By the AAN:

June 9, 2021

Neurology and neuroscientist professionals have a responsibility to work toward improving the health of all members of society and educating the public on how to prevent neurologic injury. The deaths of George Floyd, Eric Garner, and other instances where neck restraints were used by law enforcement have called into question whether these restraints are controllable, safe, and non-lethal.1

In an editorial in JAMA Neurology, the authors review carotid artery physiology and the neurological sequelae that result from restricting blood flow or oxygen to the brain—conditions that occur with the neck restraints commonly used by law enforcement.The two neck restraint techniques used by law enforcement are chokeholds (“a physical maneuver that restricts an individual’s ability to breathe for the purposes of incapacitation,” by using pressure on the trachea to restrict oxygen to the brain) and “vascular neck restraints” or strangleholds (“a technique that can be used to incapacitate individuals by restricting the flow of blood to their brain” by using pressure to the carotid arteries).2 The medical literature and the cumulative experience of neurologists clearly indicate that restricting cerebral blood flow or oxygen delivery, even briefly, can cause permanent injury to the brain, including stroke, cognitive impairment, and even death. Unconsciousness resulting from such maneuvers is a manifestation of catastrophic global brain dysfunction. In addition, individuals with underlying cardiovascular risk factors are more vulnerable to suffering significant neurological injury from neck restraint techniques, and the burden of cardiovascular disease in the United States, particularly in communities of color, remains high.3 In sum, the neurological sequelae that result from limiting blood flow or oxygen to the brain due to the use of neck restraints are potentially irreversible and entirely preventable.

Because of the inherently dangerous nature of these techniques, the AAN strongly encourages federal, state, and local law enforcement and policymakers in all jurisdictions to classify neck restraints, at a minimum, as a form of deadly force. Furthermore, because there is no amount of training or method of application of neck restraints that can mitigate the risk of death or permanent profound neurologic damage with this maneuver, the AAN recommends prohibiting the use of neck restraints.

The American Academy of Neurology is the world’s largest association of neurologists and neuroscience professionals, with 36,000 members. The AAN is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer’s disease, stroke, migraine, multiple sclerosis, concussion, Parkinson’s disease and epilepsy.



  1. Berkman, J. M., et al. (2020). “Carotid Physiology and Neck Restraints in Law Enforcement: Why Neurologists Need to Make Their Voices Heard.” JAMA Neurol.
  2. National Consensus Policy and Discussion Paper on Use of Force [online]. Available at: Accessed April 9, 2021.
  3. Carnethon, M. R., et al. (2017). “Cardiovascular Health in African Americans” Circulation (2017); 136:e393-e423


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