Physical Safety in Shibari - Anatomy, Nerves, First Aid

Shibari is edge play, meaning that you run the risk of getting permanently injured or even dying. There, we’ve scared you. So what does this mean in practice?

When we tie, we put the body in anatomically awkward positions with pressure on very small areas of the skin and flesh. Add suspension to the mix, and you have very fertile ground for nerve injuries – both from the position and from the compression. There’s also risks associated with restricting blood circulation – while usually totally benign, this is where the “death” part comes in. Cut blood flow to the head and you’re done, and pooling blood in big limbs for too long can lead to shock.

You would think that you’d definitely know if something’s wrong, but nerves and circulation issues are sneaky little bastards and can be easily missed if you don’t know what you’re looking for. Staying aware of risks and sensation changes is key.

Rope itself isn’t dangerous. The danger lies in doing stupid shit without conscious efforts to mitigate risks.

Emergency Cheat Sheet

It’s the arms: is it symmetrical?

-> YES – the issue is blood circulation. Keep monitoring and if sensation is completely gone or the color is alarming, untie.

-> NO – the issue is nerves. Untie or adjust until it’s no longer numb.

It’s somewhere else and/or it’s blood circulation: what color is it?

-> DARKER than usual: the blood isn’t getting out. You’re probably fine, but keep monitoring the sensation. Untie if there’s no sensation or if the numbness becomes asymetric. If the body part is big, let the harness stay on after taking pressure off to let blood flow return slowly.

-> LIGHTER than usual, or it was dark and now it got lighter: the blood might not be getting in. Immediately take pressure off the tie. Untie slowly, letting blood circulation return gradually.

Are there ropes on the diaphragm and/or pressing on the neck?

-> YES – cut the ropes on the diaphragm and/or neck if you can’t immediately move them to a safer part of the body. Lay them on their side in a first aid recovery position.

Is the person tied to a hashira/pole/tree and is upright?

-> YES – immediately bring them down. Do NOT lay them down. Sit them up against a wall with their knees at heart height and bent at a 90 degree angle. The fainting can be caused by harness hanging syndrome.

Call emergency services and start CPR. If there’s limbs in the way (like an arms front chest harness), cut the ropes so you can get to the chest.

-> Cut any rope around the legs so everyone can safely run out from the house.

1. Nerve Safety for Shibari

Our nerves take care of different functions: sensation, movement, and coordination. When we injure a nerve, we are affecting one or more of these functions. A nerve injury from shibari can mean anything from having a numb spot on your thigh to not being able to use your hand for several weeks.

Nerves are most vulnerable where there’s no flesh to pad them: joints and bony areas. For that reason, we usually tie on muscles, but sometimes people compromise because putting pressure on muscles often results in more numbness. The longer you compress a nerve, the longer the recovery time.

What can happen to nerves in shibari?

Nerves are also sensitive to stretching, either from actually pulling on limbs or just from a limb being bent and twisted for a long amount of time. Most people know the numbness you get in your pinky after being on your phone for too long – that’s what happens in shibari too. Almost all nerve injuries in shibari happen during suspension, especially when ropes press into the middle of the upper arm.

Types of nerve problems in shibari:

Compression. The ropes or laying on a limb is putting pressure on the nerves.
Stretching. The body position is straining or putting pressure on the nerves.
Shearing. The ropes are putting both pressure and stretching or twisting the nerves. These injuries tend to be the hardest to heal.
Blood circulation. The blood flow of the nerve is restricted. The symptoms tend to appear really fast (and subside fast too) if the problem is with blood circulation.

How do I know if it’s nerves?

Both blood restriction and nerve compression or stretching can result in numbness, but only nerve problems present with asymmetric numbness. So if just half of your hand is numb, or you can’t feel the outside edge of your leg, there’s something going on with your nerves.

Symptoms of nerve issues in shibari:

Asymmetrical numbness
Electric or burning pain
Muscle weakness

What do I do if a nerve issue appears?

