Health Considerations for Bondage
This article is written from a partnered suspension negotiation perspective. However, these considerations are also factors for self-tying and self-suspension. Many of these considerations apply to both tops and bottoms, as both roles can be physically (and psychologically) strenuous.
Negotiation
Asking about the current state of your partner’s body is an excellent place to start. When did they last eat/drink? Are they having any pain or discomfort at this moment? Do they need to use the bathroom? Are they well rested? What is their state of mind – calm, stressed, etc.?
It’s important to consider HOW you ask about health issues because that will play a big part in what information you will be given. If you ask someone: “Do you have any health problems?” in many cases, without really thinking, they’ll shrug and say, “nope!” A better question is: “What medical or health issues do you have?” or “Tell me about your health.”
Another good way to get information is to ask about what medications they take – if you don’t know what the drug is for or what its side effects could be, those are excellent follow-up questions! All of these questions are more open-ended and don’t allow for a simple “nope, it’s all good” – which is rarely an accurate answer, by the way.
Specifically, consider the “big three” – diabetes, asthma, and blood thinners. If someone has diabetes or asthma, ask them what they know about how these affect their play (and their lives in general). They are the experts on their bodies and can likely give you excellent information.
For someone who has asthma, the most important considerations to follow up with are:
Do they have an albuterol (rescue) inhaler?
Where is it?
When did they last have to use it?
What triggers their asthma?
Bondage can trigger asthma attacks, so it’s critical that the inhaler is within reach and that everyone involved in the scene knows where it is. Face-down positions like hogties put more pressure on the chest and can be more difficult for folks with respiratory issues, so choosing a different bondage position (like face-up) might be better for someone with asthma.
For someone with diabetes, follow-up considerations include:
When did you last eat?
When did you last check your blood sugar?
Have you been diagnosed with peripheral neuropathy (nerve damage)?
One big concern is that you could experience a drop in your blood sugar during play. Make sure there is a handy sugar source (like juice or high-glucose products designed for this use, like Glucola) for you if you need it. Symptoms of low blood sugar include cold and clammy skin, confusion, trembling, and more—be sure your partner or spotter is aware of these symptoms and knows what to do if you start to exhibit them. This applies to both tops and bottoms, and is especially salient for private play!
Diabetes, mainly if it is poorly controlled, is a vast topic. Over time, high blood sugar can cause peripheral vascular disease, poor blood flow (especially to the legs and feet), and peripheral neuropathy. This can cause impaired circulation and sensation in the feet, so extra caution (or avoidance) of load-bearing rope on the lower extremities is called for. Use more wrapping turns and take care to spread the load (for instance, by adding an extra hip rope), etc.
Note that lay people tend to assume that if diabetes is the disease, then insulin is the cure, and they may try to “help” an unconscious or confused diabetic by giving insulin. This is unlikely to be helpful and quite likely to be dangerous. Since low blood sugar is a much more acute concern, teach your partners to act accordingly.
For someone on blood thinners, many follow-up questions are needed – so many that it gets its own article!
Allergies are crucial to discuss. Of course, you probably don’t give a shit about a penicillin allergy, but a latex allergy could be relevant. A history of grass allergies means that there’s a chance of reaction with natural fiber (hemp) rope – consider wearing a small amount of yarn as a bracelet around the wrist for a day or so to check for any reaction. If anyone involved in the scene has a history of severe allergic reactions, do they have an epi-pen available? Where, and do you know how to use it if needed?
Considering a person’s level of activity can give you a lot of information about their health in general and cardiovascular (heart) health. If they do a 2-hour hike once a week, they’ll probably survive a physically strenuous bondage scene. If they have shortness of breath after climbing a flight of stairs, consider taking it slowly.
Asking about bloodborne disease status is always good. Hepatitis and HIV are the big ones. As a top, I always disclose my last testing date and results before asking my partner for their status. Of course, this is much more relevant for some scenes (those involving sexual contact or playing to blood) than for others (a scene involving a bondage ride with both participants fully clothed would be very, very low risk).
It’s crucial to ask about joints, including the history of injuries and degree of flexibility. Most types of bondage involve joint strain – kneeling can be hard on the knees, hair pulling can be a problem for folks with chronic neck issues, etc. Joint problems are pretty common!
Since nerve damage is cumulative, considering any history of nerve damage is essential. A previous bondage-related nerve injury is especially relevant. Something like carpal tunnel syndrome or sciatica is also nerve damage and should prompt, at the least, more cautious bondage of the affected area.
