Bondage safety

This section is for guidance only as I am not medically qualified, neither is it exhaustive. I would welcome input from the medical profession or any relevant experts.

Bondage is probably the most risky area of BDSM, but also the most popular, especially with newcomers. Accidents do happen. Many of the most experienced practitioners have had incidents. Shibari (Japanese rope bondage), in its original form, was designed not only to restrain, but to torture and kill. Do not underestimate the effects of even relatively simple bondage. Have fun but go slowly and don't take chances.

Since suspension massively increases the risks, it should not be attempted without the personal guidance of an experienced practitioner.

Do not rely on what you see on the net as a guide to what is safe bondage practice. They might be of experienced bondage models in positions tied by professionals and only held for the few seconds it takes to shoot the picture. There are also many examples of poorly executed and unsafe ties on the internet.

Always keep a safe tool capable of quickly cutting your strongest rope to hand, e.g. EMT shears or bandage scissors. If you need them, you are likely to need them quickly so always keep them to hand.

Monitor your sub very carefully. Communication is essential. Check to see if there is any unwelcome discomfort, whether a knot or rope could be adjusted for better effect. A knot digging in or a rope chaffing can adversely affect the whole experience. Eye contact will tell you volumes. Observe breathing, body language and skin temperature. Watch out for signs of problems like flexing fingers or wriggling to adjust binding positions. Ask if there's a problem and act accordingly.

Make sure you have unambiguous safe-words if you plan to delve into areas of play where "No" could mean "Yes". At other times, I prefer mores helpful feedback that tells me exactly what is wrong. A safe-word can be any pre-arranged signal or word to end or tone down the session. This is vital when “No” or other pleas to stop could be just part of the game. For example, colours are popular choices, e.g. red = stop immediately, orange = I'm approaching my limits and green = go on. Safe-words are sacred and must always be obeyed instantly. Don't even joke about ignoring them. If you have any doubt that the person tying you will not respect them, walk away. A good dominant should be aware enough to pre-empt their use.

The 'double squeeze' technique is a good alternative where a non-verbal method is preferred, i.e. the dom gives two squeezes of the hand to the sub; if all is OK, the sub returns them. Failure to respond should set the alarm bells ringing. This is good as it requires pro-activity and also a firm response reassures about motor function. An inability to grip is a possible warning about circulation or nerve issues.

The most obvious hazard to both falling and fainting are impact injuries through striking the floor or other objects.

In order to minimise the risk of fainting, you should make sure that your sub has eaten fairly recently and does not become dehydrated. Energy drinks, water and snacks are good to have handy. Alcohol and drugs (legal or otherwise) should ideally be avoided as they increase the likelihood of accidents.

However, bondage carries additional risks. Be very careful what you tie to fixed or heavy objects. For example, the consequences of tying piercings in this way and a fall could be very unpleasant - what could happen to genitals doesn't even bear thinking about. In simple terms, consider whether you'd be prepared to hang from whatever is tied if you fell or passed out!

See also Dislocation and Strangulation. Fainting or a fall can easily result in these problems, as ropes can be pulled out of position or result in unexpected stresses.

Tight bondage and hands above the head positions tend to figure in many fainting incidents. I have also noticed that corsets appear to exacerbate the problem. However, suspension is the most likely type of bondage to cause fainting as it produces extra stresses and is likely to make breathing difficult. Vey often, a rise in temperature and clamminess signify the onset, followed by dizziness. After suspension, I had a sub faint as she was being removed from the bondage and another come close to it. Fortunately, in both cases, the warning signs were heeded and they were both brought to the ground safely. Make very sure you know what you are doing before trying suspension.

At the risk of stating the obvious, make sure that any fixing or suspension points are very secure. For overhead points, you can be reasonably sure that floor joists are strong enough. However, your fixings should be of suitable specification and properly mounted. Miss a joist and you will almost certainly bring the ceiling down. Guaranteed to kill your passion, if not you or your sub. Wall mounted points will either need to be screwed into brickwork with Rawplugs, expanding bolts or directly into the battens in a cavity wall. If in doubt, get qualified help.

If the worst happened, how quickly could you get you and your playmate out of the house? It is all too easy for a candle or cigarette to get forgotten in the heat of the moment and start a fire. Could you find your safety scissors in time?

