- 61-year-old female. Employed full-time, corporate job, IT leadership, divorced.
- Diagnosed with Fibromyalgia, repetitive stress injury to right wrist, OA in neck, starting in fingers too.
- Asthma and hay fever, managed with regular medication
- A year ago, diagnosed with Type 2 diabetes, takes metformin for that. Recently lost around 50 lbs by making changes to her diet, which also helped manage her diabetes well.
- Sciatica in left side, metatarsal of left foot starts hurting after 20 min of walking (says that it feels like ice pick)
- Lower back pain
- Had been a gymnast from age 12-16.
- Osgood-Schlatter in the left knee and right hip pain. Because of the hip pain, she’s not able to sleep on her side.
- Family history of alcoholism, bi-polar depression and drug use.
- She smokes marijuana daily before bed, says it gives her relief from pain and helps her sleep.
- She was a prayer chaplain and has a very loving and supportive community, but her family support is negligible. She feels like she’s the one taking care of everyone else in the family.
- Has restless leg syndrome.
- She says she’s very competitive and wants to get all A’s, which is why she can’t go to a therapist, since it’s too abstract for her.
- Wants to learn some ways to bring relief to her sciatica pain and also be able to walk for more than 20 minutes.
- Chest breather, left side of the body has lesser ROM than right.
- Can get up and down the floor with the chair for support.

- Her lifestyle and temperament are very Rajasic, so bringing some balancing and calming practices like extended exhale. Starting with breathing-in to the count of 4 and breathing-out to the count of 6, slowly increasing the exhale till it’s twice the length of inhale.
- Discussion about stress, stress response and relaxation response.
- Vagus nerve activation exercises. Evidence-based explanation of the exercises will help her be more open to it.
- Guided relaxation with breath awareness.
- Walking meditation
- Joint freeing movements for the whole body, to relieve the tightness. Specifically focusing on her lower extremities. Spinal extensions, since her work is mostly sitting in front of a computer.
- Netra Vyayamama to relax and strengthen eye muscles and also trigger relaxation response, after a long day of staring at computer screen.
- Loving kindness towards herself.

- Yoga for Arthritis Teacher’s manual – Yoga for Sciatica.
- Adaptive yoga Teacher training manual.
- Fibromyalgia research presentation by Kayko Watanabe
- Lazaridou A, Koulouris A, Dorado K, Chai P, Edwards RR, Schreiber KL. The Impact of a Daily Yoga Program for Women with Fibromyalgia. Int J Yoga. 2019 Sep-Dec;12(3):206-217. doi: 10.4103/ijoy.IJOY_72_18. PMID: 31543629; PMCID: PMC6746047. The Impact of a Daily Yoga Program for Women with Fibromyalgia - PubMed (nih.gov)
- Verma A, Shete SU, Doddoli G. Yoga therapy for fibromyalgia syndrome: A case report. J Family Med Prim Care. 2020 Jan 28;9(1):435-438. doi: 10.4103/jfmpc.jfmpc_816_19. PMID: 32110633; PMCID: PMC7014847. Yoga therapy for fibromyalgia syndrome: A case report - PubMed (nih.gov)
- Chiusalupi M, Crupi M, Rustici R, Ciaramella A. How Does Yoga Work on Pain Dimensions? An Integrated Perspective in 2 Individuals With Fibromyalgia. Adv Mind Body Med. 2018 Fall;32(4):4-8. PMID: 31370034. How Does Yoga Work on Pain Dimensions? An Integrated Perspective in 2 Individuals With Fibromyalgia - PubMed (nih.gov)
- Islam Z, D'Silva A, Raman M, Nasser Y. The role of mind body interventions in the treatment of irritable bowel syndrome and fibromyalgia. Front Psychiatry. 2022 Dec 22;13:1076763. doi: 10.3389/fpsyt.2022.1076763. PMID: 36620663; PMCID: PMC9814478. The role of mind body interventions in the treatment of irritable bowel syndrome and fibromyalgia - PubMed (nih.gov)
- Skelly AC, Chou R, Dettori JR, Turner JA, Friedly JL, Rundell SD, Fu R, Brodt ED, Wasson N, Kantner S, Ferguson AJR. Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review Update [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2020 Apr. Report No.: 20-EHC009. PMID: 32338846. Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review Update [Internet] - PubMed (nih.gov)
- Hawk C, Whalen W, Farabaugh RJ, Daniels CJ, Minkalis AL, Taylor DN, Anderson D, Anderson K, Crivelli LS, Cark M, Barlow E, Paris D, Sarnat R, Weeks J. Best Practices for Chiropractic Management of Patients with Chronic Musculoskeletal Pain: A Clinical Practice Guideline. J Altern Complement Med. 2020 Oct;26(10):884-901. doi: 10.1089/acm.2020.0181. Epub 2020 Jul 30. PMID: 32749874; PMCID: PMC7578188. Best Practices for Chiropractic Management of Patients with Chronic Musculoskeletal Pain: A Clinical Practice Guideline - PubMed (nih.gov)
- Lazaridou A, Koulouris A, Devine JK, Haack M, Jamison RN, Edwards RR, Schreiber KL. Impact of daily yoga-based exercise on pain, catastrophizing, and sleep amongst individuals with fibromyalgia. J Pain Res. 2019 Oct 17;12:2915-2923. doi: 10.2147/JPR.S210653. PMID: 31802932; PMCID: PMC6802732. Impact of daily yoga-based exercise on pain, catastrophizing, and sleep amongst individuals with fibromyalgia - PubMed (nih.gov)
- de Orleans Casagrande P, Coimbra DR, de Souza LC, Andrade A. Effects of yoga on depressive symptoms, anxiety, sleep quality, and mood in patients with rheumatic diseases: Systematic review and meta-analysis. PM R. 2023 Jul;15(7):899-915. doi: 10.1002/pmrj.12867. Epub 2022 Oct 6. PMID: 35726183. Effects of yoga on depressive symptoms, anxiety, sleep quality, and mood in patients with rheumatic diseases: Systematic review and meta-analysis - PubMed (nih.gov)
- Matko K, Burzynski M, Pilhatsch M, Brinkhaus B, Michalsen A, Bringmann HC. How Does Meditation-Based Lifestyle Modification Affect Pain Intensity, Pain Self-Efficacy, and Quality of Life in Chronic Pain Patients? An Experimental Single-Case Study. J Clin Med. 2023 May 31;12(11):3778. doi: 10.3390/jcm12113778. PMID: 37297973; PMCID: PMC10253285. How Does Meditation-Based Lifestyle Modification Affect Pain Intensity, Pain Self-Efficacy, and Quality of Life in Chronic Pain Patients? An Experimental Single-Case Study - PubMed (nih.gov)

