Risks When Using Rope

Risks when using rope

This post is part of a series that begins with BDSM Encounters – A Framework.

This post provides information about the risks associated with using rope in a scene.  It adds to the information presented in the Negotiation & Scene Planning tutorial.  You need both.  If you intend to put rope on anyone who has a pulse (including yourself), study everything on this page.

Rope bottoms: If something goes wrong, YOU will be the one injured. STUDY THIS PAGE, as well as the one on Nerves & Circulation.

There are risks associated with rope bondage. You need to understand what they are, how to reduce them, and what to do if something goes wrong. And something will go wrong eventually, because:

Rope Bondage is Not Safe

Understanding risk is a crucial part of engaging in bondage ethically. If you do not know the potential outcomes of the activities you engage in, then you are not informed, and cannot give informed consent.

Rope bondage is some of the most dangerous and injury-prone bondage that you can do.

Many experienced BDSM practitioners consider it “edge play”. The majority of serious injuries or deaths that occur in a BDSM context involve rope or breath play (controlling when another person is allowed to breathe).

Using rope on another person without understanding the risks and how to manage them is irresponsible and dangerous.

  • If the Top doesn’t know what they are doing, a rope can be positioned improperly, impinging on nerves or blood vessels.
  • If the bottom does not know how to detect issues, they may not immediately notice when they are experiencing crucial indicators that something is wrong.
  • If the bottom is not communicating with their Top — letting them know their physical limitations, or that they are sensing an issue — the Top cannot react and address the issue.
  • Improperly placed ropes can cause severe nerve damage in a very short period of time — minutes, even seconds in some cases. Nerve damage can take weeks or months to heal, and in severe cases, may never fully heal, resulting in a permanent loss of sensation or function.
  • If blood flow is cut off for too long or happens in a person with complicating factors, clots can form. A blood clot in the blood stream (an embolism) can cause heart attack, stroke, or even death.
  • If a rope bottom falls while in bondage, they could break a limb, dislocate a joint, strike their head, or worse.

So, it bears repeating: Rope bondage is not safe.

Learn the risks.  Learn how to manage them.

Take this seriously.

Top or bottom, YOU are responsible for managing your own risk and doing what you can to protect yourself from harm. You need to accept responsibility for your own safety and advocate for yourself.

Read everything on this page more than once. Throughout this page and the rest of the site, we teach many methods to reduce risk. If you learn, practice, and apply those things, the risk of using these ties will usually be minimal — rope marks, perhaps occasional rope burn, some muscle soreness if the bottom was in a challenging position for a while — but do remember that rope bondage can never be made 100% safe.

Every body is different, every mind is different, every person’s physical capability and psychological needs are different, every location and situation is different — so every encounter has its own unique risks. Those risks need to be understood and controlled to a level that is acceptable for everyone involved.


You need to understand risk and safety considerations just as much — if not more than — Tops, so that you can advocate for yourself.  You cannot give informed consent if you are not actually informed and knowledgeable.

If you are doing decorative rope or are otherwise using ties that are not too tight and do not render you truly helpless, the risk is usually low.

The risks dramatically increase if:

  • You are truly helpless and unable to free yourself.
  • The rope is too tight on a sensitive area or becomes too tight through movement, change in position, or struggle.
  • Your body is held in a challenging position too long.

If something goes wrong, you can be injured, perhaps severely, perhaps with lifelong impacts.

So: Bottoms, read all of this chapter. You need to understand it. It will help you make better decisions about who to trust when you put your safety into another person’s hands.


If you are a Top, you are the one who has the ability to take action. Your partner cannot. They can tell you things, but if they are bound, it is your responsibility to act. Your partner has put their trust in you. They rightfully expect you to take care of them. You have a duty of care. Learn everything in this chapter — the stuff for Tops and the stuff for the bottoms — and then keep on learning. Don’t get over-confident. Play within your level of skill; proceed at a responsible pace.

Learning about risks and safety needs to be an ongoing activity

This page should not be your only source of information. Information on bondage and rope safety is constantly evolving. This section contains lots of great information and tips that have stood the test of time, but new ideas are constantly being developed and tested; the best of them make their way into the community zeitgeist. There may now be better ways of dealing with some of these things. So, stay active; commit yourself to continual learning!


