The vascular neck restraint of mixed martial arts: understanding the pathophysiology, hemodynamics, and long-term consequences.

Abstract

B Mixed martial arts (MMA) brings various forms of martial arts disciplines together as a unified sport. Sportive 'choking,' also known as vascular neck compression, vascular neck restraint (VNR), or carotid restraints are utilized in MMA to apply jugular and carotid compression and subdue one's opponent. Few studies have explored the long-term consequences of VNRs, as well as the underlying pathophysiology and hemodynamics of the restraint. A narrative review was conducted in order to explore the long-term consequences of VNRs, as well as the underlying pathophysiology and hemodynamics of the restraint. Medical literature published prior to 2025 was identified utilizing MEDLINE/PubMed and the Cochrane Library. Initial search terms included mixed martial arts, injuries, neck chokes, carotid restraints, and vascular neck restraints. Articles were then subcategorized into pathophysiology, safety profile, and medical complications of VNRs. A total of 25 research articles were included in the final manuscript. Mixed Martial Arts is the fastest-growing sport within the United States, especially among the adolescent population. The head and neck region is the most commonly injured territory, with neck chokes comprising 14.1% of reported match stoppages. The pathophysiology of VNR-induced unconsciousness is misunderstood by many. The likely pathophysiologic endpoint is cerebral hypoxia due to reduced cerebral perfusion pressure, primarily from compression of the jugular veins and carotid arteries and, rarely, from carotid sinus baroreceptor compression. In addition, few studies exist regarding the long-term consequences of VNRs. The current literature appears to demonstrate an acceptable safety profile when the VNR is performed properly. Further studies are needed to explore the underlying pathophysiology of VNR-induced unconsciousness, as well as the long-term consequences of VNR in order to guide the establishment of MMA fighter safety profiles and health-care professional management guidelines.