The client is a female in her 70’s.
She has Crohn’s Disease.
She has arthritis and is experiencing joint pain.
She has muscle pain and stiffness.
She lives alone with no pets, but has a partner. She has support from her community.

Later, she mentioned that she has Right Thoracic, Left Lumbar Scoliosis.
She also had two broken wrist bones from a fall she suffered in 2020. This makes it hard for her to get up easily from the floor.

The intake and all the sessions were completed online.

Client Goals:
1) The client would like to relieve lower back (sacrum) and inner thigh muscle pain/stiffness in order to be able to move more freely.
2) She would like to find a way to sleep through the night or get more restful sleep.

Yoga Therapist Goals:
Koshas: _x_Annamaya _x_Pranamaya _x_Manomaya __Vijñanamaya __Anandamaya

Integral Yoga: _x__Hatha ___Raja ___Bhakti ___Karma ___Jnana ___Japa

Short Term
Since she mentioned Scoliosis, I think there might be imbalances we can work on to help her body become more even and reduce the pain.

Long Term
I would like to help her reduce her stress levels, which will hopefully make it easier for her to fall asleep at night and remain asleep.

Adaptive TT Manual

Stress Management TT Manual

Carroll, C and Carroll R. Mudras of India. Singing Dragon. 2013

Miller, E.B. and Heraty, N. Yoga for Scoliosis: A Path for Students and Teachers. Printcraft. 2016

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

Kim KV, Bartley J, Ashe MC, et al. Effect of yoga on health-related outcomes in people at risk of fractures: a systematic review. Appl Physiol Nutr Metab. 2022;47(3):215-226. doi:10.1139/apnm-2021-0736
https://pubmed.ncbi.nlm.nih.gov/34914565/

• Yes

Awareness practice
Neck/shoulder warmups
Reed – lateral stretch
Dynamic twist – really liked this one, as she felt it was strengthening in her upper body
Isolated Pelvic tilt to Wave cat cow
Sunbird
Adapted down dog
Hip glide
Calf raise
Seated Yoga Nidra

I suggested she could try to practice yoga nidra before bed to help with sleep.

The client also stated that she would like to practice strengthening work that would allow her to get up and down off the floor more easily. I did not push for this, but didn’t want to prevent her from doing it if that is truly how she wanted to spend her time.

The client said her “sleep was good” last night, but it had been “up and down” the past week. She talked about how she noticed that stress can cause tension in her legs. She also noted she had been feeling “resistance” to walking as an exercise, though she was able to walk quite a bit as part of visiting a museum this week. It sounded like it was more natural for her when she walked as part of another activity, vs. walking for the sake of exercise.

Out of respect, I had been attempting to honor what the client stated in her intake as well as verbally in her sessions with me. However, it soon became clear that her current physical capabilities were different from what she stated and remembered, which I think took her by surprise.

Based on what I was led to believe, I had planned some movements for strengthening and mobility as well as some supine restorative postures. Since she hadn’t performed those types of movements recently, she was taken aback at how her body responded. I immediately altered the plan to something that was more doable for her present situation and we went on from there. It was during this session that she revealed she had scoliosis and that she had recently broken 2 bones in her right wrist to explain her decreased mobility. I was grateful that we moved slowly and that I had the tools to adapt to the existing circumstances.

I had wanted to try a restorative pose to help with stress and to help open her hips gently with gravity (supine baddha konasana with support) as well as some other supine poses. Because she did not want to practice supine poses today and wanted to strengthen her body for next week, we can try it at the next session.

• Yes

Awareness practice
Neck warmups
Shoulder rolls with scapular awareness
Dynamic twist
Seated lateral stretch
Standing Hip stretch
Standing lateral stretch
Yoga nidra

Practice Hamsi mudra during meditation. This mudra removes obstacles and produces feelings of lightness and laughter; it benefits the lungs and large intestines.

