene you want to create together. A romantic scene that focuses on the sensations of rope against the skin is quite different from playful catch-and-release tickle bondage! If you enter the scene expecting a sexy vibe and your partner wants to practice a new ankle cuff they learned, you are setting yourself up for disappointment.

    Consider the individual “why” of bondage. Are you a rope slut who loves the feel of hemp against your skin? A sadist who gets off on having a “helpless” victim? A more cerebral type who likes to work out new and different suspension ties platonically? A submissive who wants to feel like a bondage trophy? None of this is mutually exclusive and can vary from scene to scene- think about your motivations to do bondage and communicate this to your partner!

    Consider blindfolding your bottom (never let them see you sweat!). If they can’t see, their fantasies can help the moment. Blindfolds are a newbie bondage top’s best friend!

    We don’t recommend gags for new or new-to-each-other players. Don’t gag- communicate!

    Consider whether the bondage is a means to an end (“I want to be unable to stop you when you do all these horrible things to me!”) vs. the end in itself (“I want to be bound and left to float”).

    There is a big difference between decoration bondage, more “psychological” bondage, and tying a bottom and genuinely struggling to escape. As a bottom, unless escaping is part of the scene, consider struggling with your “lizard brain,” not your “but my IQ is 130, and I know I can figure out a way to get out of this” brain. Cultivate an attitude of assumed helplessness, participate in the scene, and cooperate!

    As a top, if you have a bottom that likes inescapable bondage and often tries to escape, you’ll have to use different techniques. Remember that your bondage will shift and tighten as they struggle, which you will need to monitor. Consider placing your final knots where the bottom can’t reach them or using mitts.

    Learn to make your bondage more inescapable by playing “catch and release” games where the bottom is tied up, challenged to escape (while the top closely observes how they get out), and then tied again.

  • Always consider what would happen if the bottom fell or fainted. What would they hit? Where would the ropes (and their limbs) end up if they sagged in the bondage?

    If the answer to the question of what would happen if they fainted is “well, they would probably be seriously injured or die,” adjust your bondage.

    Hogties are dangerous. There is a risk of positional asphyxia (impaired breathing) and also the potential for damage to the wrists or ankles.

    After bondage

    There’s a danger of a faint or fall after being released from a standing position (or standing after lying down for an extended period).

    It can be helpful for tops to talk their bottoms through the process of untying the ropes (“it’s not attached anymore, don’t put weight on it”) and support the bottom as they’re released. Once they are fully released, the bottom should sit or lay down, if possible.

    For more information about fainting and BDSM, read this article.

    Immobility

    Tying the limbs so they have no movement at all is very difficult. Leaving some “wiggle room” will result in safer and more sustainable bondage.

    Being held tightly immobile for extended periods, especially if the legs or arms hang lower than the heart, can cause various problems, including blood clots in the legs and pooling blood in the lower extremities. Even slight movement (such as flexing the calves) can mitigate this.

    A bottom hanging unconscious or completely immobile/unmoving in bondage could theoretically suffer from something similar to “harness hang syndrome.” This is primarily a suspension bondage issue, but could conceivably be an issue with some non-suspension bondage as well (especially if the bottom faints into it). The onset of harness hang syndrome takes about 6 minutes – none of us would leave someone hanging passed out for that long, right? If someone faints in bondage, get them down as quickly (and safely) as possible.

    Private bondage

    The inherent risks of bondage are more significant in private play vs. in a public dungeon or play space with safety monitors and others available to help if something goes wrong.

    Consider the health of the top, especially if the bottom is going to be tied “inescapably,” and if the location is isolated.

    Check references.

    Don’t get tied up in private on the first date. Negotiate carefully (safewords, etc.) first.

    Arrange a “safe call” – have a trusted friend who knows where you are, who you’re with, what you’re doing, and who expects to hear from you by a specific time. Discuss what they should do if they don’t hear from you by that time. (Come and knock on your door? Call the police?)

    Other notes

    Don’t put rope around the neck or use a collar as part of potentially weight-bearing bondage (no attaching the leash to a point on the cross, etc.).

    Don’t tie rope from the genitals to a hard point.

    Often, the hands are the first area where problems are experienced. If possible, arrange bondage so the hands can be released quickly without having to undo everything else first.

