I’ve had a ton of clients who have suffered from migraine’s. For the most part, I see those migraine’s get better using the strategies below. But, I’ve never seen a migraine sufferer not have at least one of these characteristics:
Forward head posture. I won’t get into the deep science, but suffice to say that every half inch your head is forward, the greater the stress is on the cervical spine. (1) Forward head posture is associated with greater tension-type headaches (which will usually contribute to a migraine).
Trigger points. Most of us have trigger points in our neck. In my experience, most who suffer from migraine’s have major trigger points in the neck area. This is backed up by a lot of studies which shows that individuals who have tension-based headaches will have worse trigger points than the rest of us. (2)
Non-neutral shoulder position. There is some evidence to support that higher tension in the upper traps (and potentially other muscles) is a contributor to tension-based headaches. (3) In my experience, this is reflected with elevated or depressed shoulders.
Flexed torso posture in daily life. You could have perfect neutral head posture, but if you are leaned over, you are over-stressing your neck big-time.
Now that I’ve harped on all my migraine-suffering clients, let’s get to what works. I’m surprised that more docs don't refer out to physical therapists for migraine’s, because the research shows physical methods work just as well as medications (if not better in some cases). I'd argue the physical means will at least have a chance to prevent future headaches. (4)
1. Get out of forward head posture by using the stick test. If you're reading this, you very likely have some degree of forward head posture. Here's how to really tell.
Place a broom stick on your back where the stick touches your butt, mid-back, and see if it touches your head. If it touches your head and you're not trying to touch your head to the stick, congratulations, you don't have a forward head posture. if you have to bring your head back at all, you have forward head posture.
Here's an overall good tutorial on neck position.
If this feels like you are constantly trying to avoid someone punching you in the face, that’s good. It should feel like that at first.
Over time, it will get easier, but you need to be really conscious of this. You may also need to work on extending or straightening your thoracic spine if you are rounded too much. Some clients just hate me when I am constantly putting the stick on their back and showing them their head is forward. If you’re overweight or obese, the stick may not be appropriate for you, but the back edge of your ear should bisect the middle of your shoulder.
2. Get a massage. My business partner, Matt Williamson is a master at identifying a ton of muscular, joint-based, and whole body patterns that tie into stuff like headaches. Before any training session, I’ll typically have clients roll with a softball on their necks against the wall. Often times, this will allow clients to stretch the neck muscles without them being aggravated.
3. Get your shoulders neutral. If you have depressed shoulders, you need to get them elevated, and this could mean doing shrugs. If you have elevated shoulders, you may need to focus on doing scapula depression work which is effectively, a reverse-shrug. Both ways relieve tension on the muscles, but you have to know which position you are in first. If you’re not sure, send me a pic, and ask.
4. When sitting, sit vertically. This sounds easy, but it is not. Realistically, you’ll likely need to move some cushions around to make it actually comfortable, potentially have your computer or book higher, and possibly reposition your legs. If you can’t be vertical or near vertical, you should have some head support.
I recommend patience with these evidence-based strategies. You likely won’t notice an immediate improvement, but overtime, you hopefully will see some major improvement with your headaches.
1. Cailliet R. Soft Tissue Pain and Disability. Philadelphia: FA Davis Co.,1977
2. Abboud J, Marchand AA, Sorra K, Descarreaux M. Musculoskeletal physical outcome measures in individuals with tension-type headache: a scoping review. Cephalalgia. 2013 Dec;33(16):1319-36. doi: 10.1177/0333102413492913. Epub 2013 Jun 26. Review. PubMed PMID: 23804285.
3. Bendtsen L, Ashina S, Moore A, Steiner TJ. Muscles and their role in episodic tension-type headache: implications for treatment.Eur J Pain. 2016 Feb;20(2):166-75. doi: 10.1002/ejp.748. Epub 2015 Jul 6. Review. PubMed PMID: 26147739.
4. Biondi DM. Physical treatments for headache: a structured review. Headache. 2005 Jun;45(6):738-46. Review. PubMed PMID: 15953306.
