RIP – Ennio Morricone
As Anatomists, we should be used to things being named in a way that is not helpful or often misleading. The world of eponyms has left us with literally hundreds of structures in the human body that do not provide us with any information other than who first claimed to identify it, the great vein of Galen, the Fallopian tubes and the angle of Louis to name a few.
It should not surprise us to find the same issues in other professions. Let me introduce you to the figure four choke hold in competition grappling.
There is the first issue of what is the difference between choking and strangling. This is as productive and circular as to whether jam or cream goes onto a scone first. I go with the simple, choking is an internal issue – you can choke on a piece of chicken, whereas a chicken has never strangled anyone. This creates the first issue for the pedant. The uninitiated pedant once experiencing a figure four hold might think ‘this opponent doesn’t know what they are doing. There is a large gap at the front of my throat. This isn’t a choke hold.’ and they will continue to think that right up until the moment they pass out, because the choke hold isn’t designed to choke you.
There are a lot of important structures in the neck. There is the airway or trachea. This is held open with C shaped pieces of cartilage so that it does not become compressed as the head moves around. We have the oesophagus which connects the mouth to the stomach. This is a stretchy muscular tube that spends most of its time closed anyway. We also have a lot of blood vessels as you can see in the picture. The two most important are the carotid artery and the jugular vein. They run up each side of the neck taking blood to and from the brain. They can just be seen appearing at the top of the sternocleidomastoid muscle running from the back of the head to the front of the chest (from the sternum to the mastoid process – an example of how things should be named).
If we had necks like the Sontaran from Dr Who then this wouldn’t be an issue but we have accepted the vulnerability of exposing all of these structures in a long slender neck for the ability to turn our head around and be aware of what is going on around us.
The figure 4 hold works by compressing these vessels, restricting blood flow to the brain and causing people to become unconscious. That is where the discussion should have finished but…a little knowledge can be a dangerous thing and we now have two other debates appearing.
Is it the compression of the jugular vein or the carotid artery that causes the unconsciousness? Veins are quite flat and easy to squash whereas arteries have springy walls and are better at holding their shape. The jugular vein is more superficial than the artery so it probably gets squashed first. I would be very suspicious of anyone who claims they can compress one and not the other. The figure 4 hold is a blunt instrument to an end.
Even more ludicrous then is the discussion around the carotid body. The carotid body is a small structure that sits just above the bifurcation of the carotid artery. It has a role in controlling blood pressure through out the body. Theoretically if the carotid artery were compressed below the carotid body then it would perceive a drop in blood pressure and initiate the process to increase the blood pressure. If the artery were compressed above the carotid body, it would perceive an increase in blood pressure and initiate steps to reduce it. The outcome in terms on consciousness for the opponent would be the same in both circumstances. The carotid body is about the size of a pea and, due to anatomical variation, not always in exactly the same place in each person. The pressure is being applied with something varying in size between a forearm and a thigh. I don’t think I need to point out the ridiculousness of claiming any precision in its application.