SHORT REVIEW: Anatomy of a Strangulation

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BACKGROUND 

Vascular neck restraint (VNR) is a common method of both submission in combat sports such as jiu jitsu and MMA, as well as a controversial restraint technique used by law enforcement officers. The ultimate objective with VNR is to induce a loss of consciousness (LOC). The common understanding in terms of mechanism of LOC is that the internal branches of the carotid arteries on each side are compressed, causing a decrease in blood flow to the brain. The objective of this article was to clarify some of these common misconceptions and add some other potential theories.

FINDINGS

Cerebral perfusion pressure (CPP) refers to the net pressure gradient causing blood flow to the brain, and is essentially the difference between the mean arterial blood pressure (MAP) and the intracranial pressure (ICP). The CPP typically sits around 70-90 mmHg, and a loss of consciousness may occur if the CPP drops below 50mmHg. A lowering of the CCP may occur due to an increase in the ICP or a decrease in the MAP.

Optimal application of a VNR involves compression to the neck on both sides, which compresses both the jugular veins (raising ICP) and carotid arteries (decreasing MAP). The jugular veins are more easily compressed than the carotid arteries due to the weakness of the vascular walls. It has been shown (outside of literature pertaining to VNR) that jugular compression induces a change in ICP. 

It is also thought that compression of the carotid baro-sensor (a type of mechanoreceptor that senses change in blood vessels) may contribute to a vagally-induced decrease in MAP, and that this may alone have the potential to cause a loss of consciousness.

IMPLICATIONS

Having a greater understanding of the anatomy and physiology of choke and strangulation mechanisms may increase the safeness of their practice in both combat spokes and law enforcement environments. Understanding the specific mechanical aims of application of these techniques may also help optimise technical performance. 

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About the author

Sam Gilbert

Sam Gilbert is a registered physiotherapist with the Australian Physiotherapy Association (APA) and certified strength and conditioning specialist (CSCS) with the National Strength and Conditioning Association (NSCA). He holds a bachelor’s degree in Physiotherapy from Latrobe university (Melbourne, Australia) and a master’s degree in Exercise Science (Strength and Conditioning) from Edith Cowan University (Perth, Australia).

A 3rd Dan black belt in Shinkyokushinkai Karate under the World Karate Organisation (WKO), Sam participated for over 20 years in full contact competition, winning multiple state and national titles, and culminating in a 4th place in the heavyweight division of the Shinkyokushinkai World Cup in 2009.

As the co-founder and clinical director of Club 360, the premier multi-disciplinary health and fitness center in Tokyo, Japan, Sam has combined his practical experience with an in-depth study of sports performance in relation to combat sports, and strives to help other combat athletes reach their full competitive potential, whilst at the same time decreasing injury risk and increasing competition and training potential.

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