Here’s some quirky facts about alcohol which you might not all be aware of (and in honor of my business partner's wedding dance party tonight):
1. Even if you don’t get a hangover from alcohol, alcohol increases the effects of the sympathetic nervous system which means your fight or flight system is more activated. For those who are super-busy or have high stress, alcohol doesn’t make a whole lot of sense for you. If you’re on vacation and chilling, go for it. (1)
2. The rest and relaxation part of your nervous system, the parasympathetic nervous system becomes deactivated with alcohol. Is this why binge drinkers tend to experience more anxiety, impulsiveness, and “sensation seeking”? (2)
3. Hangovers happen with alcohol due to many factors including the type of alcohol you ingest, hydration status, sleep status, genetic factors, blood sugar levels, and inflammation pathways. However, by eating healthy, drinking lots of water, and not drinking too much, you probably won’t get much of a hangover unless you really overdo it. (3,4,5,6,7,8)
4. Intoxication is accurate word for any alcohol use. Alcohol is by the way a toxin.
5. Alcohol contains 7 calories per gram. However, it’s thermic effect of feeding (or how much energy is required to digest alcohol) is ridiculously high. It’s even higher than protein which basically means your body needs to use a significant amount of energy to digest alcohol. However, it doesn’t mean you can drink a 12 pack and not gain weight because…
6. Beer guts are real. (9)
7. The amount of research on weight loss and alcohol is remarkably thin. However, alcohol appears to not affect hunger significantly. But, alcohol also doesn’t really give much feelings of being full. This makes it easy to drink more calories and can make it harder to lose weight. If you are trying to lose weight, I recommend seriously no more than one to two drinks per week.
8. Moderate alcohol intake improves heart health. However, the cancer risk of organs above the waistline goes up if you consume any amount of alcohol on a regular basis. Take your family history into consideration. (10)
9. Alcohol disrupts sleep, but can still help us get to sleep faster. If you drink alcohol to get to sleep, you need to try other alternatives. (6)
I hate to break it to you, but most American adults should not be regularly drinking alcohol because we’re simply too busy and get don’t get consistent adequate sleep. Remember, alcohol increases your sympathetic nervous system which is contraindicated for many of us (including me).
However, if you’re retired, get great sleep, don’t have a major history of cancer in your family, and aren’t super busy, drink away… in moderation. If you go on vacation, and can truly relax, I think drinking is fine. Since cardiovascular disease is still the leading cause of death in America, moderate drinking will help protect your heart.
Most American adults should in my opinion simply smoke a lot more weed. I’m totally kidding. Most people need to stop looking for an external fix like alcohol or weed, and really focus on the basics like sleep, eating healthier, self-care practices, and connecting with friends, family, and community. It’s not sexy, it’s challenging at times, but it gives by far the most bang for the buck in terms of health. In other words, get your priorities straight.
1. Grassi GM, Somers VK, Renk WS, Abboud FM, Mark AL. Effects of alcohol intake on blood pressure and sympathetic nerve activity in normotensive humans: a preliminary report. J Hypertens Suppl. 1989 Dec;7(6):S20-1. PubMed PMID: 2632716.
2. Adan A, Forero DA, Navarro JF. Personality Traits Related to Binge Drinking: A Systematic Review. Frontiers in Psychiatry. 2017;8:134. doi:10.3389/fpsyt.2017.00134.
3. Kruisselbrink LD, Martin KL, Megeney M, Fowles JR, Murphy RJ. Physical and psychomotor functioning of females the morning after consuming low to moderate quantities of beer. J Stud Alcohol. 2006 May;67(3):416-20. PubMed PMID: 16608151.
4. Bendtsen P, Jones AW, Helander A. Urinary excretion of methanol and 5-hydroxytryptophol as biochemical markers of recent drinking in the hangover state. Alcohol Alcohol. 1998 Jul-Aug;33(4):431-8. PubMed PMID: 9719404.
5. RUBINI ME, KLEEMAN CR, LAMDIN E. Studies on alcohol diuresis. I. The effect of ethyl alcohol ingestion on water, electrolyte and acid-base metabolism. J Clin Invest. 1955 Mar;34(3):439-47. PubMed PMID: 14354014; PubMed Central PMCID: PMC438648.
6. Verster JC. The alcohol hangover--a puzzling phenomenon. Alcohol Alcohol. 2008 Mar-Apr;43(2):124-6. doi: 10.1093/alcalc/agm163. Epub 2008 Jan 8. Review. PubMed PMID: 18182417.
7. Swift R, Davidson D. Alcohol hangover: mechanisms and mediators. Alcohol Health Res World. 1998;22(1):54-60. Review. PubMed PMID: 15706734.
8. Kaivola S, Parantainen J, Osterman T, Timonen H. Hangover headache and prostaglandins: prophylactic treatment with tolfenamic acid. Cephalalgia. 1983 Mar;3(1):31-6. PubMed PMID: 6342813.