We are not doctors. Nothing on this site or on this page is medical advice. Your doctor outranks this website.  This is information that has been collected and shared by kinksters around the world and is currently considered common/best practice within the community.  That is all that it is.

One of the best ways to prevent injury is to play within your skill level and your physical capabilities.

Learn, then Practice, then Play

When you first learn a new skill, you are not yet ready to use it in a scene. You need to practice outside of a scene first. Once you have a solid grasp on the new skill and are confident that you can use it correctly, you can begin to incorporate it into play.

One Thing at a Time. Focus

When incorporating new skills into practice, only introduce one new element at a time. This can apply to techniques, levels of risk, and positional difficulty. Doing so allows the Top to focus on executing the new skill or technique with intention and safety at the front of their mind while reducing the number of new variables that they have to keep track of. This also allows the bottom to slowly adjust to and understand the way that they react to the new element that has been introduced. This is especially important if something doesn’t work quite right. Introducing one new variable at a time makes pinpointing issues much easier.

Be Patient, Build Slowly

As a Top, you may desperately want to put your partner into a strict strappado with the elbows tied tightly together behind their back and spank them silly, or as a bottom you may crave to experience that sort of scene. But that is something you build up to, not something you start with. It is very rare for a person to be able to touch their elbows behind their back and even more rare for them to be able to stay in that position for any length of time. Doing so without serious flexibility and strength training brings a high risk of muscle and joint injury. Also, if you put the ropes in the wrong location, you could easily cause a compression injury to the nerves that run close the elbows.

As you begin and as you grow, take things slow and easy, work with you partner and practice each new technique before you incorporate it into play.

Enjoy the journey!

Safety and Risk Management information is presented throughout this site.  The pages in this series hold a tremendous amount of very important information that will help you reduce your risk.  We also include risk information in the various tutorials so you can see in context where a particular risk may come in to play and what you can do to manage that risk.

That said, here are a few general safety and risk management rules to keep in mind at all times:

  • Never use slip knots or knots that can tighten when pulled directly on a human body.  These are referred to as “collapsing knots”.  If rope is able to tighten, it can cut off blood flow and/or cause nerve damage (which can be permanent).
  • Don’t put a hard knot in middle of your partner’s spine if you’re going to lay them on their back on a firm surface.  (This is less of an issue on a soft, cushioned surface, but keep it in mind even then.)
  • Don’t put a knot in your partner’s armpit.
  • Don’t put uncontrolled pressure across the front or front-and-sides of the neck.
  • Check the condition of your rope before you use it. Look for frays, dirt, etc.
  • Body fluids can accumulate on rope, so wash your rope and/or have a set of rope dedicated for use on a given regular partner.
  • Discuss the risks of your planned scene with your partner and decide together how to manage them to an acceptable level
  • Pay attention to the risks of a specific tie and manage those risks.
  • Remember that changing the Bottom’s position after the tie can change muscle tightness. What was an acceptable tightness in one position, may be way too tight if you then move the person into a different position. It is best to have your partner generally in the desired end position as you are tying them.

Common Risks, Their Prevention & Treatment

What are common risks when using rope on a person?
What can you do to try and avoid these common risks?
What actions should you take immediately if one of these injuries occurs?

The intention of this section is to help people that have no medical training to be able to provide immediate assistance without causing more harm.

Again, we are not medical professionals, and this is not medical advice. These guidelines are based on the best information we had at the time of writing, based on the experiences of the rope community, our research, consultations with people that do have medical training, and advice from reputable online sources like Johns Hopkins and the Mayo Clinic.

In the event of an injury, the best course of action is to seek medical assistance from a qualified provider.

We also recommend that everyone who is interested in bondage take a basic first aid and CPR course. They are good skills to have. Hopefully you will never need them.

In the milder forms of rope bondage — where things are not too tight and/or where your partner can still adjust their position somewhat — the risks are normally quite low.

By contrast, any form where your partner is truly helpless, or in which the bondage is very tight bondage or is anchored in such a way that it may become tighter if they move or struggle, the risk is higher.

