Types of Physical Restraint Holds, Restrictive Practices, and Safe Disengagement Techniques
Types of Physical Restraint Holds and Restrictive Practices
Physical intervention in health and social care includes a range of restraint hold types and techniques used to guide, support, or safely restrict a person when there is a risk of harm.
These methods fall into three main categories: low‑level supportive contact, restrictive holds used only in high‑risk situations, and disengagement techniques that allow staff to safely release from grabs, bites, or holds.
Each technique has a specific purpose and must be applied in a way that is lawful, proportionate, and focused on maintaining the person’s safety, dignity, and wellbeing.
This guide explains each type of hold and intervention clearly so staff understand when and why it may be used within a least‑restrictive, person‑centred approach.
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31 Physical Intervention Hold Types, Restrictive Practices, and Safe Disengagement Techniques
1. Low‑Level Support Techniques
Low‑level support techniques are non‑restrictive, meaning they do not limit a person’s movement. They are used early in an incident to guide, reassure, or redirect someone who may be distressed, confused, or struggling with orientation.
These techniques aim to prevent escalation and maintain dignity.
1. Prompting / Indicating Touching
A light, non‑directive touch used to gain attention or encourage movement.
- Typically placed on the elbow, forearm, or back of the hand.
- Helps orient someone who is confused, anxious, or distracted.
- The person remains fully free to move away at any time.
- Used to gently prompt movement toward a safer area or away from a hazard.
Purpose:
To provide reassurance and subtle guidance without exerting control.
2. Upper Arm Guard
A supportive hand placed lightly on the upper arm.
- Offers stability for someone unsteady or overwhelmed.
- Helps guide movement without gripping or restricting.
- Maintains a respectful, non‑threatening posture.
Purpose:
To support balance and confidence while maintaining the person’s autonomy.
3. Straight‑Arm Indicating Prompt
A clear directional gesture using an extended arm.
- No physical contact required.
- Helps signal exits, seating, or safe spaces.
- Reduces confusion in busy or overstimulating environments.
Purpose:
To guide visually without touching, ideal for people who dislike physical contact.
4. Guiding / Escorting
A walk‑along technique using light contact at the elbow or forearm.
- The person can stop, slow down, or change direction freely.
- Used when someone needs help moving safely (e.g., unsteady, distressed).
- Maintains dignity and independence.
Purpose:
To support safe movement while allowing full control to the individual.
5. One‑Person Support Hold
A structured but non‑restrictive supportive hold.
- Used when someone is distressed, unsteady, or emotionally overwhelmed.
- The supporter stays beside the person, not behind or controlling them.
- The person can disengage at any time.
Purpose:
To provide emotional and physical reassurance without restricting movement.
2. Restrictive Techniques
Restrictive techniques intentionally limit movement and must meet strict legal tests:
- Necessary to prevent immediate harm
- Proportionate to the level of risk
- Least‑restrictive option available
- Time‑limited and continuously monitored
These techniques are used only when there is a clear and immediate risk to the person or others.
6. Double Cup Hold
A two‑handed supportive grip around the person’s forearms or wrists.
- Used to prevent striking, grabbing, or sudden arm movements.
- Maintains safe distance and stability.
- Requires continuous monitoring of breathing and distress.
Purpose:
To reduce the risk of injury during high‑risk arm movements.
7. Cupped Fist Hold
Hands form a protective “cup” around a person’s closed fist.
- Used when someone attempts to punch or strike.
- Reduces impact and protects both parties.
- Released immediately once safe.
Purpose:
To prevent injury from punching without causing pain or joint pressure.
8. Straight‑Arm Immobilisation
Arms are extended to create a safe barrier.
- Limits forward movement such as lunging or rushing.
- Maintains space without compressing the person’s body.
- Helps prevent sudden escalation.
Purpose:
To create safe distance and prevent forward aggression.
9. Seated Rest Position
A controlled seated posture that reduces risk.
- Used when a person is already seated and at risk of harming themselves or others.
- Focuses on airway safety, stability, and minimal restriction.
- Allows de‑escalation while maintaining safety.
Purpose:
To stabilise a seated person safely while reducing risk of falls or strikes.
10. Seated Leg‑Over‑Leg Control
A method of managing kicking behaviour while seated.
- Legs are positioned to reduce risk of impact.
- Avoids pressure on joints or circulation.
- Used only when kicking presents immediate danger.
Purpose:
To prevent injury from kicking while maintaining seated stability.
11. Seated Leg Isolation
Separating or controlling one leg.
- Used when only one leg is involved in kicking.
- Less restrictive than full leg control.
- Allows greater freedom of movement.
Purpose:
To reduce risk while using the least‑restrictive option.
12. Seated Full Leg Draw‑Back
A technique to bring both legs into a safer, non‑kicking position.
- Used when kicking presents immediate danger.
- Requires careful monitoring of comfort and breathing.
Purpose:
To prevent injury from repeated or forceful kicking.
13. Controlled Seated Disengagement
A structured release from a seated restrictive hold.
- Ensures the person is stable before letting go.
- Reduces risk of sudden escalation or falls.
- Supports a safe return to independence.
Purpose:
To end a restrictive intervention safely and gradually.
3. Broader Categories of Restrictive Holds
These categories help staff understand the wider landscape of restraint used in healthcare and security settings.
