November 14, 2023 • 11 mins
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
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:03):
We
Speaker 2 (00:03):
Will just be happy with the air . All right ,
we've got Robert back and ashe's laying here , uh, you can
see as he is laying here thathis ribs flare up. Now a lot of
(00:23):
times this can be even more so,but this is still a good flared
rim cage. Um, what you can'tsee is that his left rim cage
is a little flared up more thanthe right, perfectly normal. We
all have an asymmetricaltendency 'cause your
diaphragm's asymmetrical bydesign. It's just anatomically
made that way and the leftdiaphragm is more
(00:46):
disadvantaged. So thanks forcoming. Robert. You are a
typical disadvantaged leftdiaphragm . 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 downideally. That being said,
especially if you're an adult ,um, you might not be able to
(01:09):
breathe yourself into a newbody, but you do wanna have the
mobility in your cage . Nowwhen we do have somebody who is
not breathing as ideally as wewant and we don't have as much
rib mobility as we want,there's certain predictable
things that we can find. Soshoulder motion is one of the
(01:29):
biggest things that will beimpacted. So I'm gonna have
Robert scoot a little bit tothe left and I'm gonna do one
of the most important shoulderranges of motion that you need
to have to have healthyshoulders. But it also tells me
about how good your rib cage ispositioned. And here's his
right arm and I'm gonna bringhis right arm all the way over
(01:52):
here, bend this elbow and we'regonna bring this right hand
down towards the floor. I'mjust gonna make sure you don't
cheat. And here we go. Now thismotion is supposed to be at 80
degrees and let's see, 45 isprobably about there. Uh , so
what do we call that? Maybefifty fifty five. Uh , it
(02:13):
should be. And notice my otherhand is helping him cheat. It
should flop down to here easilywithout this shoulder popping
up. Now if you don't have goodshoulder range of motion, it is
most likely due to poorbreathing mechanics. Sometimes
it's actually some shouldertightness, but that's actually
(02:36):
more rare than even yourphysical therapist realizes.
There's a lot of stretches forthis shoulder that you can do
that literally are holding thisand trying to stretch this out.
But we can get this looser justby a few breaths, which we'll
do, but not yet. The otherthing that I like to look at,
and we'll check this shouldermotion on the other side in a
(02:57):
minute, but the other thing Ilike to look at is I like to
put my hands on ribs and feelhow they move. We call it
apical expansion. And by we ,that's actually a test , um,
that is uh, taut and instructedby the Postural Restoration
Institute. And it looks likethis. You're gonna put , uh,
(03:18):
you me, I'm gonna put my handon this rim cage and his uh ,
lower ribs and his upper ribsand you're gonna take a breath
air in and as he exhales yourribs should have the mobility
to go down towards your hip andsink down towards the floor.
And Robert , I'm gonna have youjust let me push on your ribs a
little more. There you go. Andrelax those ribs and he can
(03:40):
actually feel at the end of hisexhale that those ribs drop a
little extra. Did you feel thatRobert? Yep . Um , and then I'm
gonna take this one stepfurther. So that's only half of
the test. Further , I gotta beable to get ribs down on the
side that I'm pushing down on.
And then I'm gonna watch thisside of his chest 'cause he's
(04:01):
gonna inhale next and I'm gonnasee where does his air flow
into. I'm basically blockinghim from being able to breathe
into this right side. So heshould get more air airflow in
this left chest. He shouldn'tbe getting all the air foot
flow into his abdomen. 'causeguess what? Lungs aren't down
here. Lungs are up here and I'mblocking his right side from
(04:25):
filling. So I should get moreexpansion in the left side. So
let's see if you can survive aright lung collapse. Okay, I
say that jokingly takea breath of air in, exhale all
the way out. Ribs come downwhen you exhale, hold that
breath out a little bit. We'lljust really let these ribs sink
(04:46):
down and in and then take anice deep breath of air in. Ah
, alright , now we got somebelly expansion. I did get some
expansion here and then we'regonna check out the other side.
So Robert, you're gonna turnaround and face the other
direction. I'm gonna bring thatelbow out off to the side
again. I'm just gonna make surehe doesn't cheat through
(05:08):
shoulder. Bring this arm down.
