This suspension takes place hooked from the front of the body and hung vertically. Many people refer (quite possibly offensively) to this as an "O-Kee-Pa" suspension because it looks similar to a Native American rite of the same name. The vertical chest suspension is considered to be the most difficult and painful suspension. Problems reported include difficulty breathing coupled with intense pain in the sternum and armpit areas.It should be noted that many people strongly object to the use of the term "O-Kee-Pa" to refer to a vertical chest suspension, as "O-Kee-Pa" in actuality refers to a complex and deeply meaningful cultural ritual that very few modern people understand. A two point vertical chest suspension is no more an "O-Kee-Pa" than drinking a glass of wine at dinner is taking communion.