BK is a yoga and meditation teacher, 69-year-old female, retired from her regular job.
- Suffers from Rt hand neuropathy
- Spine compression in thoracic and cervical spine.
- Osteoporosis
- Two surgeries in the last year - Left hip replacement and pelvis repair, and Rt. Shoulder rotator cuff repair.
- Good sleeper but pain keeps her awake since past 6 months.
- Good social support
- Relies on her yoga and meditation practice for stress relief – low stress.
- Undergoing physical therapy for neuropathy and Rt shoulder.
- Good medical insurance, so she can see specialists.
- Has some difficulty getting up and down from the floor.

- Barrel breath -imagining that inflating the core all around as you inhale and contracting it towards the middle as you exhale.
- Extended Exhale.
- Raja Yoga – Pratipaksha Bhawana, Svadhyaya
- Restorative practice
- Guided relaxation/Yoga Nidra
- Nerve flossing, which essentially are some yoga asanas like twists and Joint freeing series.
- Yoga for Arthritis class for Sciatica.

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5. 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)
6. Fatma Seddik Amin, Heba Ahmed Abd El_Azeem Haridy, Ebtesam Mohamed Fahmy, & Yasser Ramzy Lasheen. (2023). A Multimodal approach of electrotherapy versus nerve flossing technique in patients with chronic carpal tunnel syndrome: a randomized controlled trial. Journal of Population Therapeutics and Clinical Pharmacology, 30(7), 322–334. A Multimodal approach of electrotherapy versus nerve flossing technique in patients with chronic carpal tunnel syndrome: a randomized controlled trial | Journal of Population Therapeutics and Clinical Pharmacology (jptcp.com)

• Yes

Check in – Walked on a flat surface for 5 minutes. She walked fast and her back didn’t hurt. Says her hand feels a little better and she can make a fist now. She’s in a training program for her 300-hr. yoga certification. Says, learning is fun. But she also gets competitive with herself and has trouble accepting that there are some things that she can’t do as well as she used to before like taking longer walks.
We had a chat about how she can make self-learning a fun too. What is she feeling in the moment when she can’t do something that she was able to do. Talked about Pratipaksha Bhawana, changing negative thoughts to positive. Chair JAPA movements. Introduced Extended exhale pranayama. Gentle twists in chair.

Walking at least couple of minutes every day. Setting an intention about how you would like your day to go, before getting up from the bed in the morning. Keep practicing Barrel breath and extended exhale. Self-massage on the right hand, like rolling it on a tennis ball.

She has been going to a hand PT for her neuropathy, which she says is helping. Walked on a flat surface for 5 minutes. She walked fast and her back didn’t hurt. Says her hand feels a little better and she can make a fist now. She said twisting right was tighter than twisting left.

In the middle of the session, after the twist she said her right side felt tighter than the left. She mentioned that she was diagnosed with scoliosis in the late 90’s. I asked about her angle of her curve, right or left, but she said she couldn’t remember. She said that the doctor didn’t do any follow up, so she forgot about it. I asked if she can send me her report, if she finds it.
Going forward, instead of twist or bend, we’ll focus more on lengthening.

Research some articles on scoliosis and yoga. If she sends her x-ray report, then do specific research on the curve of scoliosis. Focus on lengthening in the side stretch, rather than the bend. Continue with extended exhale, barrel breath and intention setting.

• Yes

Check-in - She came in with a cough, and every time she took a big breath in, she started coughing. I palpated her spine and seemed like she has a left C-curve in her lumbar spine. She brought her x-ray report, which confirmed that. For the practice, we were focused more on lengthening the spine. Dr. Loren Fishman published a study that showed that isometric stretches like side plank on the convex side of the curve can help reverse of scoliosis. We did asymmetrical stretching. We did the side plank against the wall, since she was having difficulty to be on the floor, because her shoulder was bothering her.

Holding the isometric stretch of side plank for at least 1-2 minutes. While in stretch, breathe using the barrel breath. Taking rests and breaks during the day.

Between the days that we met for the sessions, she helped her daughter to assemble a shed as a birthday gift. She said that she did fine and took lot of breaks and rest. But then she got sick and had a really bad cough and cold. She also shared that her stress level has increased in the past week because of a homeless situation in her neighborhood. Her partner’s stress was causing her more stress. She was diagnosed with stem cell deficiency in her eyes, for which she has started putting saline drops and has not been wearing contacts. Her back doesn’t hurt anymore when she walks, was able to walk for 7 minutes continuously. She has been able to practice yoga on the mat for a little while, which makes her feel really good.

I was a little distracted today because my son had a dental surgery in the morning. Since I teach the sessions at home, I had to take couple of breaks to see to his needs. That affected our session today. I had thought of centering myself before the session, but I was running around till the last minute to get his medications. Going forward, I’ll take a few minutes to center myself and do couple of rounds of Nadi-shuddhi pranayama, before the sessions. Or if possible, not teach on the day that I’m going through the family emergency.

Continue with the isometric stretches. Will try restorative side bend on the convex side. Look into the ‘Adaptive Yoga Teacher Training’ manual for some more suggestions. Give her a printout of the research by Dr. Loren Fishman.

• Yes

Check in. Concentrated on Pranayama practice mainly. Some joint freeing movements as well. Extended exhale, breathing into the back of the body in supported child’s pose. Netra Vyayamam. Use of blanket to tilt the pelvis forward. Nerve flossing for the hand neuropathy. Stretches like pigeon on chair for sciatica. Taking the guidance from Loren Fishman’s paper for the Scoliosis curve – Supported Side plank on the convex side of her lumbar C-curve.
End with tense and release, and yoga nidra.

Practicing extended exhale and Barrel breath as often as she can, if it doesn’t cause coughing. Practice side plank 1-2 times a day and hold it for 5 breaths at a time. Gave her the printout of Dr. Loren Fishman’s research paper as a guide.

She had been sick with severe cough and had to go to the urgent care for that, since it got worse. X-ray showed that the bottom of her lung had collapsed- Atelectasis. She was put on asthma inhaler. She hasn’t been able to go for her long walks because of her illness. Her right hand had started to bother her again. When she tried high lunge at home, it bothered her sciatica.

I realized that I do not have to do a lot of things in a session. Taking my time to work with alignment of the body, makes it a better experience for the client. We tried high lunge and I took time to work with her alignment, like the space between the feet, alignment of hips, which helped her figure out a way to do it on her own without pain. I also feel that having a mirror in my work space would help clients see what to look for when they are doing stretches on their own.

I felt like there’s have been improvement in my management of my own expectations from the sessions. I’m more open to how things show up and take cues from the client to lead the sessions.

Working on extended exhale and barrel breath for improving the lung function. Keep doing the stretches that help with the hand neuropathy and sciatica. Working on unilateral stretches for her Scoliosis.