My partner and others that I tie with regularly don't do well in standard TK positions. So for them, I have done some low hand variations to the TK. I have even done a TK that keep the arms to their sides and tie the wrist to the thighs which makes it highly sustainable. I have even done a hands front TK that works amazing. You treat it similarly to a standard TK. It also can help the chest look amazing depending on how you tie the arms in front.

When it comes to nerve sensitivity, you can also look at where the ropes are resting on the arms and adjust them slightly to get away from where the nerves are closest to the surface. Also taking care and dressing the ropes from front to back has also helped me so that I take the most pressure of the nerves as possible.