    Many bondage experts recommend a “two-finger rule” (being able to slide at least two fingers under the rope) for bondage tightness. Remember that bondage will shift as the scene progresses, especially if the bottom is struggling/squirming.

    Load-bearing rope around the upper arms (in “box” or “TK” ties) is exceptionally high risk for nerve injury.

  • This site spends pages and pages talking about nerve damage…and this is the lone little section on reduced circulation. That’s because nerve damage is more of a safety issue for most bondage. However, reduced circulation can have risks and does not tend to increase sexy bondage fun times (and can complicate the detection of nerve damage), so it’s better to avoid it.

    Let’s first define what we mean by “reduced circulation,” as there are two major subtypes:

    Impaired venous return: This is the most common circulation issue in bondage. This refers to situations where blood flow leaving the limb in the veins is obstructed (or partially obstructed), but blood flow into the limb via the arteries is unaffected. Because arteries are deeper and have tougher walls than veins, veins are almost always affected first. Signs of compromised venous return include the limb changing color and becoming purple- or red-ish, as well as generalized numbness. Over the long run, blocked venous return can be dangerous. Still, it is prevalent in bondage and not an emergency (although it can complicate the detection of nerve damage). Often this can be addressed by “re-dressing” wraps to change their position slightly.

    Impaired arterial flow: Blocking arterial flow is difficult to achieve and uncommon in bondage. This refers to a situation where you have impaired a limb off from receiving blood via the arteries. Signs of this include the limb turning a more pale color and diffuse numbness. This is much more urgent than impaired venous return and should be addressed by releasing the affected limb from bondage.

    How to avoid causing reduced circulation

    Select an appropriate bondage material. Very stretchy materials (bungee cords, tights, rubber bands, surgical tubing, etc.) have a lot of potential to act as a tourniquet around a limb because, by the time they are tight enough that the restrained person can’t just wiggle out, they are very tight indeed and are likely keeping blood from getting out (or in!) as well. There are ways to use stretchy material in bondage, but it’s essential to be aware of the potential for problems. Many prefer to use something with some softness and minimal stretch—scarves can work well, or rope of course.

    The amount of the bondage material against the skin is critical (with rope, this translates as the thickness + number of wrapping turns), especially if the bondage will be load-bearing or the restrained person will struggle. Even small increases in the amount of contact against the skin can make bondage significantly more comfortable (and safer)—consider that a 100 lb person in high heels exerts 15 times more pounds per square inch than a 6,000 lb elephant. Generally, an inch of coverage (for a 1/4 inch diameter rope, about four strands, which means going around twice with doubled-up rope) is an excellent place to start for something like basic limb bondage. When you get beyond six strands, you reach the point of diminished returns, and maintaining consistent tension becomes more difficult.

    Rope placement is also essential. If possible, stick to areas with more padding—avoid placing rope around joints (elbows, knees, armpits, groin) where blood vessels are close to the surface with little padding.

    Many bondage experts recommend a “two-finger rule” (being able to slide at least two fingers under the rope) for bondage tightness.

    Remember that bondage will shift as the scene progresses, especially if the restrained person is struggling or squirming.

    Signs of decreased circulation include cold, color change, and numbness. These signs and symptoms generally occur slowly.

    Some color and temperature change in a bound limb is to be expected and is certainly not a bondage emergency. Establish a baseline by assessing the limbs before you start so that you can tell if there are changes. You can also check capillary refill—if prolonged, you know circulation is decreased. Again, this is not a bondage emergency, but it might prompt you to adjust your bondage and certainly prompt you to monitor and communicate with your partner. Mild color/temperature change is quite different from a limb that is cold and has no pulse—use common sense here. Every person is different.

    There are a few areas of the body where circulation does matter. The head, for one—rope around the neck is high risk for many reasons. The cock and balls are another areas where circulation matters—if they’re changing colors or having temperature changes, it’s past time to take the bondage off.

  • Negotiate for specific aftercare needs before starting a scene.

    Sometimes aftercare needs vary or are unpredictable.

    Aftercare isn’t just for bottoms!

    Common aftercare needs for tops include needing validation (“you did great!” “I still love you,” “I don’t think you’re a bad person, even though you just did “bad” things to me”), reassurance that the bottom is physically and mentally OK, food and water, physical comforts like cuddling, or orgasms!

