All Episodes

December 1, 2023 23 mins

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

Mark as Played
Transcript

Episode Transcript

Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:03):
Just be happy with

Speaker 2 (00:05):
The end . Hi, I'm Dr. Sarah Petrich and, and our
last video we talked aboutattaining A-Z-O-A-A zone of
opposition so that yourdiaphragm relaxes and domes up

(00:26):
as best as possible so thatthen you can contract it better
when you inhale. So just toreiterate, when you exhale,
your diaphragm domes up intoyour chest cavity and it
relaxes. But now we're gonnatalk about when it contracts.
So if you think of , uh, yourdiaphragm domming up and if you

(00:48):
can see my fingers, they'reseparating 'cause they're the
muscles relaxing When youinhale the diaphragm, those
fingers or those muscle fibersshould get closer together as
the diaphragm flattens down andhelps pull air into your chest.
Now that being said, if yourribs splay outward as you

(01:11):
inhale, such as the case insomething like belly breathing,
or if you're just trying tosuck in your gut, those ribs
will flare out. What willhappen is maybe those, those
muscles will contract a littlebit and overlap, but the outer
borders of the muscle are goingto flatten out and you won't
get as much contraction as youwould if you kept the borders

(01:34):
of your rim cage really niceand stable and maintained a
good breathing posture. So inthe last video we exhaled, we
talked about exhaling andletting these ribs come down
and in and back so that yourbell shape rim cage can swing
back a little bit and get thatzone of apposition we've been

(01:58):
talking so much about. Now,when you inhale, you need to
maintain a little bit of zoneof apposition , meaning you
need to maintain some fibers ofthe diaphragm up against the
inside wall of this rim cage sothat it , that diaphragm
doesn't completely flatten andsplay out so that you get

(02:20):
better muscle contraction ofyour fibers of the diaphragm.
So how do we do this? Well, thefirst thing we did to attain
the zone of apposition is weexhale and then we hold that
breath out for a really nicelong time to give the diaphragm
time to relax and dome up. Butwhen you inhale, what needs to

(02:43):
happen is the abs that startedto contract when you pull these
ribs down and in it back tocreate a good position of your
rib cage , they need to stayon. Now, they're not going to
stay on and grip on, they'regonna have some mobility, but
they need to keep their , uh,their pull on the front of

(03:06):
these ribs down and in a littlebit so that as you breathe in
these ribs don't go flyingforward. That's how we maintain
your zone of apposition as youinhale, and that's how you
maintain your good breathingposture as you inhale without
completely , um, getting abowling ball , um, expansion

(03:27):
belly in the front of yourbody. So the important thing
here is can you keep your abson at least enough to keep this
rim cage position? Now we'regonna work on that with some
exercises that I'm gonna showyou in a minute. Um, some of
those exercises are just gonnabe about breathing, but some of

(03:49):
them are also going to call ina few extra, what I like to
call abdominal buddies to helpyou maintain this rim cage
position so those abs can learnhow to both pull these ribs
down and in and back and keepthose ribs down and in and back
when you inhale. So here we go.

(04:10):
All right , now I've got alovely balloon for you here.
We're gonna bend those kneesback up so that their knees are
at the same height as yourhips. Tempting to put your feet
down over there, but, and Iideally, 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 liftwith balloon. Um, and it's a ,

(04:34):
an exercise that was originatedby the Postal Restoration
Institute and we're gonna beperforming it here for the same
purposes. And that is gonna befirst we're gonna learn how to
flip that balloon to help youget a little bit of some
feedback for your breath. Soyou have to have enough power

(04:55):
behind your exhale to get theseribs down and in. And so we're
gonna make sure the balloonhelps you get that. And then
we're gonna pause. So you'regonna exhale and then you're
gonna pause and then I'm gonnahave you hold your breath out.
And then without pinching theballoon shut or biting it with
your teeth or sticking yourtongue in the hole of the

(05:15):
balloon , uh, I know all thecheats . You're going to keep
that balloon opening open asyou breathe into your nose. Got
it? Okay . Let's just do theballoon part. So you're gonna
breathe into your nose, exhaleout to the blue , And then as

(05:36):
he'll , uh, exhales all the wayout. His ribs are coming down
and in and you might be able tosee that on camera and then
hold your breath out for aslong as you calmly, comfortably
can. And I'm gonna add one morething for you to do. Can you
put your tongue on the roof ofyour mouth right now? Good.
That helps relax your neck andthen breathe into your nose.