Leaving a sub unattended is just plain irresponsible. Any of the problems in this section could occur, and with no means of escape, the consequences could be damaging or lethal.

Common sense should apply. In my opinion, those with conditions such as heart, breathing problems, blackouts or fits should avoid bondage. Bondage can be very stressful. One should also be aware of injuries or anything, which may be exacerbated.

Test ropes on yourself. Pull the rope across your own skin (a soft and sensitive area) and note how fast it has to travel before it becomes uncomfortable. Synthetic rope heats up at much slower speeds than natural fibre.

Some natural fibres can be very harsh and prickly, e.g. sisal. Using a softer fibre like hemp or jute and treating the ropes usually solves this problem and makes them easier to tie. The first stage is washing or boiling. Fabric conditioners in the wash or an oil, such as Bayu or Tsubaki, can be used to soften the ropes further if applied to the rope when it has dried. Stray fibres can be carefully burnt off with a gas flame.

Cheap polypropylene ropes often seen in builders merchants and DIY stores are unsuitable as they can shed minute splinters, especially when they become old.

To minimise the risk of strangulation, never tie a rope over the front of the neck or around the neck. Nooses are definitely out. The only safe configuration is halter neck style, so any pressure is on the back of the neck. You should also be aware of ropes, which may slip and end up around the neck. The risks are multiplied with suspension or if your sub falls or faints.

A bound submissive cannot remove a gag. It is your responsibility, so you need to be observant and not leave your sub unattended. Never use anything that could be swallowed, become lodged in the throat or obstruct the airways.

Breathing difficulties can also be caused by constriction, e.g. of the rib cage. Don't tie too tight. Remember that as you add wraps of rope or cinch the bindings, the tightness will increase.

In particular, suspension needs to be treated with extreme care as it can turn normally comfortable ties into crushing constriction. Suspension was used as a method of torture in the original forms of Shibari. It can kill. Certain positions can make breathing difficult. The degree of stress to which the sub is subjected can also increase breathing rates. Never underestimate the effect of being bound in a fixed position can have over time.

At best, lack of circulation causes 'Pins and needles' (although, this is actually a sign of the blood returning) and numbness. At worst, body parts are damaged or, in the longer term, even die without a blood supply. However, in reality, this is unlikely to be a problem as the acidic build up would make the bondage excruciatingly painful long before any serious damage ocurred. On the other hand, nerve damage is highly likely and can happen quickly. I prefer to play safe and relieve it as numbness can either mask or be a sign of nerve compression

Restricting circulation should be avoided by keeping a little slack in the ropes. The 'two finger rule' is that you should be able to slip at least two fingers under the bondage. Keep an eye out for ropes tightening during play or as you build up the bondage. Insist that your sub should not to try to be a hero and inform you immediately of any tingling, unpleasant pain or loss of sensation.

Avoid placing knots on blood vessels, e.g. on inside of wrists. Also, tie above, not on joints. The thicker the rope and the more turns, the lower the risk. Anything less that 6mm (1/4") should be avoided for general use.

Hands usually suffer first. So as not to end your scene prematurely and for safety, it is a very good idea to do your bondage so that the hands can be easily released without having to untie everything else.

Temperature is an indicator but not hugely reliable due to other causes of fluctuation. Note how warm your subs hands and feet are at the start of the scene, if they become noticeably colder, it is possible that circulation has been restricted. Another test is to squeeze a finger or toe and see how quickly the colour returns to the nail. The slower the return, the worse the circulation. Any obvious differential in colour of a bound limb should be a 'heads-up' but people vary tremendously with some being very susceptible to this.

Nerve damage is probably the most common injury. It can be painless and thus occur without any warning. It can also be permanent. The first method of minimising damage is to stick to the 'two finger rule'. The second is to familiarise yourself with the major nerves and where they are at risk from compression. I have just completed the first version of my study my study into upper body nerve injury with an emphasis on the box-tie, which I believe is the most comprehensive work to date. Insist that your sub listens to their body and tells you if anything feels odd or uncomfortable. The most common first words on sustaining such injuries are "It didn't feel right at the time but I was having such a good time, I didn't like to say".

