Intake Session
Date: 9/6/2023 8:30-10:30 AM Virtual

Intake summary:
The intake session was conducted on 9/6/2023 via Zoom. JPH is a 68-year-old Caucasian female, a retired federal prosecutor who lives alone in Chicago. She was diagnosed with plantar fasciitis (PF) in her right foot in 2006 due to overpronation, which impedes her from walking long distances, causing pain and stiffness. She has also developed RLS with cramps on her right leg, which she suspects are side effects of Rosuvastatin (statin) prescribed for controlling high cholesterol. Her primary objectives are to improve core and knee strength and balance, stretch her hips and hamstrings, and reduce the pain from PF. She wishes to get back on her feet for a long walk without fearing discomfort.

She is 5’6” and reported she weighed 220 lbs. at the last measurement taken “a while ago,” and she does not monitor it regularly. (Note: BMI is 35.5 based on this information, which is classified as “severely obese” per NIH guidelines.) She suffers occasional lower back soreness after lifting something heavy or getting up after sitting for an extended period.

JPH evaluates her overall energy level as satisfactory, as is her sleep quality. In addition to attending my weekly gentle yoga class for the past 8 months virtually, she practices tai chi and stretching classes via Silver Sneakers video for 30-60 minutes almost daily and practices breathing.

The current source of stress is a relationship issue with a fellow owner of her small condo, where she has been a treasurer of the HOA. She coordinates property maintenance with two other owners; however, the neighbor directly above her has yet to cooperate. She states she has managed the challenges “fairly well” through spiritual practice and regular prayer. She grew up as a Methodist but is not involved in any faith community; she studies astrology and tarot reading. She states she often defaults to worries, and when that happens, she seeks “new options to make space metaphysically” and asks the “Higher Power for what I need to receive” through prayer and attunement. She identified herself as spiritual, “always thinking about meaning and purpose in life.”

She has a support network of her sister, sister-in-law, and friends. Retired 2.5 years ago, JPH stated she enjoys self-exploration and renewed social interactions with old friends while “still trying to find my path” in the retired life.

Assessment:
JPH presents herself with confidence and seriousness. She is reserved but not unfriendly, detail-oriented, and intellectually curious. The pain and discomfort from PF, compounded by her excessive weight, slows her down to a hypo-aroused state, adversely affecting Annamaya and Pranamaya Kosha. Dosha is also impacted, provoking kapha quality in the body and slowing metabolism, causing more imbalance in Pranamaya Kosha. Fear of pain aggravation also affects Manomaya Kosha as it keeps her from doing what she enjoys. An unwholesome diet (described below) is another causal influence on the health of Annamaya and Pranamaya Kosha and increased tamasic quality.

Excess weight is observable. Although “overweight” was marked off in the intake form, it was not expressed as a condition she wishes to work on. During the intake session, she stayed clear from discussing the topic. JPH acknowledges the need to improve her diet, characterized by high carbs and processed, non-homecooked meals (frozen dinner, pizza), and she “craves sweets.” Imbalance in Vijnanamaya Kosha is suspected mainly in two areas: aversion to addressing the weight problem and a possibly unhealthy relationship with food and mindless eating, which is to be investigated. Some studies recognize obesity as a significant factor in PF development, possibly due to increased mechanical loading of the foot by excess weight. Also, other studies indicate that RLS occurs more frequently in individuals with obesity than in people with normal weight. (Sources can be found in the Resources and References section)

Stress and emotional disturbance due to a challenging relationship with a neighbor may be affecting the health of Manomaya. Yoga therapy can support JPH to navigate stressful situations with compassion for self and others, which elevates the state of Anandamaya Kosha.

Annamaya and Pranamaya Kosha's imbalance is observable in her movements and deficiency of vitality during the physical assessment; they are stiff and not self-assured. Instability is particularly noticeable when transitioning from one position to another (e.g., standing to seated, standing to the floor).

When weight-bearing, JPH feels pain in the right foot due to PF; the intensity is 4-5 out of 10 (10 as excruciating, which we will use as a baseline). Edema in both ankles was observable during the physical assessment. JPH presented kyphosis in the thoracic spine, limited ROM in spinal flexion, and weakness in the core structure.

