Rope and the body

Rope educators return again and again to the same parts of the body: places where a nerve or blood vessel runs close to the surface or over bone, where the airway can be pressed, or where a joint can be forced. Note: This guide is an overview of published sources, not medical advice and not a tying lesson. An injury from rope needs a medical professional, as Rope 365 and MedlinePlus both advise.

This guide collects what educators and medical sources say about each region and why. It is a summary of where sources concentrate their warnings, not a guide to placing rope, and it leaves out tying technique entirely. It is also not a map of safe places: an area that is not mentioned here is not therefore safe. Bodies differ: the ESINEM Shibari Classes course stresses that susceptibility varies from person to person and calls its own guidance no guarantee of safety. See also Nerve injuries in rope and Safety.

Why sources single out these areas

The reasons sources give are mostly about pressure. Rope 365, the practice project by Ebi McKnotty, explains that nerve injury can come from a single impact but more often builds up through repeated or long-lasting pressure. The ESINEM course treats joints as areas of particular concern for nerves and circulation, with the hips as its one exception, and notes that lying on rope, adding load or changing position can turn a tie that was fine into one that is not.

Neck and throat

Because rope here can obstruct both breathing and circulation, this is the area sources are firmest about. The ESINEM course rules out rope across the throat and nooses, and warns that rope can slide up onto the neck during suspension or if someone falls or faints. Rope 365 advises against rope around the front or sides of the neck. More in Circulation and breathing.

Chest and ribcage

Rope around the chest affects breathing. The ESINEM course notes that tension increases with more wraps, cinches or load, and that a chest tie which feels fine on the floor can become crushing in suspension. See chest harness.

Shoulder, collarbone and armpit

Rope 365 describes the armpit as the place where the arm’s nerves leave the large nerve junction called the brachial plexus, and as easily pressed by rope cinched on the inner arm. The ESINEM course likewise flags the inner upper arm toward the armpit. Rope 365 also names the suprasclavicular nerve at the top of the shoulder and collarbone, and calls box ties and strappado-type positions high-risk ties for the upper body, strappado also because of internal pressure on the shoulder.

The axillary nerve controls the deltoid, the muscle that lifts the arm out to the side; MedlinePlus lists long-term pressure and shoulder injury among causes of damage, and one person in the Cureus case series injured it in a torso suspension with the arms hanging. The ESINEM course adds dislocation: arms forced in a direction they are not built to go, with falls while limbs are attached to something fixed as the main hazard.

Upper arm

The upper arm is where the 2023 Cureus case series by Khodulev and colleagues found most of its injuries: nine of ten injured people had radial nerve injuries, mostly in the middle third of the upper arm, where rope had usually been placed. The study was small and recruited only injured people, so it shows where these injuries occurred, not that other areas are safer. MedlinePlus lists long-term pressure among causes of radial nerve damage, including pressure on the upper arm from arm positions during sleep or coma. The ESINEM course describes the radial nerve as exposed on the back and outer side of the upper arm, and Anatomie Studio’s guide to rope vocabulary notes that arm ties such as takate kote can expose the radial nerve.

Elbow

The ulnar nerve runs past the “funny bone”, Rope 365 notes, and the ESINEM course also flags the inner side of the arm near the elbow. MedlinePlus lists long-term pressure on the elbow, and keeping the elbow bent for long periods, among causes of ulnar nerve damage.

Wrist and hand

Three nerves cross the wrist. According to the ESINEM course, the radial nerve is vulnerable on the thumb side, the ulnar nerve on the little-finger side, and the median nerve is sensitive in people prone to carpal tunnel problems. MedlinePlus lists long-term wrist constriction, giving handcuffs and a tight watch strap as examples, among causes of radial nerve damage, and names trapping of the median nerve by a ligament in the wrist, carpal tunnel syndrome, as the most common cause of its damage. The ESINEM course also advises against knots over the blood vessels on the inside of the wrist, and notes that the hands usually show circulation problems first. See wrist drop.

Hips, waist and groin

The hip is the one joint the ESINEM course does not exclude, but the area still holds nerves. Rope 365 describes deep rope lines at the hip and waist pressing on the iliohypogastric and ilioinguinal nerves, and hip harnesses affecting the lateral cutaneous nerve of the thigh. The ESINEM course flags the groin crease, where the femoral nerve and artery run. In the Cureus series, one person had a femoral nerve injury that the authors attributed to rope pressing at the groin. MedlinePlus lists prolonged pressure among causes of femoral nerve damage, which can weaken the knee and change sensation at the front of the thigh, and mentions tight or heavy waist belts as one example. Rope 365 also notes the coccygeal nerves at the tip of the tailbone.

Thigh, knee and lower leg

Rope 365 lists the cluneal, obturator and femoral nerves around the buttocks, groin and thigh, and the peroneal nerves behind the knee and along the calf, where compression can cause foot drop; it rates calf harnesses and the so-called mermaid tie as the highest-risk ties in this area. MedlinePlus describes the common peroneal nerve as supplying movement and feeling to the lower leg and foot, and lists regularly crossing the legs, long constriction of the lower leg, and pressure on the knee among causes of damage. The ESINEM course adds that cross-legged positions, especially with the body bent forward, can trap nerves; see agura and futomomo.

Skin, face and eyes

Marks where rope has pressed are a common after-effect, but they vary in cause and severity, and some bruising is worth a medical check; see rope marks and Aftercare and drop. Rope 365 suggests discussing possible marks on the face, neck and forearms before tying. The ESINEM course distinguishes rope burn, where rope pulled fast across the skin damages it, from ordinary marks, and warns that a loose rope end pulled through quickly can whip round and strike the face or eyes.

Piercings and fixed objects

The ESINEM course warns against tying any body part, or piercing, to something fixed or heavy that could tear it if the person falls or faints, summed up as: do not tie anything you would not be prepared to swing by.

Individual factors

Some people are at higher risk in particular areas. MedlinePlus lists diabetes among recognized causes or aggravating factors for radial, ulnar, median and femoral nerve problems, and other conditions as well. Shay Tiziano, a rope educator who publishes on Twisted Windows, asks people with diabetes about peripheral neuropathy and avoids load-bearing rope below the knee when diabetes is poorly controlled. Rope 365 notes that conditions such as diabetes and thyroid disease may affect how nerves heal. This is why health belongs in every negotiation; see Consent and negotiation. Anyone with lasting numbness, tingling or weakness after rope should see a medical professional, as Rope 365 and MedlinePlus both advise.