9. Michael Jensen, MD, professor of medicine, Mayo Clinic, Rochester, Minn.Mayo Clinic web site.
Bobak, M., European Journal of Clinical Nutrition, 2003; vol 57: pp 1250-1253. 2010 Dietary Guidelines for Americans.
“I don’t recommend you weigh yourself every day, otherwise, you’ll go crazy.”
This is what I used to tell my clients.
My biggest concern was that clients would get discouraged because they didn’t see their weight go down right away. I would instead recommend that they weigh themselves every two weeks.
Here’s the problem. Weighing yourself everyday works pretty damn well. At least, this is what some cool studies tell us.
First, if you have lost weight already, daily weighing can help you keep it off. (1)
Second, daily weighing can help you lose weight (2)
Second, if you are not trying to gain weight (and maybe even maintaining your weight), weighing yourself daily can also help you. By simply being conscious of what you weigh on a daily basis, you are less likely to simply gain weight.
Unless you are prone to high anxiety, weighing yourself may not be appropriate for you. Otherwise, daily weighing will likely increase your awareness of how your nutrition and exercise affects your weight. Should You Weigh Yourself Every Day?
1. 168. Butryn ML, Phelan S, Hill JO, Wing RR. Consistent self-monitoring of weight: a key component of successful weight loss maintenance. Obesity (Silver Spring) 2007;15:3091. [PubMed]
2. 169. Gokee-LaRose J, Gorin AA, Wing RR. Behavioral self-regulation for weight loss in young adults: a randomized controlled trial. Int J Behav Nutr Phys Act. 2009;6:10. [PubMed]
True or False? Rapid weight loss will help you lose more weight in the long term.
Rapid weight loss has been villainized – and rightfully so. Who really has the time to do a biggest-loser like challenge and keep the weight off?
We know from some of the Biggest Loser participants themselves that they all tend to put back on some pounds, or even more pounds than they lost.
Does this mean losing weight slowly is better? No.
The research is clear. If you lose a significant amount of weight in the beginning, you tend to do better. Don’t fire your trainer yet though, there does seem to be a “sweet” spot in terms of how much you should lose.
In a an interesting study of over 1,300 adults, it was found that those who lose 10% of their weight within a year showed a 59% chance of keeping it off. 10% was the sweet spot for this study.
Let’s assume you weighed in at 220 pounds. 10% of this would be losing 22 pounds within a year. To a fitness coach like myself, this isn’t a huge amount to lose within a year.
The interesting thing about this study was that the individuals who lost a little more weight (like 15% or more) had a higher chance of gaining that weight back. If they lost even more weight (in the area of 20% or more), they had the highest chance of gaining it back.
This points towards a sweet spot for weight loss which you should strive for within one year's time.
Several studies show that those with the fastest weight loss tended to keep that weight off longer. (1,2,3,4)
However, all of these studies show that weight loss which was done faster and generally within 10% to 15% of initial body weight, stood the best chance of stay off.
This is pretty critical for goal setting. If you have an initial weight loss goal, here is a template I created for recommended weight loss within a year's time.
Unfortunately, what these studies show is a lot of people regain significant amounts of weight back. Around 30-50% of individuals who lost some weight will gain the weight back. But, at least, half will keep the weight off.
We've established that between roughly 5% and 15% is a reasonable weight loss goal within a year's time. If you're above or below that?
What happens if you can’t lose 5% of your weight? First, make sure your sleep and stress are manageable. Next, I advise you consult with a professional like myself or a local dietician. The strange thing is that even if you lose 2-4% of your body weight, you are more likely to regain that weight back on compared to if you lose more.
What happens if you lose over 15% of your weight? If you do, you’ll be a lot more likely to keep it off by following some sort of program. A lot of the studies above included weight loss programs that participants followed which allowed them to keep their weight off. The less structure you have, the more likely you are to put your old weight back on.
I’m a huge fan of the Precision Nutrition coaching program which is for one year and amazingly powerful at individuals staying accountable, getting helpful motivation, and learning.
The bias for a lot of us is to assume that if you lose a lot of weight in a short amount of time, you’ll be more likely to gain it back. This is true… but only to an extent. The ideal range weight loss range within a year appears to be between 5% and 15% . If you can stick within this range, and follow at least some program, you’ll stand the highest chance to keep that weight off for good.
