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.

Good luck!  

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.

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​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.  

• Your sleep needs to be good. 
• 90% or more of your foods (not just calories) should be coming from whole foods. 
• You should not be losing more than 1-2 pounds every week unless your BMI is above 30.  If it's slower than that, that's okay.   
• Your stress levels should be low to moderate. 
• You need to be exercising at least 5 days a week. Each session should be of at least moderate intensity for 30 minutes or more.  
• Lastly, you may just need time for your body weight set point to adapt to where you are at now.  In this case, you should focus on maintaining where you are at, and getting used to your new situation.  In this scenario, it never hurts to continue to try to eat better, get enough sleep, manage your stress levels, and exercise as much as you can. 

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. 

Final Thoughts

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.  

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.  

1. Place your foam roller under your top knee.  
   
2. Try to have your knee be perpendicular or at 90 degrees relative to your torso.  Keep this leg in position the whole time.  
   
3. Bring your arm up top, and try to touch your hand or thumb to the floor and keep the thumb in contact with the floor the whole time.  
4. Bring your arm out to the side while either inhaling the whole time or exhaling.  Practice doing both when your arm is going out.  
5. Perform repetitions for 45 seconds to one minute.  

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).  

(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.  

If you find your pelvis does not level with legs spread wide, we need to get you fixed.  This article will demonstrate the ways you can fix your pelvis with structural and strength training methods.  

It's quite possible that if you had one pelvis higher than the other when spreading your legs wide, you unconsciously stand like the picture below.  

It's also quite possible that despite what the picture shows (which is an elevated right pelvis in standing), you have an elevated left pelvis (when trying to stand symmetrically). 

How could this be?  

What happens if you pound a really long nail into the ground?  The more force you pound with, the deeper the nail will go, right?  So, imagine you spend hours or at least everyday for 30 minutes or more standing mostly on one leg.  

Whichever leg you stand on most, the deeper that hip will go into the socket (or acetabulum), which effectively makes the leg shorter.  If one leg is shorter, this will lower the that same-sided hip toward the ground more. Consequently, the opposite pelvis will be higher.  This is why if you stand a lot, you are more likely to have a socket-caused issue rather than a postural-caused issue.  

What's the fix for a socket issue?  Assume you have an elevated left pelvis issue because you stand on your right leg like the picture above. The answer is to begin to stand on the opposite leg.  However, we don't necessarily need to continue to lower the right pelvis to get the benefit of mostly standing on the left leg.  

In my experience, even standing with a depressed right pelvis like the picture above will still lead to positive results if you have an elevated left pelvis. 

That's really about it.  Here's the thing though.  You will stand on your right leg unconsciously. It means you really need to pay attention as much as possible to standing on your left leg.  

I tell all of my clients who've had this problem that that you will not be perfect.  You will find that you find yourself standing on your right leg, and when you do, it's time to swtich, not give up . The more you practice or notice yourself - and correct yourself, the faster an effect you will get.  

Let's assume you have a client who does the wide leg stance test and finds their right pelvis is still elevated.  It's no wonder as this client stands a lot and happens to stand on their left side. Again, this makes left femur deeper into the socket of the left acetabulum.  It results in a lower left side.  

In this scenario, we want to put more pressure into the right acetabulum and distract or take away pressure from the left acetabulum.  We can accomplish this with:  

It's important to note that the left leg is not supported on anything.  It's simply hanging. That's the goal because we want the left femur not so impacted into the left acetabulum.  

As you can see, I can also focus on the likely weaker left obliques by trying to raise my left pelvis to the ceiling.  

To challenge the obliques more and to get a greater distraction for the left side, you can use a DB in the crux of your left knee.  (I find this is a good left hamstring warm up too as the left hamstrings are frequently weaker than the right hamstrings.) ​

I recommend putting this exercise before stretching and strengthening exercises.  Think of it as a realignment exercise.  After this, we can begin to address mobility and stability.  ​

Before we get into the strength training, you need to make sure that all positions you are in have at least a level pelvis. Let's assume you have an elevated right pelvis.  You could also position yourself with an elevated left pelvis to correct yourself in the short term.  Let's assume you're normal pelvic position during the plank is: 

You want to make sure that you can at least get a neutral pelvis or even an elevated left pelvis in this situation (since the right pelvis is elevated) 

The next part we can focus on is the left adductors. 