It is a very serious risk with suspension bondage as this increases all the loads and stresses. Make no mistake, suspension is edge play and is never 100% safe. The most common problem seems to be radial nerve damage. Often, this can be caused when a badly tied 'box tie'/ chest-harness/Takata-kote is used as a suspension point. Common errors include: not isolating and locking off the components; catching the under arm cinch/stop ropes in the suspension ropes; including the back wraps in the cinch/stop rope and bad placing of the wraps. There appear to be two main areas where this nerve can be compromised. The most vulnerable point is the inside of the upper arm (Google: Crutch or Saturday Night Palsy). The point between the upper third and middle third of the outside of the upper arm is also vulnerable, roughly where the nerve disappears behind the bone in the diagram, i.e. the relativily unprotected area bewteen biceps and tricep. Graydancer of AdultRopeArt has started a Wikipedia type resource on the subject here. Please read and contribute to help expand it. Make sure you know where this nerve runs. diagram.

The picture below illustrates the problem. When I saw this picture, I commented to the model that the arm bindings looked badly placed. She then told me that she had suffered nerve damage lasting 3 weeks. Both parties were aware of the risks but simply got complacent. This tie needs a lot of care. Click on the image for larger picture. Addendum: On more recent examination, the the cinch/stop ropes are around both the front and back wraps. The same rope also encloses both upper and lower wraps, so cannot have been 'locked off', so can tighten. Thus, it not only serves to create a tourniquet around the arms putting pressure on the radial nerve on the inside of the upper arm, but it also seems to be pulling the upper wraps down the arm and into the position on the outer arm, previously mentioned.

Care should also be taken with the wrists. The vulnerable area tends to be the nerves around the joints, which can be damaged by ties that are too tight. Watch out for thinner rope especially as they do not form the cusioning bands that will be provided by several wraps of thicker rope. Be aware that hand ties can be put under tension in certain positions, e.g. hog-ties, suspension etc., so you can lose the safety margin you built in. Always keep an eye on the tightness of wrist ties as they are usually the first to cause discomfort. This means you need to be able to undo them quickly and easily. If possible, always make sure this can be done without the need to remove other ropes.

Obviously, physical force should be used with care. Moving a bound sub around can put unexpected strains on limbs. Falling creates, probably, the biggest hazard; not only from contact with the ground, but also where limbs are attached to a static object. Hoists, pulleys etc. should be used with care, the extra mechanical 'muscle' they provide could easily result in dislocations.

The dom should always be aware of the risk of the sub falling. Having the arms tied will hamper the sub's balance. Loose or surplus rope can cause a tripping hazard. It is not a bad idea to attach a safety rope to part of the body harness to a secure overhead point, especially if the bondage involves instability.

I make no apology for reiterating that you should never place a rope across the throat in a way that it could obstruct circulation or breathing. This brings you into the arena of breath play and I do not wish to get into the debate over whether the risks are acceptable. Passing the rope over the back of the neck 'halter-neck style' is the only safe method and even then it should not be so tight as to press on the throat.

In general, bindings should not be placed on joints, except the hips. This can lead to loss of circulation or nerve damage. Take care to place arm or leg bindings above the bony area of the joint. Leave plenty of slack as cinching will often tighten the binding more than you expect. Use the 'two finger' rule.

Always bear in mind that bindings might shift or tighten during play. Keep checking.

How much of a risk HSS really is for normal bondage situations is debatable...and it has been, frequently. Personally, I have never heard of a bondage related case but it doesn't mean it can't happen. It would appear that cases have been rescue situations where the subject has been immobile in a more or less vertical position in a seat type harness and the situation has often been exacerbated by cold and exhaustion.

This section has been reproduced with kind permission of shevah ©

There has been some intensive discussion on numerous rope e-groups on a condition called: HHS: Harness Hang Syndrome. This is an issue that both rope bottoms and rope Tops need to be aware of to keep everyone safe.

Basically, HHS is a loss of consciousness (syncope), accompanied with possible vomiting, followed by possible death in less than 30 minutes. Blood pooling is occurring in the legs due to the force of gravity and lack of movement. There is an increase of toxins in the pooled blood, which are usually carried away with normal circulation. Without the action of the muscle pumps in the legs, these toxins remain in the pooled blood and become acidotic due to the lack of oxygen in the blood. Because the blood is pooling in the lower extremities, it also reduces the amount of blood circulating throughout system.