She had just come back from the seeing the PT for the first time in 6 years. She enjoyed the visit and shared the exercises she practiced with him. She was especially appreciative of having a moist heating pad on her lumbar area and hip for 15 minutes after she had done the work. Since that moist heating pad was so beneficial for the pain, we talked through a way she could replicate it for herself at home. Even though it would have been easy to find dry heat, I observed that she needed the moisture as well, or she could worsen her already aggravated Vāta. She agreed with this and we were able to brainstorm something that was achievable.

It was definitely a balancing act for me to offer practices for this client. Given that she had just had a physical session with a PT, I wasn’t sure how much to offer. She wanted to try the practices, so we proceeded.

We started with a seated warm up, which seemed to go well. I wanted to avoid table top and supine poses, so we did some standing hip mobility work for a change. Because I was positioned so the camera could see my whole body, I was further from my computer and could not pick up nuances of how she was doing. The act of standing was tiring for her and I suspect some of the movement might have felt strange if she wasn’t used to practicing it. Again, this was a good lesson in observing the person vs. listening to the words they said. I think if I could see facial expressions from that distance, it would have helped.

If she sees the PT again before our session, we can try to focus on offering something more restorative or that requires less energy.

• Yes

Awareness practice
Neck warmups
Shoulder circles with scapular awareness
Side stretch overhead
Dynamic twist
Wrist/hand joint finger stretches/strengthening
Hand massage
Eye, tongue, hand practice
Yoga nidra

I offered her the Hamsi Mudra again as well as the Sandhi (Joint) Mudra to practice.

She came from a PT appointment and shared what they went over today. She had had a very busy week helping a friend teach a poetry class. She kept getting interrupted doing her morning practice so her body was very stiff by the end of the week. She wasn’t sleeping as well as she had been. She shared a side lying position (“kind of a restorative posture”) that her PT shared with her that was supposed to keep her in the same position so she could sleep well.

This session went better than the previous ones. We kept things pretty low key and worked on mobility in the small joints of the hand and wrist. I have a tendency to give many details when describing certain movements for safety reasons and for the client to get the most benefit from a move. Although I rely on the majority of people to stop a movement if it bothers them, I do need to remind myself to continuously verbally prompt students to listen to their bodies and take care of themselves in the practice. Otherwise, this session proceeded very well. It helped that it was the last session and that we had worked out some of the communication kinks of the previous sessions. I brought in an additional stress reducing practice, which was well received. Overall, it was a nice way to end our time together.

We met for 1 intake and 3 sessions.

This was a tough case study for me because it seemed like the client didn’t want to reveal too many “weaknesses” so I was not always working with the full amount of information. Out of respect, I relied on her to let me know what she would like to work on. However, what she stated she wanted to work on was not necessarily the thing that was bothering her the most, as indicated by her telling me about her visits to the PT.

I have to rely on what a client states they want to work on both on the intake and verbally during our sessions—at least as a starting point. Usually, I am able to tease out what the client is really looking for through conversation, questioning and observation. It was more difficult to determine the true direction this client wanted to go due to a more protected interaction with me, perhaps due to the knowledge she was being recorded. In the future I hope to be able to have a more easeful interaction since I won’t be recording our sessions. However, for future practicum sessions, I need to be more cognizant of the way the recording affects our interactions even if a client states they are ok with it.

Despite that, I do feel that we were still able to have a meaningful therapeutic relationship and that she found benefit and ease from our sessions together. I feel that the initial client goals changed from what I originally thought from our intake. She was getting some of her needs met with the PT visits, so it made sense to focus on other things with our time together. (e.g. we did not end up working on Pranayama for the sleep issues, as she was covering that in other ways with the PT.) We spent most of the time addressing the physical body (Annamaya, Hatha). She did find the yoga nidra and other relaxation/stress relieving practices (Manomaya) quite beneficial, so I’m grateful to have been able to help that way. She was also open to some thoughts on simple ways to think about Vāta and how to keep it from getting aggravated from a yogic perspective.

Since she was using these yoga therapy sessions more as a support for her PT sessions, I would plan on making myself available to her current needs if we were to meet again.