There are many possible risks and concerns, running from mild to severe. Here are some of the most common:

Spectrum of Common Risks

(More Mild)

  • Rope marks
  • Bruising
  • Rope burn
  • Musculoskeletal stress or damage
  • Stains, sprains, etc.
  • Breathing issues
  • Positional asphyxia
  • Fainting
  • Injuries sustained during a fall
  • Breaks or dislocations
  • Compression injuries

(More Severe)

Some kinds of damage heal very slowly and can therefore accumulate over time. Nerve damage is one of these, as are certain injuries to muscles, joints, ligaments, and tendons. Small amounts of damage that you might not even feel at first may not be fully healed when the next injury occurs and thus, damage can build over time to something more serious.

Rope Marks

Light to moderate pressure marks made by rope are a common side effect of rope bondage.

If the rope is tighter, the person likes to struggle, or their skin is more sensitive, severe rope marks can occur. These can take the form of bruising under the bands of rope, or they can be caused by skin getting pinched between ropes, resulting in petechial hemorrhaging (ruptures of capillaries close to the surface of the skin).


Rope marks will occur. Petechial hemorrhaging is also common, but the risk of it can be reduced by running your fingers under each band of rope, so the ropes lay on top of the skin more evenly and are less likely to pinch. That said, petechial hemorrhaging is difficult to avoid altogether.


Light rope marks typically go away by themselves after a few hours, but you can sometimes speed the process with moisturizer and light massage. Petechial hemorrhaging may take a few days to heal.

Rope marks on ankles

Rope Burn

Friction from a rope can abrade the skin or burn off the outer layers. Severe versions can break the skin. This risk applies to both Top and bottom.


Move the rope slowly and deliberately. Use the techniques shown in Handling Rope.


Topical pain-relieving treatments (such as Bengay) can be helpful. If the skin is broken, clean the wound with cool water, treat with an antibiotic cream or ointment and cover with loose gauze. If the wound is deeper than just the top layer of skin, covers a large area, or appears as if it may be charred or infected, seek medical attention.


Like any bruise, bruises from rope can take several days to heal.


Move in a controlled way. Help your partner move in a controlled way. When a person is bound, they are not able to catch themselves if they trip, faint, or fall in some other way. If they need to move around the space while tied, help them to move safely.


You can reduce the effects of a bruise if you take a few actions quickly: Elevate the affected area and rest it. Ice the affected area for 20 minutes and repeat a few times for the first day or two. If there is swelling, add a compression bandage and consider ibuprofen or other anti-inflammatory pain medication, if necessary.

For more significant bruising, see the RICE treatment below.

If the bruise is accompanied by intense pain or significant swelling, seek medical attention; there may be something else going on. If the bruise has not faded and is still sensitive after two weeks or you notice other issues in the days after the injury, consult a medical professional.

RICE: Rest, Ice, Compression, Elevation

Rest — Pain is your body’s way of telling you something is wrong. Stop, change or take a break from the activity that caused the pain. But don’t avoid all physical activity. Protect the area that is in pain. Give the body time to recover.

Ice — Cold reduces pain by reducing swelling and numbing the area slightly. Ice immediately. Cover an ice pack with a light towel and apply to the area for 15-20 minutes. Repeat every two to three hours while you’re awake for the first 24-48 hours after the injury.

Compression — To help stop swelling, compress the area with an elastic bandage until the swelling stops. You want it snug, but not too tight or you may impact circulation. Begin wrapping at the end farthest from your heart. Loosen the wrap if the pain increases, the area becomes numb, turns blue or cool, or if swelling occurs below the wrapped area.

Elevation — Raise the injured area above the level of your heart when you can, especially at night. For example, if you have pain in your knee or ankle, prop your leg up on a pillow while you sleep. This helps reduce swelling. You may find it helpful to use a nonsteroidal anti-inflammatory medications (like ibuprofen or naproxen) along with the RICE treatment.

Musculoskeletal Stress or Damage

This typically happens if a person is contorted into a position that is not typical for them, if they are held in a position for longer than their body can handle, or as the result of an unexpected movement like a fall. The knees, shoulders, and back are particularly vulnerable.

