- 64-yr-old female, single, lives alone.
- Adjunct instructor in Kinesiology at local Junior college. Also is self employed as a personal trainer. Wants to retire in 2 years.
- Loves to adopt mature dogs and care for them.
- Is a trained dancer and performed professionally between ages 16-24. Also taught dance in her 30s.
- Diagnosed with Orthostatic hypotension since 1999
- Suffers from Migraines. Taking Imitrex, Advil and sleep gives her some relief. Certain scents like lavender, stress and barometric pressure difference triggers migraine.
- Has had surgery of right metatarsal for bone chips and spurs.
- Has OA in left knee and right foot, Sciatica on left side.
- Has IBS, degenerative cervical disc, Subluxation of L4-5, Aortic Regurgitation, Peripheral Neuropathy in left foot, ankle and calf, and right hand, Swollen left foot, ankle and calf.
- Bicep tendonitis in right arm.
- Lost her dad three years ago. Says that she feels like an orphan with both parents gone. Mom had RA and died almost 15 years ago.
- Experiences fatigue now and then. When she does, she can barely move. Starting on ferritin supplement.
- Her social support includes mainly friends. She has 2 brothers and 1 sister but is not close with any of them. Has an aging aunt that she visits once in a while.
- Her goal from the sessions is to relieve the stiffness in the body, alleviate the sciatica pain and gain better mobility overall.
- Tight left shoulder, right hand tingles on flexion at the elbow, if the arm is at shoulder level.
- Pain in QL on side bends. Had to have knees bend when supine.
- Small ROM in Spinal extension.
- Tight right hip flexors.
- Chest breather but starts to deep breathe once paying attention.

- Gentle mat practice – joint freeing movements. Hip extensions like locust. Using props like couple of blankets (under hips, knees) to ease being supine
- Pranayama – extended exhalation, bhramari, nadi Shuddhi, breath of fire.
- Restorative practice after flare-ups
- Progressive relaxation
- Yoga Nidra, Loving kindness meditation, Healing light meditation.

- Yoga for Arthritis Teacher’s manual
- Adaptive yoga Teacher training manual.
- 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)
- Monro R, Bhardwaj AK, Gupta RK, Telles S, Allen B, Little P. Disc extrusions and bulges in nonspecific low back pain and sciatica: Exploratory randomised controlled trial comparing yoga therapy and normal medical treatment. J Back Musculoskelet Rehabil. 2015;28(2):383-92. doi: 10.3233/BMR-140531. PMID: 25271201. Disc extrusions and bulges in nonspecific low back pain and sciatica: Exploratory randomised controlled trial comparing yoga therapy and normal medical treatment - 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)
- Kocyigit BF, Sagtaganov Z, Yessirkepov M. The effectiveness of yoga as a form of exercise in the management of rheumatic diseases. Rheumatol Int. 2023 May;43(5):795-801. doi: 10.1007/s00296-023-05291-9. Epub 2023 Mar 1. PMID: 36856817. The effectiveness of yoga as a form of exercise in the management of rheumatic diseases - PubMed (nih.gov)
- Singh AK, Singh OP. A preliminary clinical evaluation of external snehan and asanas in the patients of sciatica. Int J Yoga. 2013 Jan;6(1):71-5. doi: 10.4103/0973-6131.105950. PMID: 23439799; PMCID: PMC3573547. A preliminary clinical evaluation of external snehan and asanas in the patients of sciatica - PubMed (nih.gov)
- Wu Q, Liu P, Liao C, Tan L. Effectiveness of yoga therapy for migraine: A meta-analysis of randomized controlled studies. J Clin Neurosci. 2022 May;99:147-151. doi: 10.1016/j.jocn.2022.01.018. Epub 2022 Mar 10. PMID: 35279587. Effectiveness of yoga therapy for migraine: A meta-analysis of randomized controlled studies - PubMed (nih.gov)

• Yes

Check-in. Body scan, breath awareness, joint freeing stretches for the whole body, paying more attention to lower legs. ‘Breath of fire’, Half sun salutation staying up on the feet. Lunge to Warrior II to extended forward fold to Goddess. Supported shavasana with bolster under the knees. Tense and release, yoga nidra to end the practice.

