After you have mastered a zone of apposition (ZOA) during exhalation, you must be able to maintain it. Dr. Sarah Petrich reviews the ZOA and the diaphragm biomechanics during the breathing cycle. She then demonstrates three exercises that train the ZOA and strengthen one’s ability to acquire and maintain the ZOA with the coordination of the abdominal muscles.
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
After you have mastered a zone of apposition (ZOA) during exhalation, you must be able to maintain it. Dr. Sarah Petrich reviews the ZOA and the diaphragm biomechanics during the breathing cycle. She then demonstrates three exercises that train the ZOA and strengthen one’s ability to acquire and maintain the ZOA with the coordination of the abdominal muscles.
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
Just be happy with
Speaker 2:The end . Hi, I'm Dr. Sarah Petrich and, and our last video we talked about attaining A-Z-O-A-A zone of opposition so that your diaphragm relaxes and domes up as best as possible so that then you can contract it better when you inhale. So just to reiterate, when you exhale, your diaphragm domes up into your chest cavity and it relaxes. But now we're gonna talk about when it contracts. So if you think of , uh, your diaphragm domming up and if you can see my fingers, they're separating 'cause they're the muscles relaxing When you inhale the diaphragm, those fingers or those muscle fibers should get closer together as the diaphragm flattens down and helps pull air into your chest. Now that being said, if your ribs splay outward as you inhale, such as the case in something like belly breathing, or if you're just trying to suck in your gut, those ribs will flare out. What will happen is maybe those, those muscles will contract a little bit and overlap, but the outer borders of the muscle are going to flatten out and you won't get as much contraction as you would if you kept the borders of your rim cage really nice and stable and maintained a good breathing posture. So in the last video we exhaled, we talked about exhaling and letting these ribs come down and in and back so that your bell shape rim cage can swing back a little bit and get that zone of apposition we've been talking so much about. Now, when you inhale, you need to maintain a little bit of zone of apposition , meaning you need to maintain some fibers of the diaphragm up against the inside wall of this rim cage so that it , that diaphragm doesn't completely flatten and splay out so that you get better muscle contraction of your fibers of the diaphragm. So how do we do this? Well, the first thing we did to attain the zone of apposition is we exhale and then we hold that breath out for a really nice long time to give the diaphragm time to relax and dome up. But when you inhale, what needs to happen is the abs that started to contract when you pull these ribs down and in it back to create a good position of your rib cage , they need to stay on. Now, they're not going to stay on and grip on, they're gonna have some mobility, but they need to keep their , uh, their pull on the front of these ribs down and in a little bit so that as you breathe in these ribs don't go flying forward. That's how we maintain your zone of apposition as you inhale, and that's how you maintain your good breathing posture as you inhale without completely , um, getting a bowling ball , um, expansion belly in the front of your body. So the important thing here is can you keep your abs on at least enough to keep this rim cage position? Now we're gonna work on that with some exercises that I'm gonna show you in a minute. Um, some of those exercises are just gonna be about breathing, but some of them are also going to call in a few extra, what I like to call abdominal buddies to help you maintain this rim cage position so those abs can learn how to both pull these ribs down and in and back and keep those ribs down and in and back when you inhale. So here we go. All right , now I've got a lovely balloon for you here. We're gonna bend those knees back up so that their knees are at the same height as your hips. Tempting to put your feet down over there, but, and I ideally, I like feet up kind of on a wall, but we'll just keep 'em on a chair. Now this is , um, called a 90 90 hip lift with balloon. Um, and it's a , an exercise that was originated by the Postal Restoration Institute and we're gonna be performing it here for the same purposes. And that is gonna be first we're gonna learn how to flip that balloon to help you get a little bit of some feedback for your breath. So you have to have enough power behind your exhale to get these ribs down and in. And so we're gonna make sure the balloon helps you get that. And then we're gonna pause. So you're gonna exhale and then you're gonna pause and then I'm gonna have you hold your breath out. And then without pinching the balloon shut or biting it with your teeth or sticking your tongue in the hole of the balloon , uh, I know all the cheats . You're going to keep that balloon opening open as you breathe into your nose. Got it? Okay . Let's just do the balloon part. So you're gonna breathe into your nose, exhale out to the blue , And then as he'll , uh, exhales all the way out. His ribs are coming down and in and you might