First aid for nerve damage

First aid for nerve damage

Question: If you get done with a bondage scene and it seems that the bottom has nerve damage, what are some helpful tips on what to do after the fact?

First aid for acute nerve damage is a difficult, complicated issue and not one that has been well researched. I’ve looked into this quite a bit and consulted a couple of kink-friendly MDs, and there seems to be no clear consensus on many details, I’m afraid.

A few points do seem relatively clear- the bottom should not compress the affected area (putting pressure on it, wrapping tightly with an ACE bandage, etc). Remember, compression is likely a causative factor in getting the injury in the first place- further compression during the acute phase of the injury will not be helpful. Additionally, the bottom should not stretch out the affected area. Remember that stretch is often a contributing factor in getting the injury in the first place. Full immobilization is a tricky issue, however. Many sources recommend immobilizing the limb, and I think in the short term (a couple days) that’s reasonable advice. However in the longer term, the bottom will want to use the muscles in the affected limb to prevent muscle wasting (physical therapy can help). As an example of the research available on this- patients with sciatica (damage to the sciatic nerve) were traditionally advised to be on bedrest while symptoms were acute. However a recent study that was published in the New England Journal of Medicine showed no difference in healing between patients who were randomly assigned to be on bedrest vs. those who were advised to continue their usual activities as tolerated. For something like wrist drop, the bottom may find it useful to use a velcro wrist splint to protect the wrist from injury (rather than it just flopping around) and help with ADLs (activities of daily living)- however splinting for limb weakness *also* seems to be controversial in neurology right now. An example of this- nurses used to routinely splint the hands of patients with severe strokes and weakness, to prevent contractures and facilitate ADLs. However this is no longer recommended based on several studies that found it unhelpful at best.

Another thing to remember is that the site of the damage may not be immediately clear or intuitive. For example, if the bottom has radial nerve damage (and subsequent wrist drop) from a box tie , the temptation is to think that their WRIST is injured, when the injury probably originates in the upper arm.

A tricky issue is whether to think of nerve damage more like a sprained ankle or more like a cut finger, or as something else entirely. The first aid that is recommended for something like an ankle sprain (which involves soft tissue damage, swelling, etc) in the first day or so is focused on trying to reduce inflammation- ice for 20 minutes every 2 hours, elevate the limb above the heart, rest the limb, take an OTC anti-inflammatory like ibuprofen (if not contraindicated for other medical reasons). Inflammation is caused by blood and serum leaking from the capillaries into the tissues, and excessive inflammation can impair the healing process. The first aid for a cut is quite different- once you stop the bleeding, you would not want to apply cold to a cut. When you cool, you cause vasoconstriction, which causes impaired perfusion (less blood flow) and impaired healing. Also, cooling reduces the activity of the immune system. To further complicate things, an ischemia/reperfusion injury (which is caused by loss of blood flow, even in just one focused area, and then blood flow returning) is different again from a trauma injury. In any case, the summary is that you want the Goldilocks of inflammation- not too much, not too little.

One study that may be relevant with regards to the ice vs. heat issue- these days cardiac surgery patients are often cooled intraoperatively as a therapeutic maneuver. Studies have found that, all other things being equal, patients who are cooled during surgery have more incidence of intraoperative nerve damage than those who are NOT cooled. Now, this most directly tells us not to do suspensions in an icebox, and that having the bottom stretch/warm up may help prevent injury. It’s hard to say whether this applies post-injury, and if there are good studies on the subject I haven’t found them. Part of the difficulty is that the type of injury that results from bondage is quite different from most other types of nerve injuries. They are different from sports injuries (which tend to be from blunt trauma rather than focal compression and are not generally an isolated injury), different from chronic conditions like diabetic neuropathy, different even from nerve conditions like carpal tunnel syndrome (which tend to be more chronic/long-term than acute and sudden onset).

So, to ice or not to ice? One final point- after nerve repair surgery (for carpal tunnel syndrome and other conditions), most sources call for icing in the acute post-operative phase, similar to what is done with an ankle sprain. As mentioned above, remember that the location of the injury may not be apparent- if the bottom has a radial nerve injury from a box tie, mostly likely the origin is the upper arm (wherever the rope was compressing), and if they choose to ice they would ice the upper arm, not the wrist. I think conservative icing for a couple of days (ice for 20 minutes every couple hours while awake, being sure to use a padded ice bag that does not cool too aggressively) is a reasonable recommendation.

