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.This is a summary of health conditions that at the very least require extra caution, awareness, and expertise for suspension (partnered and self). In some cases these issues may make certain suspension positions or practices particularly (and probably unacceptably) risky, or may mean you shouldn’t suspend at all—these conditions all exist on a continuum, and evaluation needs to take into account the entire picture of your health and fitness, not just a single diagnosis. I’ve included both the health issues and some thoughts on what they mean for suspension. Keep in mind that these are general guidelines and suggestions, not a comprehensive list…and certainly not medical advice! If you’re able to be “out” to your doctor, consider asking them if you’re healthy enough for suspension bondage. Keep in mind that most doctors won’t really know what suspension involves, so you may need to give some specifics and compare it to other physical activities. If you don’t feel you can be out to your doctor, you might ask whether you are healthy enough for strenuous yoga, circus arts (such as trapeze, silks, or pole dancing), and/or rock climbing, which have some parallels with self-suspension.
Lupus, stroke, mastectomy, lymph node removal, carpal tunnel syndrome, diabetes, Raynaud’s disease, and other conditions that cause significant neuropathy (nerve damage and impaired sensation), impaired circulation, or impaired lymphatic drainage
In many cases, these conditions may exclude the affected limb(s) from load-bearing bondage. If you've been told to avoid having your blood pressure taken or blood drawn on a limb, you should avoid bondage on that limb.
Severe asthma, COPD, and other serious respiratory issues
These are especially a problem for chest-heavy ties and positions like facedown or inversion. If you have asthma, the most important follow-up considerations are: Do you have an Albuterol (rescue) inhaler? Where is it? When did you last have to use it? Self-suspension involves many things that can trigger asthma attacks (exertion, chest pressure, excitement, and so on), so it’s critical that your inhaler can be easily located and is within reach. Facedown positions put more pressure on the chest and can be more difficult for people with respiratory issues, so you may want to choose a different bondage position (like face up), at least to start with.
Congestive heart failure (CHF), arrhythmia, valve abnormalities, and other serious heart conditions
This is a huge topic, and the degree of caution needed will vary wildly. Consult your cardiologist before attempting suspension bondage if you have these types of conditions.
Joint problems such as a history of injuries or surgeries, arthritis, gout, and more
Evaluation is extremely dependent on the joints involved. Knee issues are important to consider for futomomos or kneeling positions; any pelvis, hip, or knee problems will be an issue for ankle/gravity boot suspensions. Shoulder injuries may be aggravated by reaching behind the back to tie. The best practice for working with joint injuries is to go slowly and listen to your body—monitor carefully for joint pain and respect that pain as your body telling you to stop.
Hemophilia, taking Coumadin or other potent blood thinners, or other clotting abnormalities
I would not recommend that anyone with significant clotting abnormalities be suspended or self-suspend. Not only is there a risk of severe bruising and hematoma formation (basically large collections of blood under the skin) from even fairly “routine” amounts of pressure or shearing force, but any sort of fall or impact has even more potential to be catastrophic.
Aneurysms
An aneurysm is basically a weakened area in a blood vessel. Many things we do in suspension cause increased pressure in our blood vessels, so weakened areas are going to make suspension exceptionally high risk. Cerebral aneurysms are a particular concern for inversion; aortic aneurysms are very high risk in general. The risk increases when an aneurysm is combined with diabetes and/or obesity. If you have an aneurysm, consult your doctor before attempting suspension.
Conjunctivitis, glaucoma, or other eye problems
Likely you will need to avoid inversion, or any position that places your head below your heart. Consult your ophthalmologist.
Spinal injury
This is a broad and impossible-to-generalize category. Consult your neurologist.
History of gastric bypass surgery
You will probably need to avoid inversions (ask your surgeon), and be extremely careful of putting pressure on the abdomen with rope (such as with waistlines).
Considerations will vary considerably from trimester to trimester. First-trimester concerns include nausea and general fatigue; third-trimester concerns focus more on preventing abdominal impact, avoiding positions that cause pressure on the vena cava (on the back and right side), and dealing with loosened joints…among many other considerations! In a healthy pregnancy, you may be able to continue to do gentle self-suspension, but modification and expertise are required. Consult your obstetrician.
Skin integrity issues (like long-term prednisone use)
These issues make you especially vulnerable to shearing forces (when the rope is pulling the skin in multiple directions or rubbing across the skin, causing friction). If this is an area of concern for you, spend a lot of time experimenting with floorwork (which is less likely to produce severe shearing forces), and play with different types of rope to see which works best on your skin. Consider trying 8mm nylon/MFP rather than natural fibers.
Diabetes,
Especially if it is poorly controlled, is a huge topic.
Over time, high blood sugar can cause peripheral vascular disease, or poor blood flow (especially to the legs and feet), and peripheral neuropathy. This can cause impaired circulation and sensation in the feet, so extra caution (or avoidance) of load-bearing rope on the lower extremities is called for.
If you have diabetes, follow-up considerations include thinking about when you last ate and checked your blood sugar.
One big concern is that you could experience a drop in your blood sugar during play. Make sure there is a handy sugar source (like juice or high-glucose products designed for this use, like Glucola) for you to have if you need it.
Symptoms of low blood sugar include cold and clammy skin, confusion, trembling, and more—be sure your partner or spotter is aware of these symptoms and knows what to do if you start to exhibit them.
Note that lay people tend to assume that if diabetes is the disease, then insulin is the cure, and they may try to “help” an unconscious diabetic by giving insulin. This is unlikely to be helpful and quite likely to be dangerous. Since low blood sugar is a much more acute concern, teach your spotters/partners to act accordingly.
Again, this is not a comprehensive list and is not medical advice, but rather is intended as a starting place as you evaluate your personal risk profile and consider how to maximize safety in your rope play.
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