Initial Care Plans

Agreed-Upon Goals:
Short-term: 1) Improve the “knees-feet” alignment and stretch posterior structures to address plantar fasciitis.
2) Increase overall physical fitness and stay mindful of what I consume to manage my health, which may help alleviate the conditions in the lower extremities (e.g., varicose veins, RLS), prevent LBP, and keep cholesterol in check.

Long-term: Become able to attune to inner wisdom to gain clarity of an authentic path that aligns with my true Self to experience peace. Learn how to navigate complicated interpersonal relationships skillfully (Updated, moved from the short-term goals)

How Yoga Therapy can help my client:

• Improves the “knees-feet” alignment and stretches the Achilles tendon-gastrocnemius-soleus complex, which may help alleviate foot pain. Increases overall physical fitness via “energizing” asanas. (Annamaya)
• Elevates energic flow to address the deficiency in the system and safely activate the sympathetic nervous system. (Pranamaya)
• Cultivates sense awareness to guide the mind to a healthy relationship with food. Helps navigate stressful interpersonal situations skillfully. (Manomaya)
• Promotes self-reflection and mindful eating (Vijnanamaya)
• Offers tools to navigate stressful situations with compassion for self and others, which brings a sense of peace in her life (Anandamaya)

Specifics:

I. Asana will be given to balance Annamaya, Pranamaya, and Manomaya via:
Standing postures to promote awareness of the “knees-feet” alignment and proprioception; stretches in the Achilles tendon-gastrocnemius-soles complex. “Energizing” asanas to increase pranic flow and overall physical fitness (core and quad strengthening, balance, etc.) and experience joy of movement; Gentle inversion to reduce leg swelling.
• Mountain Pose with “knees-feet” alignment and proprioception exercise
• Chair Pose
• Seated straight-leg hamstring stretch
• Cat & Cow variation – Calf stretches – Sunbird balance – Tabletop crunch
• Vajrasana variation with feet stretching
• Prancing
• Calf and PF stretches w/block at a wall
• Warrior I variation, vinyasa-style
• Supine Head to Toe
• Resting Pigeon against a wall
• Staff Pose – Paschimotanasana w/strap (gentler version)
• Viparita Karani using a wall, w/a block
• Bicycling legs/unilateral leg extension
• Gentle bridge
+ Downward-facing Dog (three different versions – with chair support/standard version on the mat)

II. Pranayama and energy lock will be given to balance Annamaya, Pranamaya, and Manomaya by:
Applying Brahmana-type pranayama with some advanced techniques to safely activate the sympathetic nervous system and pranic flow and stimulate agni (e.g., inhale retention)
• Breath of Joy/“HA” (standing)
• Kapalabhati with gentle breath retention with Jalandhabandha
• Kumbhaka Pranayama (Jalandhabandha & Mulabandha)
• Krama Inhale (Segmented inhalation w/retention)
• Nadi Suddhi

III. Meditation and other mindfulness practices will be given to balance Pranamaya, Manomaya, Vijnanamaya, and Anandamaya via:
Applying pratyahara and mindfulness techniques to keep the mind clear through control of senses and redirecting attention towards something elevating
• 5-Senses Mindfulness Practice
• Witness Practice (also Jnana yoga)
• Discuss Pratyahara and the “Pratyahara 4-week Challenge” (also Svadhyaya)
+ Mindful Eating Practice
• Food intake journal and reflection (also Svadhyaya)
Loving Kindness Meditation (self-compassion and compassion for others)

IV. Other yogic tools will be given to balance Pranamaya, Manomaya, Vijnanamaya, and Anandamaya by:
Applying sutra teaching to cultivate compassion for self and others through self-reflection, provide a framework for positive interactions, and attain a more peaceful mind
• Alt. nostril breathing w/Pratipaksha Bhavana (Bhakti)
• 4 locks & 4 keys
• Mindfulness Practice through the Awareness of Difficult or Stressful Communication (Journaling homework)

