LB is 79-year-old female, retired and now works as intuitive artist and counselor.
- Arthritis in knees, hips and hands.
- Had a fall in 1986, dislodged a disc L4/L5. Since then, has been having back pain if she walks for more than 5 minutes. Says, that she feels her left leg is shorter than the right. Has limited ROM for adduction in left hip, felt a twinge in her quads during assessment.
- Enlarged heart, had a mitral valve repair and a pacemaker put in (2007)
- Raynaud’s Syndrome in left foot, cramps in both feet.
- Has had a dry cough since 1993, takes steroid spray for that. Gets worse when she speaks with force, cough drop helps. Says that when she speaks with an open heart, it cures her cough. She said that she was a ‘voice-over queen’ in Upstate New York in the 90’s.
- In 2010, was a caregiver for her mom, who had a terminal illness. Has been having trouble sleeping since then. Uses CBD gummies to sleep.
- Managed long-term care (in nursing home) of her spouse for 7 years before his death in Dec’22.
- Stress level low, but when stressed, takes a nap.
- She also likes to be occupied and takes on more than she can handle.
- Had been a smoker, stopped smoking 45 years ago
- Good social support that consists of family nearby, friends, and her congregation. She practices Jewish faith and is very active in her community.
- Intermittent yoga practice and infrequent exercise.
- Gets dizzy when moves her head quickly. (not vertigo)
- Has a little difficulty getting up from the floor.
- Prescription medication- Lasix, Plavix, Lipitor and Entresto

- Barrel breath -imagining inflating the core all around as you inhale and contracting it towards the middle as you exhale.
- Extended exhalation
- Restorative asanas to aid comfort in stretch.
- Guided relaxation/Yoga Nidra
- A little movement throughout the day.
- Vagus Nerve stimulation practices that can be done throughout the day.
- Chair practice with JAPA movements (for Arthritis and lubricating the joints)
- More lengthening asanas (like side stretches- supine and by the wall) to relieve the disc compression
- If she has access to a pool, discuss how she can benefit from Water Yoga (Crista Fairbrother)

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- Fishman LM. Yoga and Bone Health. Orthop Nurs. 2021 May-Jun 01;40(3):169-179. doi: 10.1097/NOR.0000000000000757. PMID: 34004616. Yoga and Bone Health - PubMed (nih.gov)
- Jeng CM, Cheng TC, Kung CH, Hsu HC. Yoga and disc degenerative disease in cervical and lumbar spine: an MR imaging-based case control study. Eur Spine J. 2011 Mar;20(3):408-13. doi: 10.1007/s00586-010-1547-y. Epub 2010 Aug 15. PMID: 20711844; PMCID: PMC3048237. Yoga and disc degenerative disease in cervical and lumbar spine: an MR imaging-based case control study - PubMed (nih.gov)
- Breit S, Kupferberg A, Rogler G, Hasler G. Vagus Nerve as Modulator of the Brain-Gut Axis in Psychiatric and Inflammatory Disorders. Front Psychiatry. 2018 Mar 13;9:44. doi: 10.3389/fpsyt.2018.00044. PMID: 29593576; PMCID: PMC5859128. Vagus Nerve as Modulator of the Brain-Gut Axis in Psychiatric and Inflammatory Disorders - PubMed (nih.gov)
- Lu YH, Rosner B, Chang G, Fishman LM. Twelve-Minute Daily Yoga Regimen Reverses Osteoporotic Bone Loss. Top Geriatr Rehabil. 2016 Apr;32(2):81-87. doi: 10.1097/TGR.0000000000000085. Epub 2015 Nov 5. PMID: 27226695; PMCID: PMC4851231. Twelve-Minute Daily Yoga Regimen Reverses Osteoporotic Bone Loss - PMC (nih.gov)
- Ades PA, Savage PD, Brochu M, Tischler MD, Lee NM, Poehlman ET. Resistance training increases total daily energy expenditure in disabled older women with coronary heart disease. J Appl Physiol (1985). 2005 Apr;98(4):1280-5. doi: 10.1152/japplphysiol.00360.2004. PMID: 15772059. Resistance training increases total daily energy expenditure in disabled older women with coronary heart disease - PubMed (nih.gov)

• Yes

Discussed how the week before went. LB said that she practiced the barrel breath throughout the day. She also went on walks around the block (twice last week). She said she had a chiropractic adjustment, which helped with her back. We spoke about if she has access to pool. She does have a heated pool but because of her Raynaud’s she can only be in the pool when the weather is really warm.
Some of the practices that I went through with LB were: -
- Getting settled and sitting comfortably in a tall chair with blocks under the feet
- Setting intention of moving in sync with the breath and staying in the present.
- Joint freeing movements.
- Asanas with more attention to lengthening the spine like, side stretches, restorative backbend using bolster as a prop.
- Supported restorative Shavasana and Yoga Nidra to end the practice.

