Prevention & Treatment

PLEASE NOTE: We are not medical professionals! 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 recommend First Aid and CPR training as an additional safeguard. Finally, if you are injured, our best advice is to seek medical treatment from a qualified facility.

Below are the most common rope-related issues and injuries that we’ve encountered through our work with others. While rope bottoms may be more at risk for most of these injuries, rope tops may also be susceptible. And either way, tops should feel the weight of responsibility when they tie, knowing that they may be part of causing these injuries to others.

Rope Marks / Petechial Hemorrhaging

While not a serious “injury,” you should know before being tied that you will likely have rope marks that can last from an hour or so to over a day. In addition, petechiae can result from the rope pinching the skin, and those marks can last for a week or more.

Prevention: Rope marks are usually unavoidable (unless there is very little tension on the ropes), but petechiae can sometimes be avoided by running a finger under the bands to settle the ropes and remove any small gaps in the bands that might pinch the skin.

Treatment: There’s no real “treatment” other than time … and maybe some moisturizer, witch hazel, or arnica cream.

Rope Burn

If the rope is moved too quickly over skin, it can cause rope burn. Severe rope burn may even break the skin. This can happen to rope tops and bottoms.

Prevention: To help avoid this type of injury, pull the rope slowly when it’s lying against the skin, don’t let the rope get caught in places where the skin folds on itself (elbows, knees, arm against body, etc.), and hold the rope out and away from the skin when possible if moving quickly. Also be careful when moving the body in rope, particularly rope that is tied to something else, that the rope is pulled and dragged across the skin.


  • Clean the wound and wrap with gauze if the skin is broken; otherwise, leave open if possible
  • Apply cool water or ice to help with pain
  • Use a topical ointment if the skin is broken
  • Witch hazel or arnica cream may help with healing if the skin is unbroken

Bruising / Hematoma

Sometimes, rope can cause bruising or a hematoma (though this is not as common as rope marks and rope burn). While these aren’t pretty to look at and can be moderately painful for a few days, they are typically not a major concern and should fade and heal on their own within a week. (If they do not, or seem to get worse over time, consult a medical professional.)

Prevention: Slow control loading of the ropes can help prevent this. Sudden pulls or stops using rope, or allowing the majority of a person’s weight to hand on only a few lines of rope, are the most likely way to cause bruising with rope.

Treatment: RICE and monitoring

  • R = Rest the muscle/limb
  • I = Ice can help reduce swelling and relieve pain (10-15 minutes/hour; indirect)
  • C = Compression (lightly, with a loosely-wrapped elastic bandage) may help
  • E = Elevate the affected area above heart level
  • Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help with pain (ask about adverse reactions)
  • Witch hazel or arnica cream may help with healing
  • See a doctor as soon as possible if you have significant swelling and discoloration or intense pain, or if the injury has not faded or is still sensitive after two weeks.

Muscle, Joint, Tendon, Ligament Stress / Damage

In many forms of rope bondage, the body is moved and contorted in ways that aren’t typical, and this can cause injuries to muscles, tendons, and joints. In addition, certain positions or contorting movements can result in injuries that may or may not manifest right away. For example, a tie that twists the body might quickly result in back and knee pain, while a hogtie might feel fine during the scene, but afterwards, result in back pain. Be mindful of these concerns as you tie or are being tied.

Prevention: To help avoid these types of injuries, make slow and controlled movements in rope. Don’t jerk or apply force quickly.

Many injuries of this type, particularly as they relate to knees, shoulders and lower back, are cumulative in nature and do not manifest right away. Through careful monitoring of the body, slow and controlled movements in rope, and proper self-care (stretching, massage, corrective exercises), these types of injuries may be minimized. However, the more frequent and intense the rope you practice, the more likely you are to suffer these kinds of injuries over time.

We also find that these are the types of injuries that rope tops are also likely to experience. Often this comes from the constant kneeling, lifting, twisting, and other similar movements involved in tying someone up, moving them around, or lifting them into the air. The same cautions, preparations, and treatments apply to tops as to bottoms.

Treatment: In most cases, RICE and careful monitoring. If the problem persists, particularly if you suspect it’s the result of cumulative damage, temporarily stop rope practice until you can see a doctor; likely prepare for some form of physical therapy.

  • Call 911 if there’s intense pain, significant swelling, the limb/muscle isn’t working properly, or there was an unusual “popping” sound with persistent pain
  • R = Rest the muscle/limb
  • I = Ice can help reduce swelling and relieve pain (10-15 minutes/hour; indirect)
  • C = Compression (lightly, with a loosely-wrapped elastic bandage) may help
  • E = Elevate the affected area above heart level
  • Provide water to get the person hydrated
  • Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help with pain (ask about adverse reactions)
  • See a doctor if pain persists more than one or two days, if the joint can’t bear weight, if the limb is cool or pale, or if there is tingling and numbness.

Fainting and Positional Asphyxiation

Fainting is the most common rope-related concerns that we have encountered (omitting rope marks / rope burn), so we feel it’s important to be familiar with causes and proper response before you go too far down the rope bondage path. Usually, fainting is not a cause for major alarm or concern and can be recovered from relatively quickly. However, fainting can often cause secondary injuries in the process of falling, and fainting can sometimes be a symptom of greater concerns.