(05:58):
Good. And you're trying to keepthe air in the balloon as you
inhale. Now exhale out and dothat again. Blowing all the way
out. Ribs are gonna come downand in and back. So that bell
is gonna swing backwards andthen, oh , you breathed in
already. We gotta do that again. Exhale all the way out . And

(06:18):
you gotta hold that breath outlonger there. Hold it out. Feel
how those ribs came down. Iwould like you to sense how
those ribs feel and almost tryto keep 'em there as you put
your tongue on the roof of yourmouth and then breathe through
your nose. Good. Do you feelthat air going into your chest
now? Mm-Hmm, .
All right . Pinch off theballoon and let the air out,
but don't point it at me. Youcan pinch it with your fingers

(06:42):
too. . All right . Sothat's one half of that
exercise. So you can just workon blowing up a balloon and
that can start getting theseribs down and in and air into
your upper chest. And it canalso promote more airflow into
the back of your ribs, but youwon't be able to feel it as
much here in this position'cause you're laying on those
back ribs. Now there is a fewmuscles that actually help put

(07:06):
you in a good position for thatto happen. Even better. So if
you press your heels down a bitinto this chair and it's gonna
be a straight down, you can usethat pressure downward to help
you kind of lift your hips up alittle bit. Yep . And when you
do that, can you do thatwithout using your stomach or
your back muscles? Yep . And itshould feel like if you had a

(07:30):
lower back tattoo, it sank downonto the table. Yep . Does it
feel kind of nice and relaxingactually to the back? Do you
feel these muscles workingbehind you? Those are your
hamstrings and they connect toyour sit bones. Those are those
butt bones that get really soreif you're sitting on a really
hard seat. So those musclesshould be holding you up. You

(07:51):
shouldn't be clenching yourglutes. We're good? Yep . All
right . We got hamstrings. Nowthose muscles help decompress
your back from down below fromyour pelvis. And now we're
gonna use your diaphragm as youblow out into that balloon to
help decompress your back fromabove. So you're gonna exhale
all the way out to the balloon,Let those ribs sink down and in

(08:15):
. Oh, look at how much morethey sink down and in hold your
air out. Hold it. Enjoy thatfeeling right here. And I'm
gonna have you inhale throughyour nose. Ah , nice. Good air
expansion in through , throughthe lungs. Exhale all the way
up. Not a lot of bellybreathing going on anymore.
Fantastic. Exhale. Hold thatbreath out. Hold it, hold it.

(08:39):
And don't forget that your legsare working and then we can
breathe into your nose. Oh , Ican hear the nose like the
nasal breathing. It's so nice.
Exhale all the way out. Holdthat breath out. Hold it, hold
it, hold it. And tongue on theroof of your mouth breathing in

(09:01):
through the nose. Pinch offthat balloon and let the air
out. All right , go ahead andrelax the leg . All right . The
legs got a little bit of aworkout . Didn't thing . Yeah .
. Yep . Did you feelhow you weren't expanding in
your abdomen? Yep . Now , um,part of the reason why we're
going over this is because weunderstand how important nasal

(09:24):
breathing is and how important.
So that's just your upperairway, but that's really, I
improved when you can exhalethrough balloon and inhale
through your nose. Um, but italso improves how you're using
your airflow through the lowerpart of your airway, which is
your chest and lungs. So if youhave those kind of good

(09:46):
mechanics, it's gonna help youmake better use of a product
like oxygen plus, because firstof all, you're getting rid of
more ex or more air before youtake an inhale. Um, you just
gotta remove the balloonthough. ? Yeah . First.
All right . So Lynn , let's doa few other , uh, exercises and

(10:07):
then we're gonna retest you andsee if some of those videos
that we did of signs that youmight have some dysfunction in
your breathing or imbalance inyour breathing. We're gonna see
if they got improved. Okay?
We're going to do somethingcalled the short seated wall
reach. And you can do this withyour backup against a wall. And

(10:28):
traditionally it is done withyour butts on the floor.
However, I'm kind of nice and Ilike to make it a little more
comfortable. So plus we don'thave a wall behind you. So ,
uh, you'd be really extrauncomfortable without uh, this
little block underneath yourbutt. So you could do this also
by the way, on like a stairstep , which is about the same

(10:51):
height. Now I'm gonna have youblow up that balloon like we
did earlier. Uh , I'm gonnahave you hold it in your right
hand. Yep . And your left arm.
We're gonna reach it forwardand you can rest it on your
knee. And I'm gonna have youput the balloon in your mouth
and I'm gonna have you exhaleout to the balloon and feel
those ribs sinking down, justblowing up that balloon so his

(11:13):
ribs are swinging back. Andthen go ahead and breathe into
your nose. And then we're gonnaexhale all the way out again.
And I'm gonna Yep . Have youlet those ribs sink down. Now
on your next inhale, don'tinhale yet. On your next
inhale, we're gonna reach thisleft arm forward a little bit
more and breathe in good. Andthen exhale all the way out.

(11:37):
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 hereand exhale out. We'll do one
last one. Hopefully the balloonballoon won't pop. We're good
so far and we'll reach this armforward a little bit more
breathing in. Pinch off thatballoon and let the air out.

