Can repeated rear naked chokes (RNCs) cause blood clots and increase the risk of strokes?

Risk of Blood Clots and Strokes from Repeated Rear Naked Chokes

Repeated rear naked chokes (RNCs) can potentially cause cervical artery dissections leading to blood clots and strokes, though the overall risk appears to be low based on current evidence.

Mechanism of Potential Injury

Rear naked chokes work by:

• Compressing the jugular veins and carotid arteries, reducing cerebral perfusion pressure
• Potentially causing mechanical trauma to the vessel walls with repeated application
• Creating conditions that could lead to endothelial damage and subsequent thrombus formation

Evidence on Safety and Risk

The safety profile of sportive choking appears generally favorable in controlled settings:

• A large survey-based study of 4,307 combat sports participants found only 0.05% reported ongoing symptoms from chokes 1
• Most practitioners (75.7%) reported experiencing near-syncope and 27.8% had been choked unconscious, yet long-term complications were rare 1

However, serious complications have been documented:

• Case reports have identified cervical artery dissections and ischemic strokes associated with sportive choking techniques 2
• A case series documented 10 cases of serious vascular injuries: 5 carotid artery dissections, 3 vertebral artery dissections, and 2 ischemic strokes without dissection 2

Pathophysiology of Potential Injury

The risk of vascular injury stems from:

1. Direct mechanical trauma: Compression forces can damage the intimal layer of arteries
2. Hemodynamic changes: Doppler studies show that choke holds can cause complete obstruction of carotid and vertebral artery blood flow 3
3. Potential for dissection: Vessel wall injury can create a false lumen where blood can enter and form clots

Risk Factors That May Increase Danger

Certain factors may increase the risk of complications:

• Pre-existing vascular abnormalities or atherosclerotic disease
• Excessive force or improper technique
• Prolonged application of the choke
• Repeated application over short time periods without adequate recovery
• Older age or presence of cardiovascular risk factors

Clinical Implications

For those practicing sports involving RNCs:

• Be aware that while rare, serious vascular injuries can occur
• Recognize warning signs that require immediate medical attention:
  • Persistent headache after choking episodes
  • Visual disturbances
  • Unilateral weakness or numbness
  • Speech difficulties
  • Dizziness that persists beyond the immediate recovery period

Conclusion

While the overall risk appears low in properly supervised settings with appropriate technique, repeated rear naked chokes do carry a small but real risk of causing blood clots and strokes through arterial dissection mechanisms. The current evidence does not support a definitive link between repeated transient chokes and chronic neurological effects 4, but acute vascular injuries can occur and may lead to serious outcomes including stroke.

For those participating in combat sports involving chokes, proper technique, supervision, and prompt recognition of warning signs are essential to minimize risk.