It's a fantasy role-playing game.

DM: You are Grog Strongjaw, a goliath barbarian . You are the member of the famous group of adventurers. Previously,  The party completed the venture of taking the Horn of Orcus to a place of safety and sealing it away, hopefully for eternity, with the help of Lady Kima and two of the Scalebearers. After heading to the basement of the Platinum Sanctuary in the city of Vasselheim, they succeeded in doing so.
DM: Okay, so as you reach up to try to get his eyes, he grasps your hands and instead begins pulling back on the wrists. You can feel the tension of the bone beginning to bend from the sheer strength and force of it. As you pull back your arms, you attempt to headbutt him again and he dodges his head out of the way, and he knows he has you at an advantageous position. What do you want the third attack to be?
Player: He's still on top of me, isn't he?
DM: Yeah. Where are you at hit point-wise, by the way?
Player: 18.
DM: He's looking pretty rough, too. So what do you want the third attack to be?
Player: Would you say he's on my chest?
DM: He's currently on your chest and waist area right now, like (grunts) holding you down.
Player: I was going to grapple him, but if he's on my chest, I'll use my thighs to shove him up towards the upper part of my body and I'll drive down my elbow at the same time. Into that whole bloody target area.
DM: Okay. As you shift upward, you bring your elbow forward. Roll for attack.
