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The following article, including footnotes, was originally published at RemedialRopes.com, which is an awesome educational project created by Stefanos and Shay, and has been re-posted here with permission. Please visit the site and support their work. 

Let’s start with an easy one- here’s a statement I hope we all recognize as bullshit: “Only skinny people can be suspended!” With me so far? Ok. Now, here’s what I sometimes hear as a counter to that particular piece of bullshit: “Anyone of any body size can be suspended!” Unfortunately… also bullshit. It’s a pit of snakes! Let’s jump in!

Being larger bodied does not exclude someone from being suspended. That said, I think making a general statement about *anyone* being able to be suspended is potentially dangerous, for two main reasons- rigger skill and health issues (some of which correlate with weight)(1).

The first of these issues is rigger skill. A rigger is a person who ALSO gets to have limits. Limits- they’re not just for bottoms! Those limits may be knowledge based (“I don’t know how to suspend larger-bodied people”) or preference-based (“I prefer to suspend only 100lb bondage models”). Of course stating one’s own skills honestly is quite different from saying “it simply cannot be done!” and having a personal preference is quite different from being a fat shaming douchebag. There are unique skills involved in suspending a larger bodied person- not any rigger can/should suspend a bottom of any body shape. Some of that skill is relatively simple (generally, more rope/more wrapping turns are called for), but some is very specific/specialized. There are safety concerns that extend to the rigger, as well. If a larger bodied suspension bottom needs down NOW, can the rigger partially support them while getting them down quickly and without injuring themselves? I think we can all intuit that this is more challenging with a 200lb bottom than a 100lb one. Having a “spotter” (another pair of hands to help should it be needed) and/or using an appropriate pulley system (which adds more complexity/another potential point of failure) may be all that is required to mitigate this, but it’s another area where additional expertise is required.

Moving on to the health aspect- being larger sized doesn’t exclude you from being suspended, but neither does being smaller sized mean you can do *all the suspensions*! There are actually potentially increased risks at the other end of the weight spectrum- most notably, very thin people are at higher risk for acute compression nerve injury (2). The key to most of this is fitness, because here’s something no one told me before I got suspended for the first time: being suspended can be very strenuous! Dynamic suspensions involving drops and position changes, or especially challenging suspensions (four wrapping turns around your ankle and up you go!) require a high level of fitness and body awareness. Which is not to imply that dynamic suspensions are more dangerous than static suspensions- in some cases they are safer, but often they do require more athletic ability.The best parallels I can think of are yoga or circus arts training (bar, hoop, silks). Are you healthy and fit enough, at whatever size, for those activities? You may need to build fitness before being able to partake in the most strenuous/dynamic suspensions. The fitness needed and strain involved is eminently scalable, it is not an all-or-nothing either-you-can-do-it-or-you-can’t activity. If you want to do these types of suspensions (and there’s no reason you have to, they’re not everyone’s kink), be realistic with your rigger, and spend some time training! Rigging involves practice, skill, and training- a suspension bottom would be well served by developing or honing rope bottom skills (like core strength, balance, and body awareness) in return! (I attended a great class by Tifereth on this subject, I hope in the future to see more rope bottoming focused classes.)

Everything we do in kink (and, you know, life) has risks. Specific health conditions increase those risks, and at some point those risks outweigh the rewards of a given activity and we sit back and say, hrm, maybe not such a good idea to do that. If you have frequent seizures, you aren’t permitted to drive. If you are on blood thinners, your doctor would likely advise you not to go downhill skiing. Likewise, there’s some kinky shit that you probably shouldn’t do if you have certain health conditions. Someone with poorly controlled diabetes shouldn’t bottom for bastinado (caning the feet) and someone on coumadin (a potent blood thinner) shouldn’t bottom for play piercing. This isn’t ableist IMHO, it’s about being rational about the risk vs. reward ratio of any given activity. That said, here is a summary of specific conditions that at the very least require extra caution, awareness, and expertise (from both rigger and bottom) for suspension. In some cases these issues may make certain suspension positions particularly (and probably unacceptably) risky, or may mean someone shouldn’t be suspended at all- these conditions all exist on a continuum and evaluation of a bottom needs to take into account the entire picture of their health and fitness, not just a single diagnosis.

• Any condition that causes significant neuropathy (nerve damage/impaired sensation), impaired circulation, or impaired lymphatic drainage requires caution with any bondage, and in many cases may exclude the affected limb from load bearing bondage. Such conditions can include diabetes, lupus, stroke, mastectomy, lymph node removal, carpal tunnel syndrome, Raynaud’s disease, etc.
• Serious respiratory issues (severe asthma, COPD, etc) (especially a problem for chest heavy ties and positions like face down or inversion)
• Heart issues (CHF, arrhythmias, valve abnormalities, etc)
• Diabetes that is severe or poorly controlled (3)
• Joint problems (this depends on the intended suspension of course)
• Clotting abnormalities (hemophilia, taking coumadin or other potent blood thinners, etc- speaking for myself, I would not suspend anyone in this group, but others may have a different risk assessment)
• Aneurysms (cerebral are a particular concern for inversion, risk increases with diabetes and obesity) or hernias
• Eye problems (conjunctivitis, glaucoma) (especially an issue for inversions)
• Spinal injury
• Bone weakness (severe osteoporosis, osteogenesis imperfecta)
• Uncontrolled high blood pressure (especially for any position involving inversion)
• History of gastric bypass (likely means the person should not do inversions, and be extremely careful of putting pressure on the abdomen with rope)
• Pregnancy
• Skin integrity issues (like long-term prednisone use)
• This is not a comprehensive list! If you’re comfortable being “out” to your doctor (which I highly recommend… and that could be a whole separate article), asking your doctor if you’re healthy enough for suspension bondage is an excellent way to get a personal check! If you don’t feel you can be “out” to your doctor, you might ask whether you are healthy enough for strenuous yoga involving inversion (4).