Fainting: When someone faints and falls over, the reason they faint is from a lack of blood flow to the brain. Thus, fainting is the brain's natural request for more oxygen-rich blood. In nature, the problem is self-rectifying - - when fainting occurs, the person falls down, blood flow can be restored easily to the brain again once the legs, heart, and brain are all on the same level. Problem resolved.

HHS: When suspended in a harness, we are prevented from falling over and correcting any feeling of faintness or lack of blood to the brain. This upright position inhibits proper blood flow and promotes additional pooling in the lower extremities.

It should be noted that research has shown that Suspension Trauma can result as long as the legs are immobile and lower than the heart. So even relatively flat inclinations of the body can result in the condition developing. *Research has also indicated that the type and fit of a harness is essentially irrelevant to the development of suspension trauma.

Although this is not a new problem, its pathological causes and preventions are still in its infancy. Harness Hang Syndrome issues were first introduced to the general rope bondage world in a post on Adult Rope Art (ARA) Yahoo group http://groups.yahoo.com/group/AdultRopeARt/ (began in August, 2001 by Jimi Tatu) in June 2002 from Lochai with the following link about Harness Hang Pathology: http://www.texasroperescue.com/library/harness_hang.htm

In March 2003, a new document was published by The US Dept. of Labor / OSHA: "Suspension Trauma/Orthostatic Intolerance" http://www.osha.gov/dts/shib/shib032404.html, it states:
"Venous pooling typically occurs in the legs due to the force of gravity and a lack of movement. Some venous pooling occurs naturally when a person is standing. In the veins, blood normally is moved back to the heart through one-way valves using the normal muscular action associated with limb movement. If the legs are immobile, then these "muscle pumps" do not operate effectively, and blood can accumulate ... thus reduces the amount of blood in circulation.

The body reacts to this reduction by speeding up the heart rate in a futile attempt to maintain sufficient blood flow to the brain." The body will then abruptly slow the heart rate and blood pressure will diminish … causing fainting". Furthermore, the article points out: **UNDER *NO* CIRCUMSTANCES LIE THE PERSON DOWN IMMEDIATELY AFTER REMOVING THEM FROM THE HARNESS !!

When Orthostatic Intolerance occurs, there is an increase of toxins in the pooled blood, which are usually carried away with normal circulation. Without the action of the muscle pumps, these toxins remain in the pooled blood and become acidotic due to the lack of oxygen in the blood.

Death can occur during or just after rescue from the victim being moved to a horizontal position, resulting in a massive return of venous blood to the shock-damaged heart. The heart and kidneys are unable to cope with this rapid re-perfusion and cardiac arrest is very possible. (This was later termed as "Rescue Death").

Suspension Trauma and Rescue Harness Safety

http://www.vertical-access.com/newsletter/200403/documents/susp_trauma.pdf?nl403 By, Dr. Bill Weems and Dr. Philip Bishop December 2003, Fire Engineering.

This article offers an account of a fire rescue practice exercise gone wrong - makes for an interesting read.

Will Your Safety Harness Kill You?

http://www.vertical-access.com/newsletter/200403/documents/orthostatic_intoleran\\ce.pdf?nl403
By, Dr. Bill Weems and Dr. Phil Bishop - March 2003, OHS. They state:

"Fall victims can slow the onset of suspension trauma by pushing down vigorously with the legs, by positioning their body in a horizontal or slight leg-high position, or by standing up. Harness design and fall injuries may prevent these actions, however."

HHS was revisited on the ARA list in September 2004:
There is a fairly recent (2002) British paper, by Paul Seddon, reports to the UK Health And Safety Initiative, which summarizes the various studies on the physiological effects of being hung in harness that is worth a serious read:

Harness Suspension: Review and Evaluation of Existing Information
http://www.hse.gov.uk/RESEARCH/crr_pdf/2002/crr02451.pdf
The objective of this review was to locate and study literature dealing with the effects of being suspended in a harness and evaluate and report on them, together with attendant issues regarding various types of harnesses, including the position of their attachment points.