I. Plantar Fasciitis:
a. Plantar Fasciitis, Symptoms and Causes, Mayo Clinic
b. What Is Plantar Flexion and Why Is It Important? Health Conditions, Healthline https://www.healthline.com/health/plantar-flexion
c. Boules M, Batayyah E, Froylich D, et al. Effect of Surgical Weight Loss on Plantar Fasciitis and Health-Care Use. J Am Podiatr Med Assoc. 2018;108(6):442-448. doi:10.7547/15-169
“Obesity is recognized as a major factor in PF development, possibly due to increased mechanical loading of the foot due to excess weight.”

d. Asanas for PF
i. Yoga for Plantar Fasciitis, Yoga International https://yogainternational.com/article/view/yoga-for-plantar-fasciitis/

ii. How Yoga Can Help Ease Heel Pain From Plantar Fasciitis, Cleveland Clinic https://health.clevelandclinic.org/yoga-for-heel-pain-plantar-fasciitis-video/

II. Restless Leg Syndrome:
a. Restless Leg Syndrome, Symptoms and causes, Mayo Clinic
b. Innes KE, Selfe TK, Agarwal P, Williams K, Flack KL. Efficacy of an eight-week yoga intervention on symptoms of restless legs syndrome (RLS): a pilot study. J Altern Complement Med. 2013 Jun;19(6):527-35. doi: 10.1089/acm.2012.0330. Epub 2012 Dec 27. PMID: 23270319; PMCID: PMC3673587. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3673587/
“These preliminary findings suggest that yoga may be effective in attenuating RLS symptoms and symptom severity, reducing perceived stress, and improving sleep and mood in women with RLS.”
- Interventions cited in this small study were included in the JPH care plans.
c. Song Lin, Huaqi Zhang, Tianlin Gao, Feng Zhong, Yongye Sun, Jing Cai, Aiguo Ma,
The association between obesity and restless legs syndrome: A systemic review and meta-analysis of observational studies, Journal of Affective Disorders, Volume 235, 2018, Pages 384-391, ISSN 0165-0327

III. Varicose Vein:
Chen YL, Cheng YT, Ye JN, Huang TL, Chen WN. Posture and Time Arrangement Influence Shank Circumference Reduction When Performing Leg Raising Exercise. Int J Environ Res Public Health. 2020;17(16):5735. Published 2020 Aug 8. doi:10.3390/ijerph17165735
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7460006/

IV. Pain:
Pain Screening Tool PEG-3, Mayo Clinic Press

V. Overweight:
a. Volger S, Vetter ML, Dougherty M, et al. Patients' preferred terms for describing their excess weight: discussing obesity in clinical practice. Obesity (Silver Spring). 2012;20(1):147-150. doi:10.1038/oby.2011.217
“In response to open-ended questions, participants offered the term “weight” as their most preferred term for describing excess weight, followed by the term “weight problem.”
b. Yoga As Medicine, Timothy McCall “Overweight and Obesity”

VI. Sutras:
a. Four Locks, Four Keys: A Simple Approach to Relationships, Integral Yoga Magazine. Sutra I.33 https://integralyogamagazine.org/four-locks-four-keys-a-simple-approach-to-relationships/

b. Pratipaksha Bhavana
Yoga Sutra of Patanjali II.33 “When disturbed by negative thoughts, opposite ones should be thought of. This is Pratipaksha Bhavana.”, Inside the Yoga Sutras by Rev. Jaganath Carrera

c. Pratyahara
Yoga Sutra of Patanjali II.54
“… control of senses is attained not by pulling the mind away from the sense object but by redirecting attention towards something elevating. One of the benefits of redirection is that it cultivates non-attachment by replacing transitory sense satisfactions with the deeper, more satisfying contentment of the sattwic mind.”, Inside the Yoga Sutras by Rev. Jaganath Carrera p.157

i. Pratyahara: The Fifth Limb of Yoga, Chopra.com
ii. Pratyahara, yogaville.org

VII. Mindfulness Practice:
a. Kabat-Zinn, Jon. Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. New York: Bantam Books, 2013.
b. Mindful Eating Practice, VHA, Office of Patient Centered Care and Cultural Transformation
c. Loving Kindness Meditation
Uchino, B. N., Bowen, K., Kent de Grey, R. G., Smith, T. W., Baucom, B. R., Light, K. C., & Ray, S. (2016). Loving-Kindness Meditation Improves Relationship Negativity and Psychological Well-Being: A Pilot Study. Psychology, 7, 6-11. http://dx.doi.org/10.4236/psych.2016.71002 Loving-Kindness Meditation Improves Relationship Negativity and Psychological Well-Being: A Pilot Study
“This pilot study suggests that LKM may be a novel intervention approach to improve well-being by fostering relationship processes. A major benefit is that it appears to be a more comprehensive approach to altering relationship perceptions as it both increased social support and decreased social negativity.”