Suspension can be amazing, sexy, and fun- but it’s also one of the riskier things we kinky perverts do. It’s edge play and is not for everyone- top OR bottom. I hope you can use this information to help you make a more accurate risk aware assessment… instead of believing bullshit.

There are three distinct areas of my personal background that inform this article and seem relevant to understanding my perspective. Those are medical/safety, bondage/rigging, and body size.

Starting with medical/safety: Whenever I write something like this, I am asked about my “qualifications”- which is certainly a reasonable question. I’m an ER nurse and ACLS (Advanced Cardiac Life Support) instructor who has spent way more time than is reasonable researching bondage safety. This post was also proofread by a kinky MD (Miette Rouge). I would, however, emphasize that I’m not posting this in any sort of “official” capacity (please don’t sue me). Also, nurses (and doctors!) can and do say idiotic/incorrect things, so using your own judgement no matter how “qualified” the source is always a good thing. 

Bondage/rigging: I began doing floor work (mostly as a bottom) in 2005. I started bottoming for suspension and learning to rig in 2011 (I’ve also done quite a bit of self-suspension). I make no pretense of being a master rigger (or a master suspension bottom)- I consider myself to be a beginner in my personal skill at both.

Body size: this is perhaps the most personal. I’ve struggled with eating disorders my entire adult life, and my weight has been as low as 120lbs and as high as 230lbs. Right now I’m in the middle of that weight range, but even at my current size, I find that I’m larger than many riggers seem used to working with, and I have to be explicit about the accommodations I require (I won’t do load bearing upper arm ties, I can’t tolerate suspension without a hip harness, I need double the number of wrapping turns around my thighs than most riggers seem to consider “standard”, etc).

I received feedback and edits on this article from a number of awesome people, most notably @MietteRouge (a kinky MD), @Guilty, and @FrozenMeursault. It is also informed by awesome bondage classes I’ve taken from instructors too numerous to name. Any remaining errors are mine.

(This is part of my BDSM Bullshit series- the first article can be found here, with more to come if you perverts are interested!)

(1) With regards to weight and health, I realize this is controversial. A quote from a recent study: “Our results… show that there is no “healthy” pattern of obesity…regardless of metabolic status, excess weight is associated in the short term with subclinical vascular disease, including impaired vasoreactivity, abnormalities in left ventricular measures, chronic inflammation…. This finding again argues against the notion that increased BMI can be harmless… our results [also] demonstrate that metabolically unhealthy normal-weight individuals have an increased risk for events equal to that of metabolically unhealthy obese persons.” “Are Metabolically Healthy Overweight and Obesity Benign Conditions?: A Systematic Review and Meta-analysis” Annals of Internal Medicine, 3 Dec 2013 http://annals.org/article.aspx?articleid=1784291

What does that tell us? First off, you can be a normal weight and still be unhealthy (duh). Fitness matters. For suspension, I think it matters a LOT. But weight matters too, from a health perspective, because it is associated with risk factors that are quite relevant to suspension bondage. There are conflicting studies, and the topic of weight and fitness as independent variables is IMHO grossly under-studied in mainstream medicine.

(2) Winfree C, Kline D. (2005) Intraoperative positioning nerve injuries. Surgical Neurology. 63: 5-18

(3) On diabetes and suspension: “Epidemiological studies have confirmed an association between diabetes and an increased prevalence of PAD. Peripheral arterial disease is usually characterized by occlusive arterial disease of the lower extremities.” -Peripheral Arterial Disease in Patients With Diabetes, Journal of the American College of Cardiology. “The prevalence of diabetes increases with increasing weight classes.” -Relationship between obesity and diabetes in a US adult population: findings from the National Health and Nutrition Examination Survey, 1999-2006. “The degree of diabetic control is an independent risk factor for PAD.” -Peripheral Arterial Disease in Patients With Diabetes, Journal of the American College of Cardiology. Again- what does this mean? Peripheral arterial disease (PAD) in the lower extremities = poor blood flow to the legs. This is often undiagnosed, and is why diabetics can end up having toe/foot amputations. As a lay person in the field, you can’t know whether a particular diabetic has PAD or not (there are some assessment hints, looking at color, temperature, pulses, capillary refill, etc- but this requires training to assess and is ultimately not conclusive to diagnose the condition). I think it wise to avoid load bearing lines on the lower extremities of someone who has PAD, and you may have to base this assessment on risk factors (diabetes, degree of diabetic control).

(4) There is actually quite a bit of literature specific to inversion- on the use of “inversion tables” to treat back pain and on the safety of various inverted yoga poses. A few things happen when you’re inverted- for one, the weight of your abdomen (including organs and adipose tissue) press up against your diaphragm, making it harder to breathe. Your intrathorasic pressure is increased (especially if you strain or hold your breath while inverted, which us perverts are known to do), as is your intracranial pressure. Blood pressure is increased (“Both systolic and diastolic blood pressures increased significantly [in response to two minutes of inversion traction]” – “Blood pressure response to inversion traction”, Journal of Physical Therapy.). Common contraindications listed for inversion include high blood pressure, glaucoma or other eye problems, pregnancy, cardiovascular disease, diabetes  (I would add that degree of diabetic control is the key here, some diabetics can do inversion and some probably should not), and ear or sinus infections. You can see an example list here. As a side note, most articles on yoga inversion I researched also listed menstruation as a contraindication for inversion. The only reason I could find for this had to do with beliefs about chakra energy flow (see this example) rather than anything I would consider a medical contraindication.