PLEASE NOTE: We are not medical professionals, and the information on this page should not be considered medical advice! What we present here is the best information we have at this time based on our research and consultation with others who do have medical training. Use this information at your own risk, and remember that all rope bondage is dangerous and carries the risk of injury. You should research this information for yourself. We also highly recommend First Aid and CPR training for all rope practitioners. In nearly all cases below, if you are medically trained, you will have more informed options that you may choose to pursue beyond the ones listed here. These steps are intended to help those without medical training to provide assistance while also not causing further harm. Finally, if you are injured, our best advice is to seek medical treatment from a qualified facility.
Generally speaking, circulation loss over a short period of time isn’t a major concern, and neither is the discoloration that typically accompanies it. In fact, discoloration is a particularly unhelpful guide for assessing risk because of the extreme variability among people: some discolor quickly and drastically, others show little to no change regardless of the degree or time involved in circulation loss.
That being said, the skin becoming darker (purple or red-ish) typically indicates impaired venous return, which is common in rope bondage and generally not a concern over short periods of time (30 minutes or so). However, the skin becoming paler can indicate impaired arterial flow, and this is a much more serious condition which should be immediately addressed. Thankfully, impaired arterial flow is difficult to achieve because arteries tend to be buried more deeply in the body and therefore are more difficult to compress. 1For a more thorough discuss on Remedial Ropes: Circulation
In emergencies, a limb can be without circulation up to 2 hours without negative long-term effects and between 30 to 45 minutes with no changes to the muscles at all; however, the general rule of thumb for first-aid tourniquets is 1 hour for upper-extremities and 2 hours for lower-extremities. (However, note that individuals with pre-existing circulation issues — such as Raynaud’s syndrome, peripheral vascular disease, diabetes, etc. — are at greater risk.) 2Reference 1 – Reference 2 – Reference 3
In the bondage world, most people will err on the side of safety and not allow blood flow to remain restricted for more than 15 to 20 minutes and will also take steps to improve circulation by dressing or moving wraps, changing positions, etc. Of course, in some cases, circulation loss is unavoidable (such as a single-leg suspension, for example).
That said, it should be noted that circulation loss can occur simultaneously with nerve impingement, and in some cases, circulation loss can contribute to nerve impingement. However, the larger concern with reduced circulation is that it can mask damage to the nerves. For example, loss of sensation could be due to loss of blood flow … or it could be the result of a compressed nerve. Therefore, it’s important to realize that when circulation is reduced, the risk of missing other important warning signs is increased, and the most common type of injury in that situation is nerve damage.
Nerve damage is the most insidious danger of rope bondage. It can happen instantly or gradually over multiple scenes. It can be masked by circulation problems. It can heal in an hour or a month or a year … or never.
Therefore, it’s important that both tops and bottoms recognize that this risk is always present, and while sometimes injury may occur due to “fault” on someone’s part, it may also occur as an unavoidable outcome of this type of activity—for which no one is to blame.
Our best advice is for tops and bottoms to learn as much as they can about the types of nerve injuries possible during rope bondage and how best to mitigate the risks, recognize the symptoms, and respond to injuries should they occur. It’s also important that bottoms learn as much as they can about their bodies in order to help tops tie them in ways that are most appropriate for the bottoms’ specific needs.
Once a bottom indicates that they’re experiencing numbness due to circulation, the burden shifts to the top to closely monitor for signs of nerve compression. And if the bottom allows the tie to continue to the point of one or more limbs going completely numb, the top must monitor closely and continually. In those situations, the bottom should recognize the additional risks they are taking.
The nerves in your body serve one or both of the following functions:
When nerves are compressed or otherwise damaged in some way, the following symptoms typically occur (though not always and not always immediately):3”Stop Getting On My Nerves! Nerve anatomy for rope bondage.” MissDoctor
Though many people report that these symptoms tend to occur in that order, one or more symptoms may occur at the same time. It’s also possible that no warning symptom will present until after damage is done.
There seem to be three common causes of nerve injury that relate to rope bondage:
There are also a few common indicators associated with an increased chance of nerve compression injury, including: history of smoking, diabetes, familial neuropathies, alcoholism, and anatomic anomalies.