1. Toubro S, Astrup A. Randomised comparison of diets for maintaining obese subjects' weight after major weight loss: ad lib, low fat, high carbohydrate diet v fixed energy intake. BMJ. 1997;314:29. [PubMed]
2. McGuire MT, Wing RR, Hill JO. The prevalence of weight loss maintenance among American adults. Int J Obes Relat Metab Disord. 1999;23:1314. [PubMed]
3. Bliddal H, Leeds AR, Stigsgaard L, Astrup A, Christensen R. Weight loss as treatment for knee osteoarthritis symptoms in obese patients: 1-year results from a randomised controlled trial. Ann Rheum Dis. 2011;70:1798. [PubMed]
4. Nackers LM, Ross KM, Perri MG. The association between rate of initial weight loss and long-term success in obesity treatment: does slow and steady win the race? Int J Behav Med. 2010;17:161. [PubMed]
A weight loss plateau sucks, pure and simple. You need to ask yourself a few questions if you experience a weight loss plateau.
How fast did I lose weight? If you lost more than 1-2 pounds per week, you may have lost weight too fast.
Everyone has a body weight set point which is the weight which your body settles at if you eat normally. Let's assume your body weight set point is 240 pounds. Now, assume you are eating at the level of a 180 pound person.
If you lose weight too fast, your body weight set point will still be closer to 240 pounds, than 180 pounds. However, the slower you lose the weight (like that of 1-2 pounds every 1-2 weeks), the more you will feel comfortable because you have given time for your body weight set point to adapt.
The bottom line is: Don't lose weight too fast!
How are my stress levels? If you have high stress levels, this will likely affect you eat, how hungry you get, how full you get, how much you exercise you get to do or have motivation for, etc. It also can affect cortisol which has been associated with weight gain.
Regardless, if your stress levels are high, breaking through a weight loss plateau will likely add more stress to your life. This is why for some clients, I tell them to actively maintain their weight or be satisfied with maintenance. No one wants to hear this, but this is the truth, and will help your clients understand that if they really want to make long-lasting changes, they are eventually going to have to do something about their stress levels.
How much sleep am I getting? How much sleep did you get last night, and make a mental note of that. How much sleep did you get the night before and make a mental note of that. If you scored 8 hours or above, you can move on. If not, you need to examine how much sleep you're getting. (And if you think you can thrive on 7 hours while losing weight, you aren't.)
Sleep absolutely affects hunger levels, and can sabotage the best diets in the world. It's associated with weight gain and eating too much.
How is my nutrition? I've known some clients that can go on commercial diets where the diet company provides all the protein bars, protein powders, and snacks. This always leads to rapid weight loss, but eventually fizzles over time.
Without getting in a majority of whole foods, losing all the weight you want to lose will be difficult, if not impossible. Anybody can do the "cabbage soup" diet and lose their first 15 or 20 pounds rapidly. Continuing to lose all your weight, then keeping it off, takes serious work.
Learning to swim is easy. Learning to compete, heck even against good grade school swimmers is challenging. You'll need a coach, lots of practice, learning from your mistakes, etc. to get better. This is what long-term weight loss is unfortunately like for many people. They need help outside themselves. They just don't fully realize that yet.
If you say "yes" to all of the following questions, you may not need to focus on your nutrition.
1. Are you getting in at least 5 total servings of pure fruits and vegetables a day?
2. Are you getting a pure protein source at every meal (like cottage cheese, eggs, beef, seafood, protein powder, etc., and no nuts or seeds count)
3. Are you getting in less than 5 alcoholic drinks per week?
4. Do you eat out at restaurants (including fast food, food trucks, etc) 3 or less times per week?
Even if you answered yes, you will at some point need to improve your nutrition.
What is the best way to avoid a weight loss plateau? It's pretty simple, but not easy.
If it's impossible for you to do any of these, you should consider maintaining your current weight for awhile, until you can focus on your weakest links. If you cannot focus on your weakest links right now, don't worry. At some point, you'll likely be able to work on them (unless you insist on being a masochist for the rest of your life).
A weight loss plateau is not the end of the world. By taking a look at a few key factors, you can determine if you should stay at your current weight, or if you can break through your plateau.
My clients laugh at me when I tell them I got to lose some weight. I'm about 195 pounds and six foot two. What they don't know is that I'll fluctuate anywhere from 185 pounds to 210 pounds. After I put on muscle mass, I need to lose fat.
And, as every knows, the hardest weight to lose is that last 5 or 10 pounds, right? I'll be honest with you, I prefer to lose fat instead of gaining muscle, and it's not because of my metabolism. I've had to learn from experience to be patient, realistic, and strategic about my fat loss. Here are my top seven strategies.