It may be several hours or even the next day before such an injury is felt. These injuries also can be cumulative. A small injury today adds to a small one last week that hasn’t yet healed, which added to one before that — you see the problem.


During negotiation, discuss the bottom’s physical capabilities. Use techniques that allow you to work within your partner’s comfort zone. For example, if your partner cannot assume a Box Tie position, don’t try to force them into one; use an Adjustable Box Tie technique instead. Both Top and bottom need to build experience with regards to what works and what doesn’t for that particular bottom.

Tops: During a scene, move in a careful and controlled manner. Help the bottom to do so as well.

Bottoms: If you want to be tied in a certain position, work on being able to assume that position when you are not tied. Strength and flexibility training can help you to work towards a desired position safely.


If there is intense pain along with immediate and significant swelling, seek medical attention immediately. If a limb or muscle stops working, or you hear a popping sound like a joint coming out of place, seek medical attention immediately.

If an injury is less severe, treat it the same way you would normally treat a bruise, strain, or sprain using the well-known RICE method (in the Bruising section above).

As always: Listen to your body. Seek medical attention if you believe you might need it.

Breathing Issues & Positional Asphyxiation

Recent research has revealed that humans need to be able to breathe. As the saying goes: You only have about three minutes to live, but the timer gets reset every time you take a breath.


Restriction: A person can breathe by moving either their diaphragm or their chest or both. If you put a tight band of rope on the soft waist, you can make it difficult for them to move their diaphragm. They then need to breathe by moving their chest instead (this results in a “heaving chest” which some people find very hot), but this can be difficult for some. Restricting both the chest and the diaphragm at the same time makes breathing much more difficult and increases the risk significantly. This is why it is important that you do not tie both the waist and chest tightly.

Positional issues: It is also possible to immobilize one or both of a person’s breathing mechanisms by putting them into extreme positions. For example, if you tie them into a tight ball or a hog tie. Such challenging positions can make breathing extremely difficult. When attempting these positions, it is critically important to work well within the rope bottom’s physical capabilities and closely monitor them. Someone unable to breathe is unable to speak to let you know there is a problem! Cases like this are where it can be helpful to give them something heavy or loud to drop if they need help.

Asthma: During negotiation, ask if your partner has asthma or any other breathing issues. Have their inhaler or other emergency tools immediately within reach. During the scene, take care to manage their breathing rate. If they are starting to breathe heavily, calm things down until they catch their breath.


React immediately the moment you detect any issue with breathing. Loosen the ropes quickly. If the bottom is in distress, cut them free. If they need an inhaler, give it to them as soon as they are able to take in breath (meaning if they are unable to draw a breath due to restriction or position, cut them free first, then give them the inhaler. If they can breathe and just need the inhaler, give it to them first, then untie them).

Fainting and Related Injuries

Loss of consciousness can happen unexpectedly and for a variety of reasons. Dehydration, low blood sugar, standing in one position for too long, standing up suddenly after sitting or lying down for a while, low blood pressure, difficulty breathing, breathing too fast or hard, blood flow issues, being too hot — the list goes on.

When a person faints while in rope, particularly if they are attached to something, they can injure themselves as they fall. As their entire body becomes ‘dead weight’, immense pressure can be applied to areas of the body that would be otherwise protected when a person is conscious and capable of adjusting their position.


Hydrate and eat a small snack roughly an hour before playing — preferably something high in protein.

Be watchful of early warning signs. If a person goes pale, starts sweating heavily, says they are feeling weak or dizzy or nauseated, reports a tightness in the chest, reports difficulty breathing, or seems to be short of breath, they might be on the verge of fainting.


If they are feeling faint, but have not fainted: Stop what you are doing and help them gently to sit on a chair or lay onthe ground. Remove any rope and/or clothing that might be impacting breathing or blood flow. If sitting, have them put their head between their knees. If laying down, have them lay on their back with their knees elevated about 12 inches or on their side with their knees bent. Offer them water or juice and then a snack when they seem like they’re able to eat.