In addition, selected harness standards were to be examined to see if and how they addressed the topic of suspension. The study concludes that, "Whatever type of harness, hanging motionless in suspension is not physiologically safe, and will eventually lead to very serious blood circulation problems."
This condition is also referred to as: Harness Induced Pathology in the following articles: http://www.caves.org/grotto/nag/html/harness.html
http://www.cancaver.ca/int/mexico/zotz/harness-death.htm

We jump to December 7, 2005, where this subject was addressed again on the Adult Rope Art egroup, "Harness Hang Syndrome, Harness Induced Pathology".
Referencing Paul Seddon's 2002 report on the physiological effects of being hung in harness:
http://www.hse.gov.uk/research/crr_htm/2002/crr02451.htm

In 2006, the growing rope community was facing this issue again with a hands-on incident that prompted the most recent discussions and caused me to comprise all this information into one article. A rope Top was scening with a rope bottom and some problems resulted after she was brought down from the suspension. Here is Gary's account from ARA, Feb 12, 2006:

"I have had the pleasure of playing with a wonderful lady who enters an almost trance-like state in a bondage tie. Recently, I placed her in a simple face down horizontal suspension. She hung motionless -- trance-like "flight" -- gently swaying back and forth to good music -- otherwise quiet room. When I started to take her down, she suffered hot flushes and nausea. These are typical pre-syncopal symptoms associated with the "Harness Hang Syndrome." And, it was my introduction to these problems.

Let me repeat the sequence of events. (1) Her legs were motionless in a suspension and (2) when her legs and arms were released and lowered (3) she developed hot flushes and nausea. While she was in a horizontal face down suspension, her legs did hang lower than her body. She did not faint during or after the suspension -- but she remained motionless during the suspension.

Note from Esinem: This appears to be a speculative diagnosis. There are many reasons why somebody might experience "hot flushes and nausea". Furthermore, the position was atypical in that it seems to have been a face down horizontal, not not vertical. I'd say the jury is very much out on this one.

Bondage and suspension safety discussions typically center around knots, support points, and ropework not constricting nerves and not causing any breathing or circulation restrictions.

Studies about the Harness Hang Syndrome problem have been conducted by people who design rescue harnesses and people who are responsible for rescuing victims who have fallen and were hanging in their safety harnesses. These studies and the HHS problems were brought to my attention by a friend who referred me to a post on the AdultRopeArt egroup by Paul (whiteknight38cdn) on December 7, 2005,
"Harness Hang Syndrome, Harness induced Pathology." Paul is also a firefighter, a member of a group responsible for rescuing people who may suffer from the Harness Hang Syndrome.

From my analysis of the literature, it seems to me only two requirements exist for HHS to occur. 1) A body position that allows blood to accumulate from gravity (venous pooling) in the legs or arms, & 2) Lack of Motion - so that the "muscle pumps" don't redistribute the blood back into the body cavity in a near normal fashion.

It is NOT necessary to constrict the femoral vein to cause HHS. The cause of HHS is lack of motion; not using the "muscle pumps" in the arms/legs to help redistribute the blood that accumulates in arms/legs hanging lower than the body cavity.

Advise: Don't allow your bottom to be motionless. If their legs are suspended below their body, be sure they move their legs. Make them flex their muscles. By moving or flexing their legs, they activate the "muscle pumps" in their legs and you won't have the HHS problem."

A very important comment was added by HouTxOwl :
"Inactivity is required for this to occur and so the 'trance-like' state is not a symptom but is instead a precursor to the event. Activity acts to "pump" the blood back through actions of valves in the veins and also works to periodically relieve the pressure on the femoral vein."

Clinical tests and research has been done on this subject since 1968, as a result of suspension harness deaths with parachuters, climbers, and cavers. Various papers were published on these results. All of these studies were situated using a "seat harness" with their subjects. And all the researchers concluded that: "A motionless subject in a chest/seat strap harness combination is subject to orthostasis with pooling of the blood in the lower extremities that can lead to the possibility of death during or just after rescue (so-called Rescue Death). Rescue Death is the result of an acute heart failure immediately after a rescue of a person in shock from a hanging position, because the blood, which has sunk to the lower half of the body, flows back too quickly to the heart."

