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Thread: Arm Pain and the Squat

  1. #1
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    Default Arm Pain and the Squat

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    I am a physical therapist and train some folks out of my garage gym using the Starting Strength model. My brother is one of them. He suffers from referred pain to the forearm with heavy squats that goes away with rest or repositioning to high bar squats. I have been trying to figure out the source of his pain as I have seen this to be a common issue with other starting strength members. Looking back at my school notes and textbooks the signs and symptoms and differential diagnosis are pointing to T4 syndrome possibly being a source of this pain. Changing elbow angle and maybe switching to high bar for a short period of time seems like good options to calm down the area. It worked for my brother and allows him to press/bench/pull following squats. Maybe we can ask the other therapists in this group and see if they are familiar with T4 syndrome as I don't believe this is a very well researched topic, but may be worth looking into.

  2. #2
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    Pages 38-40 in the book deal with this. I doubt seriously that you are seeing T4 signs.

  3. #3
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    Quote Originally Posted by bwad7 View Post
    Maybe we can ask the other therapists in this group and see if they are familiar with T4 syndrome as I don't believe this is a very well researched topic, but may be worth looking into.
    T4 syndrome is a diagnosis of exclusion, see here T4 Syndrome - Physiopedia. Thus, you must first rule out other potential diagnoses before coming to this conclusion. Given how common this complaint is with trainees performing the low bar squat, it is likely a grip and bar placement issue that is discussed in the book as Rip explains.

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    Quote Originally Posted by JHG View Post
    T4 syndrome is a diagnosis of exclusion, see here T4 Syndrome - Physiopedia. Thus, you must first rule out other potential diagnoses before coming to this conclusion. Given how common this complaint is with trainees performing the low bar squat, it is likely a grip and bar placement issue that is discussed in the book as Rip explains.
    Yes. I understand that this is a grip and form issue. What happens when the elbows are too high? Does the thoracic spine tend to go into too much flexion out of the bottom? Maybe causing referred pain from the stressed area(upper thoracic). I guess it doesn't matter what the cause is as long as it gets better with correct form. Thanks for the input.

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  6. #6
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    Quote Originally Posted by bwad7 View Post
    Yes. I understand that this is a grip and form issue. What happens when the elbows are too high? Does the thoracic spine tend to go into too much flexion out of the bottom? Maybe causing referred pain from the stressed area(upper thoracic). I guess it doesn't matter what the cause is as long as it gets better with correct form. Thanks for the input.
    I understand your rationale for thinking this way, but it is not biomechanically sound because T4 syndrome is believed to be caused by thoracic hypomobility. Moreover, the apex of the thoracic spine is between T6 and T8, so if one is not bracing appropriately, and for once reason or another succumbs to excessive flexion of the thoracic spine, they would experience discomfort at these lower levels.

    The cause is most often due to suboptimal bar position on the back rendering the arms to carry some of the load as opposed to stabilizing the bar on the back.

    Rip is posting more efficiently than I am, in that he is directing you to learn the cause of the problem and how to fix it.

  7. #7
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    Quote Originally Posted by JHG View Post
    I understand your rationale for thinking this way, but it is not biomechanically sound because T4 syndrome is believed to be caused by thoracic hypomobility. Moreover, the apex of the thoracic spine is between T6 and T8, so if one is not bracing appropriately, and for once reason or another succumbs to excessive flexion of the thoracic spine, they would experience discomfort at these lower levels.

    The cause is most often due to suboptimal bar position on the back rendering the arms to carry some of the load as opposed to stabilizing the bar on the back.

    Rip is posting more efficiently than I am, in that he is directing you to learn the cause of the problem and how to fix it.
    Gotcha. This makes more sense. Thanks for the feedback.

  8. #8
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    Quote Originally Posted by bwad7 View Post
    Gotcha. This makes more sense. Thanks for the feedback.
    Happy to help.

  9. #9
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    Any suggestions to those of us that can't get a narrow enough grip to create a good enough shelf for heavy weights (no problems with lighter squats).

    I'm not talking about not being able to get into the position because its uncomfortable, but rather physical limits in flexibility. There are DOZENS of articles and videos (Yours, Jordans, Alan Thralls, etc..) on how to fix the squat grip. But all the advice for squat arm pain seems to be geared towards those that just aren't doing it right because they don't want to be uncomfortable or they just didn't know any better. What about those with actual flexibility limits.

  10. #10
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    starting strength coach development program
    If you cannot use the low-bar position, you carry the bar on top of your traps.

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