(11:59):
Not at me though, .
Alright , now I'm gonna changeit up a little bit and we're
gonna take that balloon outcompletely. So that's a really
nice tool to kind of reset yourbreathing posture so that it's
in a really good position forwhen you inhale to getting more
oxygen, which brings me tothis. So we're gonna bring both

(12:23):
arms forward and we're gonnareach forward with both arms.
Now when we're reaching forwardwith both arms, we're actually
engaging a muscle in the backof your shoulder blade called
the serus in it Yes. Pushesyour shoulders forward, but it
also retract your ribs back sothat you restore this curvature
of your rim cage . Now I'mgonna prepare here. Okay. So if

(12:51):
you wanted to utilize , um, theoxygen plus you might decide
maybe I do a little exercise atthe same time so that I can get
all air out and then when Iinhale I can get a little more
air flow and a little takeadvantage of , um, what you can
get out of just one puff. Hereyou'll get more. Okay . So I'm

(13:13):
gonna have you inhale throughyour nose, exhale all the way
out, and reach both armsforward and let the ribs sink
back. And we got the ribs back.
Yep . And then you could keepone of these in your hands. Yep
. Breathe into your nose. Let'sdo one more exhale all the way
out rims. Go back and then youcould take this, let's put it

(13:34):
in your right hand and then youcould bring it right up to your
face. Yep . And then do a puffand inhale through your nose
and exhale out and go back toreaching forward again. Did you
feel that nice, big inhale. Yep. Yep . Go ahead and relax and
you'll get more , uh, benefitfrom just one inhale. So

(13:58):
basically you'll let yourcanister work longer for you.
Yep . So there you go. That'sthat exercise. Alright , let's
do one last , uh, movement orexercise. So I'm gonna get rid
of this balloon, no balloon forthis one and this particular

(14:18):
exercise, we're gonna go onyour hands and knees and most
people are gonna recognize itas 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 , theother way as you round your
back that's called cat . And ifyou go the other way , uh, I've

(14:42):
heard that called camel or cow . Um, but we're not
gonna do focus on this POposition because in this
position the ribs are goingdown 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 backposition for good diaphragm

(15:04):
mechanics. Uh, it's not gonnahelp us attain that zone of
apposition . So we're going toexhale and around the back into
that angry cat position. Andnow we're gonna get a lot of
flexion through the spine, butwe're gonna get these ribs to
start to come back and in. Andas you do that, we can stay

(15:26):
there and breathe in and keepthose ribs back and figure out
how to get more air expansioninto the back of the ribs. Now
start all over again, Robert,because I'm gonna have you
bring your hands back a littlebit so that they're underneath
your shoulders and I'm gonnaask you to do one more thing
when you round your back, mostpeople like you normally would,
especially if you're doing itthe yoga way, your head's gonna

(15:49):
look down towards your thighs.
But because , uh, I want usalso to consider your upper
airway, which means your throatand your head , uh, we're going
to have your head in adifferent position. I'm gonna
have your eyes looking straightbetween your hands the whole
time. If you think about if you, uh, ever have seen or done ,

(16:11):
uh, CPR training, they alwayssay tip your head back to open
up the airway. If we keep youreyes here, it's gonna be the
equivalent of open up thatupper airway here, if that
makes sense. So now I'm gonnahave you exhale and around the
back letting these rims go back. Ah , don't let your head drop
either. So start over. Yep .

(16:33):
You're looking there. Your noseis gonna stay in the same spot,
but your rim cage is gonna goup towards the ceiling. Ah .
Don't bring your head down.
You're gonna exhale, pushthrough your hands as you
exhale and use your hand pushto pull your ribs away. There
you go. Do you feel that?
Mm-Hmm. . Soyou're exhaling and pushing
with your arms, kind of likethat reach you did sitting to

(16:55):
get those ribs back and in thatfeel different. Mm-Hmm.
. Oh, let's do itagain. So, so we master it.
Take a breath of air in here,exhale. And as you exhale,
we're gonna pull those ribsaway from the floor. Even your
sternums going away from thefloor. And then you can round
your low back as well. And ifwe , uh, for you, we're gonna
focus a little more even on thelow back. Now if you hold it

(17:15):
there and take a breath of airin, where do you feel the air
flowing? More into my upperback. Your upper back where? In
the back or in the front? Inthe front. In the front. Ooh .
I like that. He did havelimited air expansion in the
front of his chest before. Yep. Go ahead and keep breathing
and we're gonna exhale all theway out when you exhale. Really

(17:37):
like the let the abdomen justdeflate like it's a balloon
deflating. And then when youbreathe in, see if you can
breathe in not into the frontof your body or the front of
your abdomen I should say. Butsee if you can feel air flow
into your back rim cage atdoll. Do you feel that? And I
can see it. Ooh . But do youfeel this wanting need to start

(17:58):
to push downward? Mm-Hmm.
. So , um, Robertwants to start letting his ribs
come down towards the floor,especially when you take that
big breath of air in . This iswhere knowing your abdominal
buddies comes in handy. So yourtriceps and your serus muscles
can actually help keep yourribs in that back bell swung
backwards position. And evenyour hamstrings here can work.