DO NOT tough it out! It will not get better, only worse. Nerve injuries worsen over time, so promptly ask for change if anything feels weird. The longer you wait, the longer you have to recover. Here’s some tools you can use when nerves get wonky:

Take the pressure off. Get the whole person or at least the affected body part out of suspension. Don’t cut suspension lines, it’s more safe to bring the person down in a controlled way.
Move the ropes. Shift the pressure of the ropes to a different spot. This should work in seconds if rope placement is the problem.
Move the body. If shifting the ropes doesn’t help, the problem is probably body position. Straighten the elbow, untwist the shoulder, bring the body to a neutral position. Find soft movement in the affected area, but don’t stretch or massage.
Untie. If movement is affected, anyone feels uncomfortable continuing the session and/or the above measures didn’t immediately work, untie the person (or at least the affected body part).
Repair & Analyse. Find a way to offer each other support, it’s scary when injuries happen. Try to understand what happened and learn from it. Make a recovery plan.
Rest & Recover. Let the nerve rest. You can use anti-inflammatory medication for any pain and swelling. Avoid pressure on the area (like sleeping on that side or doing more suspensions). See a doctor or physiotherapist if needed, for example if you are worried about persistent symptoms or muscle weakness causing injuries in day-to-day life.

Which nerves most commonly get injured?

There are a number of nerves that can get injured during shibari, most of them located in the arms. We are most concerned about injury of motoric nerves, that will make life harder because your muscles and coordination are affected.

The radial nerve runs from the armpit, twisting around the outside of the upper arm, and to the back of the hand and fingers (except the pinkie). If it’s affected, you will feel numb on the outside of your thumb and/or the back of your hand. Injury can lead to wrist drop, where you can’t lift your hand (like a gay diva or perpetual T-Rex). The radial nerve is commonly injured in a gote (or anything with arms tied behind the back), but can be affected by any tie on the back of the upper arm. This is the most common nerve to get injured in shibari.

The ulnar nerve starts in the armpit and runs straight down to the palm side of the ring finger and pinky, doing a little sneaky turn around the elbow. This is the “funny bone” nerve you know from hitting your elbow, and also commonly gets numb when you’re on your phone for too long. If it’s affected, your ring finger and pinky will feel tingly or numb. If it’s get injured, your grip will be weaker and you can have “claw hand”, rawr. It’s commonly affected in positions with the elbow very bent (like a tenshi “arm futomomo” or some arms front harnesses), or when ropes are too close to the inside of the elbow (like tight hojo cuffs).

The median nerve runs straight from the armpit to the palm side of the thumb, index finger, and middle finger. If it’s affected, you will feel tingling or numbness on the palm side of your thumb, index finger, or middle finger. If it’s injured, you will have a hard time with twisting motions (like opening door knobs) and grip strenght (especially the thumb). The median nerve is commonly affected by compression at the wrist or from shoulder rotation.

The brachial plexus is a network of nerves that starts at the neck and becomes the anxillary, radial, ulnar, and median nerves in the arm. If the anxillary nerve or brachial plexus it’s affected, you will feel numbness or tingling in one or more of the following areas: outer shoulder, inner arm, entire forearm and hand, any of the symptom areas for the other arm nerves. If it’s injured, you will have difficulties with gripping objects or lifting your arm. It’s most commonly affected by extreme shoulder rotation (gote/box tie or strappado), overhead arm positions, and pressure on the shoulders.

The peroneal nerve branches off the sciatic nerve in the legs, and is exposed at a specific point right below the (outer) side of the knee. If it’s affected, you will feel numbness and tigling on the outer side of your lower leg and/or on top of your foot. Injury can lead to foot drop, where you have difficulty lifting your toes and foot upwards or sidewards. It’s most commonly affected by tying too close to the knees or by kneeling.

Diagram of arm and leg nerve danger zones — Illustration showing key nerve pathways and anatomical danger zones. Coloured lines highlight the median, ulnar, radial and peroneal nerves.
Copyright: Ceci Ferox/Karada House

3. Blood Circulation Issues When Getting Tied

The most common risk with restricted blood flow in shibari is that the numbness can mask nerve injuries. If your whole hand is tingling or doesn’t have sensation, it’s very hard to notice that specifically your pinky is affected. There are, however, some risks directly linked to restricted blood flow itself.