After 1990, there have been numerous studies completed in suspension trauma where the subject’s legs were elevated and the addition of movement of the lower extremities. It was concluded "Just the non-movement of the legs is enough to significantly reduce that circulation. If the legs and arms aren't moving, there is no pumping action, and blood tends to stagnate in the arms and legs. This means there is less blood return to the heart, and then subsequently to the head, is what leads to the faintness."

In 1997, Bariod and Thery (French Federation of Speleologists), along with Sheehan (2000), an Australian senior vertical rescue instructor, conducted various experiments, which concluded: "Fainting (in these circumstances) is a complex medical matter. Whatever the type of harness, motionless suspension in not physiologically safe and will eventually lead to very serious blood circulation problems, including death. It seems useless to try to invent a preventative harness."

It was further recommended for those who work in harnesses: Have an actual flat work-seat built into the harness to help position the upper legs horizontally and support most of the body's weight instead of leg straps. Prevention of Suspension Trauma was only successful by maintaining leg activity by moving the legs and, where possible, pushing with the feet against a firm surface at regular intervals. But no matter the type of harness; belt, chest, full body, hanging motionless was medically detrimental to the health of the suspended worker.

After review of all testing research, it was interesting to find that in every instance where Suspension Trauma did occur, each test subject indicated a degree of pain caused by the body holding devices, i.e. the harnesses and belts used.

One other factor was exposed during many of the tests in the 1990's. Allowing the head to tilt backwards (head-up tilt) induced pre-syncopal symptoms at a quicker rate. Therefore, any suspension position from vertical to horizontal where the legs are lower than the heart, the head must be supported as not to tilt back.

Excerpts from Paul's December 7, 2005, post on the AdultRopeArt egroup, referencing Seddon's Report:

- The study concludes that, "Whatever type of harness, hanging motionless in suspension is not physiologically safe, and will eventually lead to very serious blood circulation problems."

- Most of the testers believe that HHS is caused by blood being trapped in the legs so that the net result is similar to hypovolemic shock. No blood is actually being lost, but the amount of blood available in the torso to keep the brain and vital organs sufficiently perfused with blood is inadequate nonetheless.

- Look for: Faintness. Nausea, Hot flushes. Sweats. Paleness. Breathlessness. Feeling of panic, "Graying" or loss of vision. Change in pulse rate (suddenly becoming rapid, then slowing.)

- A lot of the signs and symptoms listed above, including the most important -- fainting -- may resemble a subject who is "flying", or a deep sub-space experience. This obviously compounds the danger of our activities, especially when playing with people who go into, or affect, near catatonic states.

- In order to maintain sufficient blood circulation, Ask conscious patients to do leg contractions (pumps) to reactivate blood circulation. * Note to subs: This will also help you to prolong your suspension and mitigate problems if you can flex and pump your legs occasionally while tied.

- Important! The victim must never be laid down flat (horizontal) after being rescued from the suspended position, it could be life threatening! The blood that has accumulated in the legs flows abruptly into the heart creating a risk of heart failure.

- He/she should be positioned with the upper body very well raised, i.e., in a seated, possibly squatting or crouched posture (raised knees) for 20 to 40 minutes. Repositioning of the body to a horizontal posture (supine) should take place only gradually!

Know and prevent what can happen so that you have the power in what you want to happen.

As you can see, this is not an issue that has been neglected. Research goes back decades and continues to be updated. Because we, in the rope world, do not use many of these seat harnesses and usually not stay in an upright, vertical, motionless position, this problem does not rear its ugly head too often. And when it does, it is normally just a minimal amount of symptoms that usually does not result in a deathly outcome. Can it happen? Sure, but I have not heard of anyone dying from HHS as a result of Rope Bondage Suspension.

Hence, you should know how to prevent this condition, how to treat it if one should succumb to its affects, and also be able to spread this all-important information to others.

So, if you are going to play with rope suspension, follow these 3 rules:
1) Don't have your legs and arms lower than your heart without constantly moving and pumping the legs and arms around.
2) If you are going to me motionless, trancelike, subspace flying -- do so with your heart lower than your legs.
3) Any suspension position from vertical to horizontal where the legs are lower than the heart, the head must be supported to not allow it to tilt back.