The most common causes of fainting in rope bondage include:

  • Remaining in one position for too long. While the warning “don’t lock your knees” is well-intentioned, it doesn’t hold up to medical scrutiny. Locking your knees allows you to stand still for a long period of time, but it’s not the locked knees that causes the reduced supply of blood to the brain and results in fainting … it’s the standing still for a long period of time. Movement, particularly movement initiated by the bottom, expands and contracts muscles, and it’s this action that returns blood back to the heart to be reoxygenated and pumped back out to the body. So, the lesson here is to avoid static positions for a long period of time–particularly positions in which the bottom isn’t able to work their muscles.
  • Sudden movement after a period of being motionless can also contribute to fainting, particularly if that movement involves shifting the position of the head.
  • Restricted blood flow. Rope bondage, along with the position in which the rope bottom is bound, can result in restricting blood circulation, which may also result in a slightly lower supply of blood to the brain.
  • Restricted breathing. Some forms of bondage can also restrict breathing. This could be due to the rope being wrapped too tightly across the belly or chest, preventing the diaphragm from fully expanding to take in breath. It could also be from the particular position the bottom is in (for example, ebi ties and hogties are notorious for making breathing difficult). And while it should be obvious, rope around the neck is extremely dangerous, as it can restrict breathing and circulation, compress nerves, and result in spinal dislocation.
  • Dehydration. Dehydration can contribute to lower blow pressure, which is contributing factor in fainting. Be sure to drink plenty of water leading up to any rope interactions.
  • Extreme heat. Physical exertion in extreme heat can cause peripheral vessel dilation, which means less blood makes it to the brain. Be careful about overheating, and realize that this can happen even if the temperature of the environment isn’t extremely high.

Fainting while in ropes poses particular risks if the rope is secured to a static object that may add sudden force to the ropes when the bottom faints.

Prevention: Alone or in combination, any of these issues can result in causing the rope bottom to faint, either while in the rope or just after having the rope removed. Be attentive to these concerns, look for early warning signs, and be prepared to respond quickly and calmly.

Early warning signs include: excessive sweating, skin (particularly the face) becoming very pale or blue or red, weakness, dizziness, headache, ringing in the ear, tingling around fingertips and lips, shortness of breath, and in extreme cases nausea or incontinence.


  • If they are feeling faint but have not yet fainted, remove rope, have them sit with their arms on their raised knees, and put their head between their knees to recover. Offer water and find ways to cool them if they feel hot. Fruit juice (or water and sugar) can also help.
  • If they do faint …
    • Make sure they are breathing. If not, call 911 immediately and begin CPR if you are trained
    • Lay them on their back and slightly elevate their legs to restore blood flow
    • Loosen any rope or tight clothing
    • Check for other injuries (hit their head) or unusual symptoms (chest pain, shortness of breath, confusion, blurred vision, difficulty talking, etc.). Call 911 if other injuries present emergency concerns
  • Stay with the person until he or she is fully recovered

Compression-Related Injuries

The most common circulation-related issues are circulation loss and nerve damage. In much rarer instances, sudden and/or forceful compression of lymph nodes (particularly around the armpit and upper chest) can lead to lymphedema.

Generally speaking, circulation loss due to rope bondage isn’t a major concern, nor is the purple discoloration that typically accompanies it. In most cases, a limb can be without circulation for the length of a typical rope interaction (30 minutes or more) without any issues. (Medically, circulation loss for multiple hours is generally not a concern.) However, the larger concern with reduced circulation is that, when a limb goes numb, it can mask other important warning signs, the most common of which is nerve compression and damage.

Prevention: There are a number of places on the body where nerves are vulnerable to compression injuries, particularly in the arm-pit, around the outside of the upper-arm and elbow, around the wrist, in the inner thigh and crease of the waist/groin area, and along the outside of the knee and lower leg. Unfortunately, these are also locations where rope is often placed for many common ties. Therefore, it’s important to pay careful attention to these areas during any bondage session and monitor sensation and mobility carefully. Damage to nerves can result in anything from sensation loss to temporary (and sometimes even permanent) control of a hand or foot. For example, a rope bottom suffering from “wrist drop” may not be able to type, open a door, or perform other common tasks for weeks or months at a time.

Please see the topic “Nerves & Circulation” for additional information and important ways to monitor and check for these types of injuries.

Treatment: SWEAR (However, also consult this article: “First aid for nerve damage.”)

  • S = Stop – stop the activity immediately at the first signs of nerve compression and remove all rope or other forms of constriction
  • W = Water / Ice – Ice can help reduce inflammation and relieve pain (10-15 minutes/hour; indirect) and water/hydration can help with inflammation; however, please note that not all medical professional recommend this step
  • E = Elevate – moderately elevate the affected area
  • A = Anti-Inflammatory – non-steroidal, anti-inflammatory medication (NSAIDs)–such as ibuprofen (Advil) and naproxen (Aleve)–are often recommended because they have pain relieving and anti-inflammatory properties (maintain consistent dosage for a few days to be effective)
  • R = Rest the affected area; avoid massaging or stretching to “fix it”
  • If symptoms do not lessen in two to three days–or if there is pain or other symptoms–see a doctor