• Yes

Session 1
Session Date: 9/13/23 Time: 8:30-10:15 AM Location: Virtual on Zoom

Activities:
1. Check-in. Follow-up questions.
2. Goal-setting activities. Identified direct/indirect causes of her physical issues and specific therapy goals and plans through motivational interviewing.
3. Pratyahara (Practice, client education and discussion)
a. 5-Senses Mindfulness Practice (sounds, scents, see, taste, touch)
b. Pratyahara according to Sutra
4. Asanas:
a. In a chair
i. Joint Freeing Series
ii. Straight-leg hamstring stretch
b. Standing
i. Mountain Pose & 4-point alignment exercise
ii. Chair Pose & “knees-feet” alignment exercise
iii. Prancing - High lunge focusing on toes-feet-knees alignment
iv. Warrior I flow
c. On all-fours
i. Cat & Cow –> Calf stretches –> Sunbird balance –> Tabletop crunch (leg only)
d. Supine
i. Bicycling legs/unilateral leg extension
ii. Gentle bridge with a block between thighs
iii. Supported inversion with a block
iv. Hamstring stretches – Resting Pigeon & Big toe stretch (Removed) –> Figure four + Big toe stretch in a chair (“Big Toe Pull”)

5. Pranayama
a. Kapalabhati with a brief breath retention
6. Meditation 2 minutes
7. Review weekly assignments

Homework assignment to client:
Weekly assignment is shared with JPH in a GoogleDoc
1. Physical exercises

a. Silver Sneaker morning stretch class - daily

b. Asanas in the afternoon - daily
1) Tadasana
2) Chair Pose (Knees to the 2nd-3rd toes alignment). Extend the arms forward and engage the core.
3) Practice along the video: How Yoga Can Help Ease Heel Pain From Plantar Fasciitis, Cleveland Clinic
https://health.clevelandclinic.org/yoga-for-heel-pain-plantar-fasciitis-video/
i. Cat & Cow, calf stretch to balance pose. Add a few rounds of Cat & Cow before switching the legs for the balance pose
ii. Bridge pose with a block in between thighs
iii. Inversion with a block at sacrum (Legs up toward the ceiling) 3 mins min.

c. Walk outdoor

2. Practice Pratyahara
• “Pratyahara 4-week Challenge”. See GoogleDoc
3. Food intake journaling and observation
4. Pranayama Kapalabhati with short retention (2-3 secs)

Resources and Handouts:
1. Instructions for the practice: Yoga for Plantar Fasciitis, Yoga International
2. How to Build Home Practice (SequenceWiz.com)

JPH reported improving her diet but didn’t cook in the last seven days. She often craves sugar in the late afternoon. A suggestion was made for the mid-afternoon slump that she keep a healthy snack in the fridge, get out of the kitchen for some asanas, or walk outside.

We reviewed the goals together; the laid-out plan “all makes sense.” Although not enthusiastically, she is willing to address her current eating habits and weight management. An unsettling energy was observed, which suggested her sensitivity to the topic. She responded positively to the 5-Senses Mindfulness Practice, which helped her “feel calm and centered.” After discussing the sutra 2.55-56, the Pratyahara 4-week Challenge was introduced to improve mindfulness and sensory awareness in all aspects, not just about eating. “The practice will help me stay away from Sunday morning news on politics,” she said, which often makes her upset and uneasy, which can lead to disturbance in Pranamaya and Manomaya Koshas.

