The client is a female in her late 40’s.
She has kidney inflammation and is undergoing a steroid treatment using Prednisone.
She has hypertension, which is controlled by medication.
She is experiencing fatigue due to the medication and lack of proper sleep.
She has insomnia due to the medication, which exacerbates the fatigue.

She is experiencing pain/soreness in the neck/shoulder area.
She also has pain/soreness in the lower back and hips; her hips hold stress.
She is currently in the 4th month of a 6 month treatment for her kidney inflammation.

She lives with her husband and 2 children and has the support of family and friends.

The intake and all the sessions were completed online.

Client Goals:
1. She would like to improve her sleep to help with her fatigue.
2. She would like to gain strength and improve her posture in order to reduce her pain.

Yoga Therapist Goals:
Koshas: _x_Annamaya _x_Pranamaya _x_Manomaya __Vijñanamaya __Anandamaya

Integral Yoga: __x_Hatha __x_Raja ___Bhakti ___Karma ___Jnana ___Japa

Short Term
I would like to work with her on stretching and joint mobility to ease some of the hip pain.

Long Term
I would like to teach her some relaxation practices to help improve her sleep and reduce stress for better healing. We can try to incorporate imagery during meditation.

Stress Management Manual

Adaptive Yoga Manual

Bowman, K. Move Your DNA, Propriometrics Press; 2nd ed. 2017
Carroll, C and Carroll R. Mudras of India. Singing Dragon. 2013

Hirschi, G. Mudras: Yoga in Your Hands. Weiser Books. 2016

Stiles, M. Structural Yoga Therapy: Adapting to the Individual. Red Wheel Weiser. 2000

Pandi-Perumal SR, Spence DW, Srivastava N, et al. The Origin and Clinical Relevance of Yoga Nidra. Sleep Vigil. 2022;6(1):61-84. doi:10.1007/s41782-022-00202-7
https://pubmed.ncbi.nlm.nih.gov/35496325/

• Yes

Awareness practice
Neck warmups
Adapted eagle arms stretch
Reed lateral stretch
Dynamic twist
Thoracic stretch and twist
Tabletop – pelvic tilt into wave cat/cow
Sunbird
Hip mobility
Adapted Lower body spinal twist
Yoga nidra

She will practice mindfulness to notice where and when she holds tension in the body.

The client arrived a little stressed today because she was dealing with some of her child’s activities and all of the discord that came from it. However, after talking things through with me, she was able to bring herself down. Otherwise, things were going fine.

The client reported that sleep was “pretty good” the last few days. Using the yoga nidra recording was “magical.” It really helped with her insomnia. She didn’t want to “overuse” it, so did not play the recording every night. Over time she went from falling asleep with the yoga nidra to going into a “meditative state.” I mentioned that traditionally, yoga nidra did allow people to go into a deep, restful state that was like sleep, so she could continue to use it as a way to reduce stress vs. only for trying to fall asleep.

We kept the movements slow and low key throughout to maintain the calm we had achieved at the beginning of the session. (Following the client’s lead, I didn’t want to include activating practices today.) In addition to extended warmups to stretch and release tension in the shoulder and neck area, another focus of today’s practices incorporated hip stretches based on JAPA movements. We included a gentle restorative lower body twist to mobilize the hips and release tension. This was the area where she said she held stress and felt pain. Today’s yoga nidra incorporated some neutral imagery to provide a different experience. She enjoyed it and asked for a copy of the audio to listen to at another time.

I would like to introduce personalized imagery with the yoga nidra to see if makes a difference in lowering stress or healing for the client.

• Yes

Awareness practice
Active warmups – seated and standing: stir the pot, rope pull, bouncy twist, etc.
We used many of the vigorous, dynamic movements from Stress Management TT to help release energy
Tadasana breakdown
Extended exhales with sound
Bhramari breath
Yoga nidra with personalized imagery

She could practice Bhramari breath and yoga nidra as needed to help with anxiety or stress.

It had been 3 weeks since our last session. The client had just returned from a week long meditation retreat. (It was her third day back.) She was initially concerned about how her body would react before attending, but she was glad she went. She felt rested and replenished from the “good, nutritious food,” though "sitting for meditation wasn’t easy." She is looking forward to finishing her kidney treatment in 2 weeks.