I'm not doing a great job of keeping my pelvis level, but I should be more level.  Basically, my pelvis line in this position should be vertical.  

For the adductors, you should be able to hold this position for  along time.  You can build your way up to putting a 10 to 30 pound dumbbell on your mid thigh. Hold for 30 seconds in the top position for multiple sets.  

You may need to mobilize your adductors and abductors and to be honest, it usually never hurts to do this.  Even if you are hypermobile, stretching the shortened abductors and adductors can help turn these muscles off.  

In our case (as we are still working with the elevated right pelvis), I'm going to put my right leg on a wall as shown in the picture below to feel a good stretch in my adductors.  If you cannot make it to at least 45 degrees, then you definitely need to try to get to 45 degrees. Hold for 30-40 seconds.  

I don't do a great job keeping my pelvis level, but you should try to keep it level or even have the left pelvis elevated. 

Next, it's time to stretch out the left hip abductors.  To do this, we are going to make sure we have a level pelvis, then get into the stance like the picture below.  

As you can see, there are many different ways we can attack a lateral pelvic tilt.  Make sure that you at least test the wide leg stance first to know which direction you should go with either a postural-caused or socket-caused lateral pelvic tilt.  

Regardless which you have, you should do appropriate strength training and always make sure your pelvis is level before beginning any exercise.  I'm confident that you will get out of your lateral pelvic tilt fairly quickly if you are diligent in watching your posture and using stretching and strength training together.  

​This woman obviously looks like she is in shape, and she may or may not have a lateral pelvic tilt.  

Lateral pelvic tilt simply means that one of your pelvis is higher than the other. (This is different than a leg-length discrepancy because how far up the femur is in the socket can influence this.)

In this article, we’ll explore some postural corrections if you have a lateral pelvic tilt due to your posture.  There is another possibility which we will explore in my next article. We'll also cover the strength training corrections in the next article as well.  

Our corrections here will entail checking your alignment and correcting all the postural positions which could be contributing or causing it. 

Our first test is going to directly assess the pelvic rim using our hands.  Make sure both feet are together and that one foot is not in front of the other. 

Using your palms, make sure that you don’t tickle the hell out of your client because if you go with fingers digging into the sides, it’s not comfortable.  If you use your palms at first, they will be a lot less likely to be tickled. 

​You can either use your palms or fingers to go into the sides of the pelvis.  From here, you can use your middle fingers (or palms if they can’t tolerate the middle fingers), to see how your fingers line up.  If you find they are equal, great!  You’re done, and can move onto another assessment.  

If you find there is a half inch difference or greater, you need to correct it.  

The second assessment you need to perform is simply standing with your legs wide.  If you find that your pelvis becomes completely level or significantly improves, you should continue with the postural recommendations below.  If however you find there is no change, check out the next article.  

The corrections are simple.  The first is standing. Let’s assume you have an elevated left pelvis. To correct this, we are simply going to try to stand like this as often as we can.  ​

As you can imagine, if you had an elevated right pelvis, you are going to stand like this as often as possible. 

I think you get the idea.  Let's assume you had an elevated left pelvis. You can use a small folded up towel to put under your left ischial tuberosity.  

You wouldn't even be able to tell that you are sitting on the pad.  Here is something you need to be careful of however.  

​Since we sit so much, I've found myself and clients can ruin or efforts if we tend to lean to one side or the other. Sometimes, having a pad under our right side can cue us to lean to the left like this: 

Avoid this position and make sure to sit straight up.  You can literally ruin your efforts, because this position effectively puts us back in an elevated left pelvic position which we do not want. 

​The last position we are concerned with is our lying posture.  