be able to see that on camera and then hold your breath out for as long as you calmly, comfortably can. And I'm gonna add one more thing for you to do. Can you put your tongue on the roof of your mouth right now? Good. That helps relax your neck and then breathe into your nose. Good. And you're trying to keep the air in the balloon as you inhale. Now exhale out and do that again. Blowing all the way out. Ribs are gonna come down and in and back. So that bell is gonna swing backwards and then, oh , you breathed in already. We gotta do that again . Exhale all the way out . And you gotta hold that breath out longer there. Hold it out. Feel how those ribs came down. I would like you to sense how those ribs feel and almost try to keep 'em there as you put your tongue on the roof of your mouth and then breathe through your nose. Good. Do you feel that air going into your chest now? Mm-Hmm, <affirmative> . All right . Pinch off the balloon and let the air out, but don't point it at me. You can pinch it with your fingers too. <laugh>. All right . So that's one half of that exercise. So you can just work on blowing up a balloon and that can start getting these ribs down and in and air into your upper chest. And it can also promote more airflow into the back of your ribs, but you won't be able to feel it as much here in this position 'cause you're laying on those back ribs. Now there is a few muscles that actually help put you in a good position for that to happen. Even better. So if you press your heels down a bit into this chair and it's gonna be a straight down, you can use that pressure downward to help you kind of lift your hips up a little bit. Yep . And when you do that, can you do that without using your stomach or your back muscles? Yep . And it should feel like if you had a lower back tattoo, it sank down onto the table. Yep . Does it feel kind of nice and relaxing actually to the back? Do you feel these muscles working behind you? Those are your hamstrings and they connect to your sit bones. Those are those butt bones that get really sore if you're sitting on a really hard seat. So those muscles should be holding you up. You shouldn't be clenching your glutes. We're good? Yep . All right . We got hamstrings. Now those muscles help decompress your back from down below from your pelvis. And now we're gonna use your diaphragm as you blow out into that balloon to help decompress your back from above. So you're gonna exhale all the way out to the balloon, Let those ribs sink down and in . Oh, look at how much more they sink down and in hold your air out. Hold it. Enjoy that feeling right here. And I'm gonna have you inhale through your nose. Ah , nice. Good air expansion in through , through the lungs. Exhale all the way up. Not a lot of belly breathing going on anymore. Fantastic. Exhale. Hold that breath out. Hold it, hold it. And don't forget that your legs are working and then we can breathe into your nose. Oh , I can hear the nose like the nasal breathing. It's so nice. Exhale all the way out. Hold that breath out. Hold it, hold it, hold it. And tongue on the roof of your mouth breathing in through the nose. Pinch off that balloon and let the air out. All right , go ahead and relax the leg . All right . The legs got a little bit of a workout . Didn't thing . Yeah . <laugh> . Yep . Did you feel how you weren't expanding in your abdomen? Yep . Now , um, part of the reason why we're going over this is because we understand how important nasal breathing is and how important. So that's just your upper airway, but that's really, I improved when you can exhale through balloon and inhale through your nose. Um, but it also improves how you're using your airflow through the lower part of your airway, which is your chest and lungs. So if you have those kind of good mechanics, it's gonna help you make better use of a product like oxygen plus, because first of all, you're getting rid of more ex or more air before you take an inhale. Um, you just gotta remove the balloon though. <laugh> ? Yeah . First. All right . So Lynn , let's do a few other , uh, exercises and then we're gonna retest you and see if some of those videos that we did of signs that you might have some dysfunction in your breathing or imbalance in your breathing. We're gonna see if they got improved. Okay? We're going to do something called the short seated wall reach. And you can do this with your backup against a wall. And traditionally it is done with your butts on the floor. However, I'm kind of nice and I like to make it a little more comfortable. So plus we don't have a wall behind you. So , uh, you'd be really extra uncomfortable without uh, this little block underneath your butt. So you could do this also by the way, on like a stair step , which is about the same height. Now I'm gonna have you blow up that balloon like we did earlier. Uh , I'm gonna have you hold it in your right hand. Yep . And your left arm. We're gonna reach it forward and you can rest it on your knee. And I'm gonna have you put the balloon in your mouth and I'm gonna have you exhale out to the balloon and feel those ribs sinking down, just blowing up that balloon so his ribs are swinging back. And then go ahead and breathe into your nose. And then we're gonna exhale all the way out again. And I'm