as a kinky person with a lot of chronic pain issues, scenes and play are really really excellent for me, but I have to be careful about what I do; the wrong movement or strain can fuck me up for days, or cause dislocations. this is some insight into that and my decision-making processes as both top and bottom.
first off, what you'll hear in every 101 class: kink is risky. any time you participate in kink, you are taking a risk - there are different paradigms for approaching that risk, but I personally follow SSC: safe, sane, consensual. I evaluate the safety and potential long term consequences of any kink, I make sure I'm in a legally sound mind to do it (not drunk or high), and obviously that everyone participating is consensually participating.
when you have a chronic pain, or another disability that could be impacted by play, that adds another dimension to your calculations, but it doesn't mean "don't do it"; here's a simple example. my partner recently had me up against the wall and made me orgasm; the force of it and the tightening/clenching, along with the unusual position, caused a rib to pop out of place and some accompanying pain. I look at this on this scale:
-how dangerous is this problem? it could potentially puncture an organ, but it's a floating rib that's been popping out since I was fifteen and hasn't killed me yet, so I'm going to rank it pretty low.
-how debilitating is this problem? somewhat; it can make walking and moving painful and less desirable, and physical pain can trigger some behavior that kicks off depression for me, like any pain flare up.
-how important is the kinky behavior to me? being made to stand against a wall and come is really hot, but it's much more about the manhandling part for me. I want to be forced to do things that are physically uncomfortable.
so I weigh these out: the consequences aren't terrible, though they can snowball if I'm not careful; the need to orgasm in that specific position isn't a big deal, but my greater concern is that my partner will treat me more gingerly when I don't want him to. so this becomes "something to discuss" between us; he already knows about my rib, of course, he's just going to be surprised that apparently orgasms can cause it to pop out. but just like hiking or other mild exercise, I'm willing to suffer the consequences for a good time. of course, my partner deserves a part in the discussion too; he may feel that my rib popping out of place due to something he indirectly did is not acceptable, and we might need to negotiate something else. (That said, slouching or sleeping the wrong way can cause rib dislocations, and my recent bout of rib trouble came from being forced to sit in a bad chair for two hours for work)
all of this can go for any disability, or even non-disabled people who have lingering altered states/sub-drop after play.
I'm not so familiar with the top side of things, but I know my partner will wear braces for wrist pain; beyond this, I can suggest that any top know their limits, and find alternate ways to accomplish what the bottom wants. it would be pretty bad for my partner's shoulder and neck to pick me up; but he's studied martial arts for years and knows how to do take downs, hip throws, joint locks, etc, without putting strain on those areas. if someone has wrist issues, there are flogger that spin on a hinge and ways of throwing that minimize wrist movement.
it's a lot of the same stuff that I go through on the bottom side, but with the added dimension of, "how do I maintain (the illusion of) control through the scene".
if anyone else has input here, I'd love to see it!
going to end the post here because it's a monster—I'll get into specific kinds of play another day. just remember to have fun!