14 .Figure‑Four Arm Control
A technique where the person’s arm is positioned under the staff member’s armpit.
- Used to manage arm movement.
- Requires caution to avoid joint stress.
Purpose:
To control a single arm during high‑risk behaviour.
15. Two‑Person Holds
Two trained staff work together to stabilise an individual.
- Used when a single‑staff intervention would be unsafe.
- Helps distribute effort and reduce injury risk.
- Allows better monitoring of breathing and distress.
Purpose:
To safely manage higher‑risk situations requiring more than one staff member.
16. Standing and Seated Holds
Techniques applied while the person remains upright or seated.
- Focus on arm control, balance, and airway safety.
- Allow continuous monitoring of distress.
Purpose:
To manage risk while keeping the person in a natural posture.
17. Escort‑Based Holds
Used when moving a person during high‑risk behaviour.
- Maintains safety while transitioning between areas.
- Avoids unnecessary force.
Purpose:
To safely relocate someone who poses immediate risk.
4. High‑Risk or Controversial Restraints
These positions carry significant medical risks and are restricted or banned in many settings.
- 18. Prone restraint (face‑down) – risk of asphyxiation.
- 19. Supine restraint (face‑up) – risk of airway obstruction.
- 20. Lateral restraint (side‑lying) – safer than prone/supine but still requires strict monitoring.
Purpose:
To highlight methods that must be avoided or used only under strict governance.
5. Other Forms of Restrictive Practice
These are not physical holds but are part of the wider regulatory framework.
- 21. Mechanical restraint – devices such as belts or limb holders.
- 22. Seclusion – placing a person alone in a secure room.
- 23. Chemical restraint – medication used primarily to control behaviour.
Purpose:
To understand the full spectrum of restrictive practices beyond physical contact.
6. Disengagement Techniques
Disengagement techniques are release skills used when a person grabs, bites, or holds a staff member.
They aim to free the staff member without causing pain or injury.
24. Single Arm Grab Release
- Used when one arm is held.
- Relies on body movement rather than force.
- Protects joints and reduces escalation.
Purpose:
To safely free a single arm without causing pain.
25. Two‑Handed Arm Grab Release
- Used when both hands are gripping one arm.
- Uses posture and rotation to reduce pressure.
- Avoids pulling or yanking.
Purpose:
To release safely from a stronger grip.
26. Two Arms Grabbed Release
Used when both arms are held at once.
- Uses weight‑shift and leverage.
- Creates safe space for retreat.
Purpose:
To regain freedom of movement without escalating risk.
27. Clothing Grab Release
Used when clothing is grabbed.
- Prevents choking, imbalance, or tearing.
- Prioritises posture and controlled movement.
Purpose:
To free yourself safely while protecting the person’s dignity.
28. Hair Grab Release
Used when hair is pulled.
- Stabilisation reduces scalp injury.
- Followed by a controlled release.
Purpose:
To prevent pain and injury while safely disengaging.
28. Bite Release
Used when someone bites.
- Avoids pulling away, which increases injury.
- Uses pressure‑free methods to encourage release.
Purpose:
To reduce tissue damage and safely disengage.
30. Pinch Release
Used for small‑area pinches.
- Focuses on widening the grip.
- Minimises skin damage.
Purpose:
To release safely without escalating the situation.
31. Whole‑Hand Pinch Release
Used when the entire hand is squeezing.
- Uses body movement and leverage.
- Creates space while protecting the grabbed area.
Purpose:
To safely free yourself from a stronger, whole‑hand grip.
7. Core Safety Principles
Use the minimum force necessary.
- Avoid pressure on the chest, stomach, neck, or back.
- Continuously monitor breathing, colour, responsiveness, and distress.
- Apply restraint only to prevent imminent harm.
- Return to non‑restrictive support as soon as safe.
- Document and review all incidents to support learning and accountability.
8. Safety Principles and Legal Frameworks
Physical intervention in the UK is governed by strict legal and regulatory standards, and may only be used by staff with accredited, competency‑based training.
Safe practice is shaped by several key principles:
- Least Restrictive Option: Interventions must use the minimum restriction required to manage immediate risk, in line with the Restraint Reduction Network (RRN) Standards and CQC expectations. De‑escalation and proactive strategies must always be attempted first.
- Proportionality and Necessity: Any use of force must be proportionate to the level of harm being prevented and only applied when absolutely necessary, consistent with common‑law duty of care and the Mental Capacity Act 2005 where relevant.
- Risk Awareness and Duty of Care: Physical intervention carries inherent risks, including injury and psychological distress. High‑risk positions, especially prone (face‑down) restraint, are linked to positional asphyxia and are restricted or discouraged under CQC, RRN, and NICE guidance.
- Monitoring and Aftercare: Continuous monitoring of breathing, responsiveness, and emotional state is required throughout any intervention. A structured post‑incident review supports those involved and helps reduce future reliance on restrictive practices.
Organisations must ensure all interventions comply with their internal policies and the wider legal frameworks, including the Human Rights Act and sector‑specific national guidance.
9. Conclusion
A complete understanding of physical intervention requires more than knowing individual techniques.
Staff must understand the full continuum, from early, non‑restrictive support to restrictive holds and safe disengagement, while applying legal, ethical, and safety principles at every stage.
When used correctly, these approaches protect both the person in distress and the staff supporting them, ensuring dignity, safety, and compassionate care.
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