Health Considerations for Suspension
This is a summary of health conditions requiring extra caution, awareness, and expertise for suspension (partnered and self). In some cases, these issues may make certain suspension positions or practices particularly (and probably unacceptably) risky or may mean you shouldn’t suspend at all. These conditions all exist on a continuum, and evaluation needs to consider the entire picture of health and fitness, not just a single diagnosis. I’ve included both the health issues and some thoughts on what they mean for suspension.
Remember that these are general guidelines and suggestions, not a comprehensive list…and not medical advice! If you can be “out” to your doctor, consider asking them if you’re healthy enough for suspension bondage. Remember that most doctors won’t know what suspension involves, so you may need to give some specifics and compare it to other physical activities. If you don’t feel you can be out to your doctor, consider asking whether you are healthy enough for strenuous yoga, circus arts (such as trapeze, silks, or pole dancing), and rock climbing, which have some parallels with rope bondage.
Some conditions to consider include:
Lupus, stroke, mastectomy, lymph node removal, carpal tunnel syndrome, diabetes, Raynaud’s disease, and other conditions that cause significant neuropathy (nerve damage and impaired sensation), impaired circulation, or impaired lymphatic drainage
These conditions may often exclude the affected limb(s) from load-bearing bondage. If you’ve been told to avoid having your blood pressure taken or blood drawn on a limb, you should not apply bondage to that limb.
Severe asthma, COPD, and other serious respiratory issues
These are primarily problems for chest-heavy ties and positions like face-down or inversion. Bondage involves many things that can trigger asthma attacks (exertion, chest pressure, excitement, and so on), so it’s critical that your inhaler can be easily located and is within reach. Face-down positions put more pressure on the chest and can be more difficult for people with respiratory issues, so you may choose a different bondage position (like face-up), at least to start with.
Congestive heart failure (CHF), arrhythmia, valve abnormalities, and other serious heart conditions
This is a vast topic, and the degree of caution needed will vary wildly. Consult your cardiologist before attempting bondage if you have these conditions.
Joint problems such as a history of injuries or surgeries, arthritis, gout, and more
Evaluation is highly dependent on the joints involved. Knee issues are essential for bent leg ties or kneeling positions; any pelvis, hip, or knee problems will be an issue for ankle/gravity boot suspensions. Shoulder injuries may be aggravated by reaching behind the back. The best practice for working with joint injuries is to go slowly and listen to your body—monitor carefully for joint pain and respect that pain if your body tells you to stop.
Hemophilia, taking Coumadin, other potent blood thinners, or other clotting abnormalities.
I would not recommend that anyone with significant clotting abnormalities be suspended or self-suspend. Not only is there a risk of severe bruising and hematoma formation (basically extensive collections of blood under the skin) from even relatively “routine” amounts of pressure or shearing force, but any fall or impact has even more potential to be catastrophic. This article provides additional details.
Aneurysms
An aneurysm is a weakened area in a blood vessel. Many things we do in suspension cause increased pressure in our blood vessels, so weakened areas will make suspension exceptionally high risk. Cerebral aneurysms are a particular concern for inversion; aortic aneurysms are very high risk in general. The risk increases when an aneurysm is combined with diabetes and obesity. If you have an aneurysm, consult your doctor before attempting bondage, especially suspension.
Conjunctivitis, glaucoma, or other eye problems
You will likely need to avoid inversion or any position that places your head below your heart. Consult your ophthalmologist.
Spinal injury
This is a broad and impossible-to-generalize category. Consult your neurologist.
History of gastric bypass surgery
You will probably need to avoid inversions (ask your surgeon) and be extremely careful of putting pressure on the abdomen with rope (such as with waist lines).
Pregnancy
Considerations will vary considerably from trimester to trimester. First-trimester concerns include nausea and general fatigue; third-trimester concerns focus more on preventing abdominal impact, avoiding positions that cause pressure on the vena cava (on the back and right side), and dealing with loosened joints…among many other considerations! In a healthy pregnancy, you may be able to continue to do gentle rope, but modification and expertise are required. Consult your obstetrician.
Skin integrity issues (like long-term prednisone use)
These issues make you especially vulnerable to shearing forces (when the rope pulls the skin in multiple directions or rubs across the skin, causing friction). If this is an area of concern for you, spend a lot of time experimenting with floorwork (which is less likely to produce severe shearing forces), and play with different types of rope to see which works best on your skin. Consider trying 8mm nylon/MFP rather than natural fibers.
These are just some highlights, and this article is not in any way an exhaustive discussion of this topic. Hopefully, this has given you some ideas of the genuinely crucial information! And one more thing: taking a first aid and CRP class is a good idea if you want to be responsible and confident in your play.
