Six Contributing Factors to Nerve Damage in Bondage, aka “The Six Horsepeople of the Nervepocalypse”
No one wants their bondage scene crashed by the nervepocalypse! Most incidents of nerve damage from bondage are not as straightforward as they might seem. They involve an interplay of multiple “horsepeople of the nervepocalypse.” Knowing these factors can help you mitigate risks and stay in bondage “heaven!”
This isn’t intended to be an exhaustive list of every possible factor but rather an overview of some of the most salient ones, which include:
Individual differences in nerve vulnerability
Anatomical location (where on the body you are tying)
Duration of force
Severity and type of force (compression or shearing)
Stretch or stress positioning
Environment (internal & external)
In the rope community, we clearly understand some of these risks (location and severity of compression). Still, other factors (such as the role of positioning) are often underappreciated. Most incidents of nerve damage involve many factors interacting in complicated ways. Let’s get to know these “Six Horsepeople of the Nervepocalypse” one at a time:
Some people seem to have “bombproof” nerves; others seem to get nerve damage if you look at them funny. Like many physiological traits, nerve vulnerability can be thought of as existing along a bell curve. Where a given individual sits on the curve is likely the result of an interplay of genetic and environmental factors.
Several health conditions increase vulnerability to nerve damage. These include diabetes, thyroid or kidney disease, autoimmune diseases, and poor nutrition or vitamin deficiency (especially vitamins B6 and B12). Very thin people are at higher risk for acute compression nerve injury. [1]
There is good evidence, both in the bondage community and via scientific research, that nerve damage is cumulative; existing subclinical (asymptomatic) nerve injury is a risk factor for developing a symptomatic nerve injury. [2] 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 experience a symptomatic nerve injury the 51st time, even though there was nothing unique, different, or particularly “wrong” that 51st time.
2. Anatomical location
Where you are placing load-bearing rope on the body will undoubtedly affect your risk. Some locations are generally higher risk than others, and people will often have different areas of vulnerability. For example, I’m relatively “bombproof” around the hips, but my arm nerves seem to be made of glass.
Joints and arms are generally higher risk areas than thighs or feet. The radial nerve in the arm (particularly the mid-upper arm) is a common site of bondage nerve damage. “The radial nerve is the most frequently injured major nerve in the upper extremity." [3] Injury to this nerve can cause various sensory and motor deficits; in some cases, it can be pretty debilitating. Face down or face up box tie/TK suspensions seem exceptionally high risk.
Knees, elbows, groin, and armpits are places where major arteries, veins, and nerves are near the surface. There’s a reason you don’t see too many bottoms strung up by their elbows…and there have been some genuinely disastrous case reports when people have tried.
The lateral femoral cutaneous nerve (LFCN) seems to be the most commonly injured lower extremity nerve. It is particularly vulnerable in the Anterior Superior Iliac Spine (ASIS) area and in the crease where the thigh meets the torso. Injury to this nerve causes numbness to a patch of the outer thigh. This most frequently occurs in face-down or side suspensions that heavily load a hip harness or in ebi/" shrimp” positions – see the 5th point below for more details on the positioning.
3. 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.
I 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 the better strategy. However, I had also heard this in the context of: “well, no, I didn’t quickly untie their arm when they said they couldn’t move their hand 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 divides nerve injury into three categories according to severity: neurapraxia, axonotmesis, and neurotmesis. Another commonly used classification system divides nerve injury into five categories, first to fifth degree. [4] Neurapraxia or first-degree injury involves only temporary functional loss (conduction blockage likely caused by local ischemia [4]), 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.
Even within these grading systems, injury happens on a gradient, not step-wise. So releasing a limb from bondage right away might be the difference between a first-degree injury that resolves in a few hours or a third-degree injury that means you can’t write (and can’t work) for a month after your scene. “Identical neural injury times do not always lead to the same neural injury" [5] – here, as well, there is a large amount of individual variation.
4. Severity of compression/amount of shearing force.
There are two main types of forces that rope can apply against the body. Compression occurs when the force is aligned with the body, such as rope pressing directly into an armpit. Shearing occurs when forces are not aligned with the body, for example when rope under load slides around the hips.