I just put a salad bar in my kitchen to simplify things for my fat loss efforts.
1. Have at least one fruit or veggies (or both) with each meal.
I don't care if my clients have the same fruit or vegetable at every meal. I just want them to get them in. I personally have two to three total with every meal. I've noticed the more you have, the easier it is to have more at each meal.
2. Have a pure protein source with every meal.
This can be yogurt, beef, seafood, whey protein, wild game, chicken, eggs (with not too many yolks because it can get pretty fatty), or whatever else has a lot of protein and not too much carbs or fat.
Also, having a sandwich with two thin slices of ham does not count as a pure protein. It's literally like 5 grams of pure protein. I highly recommend at least 20 grams of a pure protein at each meal regardless if you're a man or woman. Nuts are not a pure protein even if it's peanut butter or almonds. Nuts have much more fat calories compared to protein calories.
3. Don’t get in too much fat.
Healthy fats are great like olive oil, cooking sprays, some butter, fish oil, nuts, and seeds, but you really have to watch the amount you use. If you eat low-carb, you definitely need to watch how much fat you consume.
I personally use a food scale to measure my foods, but you don't have to. Typically, a thumb portion of fat is appropriate.
4. Minimize the In-Between Foods.
I define “in-between foods” as breaded chicken strips, restaurant meals, "healthy" microwave meals, "healthy" fast food meals, protein bars, etc. These are meals which seem okay, but they often contain too many processed ingredients, not enough protein, too much fat, and not enough whole food nutrients.
5. Have a plan, template, or calorie count.
Obviously, you need to have some plan to lose weight. However, I find that without writing down what you eat, calorie counting, or having some template, it's easy to fall apart.
I really like the Precision Nutrition Online Program which I offer. Heck, even with most of my clients who I work with personally, I still have them do this program.
6. Be Slow
You should want to shoot for slow weight loss. Maybe not at first, but eventually, all weight loss should slow down.
This is to your advantage. If you take it slow, your body in the long run will have a much easier time adapting to your new weight. There is a world of difference in losing 100 pounds in two months, and losing it in two years. It'll be nearly impossible to keep 100 pounds off if you lost it in two months because your body set point is still set so high.
A body weight set point is simply where your body prefers to eat at. The only way to change this is by eating at the same level over a long period of time. And, if you don't eat gradually, it will be much harder to keep the weight off.
You know the old adage, "it's a lot easier losing the weight than keeping it off."
7. Maintain When You Need To
I have a client who lost over 50 pounds at the end of the last fall school year through the summer. Knowing he would be going back to school, and get very busy, he realized he could maintain his weight loss by continuing to eat well and get in whatever exercise he could.
Here's the reality. It is far more difficult to choose the goal of "I will maintain" than the goal "I will continue to lose weight."
However, maintenance is a very-appropriate goal at times and people should be proud that they maintained their progress. The flip side is that if you expect to lose weight, and you are not, you are a failure in your own mind. You'll also likely revert back to old habits.
Whenever I am trying to get under 10% body fat, I need to eat at a maintenance level every three to five days. When I do this, I feel normal. However, if you have me go for a week or two, you will oddly appear to be edible if I'm training you. The lower your body fat percentage goes, the more "maintenance" breaks you will need.
Fat loss can be manageable. By making sure are not cheating yourself with too many "in-between meals", and getting in enough high-quality proteins, carbohydrates, and fats, you'll do well.
Please make sure you have an appropriate goal for your lifestyle. If you just had a pair of twins, have a demanding job, and had the in-laws move in to help, please don't add in the extra stress of "losing fat" into the mix.
If you read my blog, you probably round up top in the shoulders like this.
Don't worry, it doesn't mean you're a computer geek. You probably just live in the 21st century. Unfortunately, being rounded over can lead to crappy breathing, low energy, and even low mood. (There's a reason Igor was the way he was in Frankenstein.)
I'll usually see a thoracic spine which is rounded too much (kyphosis), or which is too flat. Sometimes, I'll see both together where the thoracic spine is clearly rounded too much, and segments of it are actually too flat.
In the picture below, it's definitely too flat.
When I see something like the picture below, I'm relieved. But, only for a short bit because we have to assess movement too.
To test movement, we are going to get into a crouched position with arms on floor in front of you.
Use three positions for your arms. Rotate as far as you can up. Use one hand on your head, one hand on your shoulder, and one hand behind your back. The goal is to see if your top shoulder can clear 45 degrees (which is the red line shown in the pictures below). Don't forget to check the left and right side.