Wham, that is some fantasticshoulder motion. Now that
actually tells me that he getsbetter airflow in this left
upper chest than is right. Sothe shoulder girdle is right on
top of the rim cage . And ifthis sucker is deflated and
(05:28):
doesn't have very good airsupport, then the position of
the shoulder socket's differentand we're gonna have changes in
shoulder motion. But he's got alittle more air support under
here. So he actually has bettershoulder range of motion. Hey ,
and that left shoulder in abetter position overall for
your posture and for armmovement. Now we're gonna
(05:51):
verify this. So on the , when Iwas on the other side, I pushed
on his right rim cage and Iactually was checking to see
how good his airflow was uphere. And eh , we got belly
breathing and some airflowhere. But now I'm gonna be
checking how his airflow ishere on the right side. And I'm
(06:11):
gonna guess that it's limitedbecause his right shoulder
range of motion was limited onthe right. So we're gonna
compare the two. I'm gonna pushon this rib cage . Robert, take
a breath of air into your noseand exhale all the way out. And
I'm gonna glide the ribs downtowards his hip and sink 'em
down towards the floor. AndRobert, can you feel that I
(06:31):
can't get these ribs down aswell? It's really hard. I can
feel it. There's no, I'm gonnalet you breathe. But when I
bring his hand , when I bringmy hands down but his ribs
down, there's no, and I , Iknow that's not a technical
term but they , it should sinka little extra. That sinking
(06:51):
moment is the diaphragm fullydoming up and relaxing and you
should be able to get there,especially with my help, but
it's really hard for me even todo 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 hisinhalation. Go ahead and take a
(07:14):
breath of air in and when hebreathes in, he gets airflow
down here, but definitely lessup in this right upper shoulder
or chest. Alright , I'll letyou relax. So we can look at
rib mobility, we can look atshoulder range of motion and
there's some other shoulderranges of motion that can be
limited as well. That internalrotation motion is the most ,
(07:37):
um, easy and um , reliable one.
Um, but we can also look at hisneck motion. And even his hip
mobility can be changed ordisrupted because of airflow.
The reason why we it is for theneck is because your neck is
right on top of your rimage andif you overuse your neck for
(07:58):
breathing and as um, we call itaccessory neck breathing. So if
you use it as an accessory neckbreather more chronically, it's
going to change your neckmotion and tighten up your
neck. Now when you have anasymmetry like Robert does, so
he's got better airflow in thisleft upper chest than the
right, usually what you find ismore right-sided neck tension
(08:21):
and that will limit it , limitneck rotation to the left and
he'll have more range of motiongoing to the right because this
right neck it will limit leftrotation. So let's check it
out. All right , we're gonnacheck your neck out Robert and
relax. I'm gonna turn your headto the left and that's about
(08:45):
it. You feel that? Mm-Hmm, that is it. And
then we're gonna check to theright and boom, so much easier
night and day. And that is'cause you're not getting as
much airflow here. So theseright neck muscles overwork
much more so all the time andthat's gonna limit and affect
(09:05):
your, your neck range ofmotion. Alright , so I got
Robert on his side, I'm gonnacheck his right hip motion and
it should be better. I alsotell people this is my way of
testing whether you can standum, correctly on your right leg
when you're upright and centeryour pelvis, your rim cage and
(09:26):
your head over your right leg.
And in order to do that let letthis 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 toget this knee at least to the
midline of his body but all theway to the floor. So this knee
should line up or come all theway to the floor so that his
(09:50):
pelvis and his heart and hishead when he stands just on one
leg can center over this kneewithout creating torque. And
that's actually impacted byyour breath and through the
pelvic floor and the systems ofthe pelvis will impact how you
walk even. Let's go ahead andbring this leg back together
(10:10):
and we're gonna switch over theother 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 balanceyourself over your left leg
legitimately. Alright , well wegot a straight line, knee, hip
and shoulder and now we'regonna let this knee drop
towards the floor and do youfeel a difference there? Yeah.
(10:32):
Yep . It kind of stops just shyof that. Not terrible but could
be better. There's definitely adifference between the two
sides. So even hip mobility canbe affected by respiration. So
I guess we're gonna have to getyou breathing better. Alright ,
so I guess that's the nextvideo. Thanks everybody for
(10:54):
watching and I wanna do anextra special thanks to Oxygen
Plus I hope you learnsomething. And if you'd like to
find me, you can findme@sarahpetrich.com.
S-A-R-A-H-P-E-T-R-I-C h.com .