gonna Yep . Have you let those ribs sink down. Now on your next inhale, don't inhale yet. On your next inhale, we're gonna reach this left arm forward a little bit more and breathe in good. And then exhale all the way out. Hold that breath out, hold it, hold it, hold it. And then we can breathe into your nose, letting air flow into those back ribs. Feel 'em back here and exhale out. We'll do one last one. Hopefully the balloon balloon won't pop. We're good so far and we'll reach this arm forward a little bit more breathing in. Pinch off that balloon and let the air out. Not at me though, <laugh> . Alright , now I'm gonna change it up a little bit and we're gonna take that balloon out completely. So that's a really nice tool to kind of reset your breathing posture so that it's in a really good position for when you inhale to getting more oxygen, which brings me to this. So we're gonna bring both arms forward and we're gonna reach forward with both arms. Now when we're reaching forward with both arms, we're actually engaging a muscle in the back of your shoulder blade called the serus in it Yes. Pushes your shoulders forward, but it also retract your ribs back so that you restore this curvature of your rim cage . Now I'm gonna prepare here. Okay. So if you wanted to utilize , um, the oxygen plus you might decide maybe I do a little exercise at the same time so that I can get all air out and then when I inhale I can get a little more air flow and a little take advantage of , um, what you can get out of just one puff. Here you'll get more. Okay . So I'm gonna have you inhale through your nose, exhale all the way out, and reach both arms forward and let the ribs sink back. And we got the ribs back. Yep . And then you could keep one of these in your hands. Yep . Breathe into your nose. Let's do one more exhale all the way out rims. Go back and then you could take this, let's put it in your right hand and then you could bring it right up to your face. Yep . And then do a puff and inhale through your nose and exhale out and go back to reaching forward again. Did you feel that nice, big inhale. Yep . Yep . Go ahead and relax and you'll get more , uh, benefit from just one inhale. So basically you'll let your canister work longer for you. Yep . So there you go. That's that exercise. Alright , let's do one last , uh, movement or exercise. So I'm gonna get rid of this balloon, no balloon for this one and this particular exercise, we're gonna go on your hands and knees and most people are gonna recognize it as part of a very traditional yoga exercise called cat camel. Right? So are you familiar? Yep . Yep . So , um, as you round your back, we call ah , the other way as you round your back that's called cat . And if you go the other way , uh, I've heard that called camel or cow <laugh> . Um, but we're not gonna do focus on this PO position because in this position the ribs are going down towards the floor and that's , uh, not a bad thing. Um, your spine's gonna extend, but it's not gonna help us attain this , uh, rib cage back position for good diaphragm mechanics. Uh, it's not gonna help us attain that zone of apposition . So we're going to exhale and around the back into that angry cat position. And now we're gonna get a lot of flexion through the spine, but we're gonna get these ribs to start to come back and in. And as you do that, we can stay there and breathe in and keep those ribs back and figure out how to get more air expansion into the back of the ribs. Now start all over again, Robert, because I'm gonna have you bring your hands back a little bit so that they're underneath your shoulders and I'm gonna ask you to do one more thing when you round your back, most people like you normally would, especially if you're doing it the yoga way, your head's gonna look down towards your thighs. But because , uh, I want us also to consider your upper airway, which means your throat and your head , uh, we're going to have your head in a different position. I'm gonna have your eyes looking straight between your hands the whole time. If you think about if you , uh, ever have seen or done , uh, CPR training, they always say tip your head back to open up the airway. If we keep your eyes here, it's gonna be the equivalent of open up that upper airway here, if that makes sense. So now I'm gonna have you exhale and around the back letting these rims go back . Ah , don't let your head drop either. So start over. Yep . You're looking there. Your nose is gonna stay in the same spot, but your rim cage is gonna go up towards the ceiling. Ah . Don't bring your head down. You're gonna exhale, push through your hands as you exhale and use your hand push to pull your ribs away. There you go. Do you feel that? Mm-Hmm. <affirmative>. So you're exhaling and pushing with your arms, kind of like that reach you did sitting to get those ribs back and in that feel different. Mm-Hmm. <affirmative>. Oh, let's do it again. So, so we master it. Take a breath of air in here, exhale. And as you exhale, we're gonna pull those ribs away from the floor. Even your sternums going away from the floor. And then you can round your low back as well. And if we , uh, for you, we're gonna focus a little more even on the low back. Now if you hold it there and take a breath of air in, where