The client is a female in her mid 20s.
The right shoulder is visibly higher than the left. It was the result of a whiplash injury from a car accident when the client was 10 yrs old.
She experienced an injury on right ankle that didn’t heal properly.
There is weakness in the left knee; the leg buckles and can’t hold weight after playing volleyball.
Sleep is not always restful.
She works as an Engineer.
She plays volleyball as her main form of exercise.

She lives with a roommate and has the support of her partner and friends.

Client goals
1. “Be more in tune with my body”
2. Reduce stress

Yoga therapy goals:

Koshas: _x_Annamaya _x_Pranamaya _x_Manomaya __Vijñanamaya __Anandamaya

Integral Yoga: __x_Hatha _x__Raja ___Bhakti ___Karma ___Jnana ___Japa

Short term:
I’d like to work with her to strengthen the body so sides are more even and to prevent further injury.

Long term:
I would like to teach breathwork and mindfulness practices so she can have the requested mind/body connection and help her reduce stress.

Adaptive Yoga Manual

Stress Management Manual

HBED resources

Hyman, Garrett S.. Jumper's Knee in Volleyball Athletes: Advancements in Diagnosis and Treatment. Current Sports Medicine Reports 7(5):p 296-302, September 2008. | DOI: 10.1249/JSR.0b013e31818709a5
https://journals.lww.com/acsm-csmr/fulltext/2008/09000/jumper_s_knee_in_volleyball_athletes__advancements.14.aspx#:~:text=The%20pain%20usually%20is%20worse,in%20training%20or%20competitive%20sport.

• Yes

Awareness practice
Neck warmups: right/left, chin glide, waterfall, Head tilt with PNF (proprioceptive neuromuscular facilitation – isometric contraction against the hand), arm rotations
Shoulder circles with scapular awareness, elbow/wrist touch, alternate
Reed (lateral stretch)
Feel breath into ribcage and back (360° of breath)
Isolated pelvic tilt in tabletop to wave cat/cow
Happy puppy
Sunbird
Pelvic tilt supine to find a neutral spine
Bridge in neutral spine to one legged bridge – we found weakness
Supine windshield wiper
Happy baby
Yoga nidra

The client can explore not using the knee brace when she plays volleyball. We talked about the weakness we discovered in her right hip and what it might mean to NOT use the knee brace to prevent further weakness.

The client shared that she played volleyball the past week. The pain in her knee was “not as noticeable” when she was jumping. She did reveal though, that her ankle had been bothering her more consistently. It had been giving her pain recently. It felt like a dull pain “in the foreground” if she did anything besides walking.

This session was more about exploration and discovery. Since she sits a lot for work, we went through the body joint by joint and started to move them. She said that she could see how one might feel a little sore afterwards if this was the first time moving those joints in a long time. We used bridge with a neutral spine as our main pose for core and leg strengthening. Asking her to take turns lifting one leg slightly while keeping the hips level revealed a weakness in her right leg/hip area. This was eye opening for the client because it revealed the imbalance was present all the time and not just a case of her leg becoming tired during volleyball.

In preparation for more back of the leg strengthening work, I’d like to work with her to release any tightness in the front part of the body.

• Yes

Awareness practice
Neck warmups: right/left, chin glide, waterfall, head tilt with PNF, arm rotation-2x on left side
Moved to chair
Shoulder taps with elbow, wrist and alternating
Dynamic twist
Reed, lateral stretch
Seated isolated pelvic tilt to wave cat/cow with cactus arms
Garudasana arms
Seated lunge/quad stretch
Hip internal/external rotation foot drag
Heel roll ups and ankle circles with ball of foot on the ground
Yoga nidra

I asked the client to practice the seated lunge stretch at work.

The client shared that she played volleyball for 3 hours straight. Although she didn’t stretch after playing, she said that she stretched beforehand. She mentioned that her legs were a little sore, but there was nothing else to report physically. She noted that she was no longer using the brace during volleyball games, which was a big deal for her. After playing, she said she was mindful when moving, especially on the stairs, so that her legs wouldn’t buckle under her.

Our conversation during the check-in included talking about how different repetitive motion patterns or holding could contribute to the knee pain and weakness in her leg. If she had tightness in her leg muscles, especially the quads, that could potentially limit the movement of the knee. Combined with the repetitive forceful jumps and landings with weak and/or tight muscles, that could definitely play a part in the pain she was feeling. With that in mind, we looked into stretching the quads today for our main activity. The client was surprised at how tight her quadriceps were when we did the stretch. We also talked about how, on the flip side, the hamstrings or back side of the legs may not be used optimally when she is playing. We didn’t have enough time to address that portion in this session, but I was glad we were able to introduce the concept.