Stretching after every class that she teaches, and after her walks. She said she liked the ‘breath of fire’ and she felt rejuvenated. Doing 5 rounds of that breath when feeling fatigue and see if that helps make her feel better.

She was feeling tired and had a headache, mostly in the forehead, since she stayed up late last night figuring out some tech issues with the college portal. Her IBS is acting up, and her belly feels swollen. Right before our session, she went for a walk with a friend, and her calves feel tight and the shins hurt.

I was feeling a little tired and not well before the session and took a covid test (which was negative) in order to be sure that all was well with me, before my client walks in. Did 5 rounds of ‘breath of fire’, which energized me a little bit.

Stretches for the body, yoga nidra, intro to Kapalbhatti and nadi Shuddhi.

• Yes

Check-in. She came in with pressure headache, so I kept the practice gentle and restorative. Slow flow of asanas. Used props like 2 blocks, blankets. Worked on alignment with the help of a mirror. Setting an intention of being gentle with the body and breath.
End with tense and release, progressive relaxation and yoga nidra.

Practice progressive relaxation when she feels like a headache coming on. Suggested to listen to some yoga nidra audios on ‘Insight Timer’ app.

She’s painting her bedroom and because of the paint smell, she has been sleeping on the couch for the past couple of days. Feels tired and fatigued and has been having headache every day. Says it’s not migraine. At the time of the session, she was feeing tension around her forehead. The weather has changed in the past couple of days and because of the barometric pressure change, she’s been having headaches.

She loved the gentle flow and Yoga Nidra. Said that her headache was gone. I had planned introducing kapalbhatti for this session, so she can use that to energize herself when she’s feeling tired. But I decided against it as she was having haeadache when she came for the session. Made me feel so proud of myself. I realized that it would be great to have a folder of meditation scripts that focus on specific conditions like migraine, healing, love, so that I am more prepared to focus the meditation specific to what the client comes in with. Will start working on that.

Gentle flow, yoga nidra and meditation for headaches.

• Yes

Check-in. Body scan, breath awareness, upper and lower body warm-ups, sun salutation with the chair and at the wall. She preferred the chair, so we stuck with that. Restorative sciatica stretches, like Lord of the fishes (sitting up on a bolster), supine twist, supine figure 4, knees to chest. End with restorative legs up the chair, which I modified with 3 bolsters, instead of a chair. Progressive relaxation, loving kindness meditation towards herself and a sound bath.

Legs up the couch or chair for a little while during the day. Set an alarm on her phone for every other hour to check-in with your body and notice where she’s tensing up.

The client called me a day before our session together saying that she has had a real painful sciatica since the weekend and it was so painful that she wasn’t able to walk and haven’t gotten much sleep because of the pain. She had been applying heat and taking ibuprofen. She feels better enough to come to the session. I offered her online option but she wanted to come in-person. When she came in, she was favoring her left side, trying to stay off the right, which was causing some pain in her lower back. She said she has been feeling a pain in her pelvis too near the pubis symphysis area. She also shared that she’s having some stress at work regarding a colleague and feels unappreciated.

I was a little surprised to hear that this intense pain was on the right side, which was her ‘non-sciatica’ side, when she first came in. I asked her if she has an idea what would have caused that. I encouraged her to consult her doctor. I selected the ‘Yoga for Sciatica’ class from ‘Yoga for Arthritis’ teacher manual for this session but I had to modify a lot of them to be able to work it with her pain and discomfort. This was a great learning. She left with a feeling of relaxation and calm, which made me feel accomplished.

I feel that I’m getting a little more comfortable working with people 1:1. I was pretty proud of myself to be able to think on my feet and modify the practice as needed. Some more resources, like specific meditation scripts, might have helped more, but that’s a learning that I’m taking from this. Having a portable mirror also helped with the alignment.

Keep working on moving the joints and strengthening the muscles around the joints. Helping her develop gentle, loving practice for herself. Loving kindness meditation, Yoga Nidra.