Or if you wanna learn moreabout Oxygen Plus you can find
them@oxygenplus.com.
We
Speaker 2 (00:03):
Will just be happy with the air . All right ,
we've got Robert back and ashe's laying here , uh, you can
see as he is laying here thathis ribs flare up. Now a lot of
(00:23):
times this can be even more so,but this is still a good flared
rim cage. Um, what you can'tsee is that his left rim cage
is a little flared up more thanthe right, perfectly normal. We
all have an asymmetricaltendency 'cause your
diaphragm's asymmetrical bydesign. It's just anatomically
made that way and the leftdiaphragm is more
(00:46):
disadvantaged. So thanks forcoming. Robert. You are a
typical disadvantaged leftdiaphragm
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 downideally. That being said,
especially if you're an adult ,um, you might not be able to
(01:09):
breathe yourself into a newbody, but you do wanna have the
mobility in your cage . Nowwhen we do have somebody who is
not breathing as ideally as wewant and we don't have as much
rib mobility as we want,there's certain predictable
things that we can find. Soshoulder motion is one of the
(01:29):
biggest things that will beimpacted. So I'm gonna have
Robert scoot a little bit tothe left and I'm gonna do one
of the most important shoulderranges of motion that you need
to have to have healthyshoulders. But it also tells me
about how good your rib cage ispositioned. And here's his
right arm and I'm gonna bringhis right arm all the way over
(01:52):
here, bend this elbow and we'regonna bring this right hand
down towards the floor. I'mjust gonna make sure you don't
cheat. And here we go. Now thismotion is supposed to be at 80
degrees and let's see, 45 isprobably about there. Uh , so
what do we call that? Maybefifty fifty five. Uh , it
(02:13):
should be. And notice my otherhand is helping him cheat. It
should flop down to here easilywithout this shoulder popping
up. Now if you don't have goodshoulder range of motion, it is
most likely due to poorbreathing mechanics. Sometimes
it's actually some shouldertightness, but that's actually
(02:36):
more rare than even yourphysical therapist realizes.
There's a lot of stretches forthis shoulder that you can do
that literally are holding thisand trying to stretch this out.
But we can get this looser justby a few breaths, which we'll
do, but not yet. The otherthing that I like to look at,
and we'll check this shouldermotion on the other side in a
(02:57):
minute, but the other thing Ilike to look at is I like to
put my hands on ribs and feelhow they move. We call it
apical expansion. And by we ,that's actually a test , um,
that is uh, taut and instructedby the Postural Restoration
Institute. And it looks likethis. You're gonna put , uh,
(03:18):
you me, I'm gonna put my handon this rim cage and his uh ,
lower ribs and his upper ribsand you're gonna take a breath
air in and as he exhales yourribs should have the mobility
to go down towards your hip andsink down towards the floor.
And Robert , I'm gonna have youjust let me push on your ribs a
little more. There you go. Andrelax those ribs and he can
(03:40):
actually feel at the end of hisexhale that those ribs drop a
little extra. Did you feel thatRobert? Yep . Um , and then I'm
gonna take this one stepfurther. So that's only half of
the test. Further , I gotta beable to get ribs down on the
side that I'm pushing down on.
And then I'm gonna watch thisside of his chest 'cause he's
(04:01):
gonna inhale next and I'm gonnasee where does his air flow
into. I'm basically blockinghim from being able to breathe
into this right side. So heshould get more air airflow in
this left chest. He shouldn'tbe getting all the air foot
flow into his abdomen. 'causeguess what? Lungs aren't down
here. Lungs are up here and I'mblocking his right side from
(04:25):
filling. So I should get moreexpansion in the left side. So
let's see if you can survive aright lung collapse. Okay, I
say that jokingly
the way out. Ribs come downwhen you exhale, hold that
breath out a little bit. We'lljust really let these ribs sink
(04:46):
down and in and then take anice deep breath of air in. Ah
, alright , now we got somebelly expansion. I did get some
expansion here and then we'regonna check out the other side.
So Robert, you're gonna turnaround and face the other
direction. I'm gonna bring thatelbow out off to the side
again. I'm just gonna make surehe doesn't cheat through
(05:08):
shoulder. Bring this arm down.