Asana interventions for PF were primarily based on the Yoga for Plantar Fasciitis, Yoga International. She couldn’t reach her big toe in the Big Toe Pull in a supine position; therefore, we modified it so that she could receive similar benefits in a chair, to which she responded favorably. Instability and struggle in Sun Bird Balance suggest core muscle weakness; supported inversion was performed without issues. JPH reported minor pain in the top of the left foot, which had persisted for 1.5 days last week. She suspects it was attributable to the Vajrasana variation she had practiced following the Yoga International article given at the intake session; therefore, we removed it from the intervention for now. Applying the SMART method, we devised a daily regimen for physical exercises for AM (activation) and PM (restoration).

Managing weight can be a sensitive topic for her, but it can be addressed through honesty and care. I researched the subject, found a research paper on preferred terms for describing their excess weight with the demographics, and used the language accordingly in discussion (obese/overweight vs. weight issue/management). I also located a chair yoga video for PF produced by Cleveland Clinic, which is gentle enough for her to practice unsupervised.

Kapalabhati needs review and more practice; instructions were given for home practice. The next session will continue to focus on activation and introduce witness practice and the yogic approach to interpersonal relationships.

• Yes

Session Date: 9/20/23 Time: 8:30-10:30 AM Location: Virtual on Zoom

Activities:
1. Check-in. Review Home Practice. Discuss progress.
2. Witness Practice
3. Discussed the journaling assignment for this week: Mindfulness Practice through the Awareness of Difficult or Stressful Communication
4. Sutra study: 4 locks & 4 keys- A Simple Approach to Relationships
5. Asanas
a. Standing warm-up. Breath of Joy (“HA”)
b. On all-fours
i. Cat & Cow – Calf stretches – Sunbird balance (hold for five breaths) – Tabletop crunch (leg & arm)
ii. Thunderbolt variation
iii. Downward Facing Dog w/rolled blanket under the heel (Pedal the feet, then hold for three breaths)
c. Standing
i. Mountain – Chair Pose (for alignment/proprioception)
ii. Ardha Uttanasana/Standing Forward Fold/ (for RLS)
iii. Warrior I flow
iv. Staff Pose
v. Paschimotanasana/Seated Forward Fold w/strap (for RLS)
6. Relaxation/guided meditation:
• Savasana with Loving Kindness Meditation
7. Pranayama:
• Kumbhaka Pranayama (Jalandhabandha & Mulabandha) - Three rounds

8. Review weekly assignments

Homework assignment to client:
Weekly assignment is shared with JPH in a GoogleDoc
1. Physical exercise
a. Attend morning stretch class - daily
b. Asanas in the afternoon - daily
1) Tadasana
2) Chair Pose (Knees to the 2nd-3rd toes alignment).
3) Practice along the video:
How Yoga Can Help Ease Heel Pain From Plantar Fasciitis, Cleveland Clinic
i. Cat & Cow, calf stretch to balance pose. Add a few rounds of Cat & Cow before switching the legs for the balance pose
ii. Bridge pose with a block in between thighs
iii. Inversion with a block at the sacrum

c. Walk outside - daily
2. Practice Pratyahara:
• Continue the “Pratyahara 4-week Challenge” for the week. See GoogleDoc
3. Food intake journal and observation
4. Pranayama:
• Kapalabhati with short retention (2-3 secs)

Resources and Handouts:
1. Four Locks, Four Keys: A Simple Approach to Relationships, Integral Yoga Magazine
2. Mindfulness Practice through the Awareness of Difficult or Stressful Communication (Journaling Prompt)
3. Studies:
a. Innes KE, Selfe TK, Agarwal P, Williams K, Flack KL. Efficacy of an eight-week yoga intervention on symptoms of restless legs syndrome (RLS): a pilot study. J Altern Complement Med. 2013 Jun;19(6):527-35. doi: 10.1089/acm.2012.0330. Epub 2012 Dec 27. PMID: 23270319; PMCID: PMC3673587.
b. Chen YL, Cheng YT, Ye JN, Huang TL, Chen WN. Posture and Time Arrangement Influence Shank Circumference Reduction When Performing Leg Raising Exercise. Int J Environ Res Public Health. 2020;17(16):5735. Published 2020 Aug 8. doi:10.3390/ijerph17165735

JPH made notable progress last week. She stated she is more mindful of the placement of her feet based on the knees-to-feet alignment practice and noticed the pain from PF has decreased. She sees the difference when walking, distributing her weight “more correctly” and “feeling steady and strong.” The PF exercise video has been helpful; she practices the Bridge Pose as much as ten times daily. As part of the Pratyahara practice, she turns off TV commercials when they are negative and harsh for the senses and pays more attention to nature when walking outside. She tried turning off the TV during meals and playing classical music radio, which helped her become more conscious of her eating. She listens to the Headspace program for guided meditation, which she has practiced after the morning stretch.