We could potentially focus on working with the hamstrings or posterior side of the legs to balance out the quads.

• Yes

Awareness practice
Neck warmups: right/left, chin glide, waterfall, head tilt with PNF, arm rotation
Shoulder rolls with scapular awareness
Shoulder taps with elbow/wrists
Reed lateral stretch breathe into ribs
Dynamic twist
Tabletop isolated pelvic tilt with ischial tuberosity/pelvic floor awareness
Wave cat/cow
Happy puppy/hip sway
Spider Gwen
Sunbird with prep
Giant hip circle to child’s pose
Seated
Chair lunge with twist
Heel raises with ankle circles on ball of foot
Standing
Workshop Utkatasana (Chair pose)
Hip glide
Yoga nidra

I suggested that the client practice Chair pose. Optional: she could incorporate a strap to activate the muscles on the lateral side while performing Chair. She could also practice the single leg balance on the ball of the foot.

The client mentioned she had not played volleyball all week. She was feeling more fatigued lately, but said it was due to mental stress vs. any physical activity. She also reported that she did the lunge stretch at work and that it was much easier. When I asked her to show me how she did it, she had missed some details and when we did it together it was just as intense as last time. Because she had been “doing jointy things at work,” she asked for more “strengthening things,” particularly for her ankle.

Before we started, I introduced a single leg balance on the ball of the foot to strengthen the muscles around the foot and ankle per the client’s request. Trying this out revealed that her right foot/side was quite a bit weaker than her left. The level of weakness was a shock to the client, but I pointed out that now that we knew this information, she could move forward to make improvements. On another note, I wasn’t sure if it was because she was feeling fatigued, but the client’s wrists were sensitive today. I showed her how to prop them up with a pillow under the mat to form a “wedge” and that helped immensely.

The plan for today was to practice Utkatasana (Chair pose) for our main pose. We did the seated lunge to stretch the quads beforehand. After adding a twist to the lunge, the client said she liked the sensation of combining both stretches simultaneously. Once we started practicing Chair pose, I made a point to have her sit back to activate the back side of the legs and rely less on the quads. For a challenge, the client tried balancing on the balls of her feet without moving her upper body while she was in chair pose. This presented another way to strengthen the intrinsic muscles of the feet in a fun manner. She was happy with the offerings as something she could remember and practice by herself.

We met for 1 intake and 3 sessions.

Through the physical practices, the client uncovered old wounds and became aware of how injuries she thought were healed were still affecting her. She rediscovered an injury to her neck that occurred in a bad car accident when she was 10, as well as the alternating weaknesses in her right ankle, left knee and right hip. With this fresh perspective on her body, she recalibrated her mindset to one of taking care of her body rather than taking it for granted. The addition of breath with movement gave her an added layer of perception and a way for slowing down her “go-go-go” way of thinking and doing. She appreciated the slow, full, diaphragmatic breathing as a simple tool she could use to calm the mind and relax the body whenever she had need. (Hatha, Annamaya, Pranamaya, Manomaya)

Even though this was a physically straightforward case, there were a lot of mental/emotional adjustments that the client had to make throughout our time together. I think in her mind, there was a natural progression of expected injury as one continued in the sport of volleyball. It was almost a badge of honor to have to wear knee and/or ankle braces to play the game. Since she didn’t experience pain outside of playing, she didn’t think much of it. As we worked together, she gradually developed the realization that the weaknesses and imbalances in her body were “real” and could be improved upon with work. This prompted her to shift her attitude; she became more mindful of her movement and purposeful in how she chose to move with her newly gained insight. She stopped using the braces and made a commitment to practice ahimsa and not continue to re-injure herself through mindlessness. (Raja, Manomaya) She also really enjoyed the practice of yoga nidra and started to incorporate that more regularly in her routine as a way to destress, calm the mind and help with sleep. (Annamaya, Pranamaya, Manomaya)

I wasn’t sure what to expect with a young client asking for help with a musculoskeletal injury, but I am so pleased with how our sessions ended. I was able to help her physically, but more importantly to me, we were able to introduce tools to allow her to find some calm and peace for her mind as well.

Once she feels ready, we could have her try an adapted single leg Chair pose (Eccentric decline squat) as described in the article, for further strengthening.