    Common aftercare needs for bottoms include getting physically warm (blankets, cuddles, and maybe stuffed animals are classic), having something to drink (many bottoms swear by coconut water, sports drinks may also be a good choice), comfort, reassurance, and validation (“you did great!” “you looked sexy in that tie!” “You were super responsive and fun to tie up”), or…orgasms! 😉

    You’ll notice there’s a lot of overlap there!

    Move slowly after being untied. Body parts that have been bound for a while may have lost a bit of muscle tone, and strong or sudden movements can cause sprains.

    Well-meaning tops often try to move a part of the bottom’s body for them; this can cause injury.

    Remember that rope marks are compressed tissue; compressing them more (by rubbing them) will not be helpful. Enjoy your rope marks!

  • Bondage and gags can be a dangerous combination. Consider not using gags unless you are with an experienced partner you know and trust.

    If you are going to use a gag, carefully consider what “safe signal” you can use – it needs to be compatible with the bondage for that scene. A safe signal of opening and closing hands will not work if the bottom is tied with their back to a wall and their hands behind their butt. Sometimes a combination of grunting noises and body signals can work, but this relies on trust and a perceptive bondage top!

    Remember that nerve damage can happen in seconds, and while a bondage top can assess the bottom for signs of nerve damage, there are no perfect assessment tests. This means that even if the bondage top does nothing but assess the bottom’s nerve function for the entire bondage scene (not likely!), they are still relying on the bottom to communicate! Bondage tops cannot see nerve damage happening. If the bondage bottom can’t speak to protect themselves…there is potential for disaster.

    If you’re planning to play with a gag in a playspace with DMs, they may want (or require) you to notify them of your “safe signal.” Doing this in advance may keep your scene from being interrupted.

    If you want the feeling and look of being gagged while maintaining more safety, most folks can find a “sweet spot” with gags (at least common ball gags) where the gag will stay in and have the desired sexy effects but is just loose enough that they can spit it out of their mouths if they want/need to.

    If you want to be gagged, consider providing your own gag (shared gags are kinda yucky anyway), with the “sweet spot” for tightness indicated in some way. For a buckled gag, you could use a silver permanent marker or colored grommet to mark the appropriate hole for the buckle to fasten through.

    Gags and Suspension

    Gags are not often combined with suspension, and for a good reason. In addition to the usual considerations about communication, there is increased concern about the possibility of vomiting. Many bottoms are prone to nausea and vomiting in suspension, especially when there is inversion, tight constriction, movement, or spinning. I’ve become very nauseated in suspension; I’ve also had someone I rigged throw up while in the air (of course, I got them down right away). As a host/DM, I’ve cleaned up the mess from someone else’s unintentional suspension bondage roman showers several times.

    Throwing up with a gag in place can easily have disastrous, even fatal, consequences. If you decide to use a gag, especially for suspension, consider how quickly it could be removed in an emergency such as an asthma attack, fainting, or vomiting. A ball gag with a thin strap is easily unfastened or cut off. Heavy gags/hoods that would be impossible to remove quickly are a significant safety concern. As a bottom wearing one, you’re betting your life that you either won’t vomit or that your top will be able to remove the gag in time if you feel nauseated. Consider your risk factors (are you prone to motion sickness?) and whether this is worth it.

NERVE DAMAGE

NERVE DAMAGE

Nerve damage seems to be the most common serious injury that occurs in bondage scenes. Many of these articles contain references – those can be found here.

  • Nerve damage seems to be the most common serious injury (as opposed to minor injuries like rope marks, bruising, etc.) that occurs in bondage scenes.

    Nerve damage is more of a concern for bondage than decreased circulation (though the two can and do happen concurrently).

    There are two types of nerves we are concerned about with bondage – motor nerves, which control movement, and sensory nerves, which transmit sensation. Generally speaking, motor nerves are better protected than sensory nerves, so sensory symptoms often (but not always!) proceed to motor nerve damage.

    Danger signs for nerve damage include pain (generally described as sharp/shooting), weakness, tightness, stress, tingling, and numbness. These occur typically QUICKLY, sometimes instantly, and should be acted on immediately to prevent long-term damage.

    Keep in mind that symptoms of nerve damage will occur “outward” (the medical term is “distal”) from the injury site. So if nerve impingement is caused by rope across the radial nerve on the upper arm, symptoms will manifest in the forearm/wrist/hand.

