Suspension risks

Note: This guide is an overview of published sources, not medical advice and not a suspension lesson. An injury from rope needs a medical professional, as Rope 365 advises.

In a suspension, rope carries some or all of a person’s weight from a point overhead. It is the most visible part of contemporary kinbaku, and Rope 365 calls it a high-risk activity that is generally not advised for beginners. This guide explains why: what changes when weight comes off the floor, which risks are documented, and where the evidence is thin. It describes; it does not teach. Rope educators, Rope 365 among them, say suspension should be learned in person from an experienced teacher. See also partial suspension, full suspension and Safety.

What body weight changes

Rope 365, the practice project by Ebi McKnotty, gives the basic reason: the weight of the body increases the pressure of the rope on it, which raises the risk of nerve damage in both partial and full suspensions. The ESINEM Shibari Classes course says the same for breathing: a chest tie that is comfortable on the floor can become crushing once it bears weight, and rope can slip up toward the neck, a risk that grows in suspension or if the person faints.

The clinical evidence is limited but consistent with this. In the 2023 Cureus case series by Vasily Khodulev and colleagues, all but one of the nerve injuries they analyzed occurred during or right after full-body suspension, most of them to the radial nerve in the upper arm; the injuries followed suspensions of roughly five to thirty minutes. The authors assert that full suspension carries a higher risk of nerve injury than partial suspension, but their study included only injured people and had no comparison group, so it cannot establish relative risk. Details in Nerve injuries in rope.

Falling and equipment failure

Wikipedia’s overview of suspension bondage names falling as the main added danger of suspension, caused by a weak suspension point, faulty equipment or poor technique. It singles out inverted positions: a head-first fall from only a short height can kill or paralyze. See inversion and sakasa zuri.

The ESINEM suspension course traces dropped partners mainly to human error, equipment failure or both, and stresses that the height and surface of a possible fall make a large difference to its consequences. It describes rated hardware as generally reliable when properly installed and calls the rope carrying the load the weak point, listing abrasion, rot and rope not strong enough for the job among causes of failure. Rope 365 also counts equipment failure and unstable hardpoints among the high-consequence risks, and Shay Tiziano, a rope educator who publishes on Twisted Windows, warns that cheap imitation suspension rings have broken in use and seriously injured people. For the structures and hardware involved, see Hardpoints and suspension points.

Falls can also injure joints. The ESINEM course calls falling probably the biggest dislocation hazard when limbs are attached to something fixed, and warns that mechanical hoists add force that can dislocate joints, especially if the operator selects the wrong direction.

Breathing

Rope 365 links deaths in rope mainly to being alone or to restricted breathing. A 2022 forensic literature review by Schori, Jackowski and Schön found seventeen published deaths during BDSM play, fifteen of them by strangulation. One involved two women suspended together with rope around their necks, one of whom died of mechanical asphyxia. The authors stress that such deaths are rare and preventable. A toxicology report was mentioned in thirteen of the seventeen cases, and eight of those were positive; with four cases unreported, the review cannot say how many deaths overall involved alcohol or drugs. More in Circulation and breathing.

Fainting and harness suspension

Fainting is a known risk in rope generally; the ESINEM course lists tight bondage and hands above the head among common factors, and Rope 365’s FAQ highlights standing ties. In suspension, a faint also means a person who cannot help in their own rescue. Wikipedia notes that getting an unconscious person down, or someone whose hoist has jammed, is difficult, and that people who tie suspensions often work with spotters.

Medical literature describes a related condition in other fields. A 2021 systematic review in the World Journal of Emergency Medicine by Petrone and colleagues covers “suspension trauma syndrome”: a person held motionless and upright in a harness can develop light-headedness, nausea, sweating or confusion and then lose consciousness, sometimes without any other injury. Proposed explanations include blood pooling in the legs, though the mechanism is debated, and in the experimental studies reviewed, fainting or near-fainting was reported after times ranging from about six minutes to around half an hour. The review concerns climbing, caving and work at height, and does not mention rope bondage. Wikipedia’s bondage article connects the idea to suspensions with the legs hanging below the heart. The ESINEM course mentions this “harness hang” but says it has never heard of a confirmed bondage case. How a rescued person should be positioned afterward is disputed in the medical literature itself; the review’s own advice is prompt professional emergency care.

Health factors

Some conditions change the picture. Shay Tiziano writes that daily blood thinners may rule out suspension, and that for people with poorly controlled diabetes he avoids load-bearing rope below the knee. Rope 365’s FAQ advises anyone with a medical condition to start with their own medical professional and to ask whether the condition limits movement or pressure on the body. The ESINEM course lists heart and breathing problems, fainting and seizures among things to disclose. See Consent and negotiation.

Learning it

Rope 365’s FAQ is direct: suspension is high-risk, generally not advised for beginners, and should be learned in person from an experienced teacher; self-teaching, it notes, has led to more incidents. It describes a gradual progression under a teacher rather than a rush to complex suspensions, and says the person being suspended should also understand nerve injuries and safe equipment, and be able to ask for adjustments. Shay Tiziano tells newcomers how quickly he can bring them down and often lowers them before they ask. The Cureus authors close by calling for anatomy and safety training and for expert consensus on suspension safety guidelines.

To find in-person teaching, see Choosing a teacher, Both sides of the rope and the teachers directory. On getting someone out of rope quickly, see Cutting and emergency release.