The lack of blood or air often leads to unconsciousness or even death if the hold is maintained. Chokeholds are used in martial arts, combat sports, self-defense, law enforcement and in military hand to hand combat applications. They are considered superior to brute-force manual strangling, which generally requires a large disparity in physical strength to be effective. Rather than using the fingers or arms to attempt to crush the neck, chokeholds effectively use leverage such as figure-four holds or collar holds that use the clothes to assist in the constriction.