    Nerve damage can occur either by stretching of the nerve (ex: over-extending the arms over the head for extended periods), by compression (ex: rope pressing tightly up against the armpit), or by shearing force (ex: tight rope pulling across the upper arm). Shearing force refers to parallel surfaces sliding past one another – if you ever had a grade school classmate do a “snake bite” on your arm, you have some idea of what this type of force feels like.

    The interplay of 6 primary factors contributes to nerve injury:

    • Individual differences in nerve vulnerability. [31] Some people seem to have bombproof nerves; others seem to get nerve damage if you look at them funny.

    • Anatomical location: where on the body you are tying. Some locations are at higher risk than others. Locations where nerves are closer to the surface and the bone, such as joints and the upper arm, are generally higher risk areas. [31]

    • Duration of compression. Nerve damage happens in stages – removing bondage at the first signs of injury can keep a minor injury from becoming a major one. [1]

    • The severity of compression/amount of shearing force. [1] The increased severity of compression and risk of shearing is part of what makes suspension bondage generally a higher risk than floor work. Spreading the load over a larger area can help decrease risk.

    • Stretch/stress positioning. This also has a lot of individual variances. Remember that stretching and stress positioning may make nerves more vulnerable to compression.

    • Environment (internal & external)

    Most incidents of nerve damage involve many (if not all) of these six factors.

    As a general rule: The more force and the longer the time, the greater the damage. “Mechanisms of nerve injury include direct pressure, repetitive microtrauma, and stretch- or compression-induced ischemia. The degree of injury is related to the severity and extent (time) of compression.” [1]

    Nerve irritation may immediately resolve or lead only to temporary nerve damage (numbness that goes away quickly).

    Any prolonged irritation can lead to semi-permanent damage – nerves need weeks or even months to heal! Nerve injury can even cause permanent loss of function. “Recovery of nerve function is more likely with a mild injury and shorter duration of compression.” [7]

  • Nerve damage can occur without any warning/symptoms, even with experienced players who do “everything right.” Being able to distinguish between warning signs of damage from intense but not harmful sensations is a crucial skill for being in rope and takes time to develop.

    The sensations associated with nerve damage generally are not erotic “good pain.” Many folks report sharp, shooting pains, stabbing, burning, or a sense of heat or cold. Be alert to numbness and tingling (which also doesn’t feel erotic to most people), not just pain. If you’ve ever hit your “funny bone,” you know where your ulnar nerve is and how it feels to have trauma to it – not sexy for anyone I know.

    Sometimes nerve damage may be focused on a particular area rather than the entire limb. For example, the ulnar nerve covers, among other areas, the pinky and half of the ring finger. So, if you feel numbness and tingling only in a specific “zone” rather than an entire limb, that’s a good clue that the symptoms are due to nerve compression. However, the fact that the whole limb is numb and tingling should not be taken as reassurance that the damage is NOT due to nerve damage.

    Several experienced bondage bottoms have told me they can tell there is an issue with their radial nerve because the top of their thumb goes numb. Therefore, they monitor for this during a scene by rubbing their index finger on the top of their thumb periodically to ensure they can feel it.

    Even “minor” nerve damage can have significant consequences. A relatively mild injury to the radial nerve, if on the dominant arm, can quickly render you unable to write or type for days or weeks – a significant problem for most people.

  • As a bottom, if you notice any signs or symptoms that might be nerve-related, communicate these to your top immediately.

    As a top, what should you do if your bottom reports numbness, tingling, tightness, or pain? Immediately take steps to address it. If the symptoms are minor, experienced bondage tops may sometimes address the problem by removing or redirecting tension, shifting ropes, or changing the bottom’s position. A vital component of this is making adjustments, then quickly checking back in with the bottom to be sure the problem has been resolved.

    In the following cases, we recommend immediately untying the affected limb:

    • If you or your bottom are bondage beginners.

    • If symptoms the bottom reports are severe and sudden – “I feel my right arm just went numb.” “I have sharp pains going down my left leg,” etc.

    • If initial steps taken (loosening the rope, changing position, etc.) don’t resolve the problem.

    Anytime you have any doubt, err on the side of caution and untie.

    If untying the limb doesn’t solve the problem (symptoms are ongoing a few minutes later), begin first aid steps.

