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).  

(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: 

• Anxiety
• Relationships 
• Being too busy
• Compulsory Behavior or Addiction
• Moving
• Having a Bad Job
• Taking care of dysfunctional friends or family members 

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

• Sleep 8-9 hours a night.  If you think you are optimal at 7, you're not. 
• Eating well
• Meditation (I like Insight Timer app)  
• Hanging out with healthy family and healthy friends (as opposed to blood-sucking one's)
• Taking a vacation
• Taking full advantage of work breaks throughout the day
• Not working too man days in a row
• Watching Netflix
• Getting up every twenty minutes from your computer.  Set a timer!  
• Volunteering
• The stuff which tends to give our life more meaning.  

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:  

• Overweightness (unless you carry an abnormally low body fact percentage) 
• Alcohol 
• Smoking
• Fried foods 
• Eating too much sugar (USDA recommendation is 100 calories of added sugar for women, and 150 calories for men) 
• Eating out at restaurants, fast foods, or your favorite sub-shop three times or more per week.  
• Using a vending machine
• Eating small snacks, candies, confectionary, rolls, baked goods, cookies, most crap at a gas station, etc.  
• In the summer (like in Minnesota), you rationalize eating anything at a fair, or for that matter, anything outside. 

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.