If they did faint, but did not fall and sustain other injuries: Check for responsiveness by tapping them gently on the shoulder and asking them loudly if they are okay. They should recover within one minute. Do all of the same things you did for if they are feeling faint. Stay with them until they have fully recovered.

If they do not respond within one minute, call emergency services. 911 in North America. 999 and 112 are common in other countries. If you don’t know the emergency number for the country you’re in, find out before you start playing.

If they are not breathing or they are breathing, but remain unresponsive after one minute: If there are people present, point to a specific person and, using a commanding voice, say, “You! Call 911” (or other local emergency number). If no one is with you, call the emergency number yourself and put the phone on speaker. If you are trained, begin CPR. Follow the instructions of the emergency operator.

If they fell or suffered some injury and are not responsive: Do not move them unless doing so is absolutely necessary to prevent further injury or harm. Call 911 or your local emergency number.

Fainting - Flowchart of Immediate Actions - TheDuchy

Injuries Sustained During a Fall

When doing floor-level bondage (“floor work”, i.e. non-suspension), it is still possible for a person to fall. For example: If they are seated in a precarious position, they may tip and fall, unable to catch themselves. If a person is standing with their ankles and arms tied and they begin to fall over, it would be very difficult for them to catch their balance. If they are attached to an overhead point — not suspended from it, just tied to it — and something goes wrong, they could fall before they know what is happening. They might faint. A fall can happen from a standing position or off a piece of furniture or down an architectural feature like steps.


Be conscious of falling or tripping hazards. Keep a close watch on someone in a position where falling is possible. Keep your play area free from tripping hazards the best you can. Bottoms, be careful when in rope; particularly if moving around the space when tied. Tops, help your bottoms move safely.


Small falls: Check for injury and treat that injury. Bruising, swelling, perhaps bleeding or abrasion, as long as they are not serious, should be treated just as you normally would.

Serious falls: Any broken bones, severe pain, strikes to the head, loss of consciousness, or any indication that there may have been damage to the spine (immediate onset of pain in the neck or back, any immediate numbness that the person didn’t have before, any paralysis or incontinence) indicate that something serious has happened.

If the person is responsive and alert, they can guide your response to the injury. For example, a broken arm is serious, but it may not require that an ambulance be called. The person may instead prefer that a friend drive them to the nearest Urgent Care facility — but keep in mind that just because they think they feel okay in the moment, this does not mean they have not suffered a serious injury. Shock is common. They should still be checked out by a medical professional.

If they are not responsive or alert: Take immediate emergency action.

  • If they are breathing, do not to move them unless absolutely necessary to prevent further harm, e.g. the position they are in is preventing them from being able to breathe or impairing circulation. If they are excessively bleeding, you may need to move them to put pressure on wound. If you do need to move them, only do so the minimum amount required to resolve the issue. Don’t cut or remove the rope. Doing so risks moving them; just leave it there unless it is impacting breathing or blood flow.
  • Call 911. If there are others present, point to a specific person and, using a commanding voice, say, “You! Call 911” (or other local emergency number). This allows you to take the next actions while they deal with the call.
  • Check to see if they are responsive and breathing.
  • If they are not breathing, begin CPR if you are trained.
  • If the person becomes responsive, try to keep the person from moving. Tell them that help is on its way. Talk to them to help keep them calm.

Compression Injuries

When rope presses too deeply into a person, it can disrupt the flow of blood or damage nerves. This can happen if the rope itself is too tight or if too much pressure is being added to a person’s body using rope.

Compressing blood vessels in such a way that impacts circulation is typically not a major concern. Unless a person has a complicating condition related to blood (ask them about this), the flow of blood can usually be reduced or even cut off for quite a while without issue; 30 minutes or so. That said, it is not comfortable, so fix this issue as soon as you can; you just don’t need to drop everything to deal with it on an emergency basis.

Compressing nerves, on the other hand, is something that must be dealt with immediately. This typically presents as a change in a person’s sense of touch (perhaps the skin on some of their fingers goes numb or feels strange in some other way) or as a loss of strength or control of some part of the body (for example, “wrist drop”, when a person cannot lift their hand). Nerve compression can result in nerve damage in a very short period of time — minutes or even seconds, depending on type and severity. Nerve damage can take months or years to heal, and it some cases it may never fully heal.

