Dr. Sarah Petrich demonstrates the tests she uses in the clinic to assess breathing mechanics and imbalances for her patients. She also explains how shoulder and hip motion can also be affected by poor breathing. See Part 1 for “Visual Signs Your Breathing Posture Is Impaired.
The adduction drop test and apical expansion tests were used with permission from the Postural Restoration Institute®.
About Sarah Petrich, PT, DPT, PRC, NCPT:
As a specialist in Postural Restoration, Pilates, & Dance Medicine, Dr. Sarah Petrich provides physical therapy and Pilates training focusing on re-balancing posture, alignment and breathing for patients and wellness clients. When not in the clinic or on zoom, she's often traveling around the nation teaching educational courses to healthcare professionals, Pilates instructors and other movement specialists. You can find her and her courses on her website www.sarahpetrich.com or on Instagram at @drsarahpetrich.
Catch Oxygen Plus at @oxygenplus on TikTok and Instagram
Dr. Sarah Petrich demonstrates the tests she uses in the clinic to assess breathing mechanics and imbalances for her patients. She also explains how shoulder and hip motion can also be affected by poor breathing. See Part 1 for “Visual Signs Your Breathing Posture Is Impaired.
The adduction drop test and apical expansion tests were used with permission from the Postural Restoration Institute®.
About Sarah Petrich, PT, DPT, PRC, NCPT:
As a specialist in Postural Restoration, Pilates, & Dance Medicine, Dr. Sarah Petrich provides physical therapy and Pilates training focusing on re-balancing posture, alignment and breathing for patients and wellness clients. When not in the clinic or on zoom, she's often traveling around the nation teaching educational courses to healthcare professionals, Pilates instructors and other movement specialists. You can find her and her courses on her website www.sarahpetrich.com or on Instagram at @drsarahpetrich.
Catch Oxygen Plus at @oxygenplus on TikTok and Instagram
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Speaker 2:Will just be happy with the air . All right , we've got Robert back and as he's laying here , uh, you can see as he is laying here that his ribs flare up. Now a lot of times this can be even more so, but this is still a good flared rim cage. Um, what you can't see is that his left rim cage is a little flared up more than the right, perfectly normal. We all have an asymmetrical tendency 'cause your diaphragm's asymmetrical by design. It's just anatomically made that way and the left diaphragm is more disadvantaged. So thanks for coming. Robert. You are a typical disadvantaged left diaphragm <laugh> . Um, but we could see this rib flare , uh, and what we would like it to be. We'd like it to be able to, in a resting position, be just a little bit farther down ideally. That being said, especially if you're an adult , um, you might not be able to breathe yourself into a new body, but you do wanna have the mobility in your cage . Now when we do have somebody who is not breathing as ideally as we want and we don't have as much rib mobility as we want, there's certain predictable things that we can find. So shoulder motion is one of the biggest things that will be impacted. So I'm gonna have Robert scoot a little bit to the left and I'm gonna do one of the most important shoulder ranges of motion that you need to have to have healthy shoulders. But it also tells me about how good your rib cage is positioned. And here's his right arm and I'm gonna bring his right arm all the way over here, bend this elbow and we're gonna bring this right hand down towards the floor. I'm just gonna make sure you don't cheat. And here we go. Now this motion is supposed to be at 80 degrees and let's see, 45 is probably about there. Uh , so what do we call that? Maybe fifty fifty five. Uh , it should be. And notice my other hand is helping him cheat. It should flop down to here easily without this shoulder popping up. Now if you don't have good shoulder range of motion, it is most likely due to poor breathing mechanics. Sometimes it's actually some shoulder tightness, but that's actually more rare than even your physical therapist realizes. There's a lot of stretches for this shoulder that you can do that literally are holding this and trying to stretch this out. But we can get this looser just by a few breaths, which we'll do, but not yet. The other thing that I like to look at, and we'll check this shoulder motion on the other side in a minute, but the other thing I like to look at is I like to put my hands on ribs and feel how they move. We call it apical expansion. And by we , that's actually a test , um, that is uh, taut and instructed by the Postural Restoration Institute. And it looks like this. You're gonna put , uh, you me, I'm gonna put my hand on this rim cage and his uh , lower ribs and his upper ribs and you're gonna take a breath air in and as he exhales your ribs should have the mobility to go down towards your hip and sink down towards the floor. And Robert , I'm gonna have you just let me push on your ribs a little more. There you go. And relax those ribs and he can actually feel at the end of his exhale that those ribs drop a little extra. Did you feel that Robert? Yep . Um , and then I'm gonna take this one step further. So that's only half of the test. Further , I gotta be able to get ribs down on the side that I'm pushing down on. And then I'm gonna watch this side of his chest 'cause he's gonna inhale next and I'm gonna see where does his air flow into. I'm basically blocking him from being able to breathe into this right side. So he should get more air airflow in this left chest. He shouldn't be getting all the air foot flow into his abdomen. 