    Many nerve injuries appear to have a cumulative aspect. Therefore, if you had any issues with nerve damage in a scene, avoid risking re-damaging that nerve, particularly in the first week following the injury (even if it was minor). If you’re going to tie again, avoid load-bearing rope on the injured area (keeping in mind that symptoms appear distal to the actual injury site).

  • The bad news about nerve damage is that the top often has no way to know when it is happening other than communicating with their bottoms! This means that rope tops have a serious responsibility to educate their bottoms to alert them when they have bad pain/sensations so that they can adjust the bondage.

    Other than educating and empowering their bottoms, tops can help prevent these injuries by knowing basic nerve anatomy and nerve damage symptoms. Anecdotally, it seems that most problems with bondage are caused by damage to the radial nerve (aka “honeymoon palsy” or “Saturday night palsy”), in most cases due to tight or load-bearing ties across the upper arms, especially in a suspension context. The radial nerve wraps around the upper arm and is close to the surface around the bottom of the deltoid, where people love to put rope (especially in box ties and the like). Other forearm nerves include the medial and ulnar nerves. Note that the exact location of these nerves varies from person to person, and both location and degree of exposure will vary based on position!

    Tops should watch for signs of trouble – signs like wiggling fingers and adjusting ropes are good cues that it’s time to check in with the bottom and adjust the bondage.

    During the scene, a bondage top can check CSM (circulation, sensation, and movement) in all sorts of fancy medical ways (capillary refill, point differentiation, etc.). However, it’s essential to keep in mind that the main predictor of bad outcomes seems to be the bottom’s subjective experience in bondage. Pay attention to body language and check in frequently.

    In addition to testing for sensation, there are several motor tests:

    • The Kumar Test is designed to check all three of the nerves of the hand (radial, ulnar, and median). This test involves making the “OK” sign with the hand/fingers – please follow the link for details. [17]

    • Ask the bottom to touch the tip of each finger to their thumb. The inability to do this can indicate a problem with the radial, ulnar, or median nerve. [16]

    • If the bottom is positioned to do so, have them make their wrist and fingers a straight line with their forearm. Put your hand on the fingernail side of their hand. Have them extend their wrist (bend at the wrist towards your hand, away from the direction of their palm – this is called “wrist extension“). The inability to do this generally indicates a problem with the radial nerve (often from a box/TK tie).

    • Ask the bottom to spread out (“extend“) their fingers by themselves and against resistance. The inability to do this indicates a problem with the radial nerve, or if they cannot extend the thumb, the median nerve.

    • Ask the bottom to squeeze your fingers and *maintain* a grip. The inability to do this can indicate damage to the medial or ulnar nerve. [2]

    If the bottom has difficulty with any of these tests, it indicates that they have some nerve impairment and should be untied.

    However, “passing” any of these tests is NOT an all-clear that indicates everything is OK.

    Making frequent shifts in the rope – just a slight reposition, adjusting the tension, or temporarily releasing the pressure to allow the underlying tissues to readjust – can make all the difference. This may be as simple as running fingers under the rope or as complicated as rearranging a suspension, so the bottom is in an entirely different position.

  • We have all had a limb “fall asleep” in a non-bondage context, and we all recovered, I imagine? That sensation is usually caused by a combination of reduced circulation and minor nerve injury. The two are inseparable to some extent – reduced circulation reduces circulation to everything, including the nerves, which causes them to go haywire when circulation is restored. [9]

    Even though most of the time your body will recover when you experience these symptoms, the damage that can be done by bondage is a bit different than the type caused by crossing your legs for too long – it’s more focal compression, for one thing. Also, you can suffer from nerve damage by crossing your legs for too long or too often. [8] Thus, in a bondage context, I would never dismiss complaints of limb numbness as “just” being a “sleeping” limb.

    People who are very experienced in rope may be able to distinguish between the type of focal nerve compression that will cause long-term damage and a limb that has “fallen asleep,” however, this is an advanced level of body awareness (and unfortunately not without potential for mistakes).

  • The radial nerve in the mid-upper arm area is a common site of nerve injury for bondage. “The radial nerve is the most frequently injured major nerve in the upper extremity." [29]

    When you are first learning bondage or just starting with suspension, consider avoiding tight and load-bearing ties around this area altogether. Suspension in “box” or “takate-kote/TK” style ties require thorough training and mentoring and are high risk for nerve damage.