Wham, that is some fantasticshoulder motion. Now that
actually tells me that he getsbetter airflow in this left
upper chest than is right. Sothe shoulder girdle is right on
top of the rim cage . And ifthis sucker is deflated and
(05:28):
doesn't have very good airsupport, then the position of
the shoulder socket's differentand we're gonna have changes in
shoulder motion. But he's got alittle more air support under
here. So he actually has bettershoulder range of motion. Hey ,
and that left shoulder in abetter position overall for
your posture and for armmovement. Now we're gonna
(05:51):
verify this. So on the , when Iwas on the other side, I pushed
on his right rim cage and Iactually was checking to see
how good his airflow was uphere. And eh , we got belly
breathing and some airflowhere. But now I'm gonna be
checking how his airflow ishere on the right side. And I'm
(06:11):
gonna guess that it's limitedbecause his right shoulder
range of motion was limited onthe right. So we're gonna
compare the two. I'm gonna pushon this rib cage . Robert, take
a breath of air into your noseand exhale all the way out. And
I'm gonna glide the ribs downtowards his hip and sink 'em
down towards the floor. AndRobert, can you feel that I
(06:31):
can't get these ribs down aswell? It's really hard. I can
feel it. There's no, I'm gonnalet you breathe. But when I
bring his hand , when I bringmy hands down but his ribs
down, there's no, and I , Iknow that's not a technical
term but they , it should sinka little extra. That sinking
(06:51):
moment is the diaphragm fullydoming up and relaxing and you
should be able to get there,especially with my help, but
it's really hard for me even todo 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 hisinhalation. Go ahead and take a
(07:14):
breath of air in and when hebreathes in, he gets airflow
down here, but definitely lessup in this right upper shoulder
or chest. Alright , I'll letyou relax. So we can look at
rib mobility, we can look atshoulder range of motion and
there's some other shoulderranges of motion that can be
limited as well. That internalrotation motion is the most ,
(07:37):
um, easy and um , reliable one.
Um, but we can also look at hisneck motion. And even his hip
mobility can be changed ordisrupted because of airflow.
The reason why we it is for theneck is because your neck is
right on top of your rimage andif you overuse your neck for
(07:58):
breathing and as um, we call itaccessory neck breathing. So if
you use it as an accessory neckbreather more chronically, it's
going to change your neckmotion and tighten up your
neck. Now when you have anasymmetry like Robert does, so
he's got better airflow in thisleft upper chest than the
right, usually what you find ismore right-sided neck tension
(08:21):
and that will limit it , limitneck rotation to the left and
he'll have more range of motiongoing to the right because this
right neck it will limit leftrotation. So let's check it
out. All right , we're gonnacheck your neck out Robert and
relax. I'm gonna turn your headto the left and that's about
(08:45):
it. You feel that? Mm-Hmm
then we're gonna check to theright and boom, so much easier
night and day. And that is'cause you're not getting as
much airflow here. So theseright neck muscles overwork
much more so all the time andthat's gonna limit and affect
(09:05):
your, your neck range ofmotion. Alright , so I got
Robert on his side, I'm gonnacheck his right hip motion and
it should be better. I alsotell people this is my way of
testing whether you can standum, correctly on your right leg
when you're upright and centeryour pelvis, your rim cage and
(09:26):
your head over your right leg.
And in order to do that let letthis 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 toget this knee at least to the
midline of his body but all theway to the floor. So this knee
should line up or come all theway to the floor so that his
(09:50):
pelvis and his heart and hishead when he stands just on one
leg can center over this kneewithout creating torque. And
that's actually impacted byyour breath and through the
pelvic floor and the systems ofthe pelvis will impact how you
walk even. Let's go ahead andbring this leg back together
(10:10):
and we're gonna switch over theother 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 balanceyourself over your left leg
legitimately. Alright , well wegot a straight line, knee, hip
and shoulder and now we'regonna let this knee drop
towards the floor and do youfeel a difference there? Yeah.
(10:32):
Yep . It kind of stops just shyof that. Not terrible but could
be better. There's definitely adifference between the two
sides. So even hip mobility canbe affected by respiration. So
I guess we're gonna have to getyou breathing better. Alright ,
so I guess that's the nextvideo. Thanks everybody for
(10:54):
watching and I wanna do anextra special thanks to Oxygen
Plus I hope you learnsomething. And if you'd like to
find me, you can findme@sarahpetrich.com.
S-A-R-A-H-P-E-T-R-I-C h.com .
Or if you wanna learn moreabout Oxygen Plus you can find
them@oxygenplus.com.
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