JPH demonstrated motivation and commitment to the home practice regimen (asanas and pranayama), which is also observable in her email inquiries on details of each practice and duration, for her to “do them correctly.” She didn’t come forward to discuss the diet (what she ate, etc.), which may suggest she didn’t make progress over the last week.

She performed asana interventions without much difficulty. The modified, gentler version of the Vajrasana variation no longer caused pain. Downward Facing Dog was supported with a roll-up blanket under the heels. She surprised herself, remarking, “I didn’t know I could do DFD!” Improved awareness in physical alignment and proprioception was observable while exhibiting calmness during challenging asanas, such as the Chair Pose. I encouraged her to expand the attitude of non-reactivity she learned in the asana practice to promote equanimity in daily life. She was introduced to Kapalabhati with short retention; we ensure her proficiency so that she can practice safely at home. The effects of extended inhalation were also explained.

JPH didn’t have to interact with the upstairs neighbor this week; however, she stated that Four Locks and Four Keys “will be handy” for the upcoming trip, where she will be in a group setting. As for the reading assignment, a scientific study on yoga interventions for RLS will be shared via Google Docs as she expressed interest.

Her progress reflects my client’s total commitment and compliance with home practice. Experiencing some tangible improvements (no pain in her feet, ease and steadiness in walking) must be empowering to her as she suffered from PF for as long as 17 years. The application of the Yoga Journal’s PF intervention seemed quite effective.

Mindful Eating Practice will be introduced. Jalandhabandha & Mulabandha will be added to Kapalabhati to increase Brahmana qualities in her practice.

• Yes

Session Date: 9/27/23 Time: 8:30-10:15 AM Location: Virtual on Zoom

Activities:

1. Check-in. Review Home Practice. Discuss progress.
2. Mindful Eating Practice
3. Pranayama:
• Krama Inhale (Segmented inhalation)
4. Asanas: On all-fours – Standing – Inversion
i. Cat & Cow – Calf stretches – Sunbird balance (hold for five breaths) – Tabletop crunch (leg & arm)
ii. DFD w/rolled blanket under the heel
iii. Ardha Uttanasana/Standing Forward Fold
iv. Calf and Plantar Fascia stretch w/block at a wall
v. Viparita Karani

5. Pranayama:
i. Kumbhaka Pranayama (Jalandhabandha & Mulabandha)
ii. Alternate Nostril Breathing with Pratipaksha Bhavana

6. Progress assessment

Homework assignment to client:
Weekly assignment is shared with JPH in a GoogleDoc
1. Asana
Try this active sequence daily for the week:
a. Breath of Joy - 3 short INH & Vigorous EXH with “HA!”, moving the arms like conducting an orchestra, knee slightly bent (x10)
b. Come to hands and knees:
i. Cat & Cow→ Calf stretches/Runner’s Lunge→ Sunbird balance (hold for five breaths)→ Crunch. Touching opposite knee and elbow under the body while rounding the back (x3) →Cat & Cow
ii. Tabletop to Thunderbolt “gentler” variation. Place blocks on the floor beside the thighs, rest palms on them (hold for five breaths)
iii. DFD w/rolled blanket under the heel (Pedal the feet, then hold for three breaths)→Cat & Cow

c. Standing:
i. Tadasana - “knees-feet” alignment exercise
ii. Chair pose - “knees-feet,” full pose (x2, hold for three slow breaths)
iii. Ardha Uttanasana for RLS (x2, hold for three slow breaths. Awareness in the core)
iv. Warrior I-Namaste flow with the breath. EXH to Warrior, INH to prayer with front knee extended. Back foot directly pointed forward (x10 reps/each, move slowly. Awareness in the core)

f. Seated on the floor, legs extended:
i. Dandasana/Staff Pose (1-1.5 min)
ii. Pachimotanasana/Seated Forward Fold) w/strap for RLS (1-1.5 min)