• Yes

Check -in. Spoke to her about walking meditation and also the stretches that she can do while walking her dog, since he’s slow to walk.
Practice included- body scan, breath awareness, Joint freeing movements, Netra Vyayamama, Up-down movement gave her headache. Bhujangasana, tense and release, supported shavasana, loving kindness meditation towards herself.

Joint freeing movements during the walks with her dog. Extended exhalation. Encouraged her to keep doing the Netra Vyayamama to strengthen the eye muscles.

Started using Nioxin for hair fall, which caused more hair to fall and now she has a bald spot that she was covering with a ballcap. She asked if she can have the cap on for the whole practice. I asked her to remove it when she was prone on the floor for spinal extensions, which she was reluctant to do. I offered to stop the recording and she removed the cap for just the prone practice, put it back on as soon as we were done. Said her neck felt stiff after the day of work. Did half-fish pose at home, which helped quieten down her sciatica pain. She said she has been practicing extended exhalation before bed, which is helping her sleep better. Said her dog is old and is very slow.

I felt a little odd insisting on her removing her cap for the practice, since I could clearly see that it was interfering with her practice. Will suggest any other head covering, maybe scarf for the next session.

- Extended exhalation
- Netra Vyayamama
- Self-love meditation

• Yes

Check-in. Body scan, breath awareness, Joint freeing stretches, Balancing asanas like tree and lunge, with chair as the prop. Restorative supported shavasana, tense and release and loving kindness meditation towards herself.

Breath awareness. Stretches while walking the dog. Try and do as many stretches as she can during her travel, in her hotel room, at the airport, go for walk with a colleague.

Came straight from work, said her neck feels stiff. Had friends’ visiting. Took them around town and had spa, massage and acupuncture treatments. Said she has been doing her stretches while walking her dog, remembers to breathe out more than breathing in. Stressed about her upcoming work travel, since she doesn’t have anyone to take care of her dog. I smelled Bengay when she walked in and I asked where is the pain, and she said her lower back was bothering her. Says she wants to start dating but is very self-conscious of her looks, especially her hair. Talked about wanting to teach and we discussed some options to bring her intellectual stimulation.

I felt good about the session. When she came in, I saw that she was not wearing her hat and had her hair up in a tiny bun. I mentioned that it looked good on her. After the class, as she was leaving, I asked her if she would like to sit in the chair while she puts her sandals on, she said she’s fine. But while wearing the sandals, she disbalanced and almost fell. Thankfully, I was standing right beside her and caught her. There are couple of stairs leading to my front door. Might have to think about getting a railing for the stairs for people to hold on to, if I keep seeing clients at my house.

Keep doing the stretches, loving kindness meditation towards herself, exploring some more ways that she can incorporate the stretches, meditation and relaxation in her daily life.

• Yes

Check-in, Body scan, breath awareness, extended exhalation, Netra Vyayamama, Joint freeing exercises, Balancing stretches on chair and standing.
Tense and release, restorative supported shavasana, yoga nidra and then neutral imagery meditation about her secret place.

Keep incorporating the stretches in her daily routine.

Client came in happy and said that she’s feeling proud of herself. Said she’s found a sitter for her dog, while she will be away on a work trip, and also found a hair wig consultant who will help her get fitted for a wig soon, so she’ll have that for her trip. Said that she’s been doing the lunges while heating her tea, eye exercises at the end of her work meetings on zoom. Said that in the start it hurt her eyes when she does that because her eyes are not used to seeing without glasses.

Client’s son tested +ve for COVID. She said she’s not had any contact with him, even though they live in the same house. I wore mask during the whole session. I’m glad I did, because she called a week later saying that she tested positive as well.

I was a little stumped when I saw her wearing her hat for the session and was not sure how to proceed in the next session. But having a chat with my mentor helped me realize that I can be assertive (in a nicer way), in order to help her with her practice. Also gave me an opportunity of bringing ‘love for oneself’ in the practice with ‘loving kindness meditation’.

Work on balancing stretches and also core strength by incorporating boat, balancing table with the chair or countertop as props.