do you feel the air flowing? More into my upper back. Your upper back where? In the back or in the front? In the front. In the front. Ooh . I like that. He did have limited air expansion in the front of his chest before. Yep . Go ahead and keep breathing and we're gonna exhale all the way out when you exhale. Really like the let the abdomen just deflate like it's a balloon deflating. And then when you breathe in, see if you can breathe in not into the front of your body or the front of your abdomen I should say. But see if you can feel air flow into your back rim cage at doll. Do you feel that? And I can see it. Ooh . But do you feel this wanting need to start to push downward? Mm-Hmm. <affirmative> . So , um, Robert wants to start letting his ribs come down towards the floor, especially when you take that big breath of air in . This is where knowing your abdominal buddies comes in handy. So your triceps and your serus muscles can actually help keep your ribs in that back bell swung backwards position. And even your hamstrings here can work. If you imagine pushing your shins down into the floor . And as you should push the , the knees down into the floor, your abdomen can pull away from the floor. See if you can find that. You feel that? Mm-Hmm. Do you feel these muscles? Mm-Hmm ? <affirmative> . Oh , okay. Yep . All right . Go ahead and relax. All right . I'm just gonna have you do , I'm, I'm just gonna double check . Go ahead and push those knees down again. And as you push them down, it should feel like if you had a tail on each butt cheek that they're going to , those tails are gonna point down towards your knees. Mm-Hmm . <affirmative> . And this is rounding. Then we're gonna add the arms. We're gonna exhale and round the back a little more with those arms. So we've got hamstrings helping kind of around the back and we're using those arms to help around the back. And we're gonna stay there and use those arm muscles to help keep that shape of the rim cage as you take a breath of air in and not let the air go into the front of the abdomen. Exhale all the way out . We're gonna use the arms and the legs to help deflate the abdomen. And then we're going to keep the air out of the abdomen as you breathe in. Ooh , that's a little harder to breathe in. Mm-Hmm. <affirmative>. Yes. Exhale all the way out. Now I know you got it. And yet your airflow might feel a little restricted if you're tight in the back of the ribs or in your upper chest. But as you do that a few more times, you're gonna get more mobility of the ri cage and it'll actually help even your resting breathing. Go ahead and , and relax. 'cause I'm a little tired for you. <laugh> . All right . And did you feel your abs working? It
Speaker 3:Was getting easier to breathe as we went
Speaker 2:Along too . Oh , it was getting easier to breathe as you went along. Perfect. Um, and uh, let me go back. Did you feel those abdominals working? Mm-Hmm. <affirmative> . Did you feel 'em just in the center or on the sides? Towards the sides. Perfect. I couldn't even have asked you to say it any better. Um, so the sides of the ab abdominals are really more what if you sense those, those are your obliques and your deeper abdominal muscles that actually support both respiration and it should do that first. But then also they're more important for core stability for spine and joint health as well . All right , thank you very much. Now let's go ahead and recheck the shoulder and the neck and see how those are looking. So the right shoulder was pretty limited before, so we're gonna go ahead and check it again. We had, what did we say? 50 55 degrees. 55 ? Yep . Um, so I'm gonna protect this shoulder, make sure it doesn't cheat . And here's 45. Here's 55 and it just keeps going. That's 80 degrees. That's perfect. Textbook right there. So nicely done. Uh , let's come back center . I'm gonna check your neck as well. And we had limited, pretty significantly limited left neck rotation and then the right one was pretty darn good. So relax here and boom. Lovely. It was like something like that. Mm-Hmm <affirmative> . But now it's really nice and loose. Ooh , you're gonna sleep well the night . Relax here and we're gonna turn it to the right right's. Still good. It's still just as good as before but now the left is matching it. All right . Very nice. Then I'm gonna push on your ribs on this left side. That was the side that was harder for me to push down. And then it was also harder for to us to get air expansion up here in the right upper chest. And this is a much more picky test. So we'll see how it goes. Take a breath of air in here. I like that nasal breath. Exhale all the way out. Hold out that air, see if those rims can sink down a little extra. It's a lot easier for me to push these ribs down though. Can you tell? Mm-Hmm, <affirmative> , let's see. It's completely out of air. And then breathe in. Ah , do you feel that airflow up here? That's exactly what we want. So we actually , uh, helped neutralize your spine and give you more shoulder motion and more neck motion. But all through just some , some breathing techniques but in specific positions to help encourage rims to come down and in hold your breath out before you breathe in. Alright , 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.