Death in custody is an event that requires an exhaustive medico-legal investigation, there are different assumptions and situations in which an individual dies in conditions when he is deprived of liberty and third parties are the guarantors of his safety. The moment of arrest of a violent or combative individual sometimes culminates in the sudden and unexpected death of the detainee; the state of intoxication or psychiatric conditions such as excited delirium have been linked to these situations. Similarly, if violent gestures with sufficient entity to cause death emerge from the investigation, the cause of death may be clarified; but sometimes the detention with restraint maneuvers of a healthy subject, with no medical, toxic or psychiatric history that may explain the sudden death, constitute a challenge for the forensic physician to reveal the circumstances that explain the death. Positional asphyxia has been an argument that has tried to explain the etiology of death in these cases, but although it exists as an entity, different studies have discredited its prominence as the sole cause of death in these cases. The excessive response to physiological mechanismsto face stressful events, after an energetic physical activity, and the individual perception of the event, may justify, after a thorough medico-legal investigation and contextualization of the fact, as an explanation of the cause of death during restraint.