    Avoid wrapping any rope that will bear load or be under more than a minor tension around the knees, elbows, groin, and armpits. These are places where major arteries, veins, and nerves are near the surface. Studies have documented nerve damage to both the radial and medial nerves caused by blood pressure cuffs positioned too distally on the arm (not high enough, overlapping with the elbow area) – the recommendation of these articles was to be sure blood pressure cuffs are placed proximally (close to the center of the body) enough to avoid overlap with the bend of the arm. [3] [4] [5] Try to stay on the “meaty” parts of the extremities.

    The lateral femoral cutaneous nerve (LFCN) seems to be the most commonly injured lower extremity nerve. Injury to this nerve causes numbness to a patch of the outer thigh. This most commonly occurs in ebi/" shrimp” positions (where the bottom is bent over, with their torso pressed to their legs) or in face down or side suspensions using a hip harness where rope applies load in the hip area (along the panty line).

    You can dramatically reduce compression by having more bondage material against the skin – this makes tying up someone’s wrists with a fluffy scarf generally lower risk than restraining them with a zip tie. If you’re using rope, this means making more wrapping turns or thicker rope (8mm is the thickest I would recommend, thicker than that isn't easy to work with).

    Often, the hands are the first area where problems are experienced. If possible, arrange the bondage so the hands can be quickly released without having to undo everything else first.

  • Diabetes is a serious risk factor for nerve injury. About half of people with diabetes develop nerve damage (“peripheral neuropathy”) due to their diabetes, and pre-existing/chronic nerve damage is an important predisposing factor for acute nerve damage. [11] [12]

    Very thin people are at higher risk for acute compression nerve injury. [11]

    Other conditions that can make people more prone to nerve damage include alcoholism, poor nutrition or vitamin deficiency (especially vitamins B6 and B12), thyroid disease, kidney disease, and autoimmune diseases like lupus or MS. [14] “Systemic conditions such as obesity, diabetes, rheumatoid arthritis, and other neuropathies will similarly render a given individual more susceptible to the development of…compressions.” [27]

    Existing subclinical (asymptomatic) nerve injury is a risk factor for developing a symptomatic nerve injury. [11] Studies of baseball players have shown that cumulative microtrauma from repetitive overuse places them a risk for peripheral nerve injury of the upper extremities. [13] “A proximal level of nerve compression could cause more distal sites to be susceptible to compression.” [30]

    In a bondage context, there is anecdotal evidence that bondage injuries are cumulative. This means that perhaps someone who has been in a box tie the same way 50 times and never had symptoms of nerve damage might the 51st time suffer from a symptomatic nerve injury, even though there was nothing unique, different, or “wrong” that 51st time.

    A cold environment may be a risk factor for nerve damage. Intraoperative nerve damage is similar to bondage nerve damage in many ways – it is generally compression and position related. A relevant study found that all other things being equal, patients cooled during surgery have more incidence of intraoperative nerve damage than those not cooled. [3] So it’s likely risky to do suspensions in an icebox, and warming up before a scene may help prevent injury.

  • Signs of nerve damage that may be noticed after a scene include weakness (often focal, depending on the affected nerve), numbness, tingling, pain, difficulty with fine motor control, and specific signs like wrist drop (which generally indicates radial nerve damage).

    These symptoms may resolve over an hour or so. It is also possible that recovery could take months or years, or the injury could be permanent.

    An indication that experienced bottoms report regarding recovery time is that if there is a notable improvement over the hours following the injury, generally, recovery will occur within a matter of days. If it takes days to see progress, it will likely take weeks to recover. Longer time to initial improvement = a longer time to full recovery.

    The most commonly reported bondage-related nerve injury seems to be radial nerve compression damage from box or TK ties. The three main effects of radial nerve damage are decreased range of motion, altered sensation, and impaired strength. Folks who have experienced this injury have reported that range of motion came back first, then strength, and finally sensation.

  • This is a quick summary. A detailed discussion of this topic can be found in the articles section.

    Avoid stretching out the affected area. Remember that stretch is often a contributing factor in getting the injury in the first place.

    Avoid compressing the affected area. Again, compression is a causative factor, and more compression will not be helpful. Compression includes: wrapping with an ACE bandage, massage, or even sleeping on the affected limb.

    I no longer recommend applying ice as routine care after a bondage-related nerve injury. If you choose ice, do so only for the first day. Apply ice to the site of damage for 10 minutes every hour while awake, being sure to use a padded ice bag that does not cool too aggressively.