'cause guess what? Lungs aren't down here. Lungs are up here and I'm blocking his right side from filling. So I should get more expansion in the left side. So let's see if you can survive a right lung collapse. Okay, I say that jokingly <laugh> take a breath of air in, exhale all the way out. Ribs come down when you exhale, hold that breath out a little bit. We'll just really let these ribs sink down and in and then take a nice deep breath of air in. Ah , alright , now we got some belly expansion. I did get some expansion here and then we're gonna check out the other side. So Robert, you're gonna turn around and face the other direction. I'm gonna bring that elbow out off to the side again. I'm just gonna make sure he doesn't cheat through shoulder. Bring this arm down. Wham, that is some fantastic shoulder motion. Now that actually tells me that he gets better airflow in this left upper chest than is right. So the shoulder girdle is right on top of the rim cage . And if this sucker is deflated and doesn't have very good air support, then the position of the shoulder socket's different and we're gonna have changes in shoulder motion. But he's got a little more air support under here. So he actually has better shoulder range of motion. Hey , and that left shoulder in a better position overall for your posture and for arm movement. Now we're gonna verify this. So on the , when I was on the other side, I pushed on his right rim cage and I actually was checking to see how good his airflow was up here. And eh , we got belly breathing and some airflow here. But now I'm gonna be checking how his airflow is here on the right side. And I'm gonna guess that it's limited because his right shoulder range of motion was limited on the right. So we're gonna compare the two. I'm gonna push on this rib cage . Robert, take a breath of air into your nose and exhale all the way out. And I'm gonna glide the ribs down towards his hip and sink 'em down towards the floor. And Robert, can you feel that I can't get these ribs down as well? It's really hard. I can feel it. There's no, I'm gonna let you breathe. But when I bring his hand , when I bring my hands down but his ribs down, there's no, and I , I know that's not a technical term but they , it should sink a little extra. That sinking moment is the diaphragm fully doming up and relaxing and you should be able to get there, especially with my help, but it's really hard for me even to do it. So let's do it again. Take a breath of air in , exhale all the way out . Ah , okay. That's hard for me to do. And then I'm gonna judge his inhalation. Go ahead and take a breath of air in and when he breathes in, he gets airflow down here, but definitely less up in this right upper shoulder or chest. Alright , I'll let you relax. So we can look at rib mobility, we can look at shoulder range of motion and there's some other shoulder ranges of motion that can be limited as well. That internal rotation motion is the most , um, easy and um , reliable one. Um, but we can also look at his neck motion. And even his hip mobility can be changed or disrupted because of airflow. The reason why we it is for the neck is because your neck is right on top of your rimage and if you overuse your neck for breathing and as um, we call it accessory neck breathing. So if you use it as an accessory neck breather more chronically, it's going to change your neck motion and tighten up your neck. Now when you have an asymmetry like Robert does, so he's got better airflow in this left upper chest than the right, usually what you find is more right-sided neck tension and that will limit it , limit neck rotation to the left and he'll have more range of motion going to the right because this right neck it will limit left rotation. So let's check it out. All right , we're gonna check your neck out Robert and relax. I'm gonna turn your head to the left and that's about it. You feel that? Mm-Hmm <affirmative>, that is it. And then we're gonna check to the right and boom, so much easier night and day. And that is 'cause you're not getting as much airflow here. So these right neck muscles overwork much more so all the time and that's gonna limit and affect your, your neck range of motion. Alright , so I got Robert on his side, I'm gonna check his right hip motion and it should be better. I also tell people this is my way of testing whether you can stand um, correctly on your right leg when you're upright and center your pelvis, your rim cage and your head over your right leg. And in order to do that let let this leg relax. I gotta be able to get this leg in alignment, this knee, hip and shoulder all in line and I should be able to get this knee at least to the midline of his body but all the way to the floor. So this knee should line up or come all the way to the floor so that his pelvis and his heart and his head when he stands just on one leg can center over this knee without creating torque. And that's actually impacted by your breath and through the pelvic floor and the systems of the pelvis will impact how you walk even. Let's go ahead and bring this leg back together and we're gonna switch over the other side. I'm gonna grab your right hip, sorry left hip. We're testing the left side, relax this leg and let's see if you can stand and balance yourself over your left leg legitimately. Alright , well we got a straight line, knee, hip and shoulder and now we're gonna let this knee drop towards the floor and do you feel a difference there? Yeah. Yep . It kind of stops just shy of that. Not terrible but could be better. There's definitely a difference between the two sides. So even hip mobility can be affected by respiration. So I guess we're gonna have to get you breathing better. Alright , so I guess that's the next video. Thanks everybody for watching and I wanna do an extra special thanks to Oxygen Plus I hope you learn something. And if you'd like to find me, you can find me@sarahpetrich.com. S-A-R-A-H-P-E-T-R-I-C h.com . Or if you wanna learn more about Oxygen Plus you can find them@oxygenplus.com.