The increased severity of compression and risk of shearing is part of what makes suspension bondage generally higher risk than floor work. “The degree of [nerve] injury is related to the severity and extent (time) of compression." [4] Longer duration and more extreme compression/shearing will result in more severe injury.
You can dramatically reduce compression force by applying less load or by having more (evenly tensioned) 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 can mean making more wrapping turns, carefully monitoring tension, or using thicker rope (although thicker rope has its problems, like very bulky knots).
5. Stretch/stress positioning
In some cases, it is not the rope that compresses the nerve but rather the body's position. “Stretch-related injuries are the most common type [of nerve injury seen in clinical practice]. Peripheral nerves are inherently elastic… but injury occurs when traction forces exceed the nerve’s capacity to stretch." [3] Nerve damage can be caused by extended positions, either due to direct stretching and strain on the nerve or because the stretch causes a nerve to be pressed against another body structure (such as a boney prominence). As well as happening in stretched or extended positions, positioning nerve injuries can occur due to flexed or “bent” positions. This is especially common in ebi/”shrimp” ties, where the person in bondage is folded over their legs for an extended period.
Tolerance for stretch also has a lot of individual variances – are you noticing that as a theme here? Additionally, stress positioning may expose nerves and make them more vulnerable to external compression (think of how a tight rubber band is more susceptible to damage than a relaxed one). All these factors play together in complicated ways.
6. Environment (internal & external)
This broad category can include factors like communication and trust between partners, use of intoxicants, hydration, and more. This article will focus on two possible environmental factors: temperature and performance.
Studies on intraoperative positioning nerve injuries (similar to bondage injuries in numerous ways) demonstrate that cold is a risk factor for nerve damage. [2] Revisiting the rubber band – think of how much more brittle a frozen rubber band is than a warm one. Cold also decreases your flexibility and alters your sensory perception. Therefore, doing bondage outside in the winter (or even just in a chilly play space) is higher risk. Additionally, warming up before being tied may help prevent injury. There can be issues at the “too warm” end of the spectrum as well – being hot is a risk factor for vasovagal syncope (fainting), for example.
Another important environmental risk factor is having an audience. Being in a performance setting can alter your body awareness (and connection with your partner) in myriad ways. The adrenalin rush of the spotlight often significantly increases pain tolerance, and performers frequently push through warning signs of injury because “the show must go on.”
Avoiding the Nervepocalypse
What can you do to avoid the six horsepeople of the nervepocalypse crashing your bondage scene?
Be aware of different kinds of nerve pain – numbness (especially if it is localized to a smaller area rather than the entire bound extremity), burning, a sharp or cold feeling, and tingling – and do frequent checks. Consider your allowable risk budget and where to allocate it. Note and address symptoms of nerve damage rapidly. “Recovery of nerve function is more likely with a mild injury and shorter duration of compression." [2] Always have a reliable, safe cutting implement within reach, and know when and how to use it safely. Empower your partner(s) to communicate with you for partnered bondage. Don’t let your ego get you into (too much) trouble.
Surviving the Nervepocalypse
Sometimes, despite everyone’s best intentions, an injury occurs. Make a plan for mishaps like this before they happen, handle injuries in a supportive manner, implement appropriate first aid measures, and know when to seek medical evaluation. Hopefully, you’ll recover quickly and ease into bondage, having taken lessons from your bout with the six horsepeople!
References:
Stewart JE. (2000) Focal peripheral neuropathies. 4th Ed.
Winfree C, Kline D. (2005) Intraoperative positioning nerve injuries. Surgical Neurology.
Burnett M, Zager E. (2004) Pathophysiology of peripheral nerve injury: A brief review. Neurosurgical Focus
Peripheral Nerve Entrapment and Injury in the Upper Extremity, Am Fam Physician. 2010 Jan
Clinical Features of Wrist Drop Caused by Compressive Radial Neuropathy and Its Anatomical Considerations, Journal of Korean Neurosurgical Society