    It’s important to remember that the site of the damage may not be immediately apparent or intuitive. For example, if there is radial nerve damage (and subsequent wrist drop) from a box tie, the temptation is to think that the wrist is injured when the injury probably originates in the upper arm.

    Generally, nerve injuries resulting in mild symptoms in isolation likely do not require a trip to the emergency room right this second. Still, if there are any concerns that there may be further or more severe injury (ongoing circulation compromise, severe deficits, ongoing pain, deformity of the limb, hematoma (large bruise) which could compress the nerve, etc.), then a trip to the ER would undoubtedly be appropriate.

    As a guideline: the “deader” the limb and the slower it resolves, the more urgently you should visit the local ER. You can easily wait if you have a bit of tingling in your pinky from hitting your funny bone. On the other hand, if your whole arm is numb, pale, and doesn’t get better – rush to the ER immediately. Remember: Tell the ER docs the truth. They need to know exactly what happened. The more authentic the story you’re telling is, the less likely they will suspect any abuse.

    See an MD (a neurologist if possible) within a few days if symptoms persist.

    After the first few days, you can consider using gentle heat.

    Gentle mobilization as soon as possible is recommended, with braces only as needed to prevent further injury. Consult a physical therapist if possible.

    Consider taking a pain & anti-inflammatory medication like ibuprofen. This is somewhat controversial from an “optimal healing” perspective; however, if you have pain, these medications may help by facilitating mobilization.

    Nerve damage can be exacerbated by vitamin B-12 deficiency. Taking B-12 supplements, if your doctor OK’s it, could help with healing.

MYTHS AND MISCONCEPTIONS

MYTHS AND MISCONCEPTIONS

There are some amazing myths and misconceptions out there about bondage. Have you heard these?

  • This is an interesting one. I’ve had people insist that someone with nerve damage following a bondage scene does not have nerve damage due to focal compression caused by the rope but instead has “mild damage to the nerves of the entire limb” caused by “loss of blood flow to the limb.” The suggested fix for this was to reperfuse the limb more frequently (taking weight off a futomono, for example) – which may work to prevent nerve damage by moving the ropes and altering the sites of focal compression. However, reperfusion to the limb preventing nerve damage (or loss of circulation, in isolation, causing nerve damage) is not a thing.

    Muscle is more vulnerable to ischemia than nerves. Lack of blood flow to a limb in isolation does not cause nerve damage. For example, surgical guidelines consider the application of a tourniquet to a lower extremity for 2 hours or upper extremity for 1.5 hours to be safe (there is always a risk of complications, of course, but it is relatively low). After that time, a deflation of at least 10 minutes is recommended. [1]

    Interestingly, animal studies (ethically – not into it. But the data is relevant) show that there is damage to nerves where they are directly compressed by a tourniquet (as demonstrated in nerve conduction studies), but interestingly no abnormalities in the conduction velocity of the same nerves distal to the injury [2] Which is to say, if the tourniquet was around the thigh, there was no damage to nerve segments running in the lower leg. This tells us that mechanical compression caused the damage, as nerve segments that suffered a lack of blood flow without direct compression were unaffected.

    In practice, I think the more important thing is that decreased circulation and the symptoms thereof complicate the detection of focal nerve damage and compression and increase vulnerability in that way, even if not strictly physiologically increasing vulnerability.

    References:

    [1] Tourniquets in orthopedic surgery. http://www.ncbi.nlm.nih.gov/pubmed/22912509

    [2] Intermittent reperfusion fails to prevent posttourniquet neurapraxia. http://www.ncbi.nlm.nih.gov/pubmed/10447158

  • In the bondage scene, we have heard people say that “once the damage is done, it’s done, and there’s nothing you can do about it.” This is true in the sense that there is no quick cure for nerve damage, and prevention is by far the better strategy. However, we have also heard this used to say, “well, no, I didn’t quickly untie her arm when she said it was numb because the damage was already done at that point.” This is a gross misunderstanding of the mechanisms involved.

    While it’s true that once the damage has occurred, you can’t quickly fix it, nerve damage isn’t an “all or nothing” thing – it happens in degrees.