2. Mindfulness
a. Continue Pratyahara 4-week Challenge. See GoogleDoc
b. Journaling using the Awareness of Difficult or Stressful Communication)
c. Food intake journal. How did it affect your body, energy level & mind? What was helpful, not helpful?
3. Pranayama
a. Kumbhaka Pranayama (Kapalabhati →Jalandhabandha & Mulabandha) (3 rounds)
b. Nadi Suddi (2-3 mins)
c. Meditation 5 mins

Resources and Handouts:
Study: Loving-Kindness Meditation Improves Relationship Negativity and Psychological Well-Being: A Pilot Study

PF is well under control, with no pain in the past seven days. RLS has also seen improvement: she did not wake up from muscle spasms/cramps last week. Downward Dog and Sun Bird Balance with crunch continues to be challenging, but overall, the active asana regimen given for this week was “invigorating” to her. She reported, “It feels good to stretch the hamstrings and lower body to release tightness,” demonstrating improved attunement with sensations without getting caught up with how it should look. She walked for an hour and felt great afterward without any foot pain.

JPH stated she needs to work harder on Pratyahara. She still struggles to break the habit of keeping the radio or TV on throughout the day, but she changes to quiet music occasionally to manage sensory overload. She noticed cutting down on sugary food and carbs has become easier, although she still craves crunchy snacks in the afternoon. She cooked one meal at home. Her stress level was low as she didn’t interact with the neighbor.

We reviewed the initial goals and assessed progress. She reported that she is more aware of the “knees-feet” alignment and is very happy about alleviating PF pain: “It was a success, and I have even more incentive to practice.” She feels “more confident in getting from/to the floor, and more attuned to the body.” She wants to keep the momentum going and suggested future sessions for maintenance.

The exit interview and feedback by JPH were positive, as we reviewed the tangible and intangible improvements from the baseline taken at the intake session three weeks ago. PF pain scale has reduced from 4-5/10 (Pain as bad as imaginable) to zero, and the frequency of RLS has improved from one or two nights/week to zero. She can now easily transition to tiptoes and enjoys decreased stiffness in her hamstrings.

JPH has been empowered by yoga therapy and gained more energy and confidence in her body. She has diligently adhered to a long list of weekly home practices, from asanas and advanced pranayama to journaling and other contemplative assignments. Her commitment to home practice was remarkable; we celebrated the successes together.

The case study highlights the brilliance of yoga therapy, which empowers people by providing space for exploration and opening the door to access their own healing potential. It is what separates this holistic healing modality from conventional Western medicine, where patients are oftentimes mere recipients of treatments. My client was an active participant in the collaboration, disciplined and committed, inquisitive, and firmly adhered to home-based practice—her hard work paid off.

JPH commented that she did not know that yoga could help her overcome plantar fasciitis or RLS. She was unaware we would take such a comprehensive approach to reaching goals. And pranayama, yoga principles, mindfulness, and pratyahara expanded her awareness of options available to her in treating pain, handling stress, and developing a calmer mindset. I was thrilled that she appreciated the benefits of our yoga therapy sessions, not just for reducing pain but also for giving her the embodied experience of holistic healing. The integrated approach gave clarity to each layer of her being to attain equanimity and peace.

In retrospect, the four-week session was too short to gain insight into her relationship with food and her weight. Body image is a sensitive subject to many people and can easily turn into trauma. Her discomfort with discussing weight management was evident to me, and I instinctively knew I had to tread lightly to avoid causing harm or offense. At the same time, her being overweight was causing physical and energetic imbalance, so circumventing this issue was not an option. I sought the wisdom of Pratyahara in the sutras. Inspired by Chopra.com, I came up with “gamifying” it into a weekly sensory challenge where she can practice awareness on each of the five senses. I also incorporated mindfulness techniques and inspirations and built the framework around addressing the issue while observing ahimsa and satya. This case study challenged me to find a solution in an otherwise uncomfortable conversation. And the answer was right there in the sutra.

A follow-up session was requested after JPH returned from a trip in mid-October. A one-hour session is scheduled on 10/23, 8:30-9:30 AM Pacific.