One of my favorite go-to exercises to correct a flat or kyphotic curve is the sidelying thoracic rotation mobilization with the foam roller. (Please note that checking the pec and lat length is highly advisable as these are commonly tight and restrict movement of the thoracic spine. We'll go into this later.)
Here is how we do it.
You can use a weighted DB too for assistance if you need to. Remember though, try to move your thoracic spine as much as you can, not just your shoulder.
The thoracic spine is still one of the most problematic areas I see. It can affect your neck, hips, shoulders, and low back. When both alignment and thoracic mobility are optimized, breathing and energy improve, as well as whole upper body performance.
If you practice sitting up tall (but not too tall because you don't want a falt thoracic spine) and practice these mobilizations to make sure your thoracic mobility test is neutral, you'll not only feel better, you'll look better too.
This is my HRV trend for the last month. HRV stands for "heart rate variability," and it is probably my go-to answer when people ask me, "how do you get in great shape?"
What is heart rate variability?
Heart rate variability simply measures the variability of the time between heart beats.
To start with, we measure the amount of time between each heart beat. Next, we measure the variability, or how much change occurs between each heart beat. We can use any number of equations to calculate this, but at the end, we end up with a number like 77 which is what I had today and is representative of Bioforce HRV which is what I use. What does this number mean?
Our parasympathetic nervous system which is our "rest and relaxation" system downregulates or really tries to regulate our heart beat, so there is no variability in our heart rate variability. Our sympathetic nervous system is our "let's get excited and kill the competition!" system. It upregulates our nervous system. This system also creates a lot of variability in the system.
To put it simply, if you're heart rate variability is too variable, meaning, too sympathetic, it will be reflected in a lower score. However, if your heart rate variable is not variable enough, mean, it's too parasympathetic, it'll be reflected in too high of a score.
In the Bioforce universe (bioforcehrv.com), here's ideally where you should be if you are a recreational exerciser (including many athletes, excluding long-distance runners).
75 - 85
(Okay, I've just give you a recipe to get in great shape. All you have to do is go get it, right?
These are the biggest problems I've seen as it concerns why people aren't getting the HRV scores they should:
1. You're too stressed
If you work 40 hours plus a week, and have kids, you got stress. Even if you don't have kids, you're life could be stressful from:
The point is that a lot of stress typically increases the sympathetic nervous system, and you'll see it reflected in your HRV score too.
2. You don't do enough parasympathetic activities.
You need to be practicing non-stressful things like
If you don't do these things, you seriously need to examine your life... or get a divorce.
3. You don't train enough.
In my experience in getting a 75-85 HRV score, you should definitely be training at least 5 times a week. This would likely include two or three strength training sessions and two or three cardiovascular-based sessions. If you can't get that in because you are too busy, don't worry. Wait until you are not busy enough, before you "force" a sixth or seventh session. If you force these in, you'll burn out quick.
4. You don't train long enough.
Sorry to tell you, but that 20 minute walk is not really cardio. While it is parasympathetic-dominant activity and is great for relaxation, it won't magically increase your score up to 80. You need to be doing some serious cardio for at least 30 minutes with a heart rate in the 120's or higher.
This is me combining the best of both worlds with grilling some healthy foods and getting in some intervals at the same time. It looks ridiculous, but if you really want it bad enough, you will find ways to accomplish what you need to do.
These were my stats after the session. In the amount of time it took me to actually cook the chicken and veggies on the grill, I got in a great cardio session.
5. You a lot more crappy foods than you realize
These are not great for your HRV scores:
For those who are looking to drop weight or improve their body composition, it is pretty critical to be strict around these things. You don't need to be irrationally defiant, but you should have very clear plans and boundaries.
Getting a high HRV score is challenging, but with patience, and a willingness to change, you can do it.
If you have a neutral scapula and a neutral humerus, you need to maintain that neutrality.
For the scapula, this means doing a balanced combination of aBduction work (i.e. push ups, protractions, etc.) and aDduction work (i.e. rows, scap retraction holds, etc. ).
For the humerus, it means doing a balanced combination of internal rotation (i.e. push ups, chin ups, etc.) and external rotation (i.e. DB external rotations, face pulls, etc.).
Even while trying to maintain a balanced combination, you may find yourself in rows 2nd through 6th below.
If you play a sport, where the upper body is used at all, you'll also likely find yourself in rows 2 through 6.
Let's go into treatment options if you are in rows 2nd through 6th by starting on row 2.
