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Brachial Plexus and Subclavian Artery

Brachial Plexus and Subclavian Artery

Martial artists often train in a posture that I refer to as the “closed chest, inside fighting” position. This involves tightening the abs, flexing the pecs, serratus, teres major, lats, and obliques, while rotating the shoulders forward and pulling them down. This position makes the ribs much less vulnerable to strikes, and although it restricts breathing, it does make it much harder for someone to knock the wind out of you.  In some schools this is the principal posture from which techniques are practiced and executed. While this sort of training can be very useful,  it can cause or contribute to a number of problems including shoulder impingement, neck pain, head aches, carpal tunnel syndrome, and thoracic outlet syndrome. Falling, as when taking ukemi, can have similar consequences. Active measures should be employed to ensure that one can maintain good posture when off of the training floor, and to maintain mobility in the thoracic spine and shoulder girdle.

Thoracic outlet syndrome (TOS) can cause chronic pain, weakness, or  numbness in the arm and shoulder. Here are a couple TOS related sites that you should take a minute or two to read:

Thoracic Outlet Syndrome

From the “Your Orthopaedic Connection” site.


Thoracic outlet syndrome gets its name from the space (the thoracic outlet) between your collarbone (clavicle) and your first rib. This narrow passageway is crowded with blood vessels, muscles, and nerves. If the shoulder muscles in your chest are not strong enough to hold the collarbone in place, it can slip down and forward, putting pressure on the nerves and blood vessels that lie under it.

Read the rest here.

Thoracic Outlet Syndrome

From MedicineNet.Com


What is thoracic outlet syndrome?
Thoracic outlet syndrome is a condition whereby symptoms are produced from compression of nerves or blood vessels, or both, because of an inadequate passageway through an area (thoracic outlet) between the base of the neck and the armpit.

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Thoracic Outlet Syndrome
From the VascularWeb.Org site.


What is thoracic outlet syndrome?
Your thoracic outlet is a small space just behind and below your collarbone. The blood vessels and nerves that serve your arm are located in this space. Thoracic outlet syndrome (TOS) is the presence of hand and arm symptoms due to pressure against the nerves or blood vessels in the thoracic outlet area.

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Here are some videos of exercises that I recommend to my students to help them maintain good posture (the first one gets TKRI props for using tape and tennis balls):

The carotid is more easily seen in this image than the vertebral artery.

Vertebral Artery

Vertebral Artery

From the eMedicine site:

The typical presentation of VAD is a young person with severe occipital headache and posterior nuchal pain following a recent, relatively minor, head or neck injury. The trauma is generally from a trivial mechanism but is associated with some degree of cervical distortion.

Focal neurologic signs attributable to ischemia of the brain stem or cerebellum ultimately develop in 85% of patients; however, a latent period as long as 3 days between the onset of pain and the development of CNS sequelae is not uncommon. Delays of weeks and years also have been reported. Many patients present only at the onset of neurologic symptoms.

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The major causes of stroke in young adults and children differ from those in older people. Dissection of the internal carotid and vertebral arteries in the neck accounts for about a fifth of strokes in the young compared with about 2.5% in older patients.

…The incidence of arterial dissection is increased in patients with fibromuscular dysplasia, migraine, or hypertension; in smokers; and in those taking oral contraceptives. It is commonly associated with trauma or manipulation to the neck.

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From the above it seems clear that care should be taken by to avoid rapid and extreme flexion, extension, and rotation of one’s partner’s head. Percussion of the neck should likewise be avoided. Those techniques that require such movements should be modified by limiting the velocity and degree of manipulation, and/or contact. Children’s necks are especially vulnerable and therefore these techniques are not appropriately practiced on them. Newer students who have not yet demonstrated their ability to use discretion in their application of force in partner work should not be encouraged or allowed to practice these kinds of techniques.

Instructors should carefully observe students when they are engaged in practicing encounters in which neck manipiulation is required, and should take seriously any complaints of headache, nausea, changes in vision, or other related symptoms.


All martial arts are physically demanding and hazardous. Injuries are seen throughout the spectrum of expertise. Amateur participants are the most likely to sustain sprains and soft-tissue injuries in karate, mixed martial arts and Thai kick boxing; among professional fighters the main risks are fractures and life threatening injuries

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The hurdlers stretch is ubiquitous in karate. It is also potentially damaging to the knee of the bent leg and not particularly effective as a stretch for the hamstrings of the extended leg. Hurdlers use the stretch because it approximates the position they are in the air when clearing the hurdles. Most coaches recognize the danger of this stretch and take measures to reduce the negative effects while still employing it for hurdlers. The reason is pretty simple, hurdlers need to hurdle, and they will hurdle until they are no longer competing in the sport. Their determination to win, and their relatively short competitive careers tip the cost/rewards scale in favor (slightly, and debatably) of the use of this stretch. In this article I will argue that hurdlers stretches are inappropriate for karate people because the stretch is intrinsically dangerous to the knee, that there are important differences between karate and hurdling that need to be kept in mind when evaluating the relationship between risks and rewards associated with the use of the hurdlers stretch, and finally I will suggest some alternatives to the hurdlers stretch.

Before I get into the body of this article I want to direct our readers attention to several online articles that present similar concerns regarding hurdlers stretches.

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"Try to see yourself as you truly are and try to adopt what is meritorious in the work of others. As a karateka you will of course often watch others practice. When you do and you see strong points in the performance of others, try to incorporate them into your own technique. At the same time, if the trainee you are watching seems to be doing less than his best ask yourself whether you too may not be failing to practice with diligence. Each of us has good qualities and bad; the wise man seeks to emulate the good he perceives in others and avoid the bad."
Funakoshi Gichin


July 2020

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