Another potential factor is the “Double-Crush Symptom,” which theorizes that nerve compression at one site can cause an increased chance for compression injury at another site. 4Mackinnon, Susan E. & Christine B. Novak “Compression Neuropaties” Green’s Operative Hand Surgery 28, 921-958, 2017. Electronic. To be safe, if addressing the immediate, suspected area of concern doesn’t have a positive effect, remove all rope along the system (or, if unsure what that system is, remove all rope).
It’s also worth noting here that people with “loose” skin (elderly, someone who experienced recent, drastic weight-loss, etc.) or people with large amounts of subcutaneous tissue (typically comprised mainly of fat cells) may be at greater risk of experiencing nerve injury through the shearing forces that usually occur at the edge of a cuff or band of rope. This is because the rope will hold to the skin, but the skin itself may allow the rope and the skin to rotate back and forth, causing shearing, which can injure the nerve. In these cases, take extra precautions to make sure the cuff is tensioned evenly, to make sure the cuff is tensioned correctly to fit the shape of the body part being tied, and to make sure the band is wide enough to appropriately distribute the load it will take.
One other contributing factor to the likelihood of nerve compression injury is physical variability: some people are simply more prone to nerve compression injury than others. Palpating common vulnerable nerves and noting both sensitivity and location can help reduce risk. In addition, certain types of diseases (such as multiple sclerosis (MS) and other demyelinating diseases) can make people more vulnerable to nerve compression injuries.
Throughout this course, we will try to provide specific recommendations, exercises, and tips to help tops “tie well,” to help bottoms recognize when something is or isn’t being tied well, and to help both communicate effectively. However, the following general guidelines relate directly to mitigating risk of nerve injury:
When we combine these concepts with the common causes above, it becomes clear that merely “putting the rope in the right place” or “avoiding putting the rope in the wrong place” is only one part of mitigating the risk of nerve injury. Therefore, as helpful as diagrams like the ones below may be, they are not all we need to consider when thinking about preventing nerve injury.
It’s also worth noting here that repetitive injury, to one degree or another, seems to be fairly common among experienced rope bottoms. This means that the nerve (and usually the same nerve or group of nerves, typically related to the same tie and similar placement) is stressed incrementally over many different rope sessions — none of which are severe enough to cause noticeable injury individually. However, over time, those micro-injuries can add up until a particular rope session causes the injury to become apparent.
This can happen even if the rope is “tied well” each time. Remember, the type of rope bondage we practice is inherently dangerous and injury (including micro-injury) happens even to experienced bottoms being tied well by experienced tops.
In that case, it’s important to note that this latest rope session may not have “caused” the injury by itself, and so the top during that session isn’t “to blame” (provided the top was tying well, good communication happened, and other precautions were taken). This is simply one of the risks of rope bondage that both tops and bottoms should understand in order to practice rope in a risk-aware manner.
There are a number of indicators and checks that both tops and bottoms can do to help them distinguish between circulation loss and nerve compression. However, we call these “false negative” tests because it’s possible to “pass” them and still end up with some type of nerve damage. Still, they’re the best we have, and are worth doing regularly.
|Circulation Loss||Nerve Compression|
|Speed of Sensation Loss||Gradual||Sudden|
|Area of Sensation Loss||Whole Limb||Partial Limb / Fingers|
|Mobility Checks||No Loss of Mobility||Loss of Mobility|
|Capillary Nail Refill||Slow Refill||Normal Refill|
Most rope practitioners are warned early on to avoid tying tightly around joints. Not only are joints weaker areas of the body, but nerves are typically exposed in these areas, so compression is more likely. In addition, the general advice to tie on the meaty parts of the limb or body is also helpful, as muscles tend to protect the nerves. However, this advice has more nuance: it is not always true at every location, and in some instances, muscles can contribute to the compression. Therefore, in addition to this general advice, we recommend that you familiarize yourself with the nerves listed below, their vulnerable locations, and the implications of compressing them.
The diagrams below should give you a general sense of the path and sensory innervation for these nerves. However, please note that we provide these only as general reference! Statistically, for around 80-85% of people, the location of any given nerve will roughly line up with the diagram below, but that means that this diagram is not accurate for 15-20% of people (roughly 1 in 5) for any given nerve (not to mention that this diagram is not drawn to scale)! This diagram is a helpful general reference, but each body is unique, and spending time learning about the particular concerns of each body in rope is time well spent.
Many nerve-related injuries affect the arms, so let’s take a closer look and point out a few particularly problematic areas: the armpit region, the lower region of the upper arm, and the wrist.