In this scenario, we want to keep the scapula neutral. However, the humerus is internally rotated because the pencil points inward. The humerus might be internally rotated because of a mobility restriction (i.e. tight pecs), stability restriction (i.e. weak external rotators), or both.
We don't need to make this more complicated than it is. If you want to test the length of the pecs and lats, you are welcome too. However, I've found that even if you don't find them to be short, it can still help to deactivate dominant pecs and lats which can help in correcting the dysfunction.
In our case, we're going to go through everything.
Let's begin with the pecs. The pecs are a primary humeral internal rotator, and if you're client has done any significant amount of bench pressing or push ups, chances are their pecs may be tight or at the very least contributing towards greater stiffness than the humeral external rotators.
Let's stretch them out. We're going to focus on a static hold for this stretch because this is one of the best ways to help deactivate the pecs. If our scapula is too abducted, this is a great opportunity to try to squeeze the shoulder blade together. Noticed that I said shoulder blade, not shoulder blades. The other shoulder blade might not need squeezing, so make sure you individualize your programming.
This gives us two ways to do our pec stretch. The first is without us trying to retract (or adduct) our scapula, and the other is with trying to retract the scapula.
In the picture below, I'm trying to feel a stretch in the pec area, and not adduct my scapula since it's not abducted.
The last major internal rotator of the shoulder are the lats. We've covered stretching the lats before, but I want to point out that we want to make sure we eternally rotate the arm, then bring our arm overhead. This is a basic lat stretch:
We've addressed the mobility, so let's focus on stability. Specifically, we need greater external rotation of the humerus. We need to work on the primary external rotators which are the infraspinatus, teres minor, and the supraspinatus.
In order to do this correctly, you need to make sure you are getting pure rotation from the shoulder. If you feel or notice forward or posterior translation of the shoulder, you are compensating. You'll see what I'm 'talking about below.
We've come to the third row. We have a scapula which is abducted and a humerus which although it points forward is actually externally rotated. The reason why the humerus is externally rotated is, if the scapula is abducted, this will bring the scapula closer towards the humerus. But, there should always be a one-to-one relationship between the scapula and the humerus.
In order for the humerus to stay neutral, if the scapula becomes more abducted, the humerus must internally rotate. Therefore, if the scapula becomes abducted, but the humerus doesn't internally rotate, this makes not only the scapula non-neutral, but it makes the humerus non-neutral. It makes the humerus externally rotated.
This brings us to the trickiest row out of all the rows, the fourth row.
This row allows for three possibilities:
1. The scapula is abducted moderately, the humerus is internally rotated moderately, which makes the humerus neutral, but the scapula abducted. The only treatment option here is to correct the abducted scapula.
2. The scapula is mildly abducted, the humerus is heavily internally rotated, which makes the humerus too internally rotated. However, the scapula should still be corrected. The humerus needs external rotation which we covered in condition two above.
3. The scapula is heavily abducted, the humerus is mildly internally rotated, which makes the humerus externally rotated. Again, the scapula position still needs to be corrected.
Let's treat the abducted scapula which applies to all three conditions above. We need to adduct the scapula. To do this, we can use a variety of exercises including rows, arms overhead scapula adduction, and face pulls. Since everyone knows what rows and face pulls probably are, I'll demonstrate amrs overhead scapula retraction which is one my favorite drills.
The last rows are effectively the same, but one is more serious.
The only difference between row 5 and 6 is that row 6 is a more serious version of row 5. In both conditions, we need to correct the adducted scapula. Even if during the pencil test, the pencil points forward, the adducted scapula results in an internally rotated humerus. However, if the pencil points inward at all during the pencil test, the humerus is even more internally rotated.
We can clearly see we need greater abduction in the scapula for both conditions. For this, we can use some scapula protractions like these. The most popular protraction exercises are either the push up with a plus or the push-up protraction (without the bending of the elbow).
I prefer the push up protraction without bending the elbow when individuals have an adducted scapula. The reason why is because when the humerus is internally rotated, doing push ups isn't going to help that.
What will help the internally rotated humerus are DB external rotations. If you have the row 6 condition, you will definitely need to focus on DB external rotations.
You should see an almost immediate improvement after doing these exercises. Make sure to to monitor the scapula and the humerus over time to make sure they get neutral (or at least are closer to neutral). I've found that for some clients, it can take quite awhile (like many months or over a year) before even alignment is cleared up. Have patience, be persistent, and assess periodically.