Check out Nerves & Circulation for more information about this crucial area.

Nerves & Circulation


Learn where nerves typically travel close to the surface of the skin and therefore may be more vulnerable to compression. Particularly risky areas include the wrist, the outside of the upper arm and elbow, the armpit, and the inside of the leg and crease where the leg and waist meet near the groin. We’ll talk much more on this in the Nerve Compression section below (p.###). We will also point out specific risks in the tutorials themselves, along with methods to reduce those risks by managing how tightly the rope is tied or the placement of rope — or both.

Remember that changing the bottom’s position after the tie is complete can change the tightness. What was an acceptable tightness in one position may be too tight if you then move the person into a different position. It is best to have your partner get into the general position you want them in as you are tying them.

Learn how to test for changes to touch sensitivity and strength. Teach your partner how to do those tests themselves and have them build them into habits. There’s more on this in Major Indicators of Compression, in the Nerves section below.

Check out Nerves & Circulation for more information about this crucial area.



If you or your partner detects that an issue may be occurring — for example, the bottom’s thumb or forefinger start to go numb — take action immediately.

Move the band of ropes causing the compression; even 1 inch or so can make a difference. If the issue does not resolve in 15 seconds, remove that element of the bondage.

Build quick releases, or “outs”, into your bondage. For example, use a Slipped Somerville Bowline  as part of a Box Tie so you can release the wrists in just seconds, thereby relieving the pressure on the upper arms.

If the issue seems severe, and you cannot release them quickly, cut the ropes off. If you need to cut ropes, be sure your bottom won’t fall and injure themselves in a different way!

If an injury occurs:

If there is intense pain, seek medical attention immediately.

If a lower-severity injury occurs, there is little that can be done at home to fix it.

Anecdotes suggest that if you know the specific site of the issue, it can be helpful to rest it for a few hours then resume gentle movement of it the next day or so. DO NOT try to stretch or massage it to try to get things back in place. That doesn’t work with nerves and can cause further damage. Keep in mind that the location of the injury may not be the location where the symptom is felt. For example, when the radial nerve in the upper arm is compressed, it is often felt as numbness in the thumb or forefinger. Read Major Indicators of Compression in the nerve section below for more information.

Keep in mind that nerve damage can be cumulative. A little today on top of unhealed damage from the week before will just keep building.

If you are still feeling symptoms after 2-3 days, consult a medical professional.

Other Important Considerations

Bodies are not clean. Rope goes on bodies. Extrapolate from there.

Rope can (and should) be cleaned but cannot be fully sanitized. If rope comes into contact with bodily fluids other than sweat — for example, if it’s run between the teeth or between the legs, through/around the genitals or across the anus — there is no guarantee that you will be able to remove all traces of those fluids or materials.

What if a piece of rope was around someone’s foot and they had athlete’s foot and then that same piece of rope is placed in your mouth? – Ick –

Consider STI transmission. The risk here is relatively low compared to other forms, but it can still be a risk.

If you would like to reduce the risk in this area, use a barrier method between your partner and your rope. Alternatively, if a Top plays with a particular person routinely, they may reserve a particular piece of rope –a personal rope — for that person.

Many rope bottoms take on this responsibility themselves for their own health and hygiene. They carry their own personal rope kit that is “fluid bonded” and will only ever be used on them. If plans call for rope to touch their genitals or mouth, they use their own personal rope.

Next… Nerves & Circulation

Nerves & Circulation

The information on this page was based heavily on the work of the amazing team at RopeStudy.com. They worked with many respected riggers around the world, with medical professionals and skilled graphics artists to create a clear, comprehensive, and succinct guide to reducing risks in rope bondage. With their permission, we have used their amazing work, along with further input from Grey’s Anatomy, John’s Hopkins and several other reputable medical sources, to guide this update of TheDuchy.

We owe many thanks to MaiitsohYazhi and Bound_Light and the knowledgeable people that provided them with information, suggestions and resources.  You can visit ropestudy.com/nerves to find a list of the sources and people they consulted.

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