This meeting was all about releasing nervous energy. We initially started our session with our usual warmup, but I noticed that the client was not able to sit still and kept moving. We then transitioned to more active and energetic movements. I didn’t know if there was pent up energy from enforced stillness at the retreat or if it was due to anxiety from the medication. However, it was clear that her body needed some release.

I wanted her to have a solid base to perform the movements, so we did a detailed review of Tadasana before moving into our standing practices. We also integrated breathing practices with sound to release and soothe. The standing forceful exhalation with audible sigh, using arm movements into a slight forward bend helped in the calming process. As she became more settled, we practiced Bhramari Breath to further soothe her mind. At that point she was ready for the yoga nidra, which we practiced with personalized imagery. I was happy to find out that our work that day was well received, as I received a text message afterwards thanking me for the session.

This client was open to working with the subtle/energetic practices, so I planned to introduce some mudras for joint pain during our next session.

• Yes

Awareness practice holding Sandhi Mudra (for joints)
Upper body neck/shoulder warm ups
Reed (lateral stretch)
Incorporated forearm, wrist, hand, finger mobility/stretches and massage
Pelvic tilts with wave cat/cow
Hip mobility/joint work
Ankle/foot/toe mobility/stretch/massage
Yoga nidra with personalized imagery

She will try to incorporate the Bhudi Mudra (p.88) (fluid mudra) to help with disorders of the kidney and bladder during her meditations.

The client reported for the last several weeks that she had been suffering from pain and swelling in her joints, as well as eye problems (blurry vision and sensitivity to light), and memory loss. For the first 10 days after the symptoms first appeared, she did not know what was happening to her body and she could not contact her specialist physician because they were on vacation for the month. It was not until she had done some research for herself and spoke to her Primary Care Physician that she determined these were most likely withdrawal symptoms from stopping the prednisone treatment. (Her PCP also mentioned her sugar levels could fluctuate for the first month or so.) She was understandably frustrated because her specialist physician did not warn her this could happen after 6 months of taking a steroid medication.

The pain has affected her standard of living. She cannot walk for long periods due to pain and swelling in the joints. Driving is difficult, as there is hip pain from sitting.

Because the client mentioned that the joint pain could lessen with movement, this session was all about moving and stretching the joints and other parts of the body that didn't receive as much attention. She mentioned that she felt the most sensation/pain in the finger, toe and hip joints, so we made sure to concentrate on those areas. By focusing on joint movements my hope was to increase the amount of synovial fluid flowing over and through the joints. The squeezing and contraction of the small muscles could also help refresh and move fluid throughout the body to help reduce the swelling.

Since she was open energetically, she held the Sandhi (joint) Mudra to facilitate joint healing while we performed the Awareness Practice. For this session we were also able to use imagery personalized for her during the yoga nidra.

1 intake 3 sessions

This was an interesting Case Study for me as we met over an extended period of time (2 months) due to the client’s schedule. Because of that, her immediate needs changed from session to session depending on what she was dealing with in her life and how her body was doing with the medical treatments. This seemed like a realistic example of what one might find with yoga therapy clients outside of the practicum environment.

Although working on improving strength and posture was one of her goals, when we actually met for our sessions, other needs took priority. More often than not we ended up adapting the physical practices (Hatha, Annamaya) in a bottom-up approach to calm and soothe her mind (Manomaya) rather than to strengthen the muscles per se. It did help to understand the mechanics and physiology of movement to help with the swelling and joint pain for the last session, though.

Despite her short-term needs evolving, the long-term goals I had set for her remained the same. I was grateful to be able to offer practices that supported her stress reduction needs at each session. In some cases, simply talking things through with her and offering other perspectives from the sutras (Raja) helped to alleviate her worries and concerns. The breathing techniques we practiced (Pranamaya, Manomaya) had an immediate effect on calming her nervous system and focusing her mind to allow her to end the session feeling better than when she started. She also really appreciated the yoga nidra and said it was the most helpful tool for her.

I would do the same thing given a similar situation. This client provided a wonderful lesson for me in adapting the session to what was happening in the present moment. Even though my plans did change from meeting to meeting, having an overall intention to aid the client’s healing process through stress reduction or restorative practices kept our sessions cohesive and meaningful.

The client will be out of the country for a month. If we are able to meet after she returns,
I’d like to teach this client the eye/tongue/hands practice as a stress reduction tool as well as review some of the dynamic movements we had practiced in a previous session.