Thoracic Outlet Syndrome, Low Bar Squats and Radial Nerve Discomfort

Disclaimer: This is a blog, not a diagnostic tool for you pain/ symptoms. Please see a health care professional if you are in pain.

 A solid low bar position - Scapulae depressed and retracted, neutral neck and wrists

A solid low bar position - Scapulae depressed and retracted, neutral neck and wrists

 

It is well understood that the mobility demands of low bar squatting far outweigh that which is required for high bar squats. As such, it isn’t uncommon for lifters to complain of upper extremity pain when transitioning to low bar for the first time or re introducing low bars into their program after a period of accessory movements.

 

 

In the low bar squat pain typically presents at the wrist, medial elbow, anterior shoulder and sometimes lifters complain about losing feeling in their arms throughout longer duration sets and even experience radiating nerve pain down the back of their tricep, elbow and into the forearm and hand. This nerve pain and loss of feeling is what I want to open up a discussion on today.

 The Thoracic Outlet

The Thoracic Outlet

Thoracic Outlet Syndrome is compression of both the vascular and neural systems that run between the clavicle and the first rib, the thoracic outlet. Thoracic outlet syndrome can present itself with radiating pain into the upper back and arm, as well as reduced blood supply/ blood pressure to the distal aspects of the arm (loss of feeling in the arms) due to compression of the subclavian artery. The most notable neural network that runs through the thoracic outlet is the brachial plexus, responsible for almost all innovation of the upper extremity. The brachial plexus divides into three cords, the posterior, anterior and medial cords. The posterior cord is where the radial nerve begins and innovates the entirety of the posterior/ extensor muscles of the arm, triceps, forearm and wrist extensors. When the brachial plexus is compressed as it passes through the thoracic outlet radiating nerve pain can present.

 Radial Nerve from the Posterior View

Radial Nerve from the Posterior View

The scalene group is often spoken about in regards to thoracic outlet syndrome. This group of muscle originates at the transverse processes of the cervical spine, attach on the clavicle, first and second rib and is responsible for cervical rotation/ lateral flexion and cervical extension from bilateral activation of the anterior scalenes. As such, the scalene group can also elevate the first and second rib and reduce the space within the thoracic outlet leading to entrapment of the structures running through the thoracic outlet.

 The Scalene Group

The Scalene Group

The subclavius muscle runs superior to the collar bone attaches on the first rib and has the job of stabilising the sternoclavicular joint, where the collar bone attaches to the sternum. The subclavius can also depress the collar bone closing space between the collar bone and first rib reducing available space through the thoracic outlet.

 Subclavius Muscle

Subclavius Muscle

It is not uncommon for both of these muscles to become ‘over-active’ and short/ tight significantly altering the pathway of the brachial plexus and subclavian artery through the thoracic outlet underneath the collar bone and above the first rib. For those who present with forward head posture and poor scapulothoracic stability in maintaining scapular depression and retraction in the low bar position, it is easy to see how the thoracic outlet can easily be compressed causing irritation to the neural network and vascular system that passes through this space.

 A poor Low Bar Position - scapulae anteriorly tilted, neck and wrists extended, elbows flared

A poor Low Bar Position - scapulae anteriorly tilted, neck and wrists extended, elbows flared

 

How can you improve these issues?


Soft tissue work through the upper pec/ subclavius/ pec minor and some specific scalene release work can reduce the compression of the thoracic outlet allowing more space for the structures that pass through. Improving thoracic extension and lower trap activation can go a long way in setting a more optimal scapular position in the low bar squat if this is your issue. Diaphragmatic breathing can help to reduce the involvement of the scalenes and sternocleidomastoid muscles, supplementary breahting muscles, through inhalation. Improving shoulder flexion in a population that is heavily depressed, retracted and downwardly rotated can also improve symptoms. Finally, being aware of you neck position throughout the squat and maintaining a neutral neck can significantly reduce the scalene activation in the low bar position.

Disclaimer: This is a blog, not a diagnostic tool for you pain/ symptoms. Please see a health care professional if you are in pain.

This is only something that has recently become apparent with a small handful of our powerlifters here at Melbourne Strength Culture. I would love to hear about your own experiences with yourself and/or your lifters with this posterior/ extensor neural pain and loss of feeling in the arm during low bar squats. Don’t hesitate to drop me an email at melbstrengthculture@gmail.com.

About the Author
Jamie Smith, Owner and Head Coach at Melbourne Strength Culture
IG: @j.smith.culture
YouTube: Melbourne Strength Culture