Other considerations for if a nerve injury has occurred: generally, I wouldn’t think that nerve injuries resulting in mild symptoms in isolation would require a trip to the emergency room RIGHT THIS SECOND, but if there are any concerns that there may be further or more severe injury (ongoing circulation compromise, severe deficits, ongoing pain, deformity of the limb, hematoma (large bruise) which could compress the nerve, etc) then a trip to the ER would certainly be appropriate. A bottom with nerve damage may recover in a few minutes, a few hours, a few days, a few months… or they could end up with permanent nerve damage, for which there is little medical treatment (there are some surgeries, they have varied success rates).

Another problem is that any “funny feelings” or numbness can be due to a bunch of different causes: direct trauma by compression of the nerve, swelling of other tissue (or even internal bleeding) that compresses the nerve, and not to forget impaired blood transport into the limb caused by traumatic occlusion of a blood vessel.

As a guideline: The “deader” the bottom’s limb and the slower it resolves, the more urgently they should visit the local ER. So, if they have a bit of tingling in their pinky from hitting their funny bone, they can easily wait. If their whole arm is numb, pale and doesn’t get ANY better in 10-20 minutes – RUSH to the ER IMMEDIATELY. And remember: Tell the ER docs the truth. They won’t judge you, and they need to know exactly what happened. The more authentic the story you’re telling is, the less likely they will suspect any abuse.

A first aid summary: Consider conservative icing (ice for 20 minutes every couple hours while awake), mild immobilization of the affected limb (don’t stretch it out), taking an anti-inflammatory like ibuprofen (if not contraindicated for other reasons) and see an MD (a neurologist if possible) within a few days if symptoms persist. Nerve damage can be exacerbated by vitamin B-12 deficiency. Taking B-12 supplements, if it’s OK’d by your doctor, could help with healing.

From a top’s perspective, what should you do if your bondage bottom has these symptoms after you untie them? Hopefully the possibility of this happening was discussed beforehand, and the bottom was educated about the risks and also the things they could do (such as communicating!) to help prevent injury. A bottom cannot give risk aware consent (the hallmark of the RACK model) if they are not risk aware! I also believe bottoms have a responsibility to be proactive about risk education, by the way, but that’s getting off topic.

So, sometimes, despite everyone’s best efforts and intentions, an injury results. This is an important (and often overlooked) point to cover in negotiation- hey, it’s possible you could get an injury. Do you have health insurance? Who will be financially responsible if something goes wrong? (Note that injuries don’t just happen to bottoms, but that’s also getting beyond the scope of this article.) IMHO the top *always* needs to take responsibility for what happened (not *sole* responsibility, but responsibility) and at the least needs to listen to (and not minimize) the bottom’s symptoms and concerns, provide emotional support and aftercare, start basic first aid as outlined above, and follow up with the bottom over the days and weeks after the injury to see how they are doing and if further support is needed.

One final note is that there is emerging evidence, both in scientific journals and also anecdotally in the bondage community, that nerve injuries can be cumulative. For example, studies have shown that having existing sub-clinical damage to the ulnar nerve before surgery makes it more likely that a patient will come out of surgery with an intraoperative positioning injury to the ulnar nerve.  Studies of baseball players have shown that cumulative microtrauma from repetitive overuse places them a risk for peripheral nerve injury of the upper extremities. This means that a bottom who has been put in a box tie the exact same way 50 times and never had symptoms of nerve damage, might the 51st time suffer from a symptomatic nerve injury, even though there was nothing special, different, or “wrong” that 51st time.


Stef and Shay bounce houseStefanos & Shay ( are a vivacious, unconventional D/s couple with over 8 years of experience educating, hosting, performing, and advocating together within the BDSM community. Issues they are passionate about include risk awareness and healing/recovery from abuse. Shay is a nurse by day and education director for the SF Citadel by night; Stefanos is all kink all the time in his professional life as the Producer/Steward of’s The Upper Floor and CEO of Bondage-a-Go-Go. They’re compulsive volunteers within the leather community, and identify as pansexual polyamorist playsluts (and probably a few other P’s they haven’t thought of yet).

 This is a rather nuanced treatment of this topic. For a practical summary, click here.

This article  originally appeared in Kink-E-Zine, in a column called “Private Duty” that had an ask-the-kinky-nurse format. These articles were edited by a kinky MD, Dr. Who. 

Re-posted with permission

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