Keep practicing Barrel breath. Incorporating joint-freeing stretches throughout the day. Going for walks, have a friend accompany her. Taking few minutes of quiet time throughout the day.

Her back felt a little better. Her pain was almost gone. She didn’t have to take the sleep aid to fall asleep. Since the day was warm, her Shoulder ROM was more than the previous time.

During the restorative side bend, with bolster as a prop, she felt a little discomfort in her shoulder, and it was difficult for her to be in that stretch. I planned to do a C-stretch on the mat, but it was difficult for her to lie flat on the floor. So, all side stretches were done sitting on the bolster. I found myself second guessing a few times, during the side stretches, which resulted in a confusion on my client’s part as to what I was trying to do. I have to have more confidence in what I am doing.

The same practices as session 1. Add extended exhalation in the practice. After check-in with her at the start of session 2, tweak the practice accordingly.

• Yes

Check-in - She shared that she felt sore after our previous session, which didn't feel good to her. She also shared that she realized that she has a tendency to compete, if there's no one else then with herself. So, I suggested that we set an intention of practicing Ahimsa throughout our practice today and then taking that into her day.
- Barrel Breath
- Setting an intention to practice Ahimsa with her body and paying attention to what her body is telling her.
- Joint movements for the upper and lower body in the chair.
- introduction to extended exhalation.
- Side stretches in the chair, lunge for psoas stretch, using chair as a support
- Restorative Shavasana and Yoga Nidra.
- Check-out

Practicing Ahimsa throughout the day. Asking for help in lifting heavy things and taking breaks during the day. Practice extended exhalation during the breaks. Keep taking few minutes of quiet time breaks during the day. I sent her the video of our first practice session together, so that she can look and practice on her own at home.

She was able to walk 2.5 miles uphill during the week, with a friend. She was getting ready for an event over the weekend at her congregation, so she was lifting heavy things, due to which her pain level was 4-6 when she came in. As the weather is getting warmer, she said she'll be able to go to the pool. A couple of nights, she had to take sleep aid to sleep.

I felt that the session went well. I feel a little more confident in my approach and delivery of the plan. My client felt rested and ready to take on the event over the weekend. The sessions are in-person at my studio, which is in my house. There was a little disturbance because of my husband's work call. But that happened during the start of the session and the rest of the session went pretty smoothly.

- Continue with Barrel breath and extended exhalation.
- Intention setting for Ahimsa and self-study.
- Continue with gentle movements from session 1 and 2, that create space in the body, and help with minimizing disc compression.
- Add some vagus nerve toning exercises to get to a restful state.
- End with Yoga nidra.

• Yes

Check-in - Client said that she took breaks during the event. Didn't ask for help as much as needed. Went on a couple of short walks. Had another chiropractic adjustment. Paid attention to how her body felt and practicing Ahimsa. Weather cooled down a little bit, so she wasn't able to go to the pool.
- Setting an intention of giving love to yourself through the breath, during the practice.
- Extended exhalation and Barrel breathing
- Gentle movements from session 1 and 2
- Side stretches and supported backbends.
- Vagus nerve stimulation through humming and temple massage.
- Supported Shavasana and Loving kindness meditation towards herself.

She'll be travelling a lot in July, so practicing gentle joint movements in her room seated or supine in the bed. Paying attention to how her body feels, taking breaks and quiet time. Extended exhalation during breaks. Doing vagus nerve stimulation exercises before bed to get into relaxed state and sleep better. Asking for help whenever needed.

I thought the session went really well. The client felt rested and calm. She felt that her tension and stress from the weekend event just melted away during the Loving Kindness meditation. She said she's paying more attention to keeping her spine lengthened when she's sitting or standing.

During the whole movement part of the session, I was cuing her to keep her spine lengthened. After a few times, she asked me what I meant by that. I did explain this in the first session with visual cues, but it would help if I kept coming back to it again and again.

This being my first case study was a big learning experience. Figuring out the way to take notes that works for me, while fully paying attention to the client was a little difficult. I was documenting in a separate word document and waited to put that in the portal, so I can log everything at once. But I realized that it created double work for me, so documenting on the portal directly is a way to go for me from now.
Being confident in delivery of the plan and not second- guessing myself.

- The client enjoys music, so bringing sound therapy for more relaxation.
- Talking about different ways that she can bring some movement throughout her day, without tiring herself out.
- Keep practicing Ahimsa with her body, practicing positive self-talk.