For those with wide hips and a small torso, this can be a real problem.  It can be even more of a problem if you only sleep on one side or the other.  One of the best ways to stay neutral is to sleep on both sides.  If you can't however, one thing you can do is to use a pillow under your torso like this:  

Lastly, some people simply like to lean to one side or the other when they are lying down.  This can lead to a lateral pelvic tilt.  It simply feels more comfortable to them.  If you can get a picture of yourself, you might look like this: 

To correct this, you need to try to get into the opposite posture. It will feel weird.  In fact, all of your new postures should feel strange and unfamiliar at first.  It's because you don't do them.  By making sure that you address all of your main postures, you will get out of lateral pelvic tilt. 

​When I get clients in the gym and I tell them to simply stand up straight, here is often what I see:  

The weird thing is that we can’t really know if we are rotated because it’s simply normal to us. In other words, your neutral is not neutral.   

The problem is pelvic alignment is a big deal.  The pelvis can of course effect the pelvis, but it can also affect the low back, the hip, the knee, thoracic spine, neck, all the way down to the ankles. 

For individuals suffering from back pain or hip pain, I highly recommend taking the 10 seconds required to merely check for pelvic rotational asymmetry at every session. 

What is pelvic rotational alignment?  It’s simply this: 

Put your fingers on the ASIS and make sure your thumbs are of equal distance to you.  If you find that one thumb is farther away from you like this picture below, you have a pelvic rotation. (It's difficult to really tell in the picture, if you try it out, you'll quickly be able to tell.)

You can also do a self-assessment by putting your own thumbs on your ASIS and see if any of them are more forward than the other.  

​It might not seem like a big deal, but if you find one thumb is more forward than the other, this automatically entails:

·The lumbar spine is automatically rotated because of the close proximity to the pelvis. 
·The thoracic supine and upper thorax are automatically rotated (or have a torque) because of the rotation going on in the lumbar spine. The upper thorax may compensate or not.
·One of the femur’s will internally rotate while the other will automatically externally rotate. 
·The knee joint may be internally or externally rotated.
·The ankle joint may be affected either in internal/external rotation or pronation/supination.
 
Typically, the low back and the hip joint will experience the most discomfort or pain when there is a pelvic rotational malalignment. 
 
Luckily, our corrections are fairly simple.  While there are some specific muscles we could chase like the TFL, lumbar erectors, or even lats, we need to correct the posture which gave rise to our malalignment.  (Releasing tight muscles can definitely help too, but let’s start with the posture.)
 
Addressing posture becomes fairly simple.  Since our malalignment likely arose from either a sitting, sleeping, or standing position, we need to focus on correcting all of these. 
 
Stand up, and reverse your pelvic position like this: ​

I will even try to rotate my clients pelvis towards the right and ask them to resist me.  This will strengthen the muscles which have become weakened to the pelvis being rotated towards the right.  

You need to hold this and then observe if your pelvis gets neutral. 
 
If you are training, make sure that you always start neutral. Be careful for lifts like squats and deadlifts because it is very difficult to control your pelvis with these type of lifts, especially if you are lifting heavier weight.  If you’ve had pain with these type of lifts and you have a pelvic rotation, it’s very possible the rotation has contributed to your pain. 
 
This isn’t the end of the story. You need to make sure that your pelvis is corrected when sitting.  Chances are that you got a pelvic rotation from sitting like this: 

To correct, you need to have your clients sit in an eutral posture. 

When lying down,
 
You need to make sure that you aren’t lying on a groove.  Make sure your bed is flat.  You can even check your ASIS while laying down to make sure they are level.  If not, you should put something under the glute which is lower or sleep in a different part of your bed.  

Let's assume you are correcting a pelvic rotation towards the right.  This means, we need to make sure the pelvis is neutral or temporarily goes towards the left.  

When sleeping on your side, you should discourage right sidelying because it promotes a rotated pelvis towards the right. 

You could use a cushion under your top knee in the picture above if you really liked laying on your right side.  

I would say more emphasis should be placed on sleeping on your left side because this promotes your pelvis rotating towards the left.  

I'll find some individuals who only sleep on their right side, and sleeping could be the sole culprit.  

Still, you should examine everything to help them get neutral.  

Pelvic rotation is often a culprit in hip and low back pain.  Once you correct it, you may not alleviate all of your pain, but it is definitely a step in the right direction.