(18:23):
If you imagine pushing yourshins down into the floor . And
as you should push the , theknees down into the floor, your
abdomen can pull away from thefloor. See if you can find
that. You feel that? Mm-Hmm. Doyou feel these muscles? Mm-Hmm
? . Oh , okay.
Yep . All right . Go ahead andrelax. All right . I'm just
gonna have you do , I'm, I'mjust gonna double check . Go

(18:45):
ahead and push those knees downagain. And as you push them
down, it should feel like ifyou had a tail on each butt
cheek that they're going to ,those tails are gonna point
down towards your knees. Mm-Hmm. . And this is
rounding. Then we're gonna addthe arms. We're gonna exhale
and round the back a littlemore with those arms. So we've
got hamstrings helping kind ofaround the back and we're using

(19:06):
those arms to help around theback. And we're gonna stay
there and use those arm musclesto help keep that shape of the
rim cage as you take a breathof air in and not let the air
go into the front of theabdomen. Exhale all the way out
. We're gonna use the arms andthe legs to help deflate the
abdomen. And then we're goingto keep the air out of the

(19:27):
abdomen as you breathe in. Ooh, that's a little harder to
breathe in. Mm-Hmm.
. Yes. Exhale allthe way out. Now I know you got
it. And yet your airflow mightfeel a little restricted if
you're tight in the back of theribs or in your upper chest.
But as you do that a few moretimes, you're gonna get more

(19:47):
mobility of the ri cage andit'll actually help even your
resting breathing. Go ahead and, and relax. 'cause I'm a
little tired for you. .
All right . And did you feelyour abs working? It

Speaker 3 (19:59):
Was getting easier to breathe as we went

Speaker 2 (20:01):
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. . Did youfeel 'em just in the center or
on the sides? Towards thesides. Perfect. I couldn't even
have asked you to say it anybetter. Um, so the sides of the
ab abdominals are really morewhat if you sense those, those

(20:23):
are your obliques and yourdeeper abdominal muscles that
actually support bothrespiration and it should do
that first. But then alsothey're more important for core
stability for spine and jointhealth as well . All right ,
thank you very much. Now let'sgo ahead and recheck the
shoulder and the neck and seehow those are looking. So the

(20:44):
right shoulder was prettylimited before, so we're gonna
go ahead and check it again. Wehad, what did we say? 50 55
degrees. 55 ? Yep . Um, so I'mgonna protect this shoulder,
make sure it doesn't cheat .
And here's 45. Here's 55 and itjust keeps going. That's 80
degrees. That's perfect.
Textbook right there. So nicelydone. Uh , let's come back

(21:08):
center . I'm gonna check yourneck as well. And we had
limited, pretty significantlylimited left neck rotation and
then the right one was prettydarn good. So relax here and
boom. Lovely. It was likesomething like that. Mm-Hmm
. But now it'sreally nice and loose. Ooh ,

(21:32):
you're gonna sleep well thenight . Relax here and we're
gonna turn it to the rightright's. Still good. It's still
just as good as before but nowthe left is matching it. All
right . Very nice. Then I'mgonna push on your ribs on this
left side. That was the sidethat was harder for me to push
down. And then it was alsoharder for to us to get air
expansion up here in the rightupper chest. And this is a much

(21:55):
more picky test. So we'll seehow it goes. Take a breath of
air in here. I like that nasalbreath. Exhale all the way out.
Hold out that air, see if thoserims can sink down a little
extra. It's a lot easier for meto push these ribs down though.
Can you tell? Mm-Hmm, , let's see. It's
completely out of air. And thenbreathe in. Ah , do you feel

(22:20):
that airflow up here? That'sexactly what we want. So we
actually , uh, helpedneutralize your spine and give
you more shoulder motion andmore neck motion. But all
through just some , somebreathing techniques but in
specific positions to helpencourage rims to come down and
in hold your breath out beforeyou breathe in. Alright ,

(22:42):
thanks everybody for watchingand I wanna do an extra special
thanks to Oxygen Plus I hopeyou learn something. And if
you'd like to find me, you canfind me@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.
Advertise With Us

Popular Podcasts

Stuff You Should Know
Dateline NBC

Dateline NBC

Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com

On Purpose with Jay Shetty

On Purpose with Jay Shetty

I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!

Music, radio and podcasts, all free. Listen online or download the iHeart App.

Connect

© 2025 iHeartMedia, Inc.