Arterial compression. As long as blood is getting into the limb, you’re more or less safe even if you get numb (vein compression). If blood can’t get in, you’re in trouble. Our tissues need oxygen, and shit will go sideways if they don’t. Muscles, nerves, and skin can get damaged. You can notice arterial compression by looking out for the signs:

A limb got darker at first, but then it got lighter
A limb looks pale, grayish, or dull
When you press in on the palm of the hand or sole of the foot, or squeeze the tip of the finger and the nail, the imprint or nail doesn’t return to pink/reddish quickly
Loss of strength
Pain in the limb

Pooling blood & shock. If a limb is tied up and hanging down, or just tightly tied for a long time, you run the risk of reperfusion injury. What this means is that the blood gets cold and loses it’s oxygen, and when it then comes back to the body it can cause shock and injury to the kidneys. The bigger the limb is, the bigger the danger. Any upright positions with circulation to the legs is blocked are especially risky as blood very easily pools in the legs if the muscles are not active. This is called harness hanging syndrome, and happens most commonly when tying on hashira or other vertical objects. The warning signs might not come up at all, so the best course of action is to treat all blood compression in the legs as potential risks. Here’s how you mitigate:

Untie slowly and gradually. Fist, take the pressure off the harness but leave it on. 5-10 minutes later, start slowly untying it.
Use a seated recovery position. If you can’t untie slowly (for example if the only harness was a hip harness), make sure not to immediately lie the person down. Instead, lean them on something and bring the knees to heart height.

4. Other Physical Risks in Rope Bondage

We mostly concern ourself with nerve issues and circulation problems while tying. There are some other, less frequent, issues that can come up. Fainting can be scary, and sometimes life-threatening. Falling can happen for a number of reasons from losing your balance to a suspension point falling from the ceiling. The weird positions we tie each other in can cause damage to joints, and rope can cause annoying irritation to the skin.

Fainting in ropes is not a pleasant experience, and even feeling dizzy can feel very icky. Dizziness often comes with nausea and cold sweats, which really don’t support a having an enjoyable experience. Fainting can happen due to different reasons:

Strangulation: If ropes are close to or around the neck, they can block airways and/or blood circulation to the brain. This can quickly become fatal, and any rope that can’t be moved should immediately be cut as soon as the person in ropes feels dizzy.

Standing & Tension: If you stand with your knees locked and your arms bent behind your back, at some point you will probably feel dizzy. Locked knees deactivate your leg muscles, and blood starts to pool in your legs. At some point your body makes the executive decision that your brain needs oxygen, so you faint. Sometimes just a strained upper body position can make you feel dizzy, likely doe to tension around your neck.

Vasovagal response: If there’s pressure on the diaphragm – for example in a vertical suspension or on a hashira – the vagus nerve can get overstimulated. This can lead to dizzines or fainting. Some people have a sensitive vagus nerve, and some never experience problems. You can press in on your own diaphragm to gauge how yours reacts. A vasovagal response can also be triggered by other situations, for example standing for too long or physical exertion.

Positional asphynxia: The body position is preventing a person from getting enough oxygen. This can happen for example if a person is restrained with their arms behind their back and playing prone (face-down), especially if there’s pressure added to their back. If the person seems to have a hard time breating, or their skin starts turning pale, grayis, dull, or blueish, reposition them so they can breathe better.

Harness Hanging Syndrome: Blood is trapped in the legs, usually due to hanging in a hip harness in an upright position. There’s not enough oxygen to reach the brain, which leads to fainting. Complications from harness hanging syndrome can be fatal. Check “Polling Blood & Shock” in the previous chapter.

There are different reasons someone might fall in shibari. If you’re tying standing up, either of you could stumble or faint. If you’re doing suspension:

you can suddenly lose your grip strength or accidentally open a suspension line that wasn’t locked properly,
the suspension line can break, for example because it’s too old and not cared for or because your suspension point has a jagged edge,
the suspension point can break, come loose, or fall over – a bamboo can split, your concrete ceiling suddenly fails, or you were swinging too hard on your tripod.

You want to mitigate these risks as well as you can. Always use your best, newest and well cared for ropes as suspension lines, or get synthetic ones. Check the structural integrity of the suspension point – assess if there’s any cracks, wobbliness, or other worrying details. Add secondary safety lines if you’re about to handle a line that is risky, i.e. if you lose your grip, the person lands on their face.

We tend to tie people into very non-ergonomic positions – and we often do this in non-ergonomic ways. Both tying and getting tied can over time result in cumulative joint damage. If you repeatedly cause trauma and inflammation in a joint, at some point there’s no coming back anymore. Over time, the protective cartilage in the joint wears down. This goes for hooking ropes with your fingers, shoulders in arms-back positions, and everything between.