You've all see the big guys that look like this:
Well, the problem is their not neutral. By that, I mean their shoulders are not neutral. If hold a pencil in our hand, that pencil should point forward like this.
This is actually called the Pencil Test. Simply hold a pen or pencil in both hands. Stand up. Relax. Look down at your hands. Note the angle measure of each of the pens in your hands. If they point forward, you can just write "forward."
However, if it points inward at all like this, you may or may not mean you have a problem with your shoulder. You may have a problem with your scapula, shoulder, or both.
To find out which area you have a problem with, we also need to assess the scapula.
We are going to measure the distance from the middle of your spine to the scapula. For our purposes here, we'll measure the middle of the scapula, meaning this area here:
On the scapula, I want you to measure not at the top of the scapula, nor at the bottom. Measure in the middle of the scapula like the picture shown above.
Next, note the measurement. You need to keep track of this over time. Then, we will compare it to the humeral findings above.
A normal measurement of the distance from the middle of the spine to the middle of the scapula is 2.5 to 3 inches. If you are below 2.5 inches, you would be considered aDducted. If you are greater than 3 inches, you are considered aBducted. In either case, you need to try to get back into the normal range.
Here is what you need to know. The scapula and the humerus are intimately connected. The most essential group of muscles which connect directly from the scapula to the humerus are the deltoid, teres major, and the four rotator cuff muscles (supraspinatus, infraspinatus, teres minor, and subscapularis.)
If either the scapula or the humerus is out of neutral alignment, it will affect these muscles.
Here's the thing. There are a lot of variations for how the humerus and scapula will be and we are going to go over all possibilities here.
Here is a chart I created to help you.
Let's examine the first row.
If your scapula and humerus is neutral, you don't have to worry about anything. You just need to try to maintain that neutral posture. However, I don't often see much clients who find that are initially like this. They'll usually fall somewhere in rows two to six.
If you are in the second row, you have a neutral scapula position, but your humerus is internally rotated (because the pencil points inwardly). Because of this, you need to get your shoulder more externally rotated. We'll go over these treatments in the next video series.
If you are in the third row, you have a scapula which is aBducted, and you have a shoulder which is externally rotated. You might ask, "but the pencil faces forward, how can I have an externally rotated shoulder?" Well, you would have a neutral shoulder alignment IF your scapula is also neutral. However, if you scapula is abducted, it results in an externally rotated position for your humerus.
This is why the treatment for this condition is both to get your scapula more adducted, and to get your shoulder more internally rotated.
In the fourth row, you have a scapula which is abducted, and you have a pencil which faces inwardly. In this situation, there are three possibilities for the humerus, and we'll cover those right now.
Let's assume you have a scapula which is abducted to 3.5 inches. Let's also assume you have pencil test which results in the pencil inwardly rotated at 45 degrees. In this case, your humerus would actually be neutral, and we would only need to adduct your scapula to get it back to neutral.
Let' assume a different scenario. You're scapula is abducted 4 inches. The angle of your pencil is only rotated inwardly by about 20 degrees. In this case, because the scapula is so abducted, and the inward rotation of the arm is slight, your shoulder is still considered externally rotated. You definitely need to get the scapula adducted, but you can still focus on internal rotation for the humerus.
In our last scenario (under row 4), let's assume you have a scapula which is abducted to 3.25 inches. Now, assume you have a pencil test which is 90 degrees. Basically, the pencil is pointing at the other arm. In this scenario, we have slight abduction of the scapula, and significant internal rotation of the humerus. We can still focus on adduction for the scapula, we we would make sure to try to externally rotate the humerus as part of our treatment.
In row 5, we have an individual who has an aDducted scapula, and a pencil test with the pencil facing forward. In this scenario, we actually have a humerus which is internally rotated. We will need to focus on adducting the scapula and externally rotating the humerus.
In row 6, we have an individual who has an aDduted scapula, and a pencil test with the pencil facing inward. This is a dangerous scenario and in many cases that I've seen, accompanied by shoulder, neck, or upper back pain. It is imperative to not only get greater abduction for the scapula, but to really get the shoulders more externally rotated. In this scenario, we likely have a rotator cuff which is stretched out not only from the scapula being more adducted, but from the humerus being more internally rotated.
With just two simple variables: the scapula and the humerus, we need to be careful which exercises we choose. With anyone who plays a throwing sport, or has had a history of injury around the shoulder, it is critical to understand and track the measurements of both the scapula and humerus. Both need to be neutral (or get more neutral), and stay neutral.