    Several grading systems are used to describe nerve damage. The most common, developed by Seddon, divides nerve injury into three categories according to severity: neurapraxia, axonotmesis, and neurotmesis. Another commonly used classification system developed by Sunderland divides nerve injury into five categories, first to fifth degree. Neurapraxia or first-degree injury involves only transient functional loss that spontaneously resolves, while injuries on the other end of the spectrum involve complete severance of the nerve from which there will be no recovery without surgical intervention, and maybe not even then.

    Even within these grading systems, injury happens on a gradient, not step-wise. [2] [7] So releasing a limb from bondage might be the difference between a first-degree injury that resolves in a few hours vs. a third-degree injury that means you can’t write (and can’t work) for a month after your scene.

  • What can I say? I’ve heard this myth from experienced bondage tops (even instructors), which boggles my mind. The rest of this site has given a lot of information about other signs of nerve damage – loss of movement can be a sign, but it’s often a late sign. You can have severe nerve damage but still have movement in your fingers…and then you’re untied, realize you are numb, have poor fine motor control, and have wrist drop…but those fingers wiggle all around!

    One reason this is so egregious is that there are different types of nerves — some carry sensory information, some just carry motor information, and many are “mixed” (they carry both sensory and motor information). So it is possible to damage a sensory nerve without damaging a motor nerve. For example, the long thoracic nerve has no sensory functions, while the median nerve, which goes into the hand, has five branches with only sensory (no motor) functions. [7]

    Bottom line: assessment for nerve damage is much more complicated than wiggling fingers.

  • I have heard some bondage tops recommend checking circulation if a bottom complains about numbness or tingling because if circulation is decreased (indicated by delayed capillary refill, cooling of the limb, color changes, etc.), they then feel they can chalk up the sensation changes to decreased circulation. Since short periods of reduced circulation aren’t dangerous in isolation, they feel that signs of decreased circulation indicate that the numbness is “just” due to reduced circulation and therefore is no cause for concern.

    The trouble with this is that reduced circulation and nerve damage are not mutually exclusive and often happen together — arteries, veins, and nerves often run in very close proximity. The fact that circulation is impaired doesn’t mean that you can’t also have nerve damage occurring at the same time. If there is a way (short of hooking up to an electromyography (EMG) machine, which is used diagnostically to test for nerve damage and which I imagine most of us don’t keep in our toy bags) to say for sure that decreased circulation is happening totally in isolation with no involvement of nerves at all, I don’t know of it. Some people experienced with being in rope may be able to distinguish this within their own body, but that requires advanced body awareness and is unfortunately not error-proof.

  • This one kills me (and yes, I’ve heard it from prominent educators). It’s a bit like me saying: “I’ve never seen someone in the ER who was injured because their car hit an elephant, so it must be the case that if your car ran into an elephant at 60mph, you wouldn’t be injured.”

    It is true that, anecdotally, most bondage nerve injuries occur due to rope around the wrists and the upper arms. While I know of several cases of injury from a rope around the elbows (damaging the ulnar or radial nerves) and knees (damaging the peroneal nerve), it isn’t common. I would theorize that this is because putting load-bearing rope around the knees and elbows is clearly a bad idea, most people have been counseled not to do it, and most people don’t do it (especially people who do suspensions, where the majority of injuries occur). Just like I’ve never seen a car vs. elephant injury in the ER, you don’t see many injuries due to someone being strung up by their elbows. But that doesn’t mean that it isn’t a potentially harmful activity!

    Multiple studies across decades of research have documented nerve injury due to the placement of blood pressure cuffs too close to the elbow [3] [4] [5] — the overall recommendation of these articles was to place the cuffs more proximally (away from the elbow and up on the arm). Why? Because in the elbow area, the nerves and blood vessels are close to the surface with little “padding” and are more prone to injury. In the words of one study author: “Locating the cuff higher on the arm, away from the elbow joint, to avoid the most superficial portion of radial nerve, may prevent this type of compression injury…” [4]

    Moving on to the knee area, in the words of another author talking about the peroneal nerve at the back of the knee: “It is well established that the peroneal nerve is susceptible to injuries due to its anatomical course… Due to its superficial anatomical course around the fibular neck [at the knee], where it is covered only by skin, subcutaneous tissue, and a fat pad, the nerve is susceptible to damage due to pressure against the bone…” [6]

    Putting load-bearing rope directly around the joints is very high risk. The low number of reported incidents involving this mechanism shows that most people understand this fact and avoid such bondage.