To mitigate the risks, you can focus on ergonomic positions and movements, and strengthen the muscles around the joint. If the joint is already hurting, take care of the inflammation by using anti-inflammatory creams or medication, and support it with a brace if needed.

Skin irritation can be uncomfortable, but is not dangerous. It can happen due to different reasons:

Bruises: sometimes there’s a lot of pressure on one part of the tie, for example the lower wraps of a futomomo, and you get bruised. This can be a nice memory of a good time, but if it seems like a bone is bruised, you’ll be better off avoiding tying on that spot for a while.

Rope burn: a rope is dragged across the skin with too much friction and/or speed, for example pulling ropes under a limb or the body turning inside a harness in a suspension. A thin layer of skin is dragged away with the rope, leaving a raw spot that feels tender. To mitigate rope burn, try to prevent ropes from moving on skin with too much pressure.

Blisters: some people’s skin blisters when a tiny piece of skin gets stuck between strands of rope, or if the rope is dragging over the skin. To mitigate blistering, tie with more tension and/or on top of clothing.

Petechia: if there’s a bit of skin trapped between two bands or wraps of rope, this part sometimes forms a petechia bruise. Blood gets trapped in that part of the body and with more and more pressure, small capillaries burst. This can sometimes happen in a whole limb if the circulation is blocked. If there’s no other symptoms, petechia is harmless.

Allergy: Rope materials themselves and JBO (jute batching oil) can sometimes cause allergic reactions. If you have a rash after getting tied, make sure to change rope materials.

5. Risk Assesment & Mitigation

There are real, and sometimes serious, risks in shibari. You want to be prepared and mitigate them as well as you can.

Before the session: understand the risks of what you’re about to do and think about how you will mitigate the risks. Check in about any previous injuries and flexibility limits or hyperflexibility. Talk about how you will know if something goes wrong while you’re tying (our recommendation: the bottom is responsible for communicating changes in their body), and if you will use specific language or communication tools for alerting or checking in (like a traffic light system).

What is a Risk Profile?

A risk profile is a risk assessment and plan you make for yourself based on your own desires and boundaries.

To make a risk profile, answer these 6 questions:
1. What kind of play do I like to engage in? (Desires)
2. What are the risks of that play?
3. How likely are the risks?
4. How severe are the risks?
5. How can I mitigate the risks?
6. Which risks am I willing to take? (Boundaries)

During the session: if you’re getting tied, make sure to regularly check for sensation loss. Hands you can do yourself: scratch different fingers on the inside & outside to feel for asymmetry. If you’re worried about any other body part, ask your rope partner to scratch – for example the outside of the lower leg or on your shoulder. If something feels off, err on the side of caution – you don’t have to stop the session completely because you need to untie one body part, so don’t power through just so the fun wouldn’t end. Here’s how you can mitigate risks in suspension:

Reduce load on sensitive areas like the lower part of the upper arm by adding more points of support, choosing the right angle, and/or avoiding loading the wraps on those body parts.
Avoid static positions. Find ways to adjust ropes, move the body, and shift weight by making small height adjustments, tying close to the ground, or through transitions.
Spotters. Don’t tie above your actual skill level without asking a more experienced tyer to spot for you (keep and eye and step in when needed). At Karada House rope events, we always have someone available to spot for you.

After the session: if an injury happened despite these precautions, stay calm. Shame, defensiveness, and judgement will only make the recovery harder and create a rupture in the relationship. Analyze what happened – was it a freak accident, or is there something you need to tweak in your communication? Try to learn from what happened.

6. What next?

Now you got the basics, it’s important to understand the safety considerations for each harness and suspension position you tie. There is no universal truth about where exactly nerves are the most exposed, and each body is different. Some people have more flesh protecting the arms, and some less. Some people are stiff while others are hypermobile. The only way to really get it is to continue always learning.

Progress at a conservative pace and be wary of the moment when you feel you know everything – you’re probably wrong. The real risks materialize in suspension, so don’t rush it.

At the Karada House Rope School you will get comprehensive understanding of anatomy and safety in each class you attend. We will help you with choosing the right tension and placement for the harness you’re using, and the specific body you are tying. Our suspension classes offer a deep dive into understanding how to choose the right angles, and how to communicate when something’s off.

Ceci Ferox

Sources:

Khodulev V, Klimko A, Charnenka N, Zharko M, Khoduleva H. Acute Radial Compressive Neuropathy: The Most Common Injury Induced by Japanese Rope Bondage.