- 66-year-old female, retired, yoga teacher, married, has one child.
- Diagnosed with Ankylosing Spondylitis in her 20s. Has HLA-B27 marker. Family history of AS.
- Moderate stress, mostly concern about her husband’s health, who’s been diagnosed with Parkinson’s. She’s the primary caregiver for him. Her yoga practice is a way to cope with her stress.
- Had a couple of episodes of Uveitis (in 2020, 2021). No permanent eye damage, uses steroid eye drops for that. Her doctor thinks that it might be because of the COVID vaccine. Can’t do any eye movement exercises when she has flare ups.
- Has pain in the lower cervical spine C7-T1. It worsens at the end of the day. Lot of neck movement causes pain/strain. Goes to a cervical chiropractor, which helps. Wrapping a scarf around her neck helps.
- Is lactose intolerant but can eat yogurt and cheese in small quantity.
- Had COVID in Dec 2022, had mild symptoms, prescribed Paxlovid.
- Says that she starts feeling fatigue around 3pm. A cup of tea and some shut eye helps. Also loves restorative practice and guided relaxation, which helps with her fatigue.
- Pain in left SI joint. Icing helps with the pain. When the pain is more, she has trouble walking as well. Sometimes goes to a massage therapist, but says that that doesn’t help much. When there is a flare up, she can feel the Sciatica pain and sitting worsens it.
- She feels like her left hip is hiked up, so she walks with a little rotation. I found that her left hip was a little externally rotated while moving.
- Can get up and down off the floor with ease.

- Breath awareness. Balancing and calming practices like
- Pranayama – 3-part breath, Nadi Shuddhi, Bharamari
- Asanas – JAPA movements for all the joints. Using the assistance of chair and wall for adding challenge. Restorative backbend. Core strengtheners like boat, bridge.
- Guided relaxation- neutral imagery

- www.yogaforas.com
- Yoga for Arthritis teacher training manual
- Singh J, Metri K, Tekur P, Mohanty S, Jha M, Singh A, Raghuram N. Designing, validation, and feasibility of a yoga module for patients with ankylosing spondylitis. J Ayurveda Integr Med. 2022 Jan-Mar;13(1):100479. doi: 10.1016/j.jaim.2021.06.019. Epub 2021 Dec 23. PMID: 34953604; PMCID: PMC8724870. Designing, validation, and the feasibility of a yoga module for patients with ankylosing spondylitis - PMC (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 | Rheumatology International (springer.com)
- Acar Y, Ilçin N, Sarı İ. The Effects of Tele-Yoga in Ankylosing Spondylitis Patients: A Randomized Controlled Trial. J Integr Complement Med. 2023 Nov;29(11):727-737. doi: 10.1089/jicm.2023.0022. Epub 2023 May 31. PMID: 37257184. The Effects of Tele-Yoga in Ankylosing Spondylitis Patients: A Randomized Controlled Trial | Journal of Integrative and Complementary Medicine (liebertpub.com)

• Yes

Body scan with breath awareness. JAPA movements for neck, shoulders, hips, spine and feet. Side bend, twist and cat-cow, keeping the cow neutral and the cat-movement only in the thoracic spine. Supine stretches like pelvic tilts and circles, figure 4 and prone stretches like Locust, with a rolled blanket under the ankles.
Tense and release, Yoga Nidra and loving kindness meditation.

Asked her to explore yogaforas.com and come back with questions for the next session. Continue doing joint stretches during her day working at her desk.

Had a dull pain in the lower back, and mild fatigue.

This is my first AS client. It gave me an opportunity to explore this condition and know as much as I can about it. Some of the research on this condition is very informative like the first research paper I listed. That paper listed a whole bunch of practices that were found beneficial for the group in the trial. Exploring yogaforas.com gave me a lot of ideas to work with this specific condition.

Keep up with the above practice and add 3-part breath, Nadi Shuddhi. Add a little more support like bolster for the seated side bends and twists, maybe try it against the wall.

• Yes

Body scan with awareness of eyes, tongue, hands and feet. 3-part breath, JAPA movements. Standing arms swinging and gentle twists. Seated forward fold, Dandasana with leg lifts (folded blanket under the knees). Gentle side bends and twists in Supported hero pose. Supine postures like knee stretches, straight leg raises, hip circles, pavanmuktasana (single and then both legs together). Bridge with block between the knees.
Tense and release, Neutral imagery meditation.

Adding the above stretches to her yoga practice. Practice 3-part breath two-three times a day.

She says her back feels better and she doesn’t have pain. Sleep was not great because of the Daylight Savings Time change. She said she didn’t get a chance to explore the yogaforas.com but would do it soon.

I felt hurried at the end with shavasana and relaxation because the client had to go to a meditation class.
The client said that she loves Suryanamaskar but has not been able to do it because her back feels unstable, so I came up with a Supine Suryanamaskar, wasn’t sure if it was going to work. I tried that with my client, and she loved it! She said she’ll incorporate that in her practice and if I can make a video of that and send it to her. I felt so proud of myself in that moment. 😊

I was not able to introduce Nadi Shuddhi in the last session, so will add that with Bhramari

• Yes

Centering with 3-part breath, JAPA movements. Standing locust and lunge (with the chair). Supine sun salutation, Pavanmuktasana, figure 4, twist with bolster under the knees and folded blanket in the between the knees (nose pointing towards the ceiling and moving arms out and in on the breath).
Supported shavasana with bolster under the knees. Tense and release, Yoga nidra and breath awareness meditation.
End with Nadi Shuddhi and Bhramari.

Look into the yogaforas.com and explore it on your own, ask if she has any questions. Adding some of the above stretches in her daily practice. Taking mini breaks during the day.

She said that her back felt great for a couple of days after the last session. She has had the last adjustment in late summer and says would like to get that done. Feels tension/pain on the left side of the neck, feels out of alignment @C1, C2. Feels that her SI joint is mis-aligned.

I felt good about the sessions. With help from my mentor, I was able to explore Ankylosing Spondylitis and feel more confident about working with people having this condition. I realized that I have access to so many resources and have help, if needed.

I felt confident enough to come up with a series of stretches that I know would benefit my client. I feel I am getting more confident about my knowledge and expertise.

Keep up with the gross and subtle practices to help her manage the pain and also cope with the stress of her husband’s health condition.