Health Considerations for Suspension

For general health negotiation for bondage, see this article. For more general thoughts on negotiation, see this article. More specific discussion of weight and suspension can be found here.

tutu facing back

Everything we do in kink (and, you know, life) has risks. Specific health conditions increase those risks, and at some point those risks outweigh the rewards of a given activity and we sit back and say, hrm, maybe not such a good idea to do that. If you have frequent seizures, you aren’t permitted to drive. If you are on blood thinners, your doctor would likely advise you not to go downhill skiing. Likewise, there’s some kinky shit that you probably shouldn’t do if you have certain health conditions. Someone with poorly controlled diabetes probably shouldn’t bottom for bastinado (caning the feet) and someone on coumadin (a potent blood thinner) shouldn’t bottom for play piercing. This is simply about being rational regarding the risk vs. reward ratio of any given activity.

That said, here is a summary of specific conditions that at the very least require extra caution, awareness, and expertise (from both rigger and bottom) for suspension and self-suspension. In some cases these issues may make certain suspension positions particularly (and probably unacceptably) risky, or may mean someone shouldn’t be suspended at all – these conditions all exist on a continuum and evaluation of a bottom needs to take into account the entire picture of their health and fitness, not just a single diagnosis.

  • Any condition that causes significant neuropathy (nerve damage/impaired sensation), impaired circulation, or impaired lymphatic drainage requires caution with any bondage, and in many cases may exclude the affected limb from load bearing bondage. Such conditions can include diabetes, lupus, stroke, mastectomy, lymph node removal, carpal tunnel syndrome, Raynaud’s disease, etc.
  • Serious respiratory issues (severe asthma, COPD, etc) (especially a problem for chest heavy ties and positions like face down or inversion)
  • Heart issues (CHF, arrhythmias, valve abnormalities, etc)
  • Diabetes that is severe or poorly controlled
  • Joint problems (this depends on the intended suspension of course)
  • Clotting abnormalities (hemophilia, taking coumadin or other potent blood thinners, etc- speaking for myself, I would not suspend anyone in this group, but others may have a different risk assessment)
  • Aneurysms (cerebral are a particular concern for inversion, risk increases with diabetes and obesity) or hernias
  • Eye problems (conjunctivitis, glaucoma) (especially an issue for inversions)
  • Spinal injury
  • Bone weakness (severe osteoporosis, osteogenesis imperfecta)
  • Uncontrolled high blood pressure (especially for any position involving inversion)
  • History of gastric bypass (likely means the person should not do inversions, and be extremely careful of putting pressure on the abdomen with rope)
  • Pregnancy – see this article for more details about pregnancy and BDSM
  • Skin integrity issues (like long-term prednisone use)
  • This is not a comprehensive list! If you’re comfortable being “out” to your doctor (which I highly recommend… and that could be a whole separate article), asking your doctor if you’re healthy enough for suspension bondage is an excellent way to get a personal check! If you don’t feel you can be “out” to your doctor, you might ask whether you are healthy enough for strenuous yoga involving inversion.

Suspension can be amazing, sexy, and fun – but it’s also one of the riskier things we kinky perverts do. It’s edge play and is not for everyone, top OR bottom. I hope you can use this information to help you make a more accurate risk aware assessment.

About the author: Whenever I write something like this, I am asked about my “qualifications”- which is certainly a reasonable question. I’m an ER nurse and ACLS (Advanced Cardiac Life Support) instructor who has spent way more time than is reasonable researching bondage safety. I would, however, emphasize that nurses (and doctors!) can and do say idiotic/incorrect things, so using your own judgement no matter how “qualified” the source is always a good thing. 

I received feedback and edits on this article from a number of awesome people, most notably @MietteRouge (a kinky MD), @Guilty, and @FrozenMeursault. It is also informed by awesome bondage classes I’ve taken from instructors too numerous to name. Any remaining errors are mine.

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(1) Winfree C, Kline D. (2005) Intraoperative positioning nerve injuries. Surgical Neurology. 63: 5-18

(2) On diabetes and suspension: “Epidemiological studies have confirmed an association between diabetes and an increased prevalence of PAD. Peripheral arterial disease is usually characterized by occlusive arterial disease of the lower extremities.” -Peripheral Arterial Disease in Patients With Diabetes, Journal of the American College of Cardiology. “The prevalence of diabetes increases with increasing weight classes.” -Relationship between obesity and diabetes in a US adult population: findings from the National Health and Nutrition Examination Survey, 1999-2006. “The degree of diabetic control is an independent risk factor for PAD.” -Peripheral Arterial Disease in Patients With Diabetes, Journal of the American College of Cardiology. Again- what does this mean? Peripheral arterial disease (PAD) in the lower extremities = poor blood flow to the legs. This is often undiagnosed, and is why diabetics can end up having toe/foot amputations. As a lay person in the field, you can’t know whether a particular diabetic has PAD or not (there are some assessment hints, looking at color, temperature, pulses, capillary refill, etc- but this requires training to assess and is ultimately not conclusive to diagnose the condition). I think it wise to avoid load bearing lines on the lower extremities of someone who has PAD, and you may have to base this assessment on risk factors (diabetes, degree of diabetic control).

(3) There is actually quite a bit of literature specific to inversion- on the use of “inversion tables” to treat back pain and on the safety of various inverted yoga poses. A few things happen when you’re inverted- for one, the weight of your abdomen (including organs and adipose tissue) press up against your diaphragm, making it harder to breathe. Your intrathorasic pressure is increased (especially if you strain or hold your breath while inverted, which us perverts are known to do), as is your intracranial pressure. Blood pressure is increased (“Both systolic and diastolic blood pressures increased significantly [in response to two minutes of inversion traction]” – “Blood pressure response to inversion traction”, Journal of Physical Therapy.). Common contraindications listed for inversion include high blood pressure, glaucoma or other eye problems, pregnancy, cardiovascular disease, diabetes  (I would add that degree of diabetic control is the key here, some diabetics can do inversion and some probably should not), and ear or sinus infections. You can see an example list here. As a side note, most articles on yoga inversion I researched also listed menstruation as a contraindication for inversion. The only reason I could find for this had to do with beliefs about chakra energy flow (see this example) rather than anything I would consider a medical contraindication.

 

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