Decreased sensation, numbness, tingling, or a burning sensation in a given area of the hand can indicate possible nerve compression or damage to the corresponding nerve somewhere along the arm (see the diagram below).
In addition, the inability to move the hand in particular ways can indicate a problem with a specific nerve as well:
Compression-related injuries in the torso and hips tend to result mainly in sensation loss rather than limitations in movement, but these can still create challenges to normal movement and functions. The major areas to watch here are along the side of the ribcage, along the top of the hip bones, and along the “panty line” in the crease of the leg and thigh.
The major areas to consider in the leg are around the knee and ankle. Avoid tight rope around either location to minimize the chance of compression.
Sciatic Nerve: This nerve deserves mention here, though it would be extremely rare for it to be compressed by rope. Instead, this nerve is often affected by long periods of extreme flexion. For example, if the legs are held or tied back along the sides of the body for a long period of time (as in a position for sex), this may result in decreased sensation, numbness, tingling, or burning along the outside of the thigh and may also result in “buckling legs” … where the legs don’t seem to function correctly at first and need some time to recover before they feel stable again. (Also worth noting that those with pre-existing complications with their sciatic nerve will want to be particularly careful about the positions in which they are tied for any length of time.)
PLEASE NOTE: Ultimately, it does not matter if you correctly identify which specific nerve is experiencing compression. Given individual variability and that nerve compression can happen at any point along the nerve and be caused by a variety of direct and indirect means, this can be difficult even for medical professionals. Do not waste time trying to determine which nerve is experiencing trauma. Instead, when sensation and mobility are compromised, respond immediately to alleviate all potential sources of compression and/or untie and follow the steps below.
At the first sign of potential nerve compression injury, take all necessary steps to relieve pressure in the affected area and/or possible sources of the compression. This may involve shifting the position to relieve pressure from the rope (which bottoms may also be able to do for themselves), but likely involves removing/untying the rope and/or ending the session completely and removing all rope.
The level of experience and risk profile of both the top and the bottom will determine your response. However, if changing position doesn’t cause immediate and noticeable relief, and untying in the specific area doesn’t cause immediate and noticeable relief, we advise ending the session and removing all rope. Please note that time is a significant factor in nerve compression injuries, and the sooner you address the issue, the more likely the issue will be minor and will heal quickly on its own. Every minute you delay can greatly increase the damage.
The current commonly-accepted initial treatment for nerve compression injuries is listed below. However, note that there are some disagreements in the medical community. We recommend reading “First aid for nerve damage” for a more complete understanding.
In all cases, and regardless of the first aid approach used: if symptoms do not lessen in 24-48 hours — or if there is pain and/or other symptoms accompanying the injury — see a doctor as soon as possible (with urgency determined by degree of mobility loss and/or pain).
Special thanks to RopeJester, Shayblondie, Hedwig, Topologist, MissDoctor, IPCookieMonster, Esinem, St3amPunk, and the many others who provided resources and suggestions, including the specific resources linked below.
Please spend time carefully reviewing these additional resources:
Remedial Ropes is an excellent resource for rope-bondage-related safety information.
We also recommend the Zygote Body website to help you better visualize the location of various nerves in the body. There are other similar sites, but we’ve found this one to be particularly useful. Free accounts give you access to all the features you are likely to need.
|↑1||For a more thorough discuss on Remedial Ropes: Circulation|
|↑2||Reference 1 – Reference 2 – Reference 3|
|↑3||”Stop Getting On My Nerves! Nerve anatomy for rope bondage.” MissDoctor|
|↑4||Mackinnon, Susan E. & Christine B. Novak “Compression Neuropaties” Green’s Operative Hand Surgery 28, 921-958, 2017. Electronic.|
|↑5||See “The Brachial Plexus – Animated Review” and “The Brachial Plexus II: Animated Review“|
|↑6||Hasan, Syed & B Rauls, Russell & L Cordell, Cari & S Bailey, Mark & Nguyen, Thao. (2014). Zone of Vulnerability for Radial Nerve Injury: Anatomic Study. Journal of surgical orthopaedic advances. 23. 105-10. 10.3113/JSOA.2014.0105.|
|↑7||See “Rope Incident Report – Injury to the Lateral Femoral Cutaneous Nerve” for detailed discussion|