- 62-yr-old female, married, works from home, has two adult cats, likes to repurpose furniture.
- Has scoliosis, S curve, right lumbar C-curve.
- Psoriatic arthritis, diagnosed when she was 27 yrs’ old. Didn’t start on the medication since she was going through infertility treatment at the time, which resulted in rapid progression of the disease. Administers biologic injectable herself. Supposed to every four weeks but goes to 5-6 weeks to stretch her dollar.
- Had hysterectomy when she was 50.
- Diagnosed with Hashimoto’s at 58.
- Last year had two falls one after the other. Fractured her nose and left side in the first fall and hurt her nose again in the second fall. Hematoma on her left side of the forehead. Doctors think that she will need a nose surgery later. She thinks that the reason for the fall might be that her joints are so stiff and she didn’t lift her foot high enough to clear the tree root (1st time) and the stairs (2nd time). She got a cane to walk around but is now afraid to go out of the house.
- Has moderate stress levels because of her health and her husband’s health. She copes with that by keeping busy, caring for her niece and sometimes stress eating. Thinks that she doesn’t drink enough water. Considers herself a ‘carb addict’.
- Had a left hip replacement in 2006 (lateral). Recovery was fast.
- Had controlled High Blood pressure.
- OA in both knees. Doctor says that she might need knee replacement in the next couple of years.
- Has Osteoporosis in forearms. Has to be careful carrying things, since she’s at higher risk of fracture.
- Has good support system of her family, friends and community. Loves to volunteer.
- She thinks she’s overweight and doesn’t like to be around people.
- Loves water aerobics but an adverse incident turned her away from that. She doesn’t use her condo’s pool anymore.
- Stiffness in her joints, limited mobility in the wrists (wrists fused), middle and ring finger of the left hand do not bend. Pain in both knees going up and down the stairs, has 22 stairs leading up to her condo, stiff ankles.
- Side sleeper. Likes to sleep with a pillow under her knees, since her knees lock. Has an adjustable bed and a chair lift to help her get up. Has to move around when she wakes up, to warm up her joints.
- Chest breather, uses her shoulders when she breathes. Cuing the ‘shoulder blades in back pocket’ helps her stabilize the shoulders.
- Her left knee was swollen, so her movement in that knee was very limited. She said it’s been 5 weeks since her last injectable, so all her joints feel like they are filled with cement.
- She had a headband covering her entire forehead. Says that it covers hematoma and also helps with the nerve pain that she has started feeling.
- She had chair pads on the chair which helps give her height and helps with less flexion in the knee.

- Joint freeing exercises.
- Reframing negative thoughts to positive one (Pratipaksh Bhavana) by the use of affirmations.
- Talking about kleshas, especially Asmita (ego) and Abhinivesha (fear and anxiety).
- Working with Prana Vayu (for the incontinence) with pranayama.
- Loves guided relaxation, so incorporating loving kindness towards herself in that.
- Yoga Nidra to bring relaxation and healing to each kosha.

- Yoga for Arthritis teacher manual
- Yoga for Scoliosis by Elise Miller
- Adaptive Yoga teacher training manual
- Yoga Nidra meditations by Julie Lusk
- Fishman LM. Isometric Yoga-Like Maneuvers Improve Adolescent Idiopathic Scoliosis-A Nonrandomized Control Trial. Glob Adv Health Med. 2021 Feb 24; 10:2164956120988259. doi: 10.1177/2164956120988259. PMID: 33717658; PMCID: PMC7917413. Isometric Yoga-Like Maneuvers Improve Adolescent Idiopathic Scoliosis—A Nonrandomized Control Trial - PMC (nih.gov)
- Roberts JA 4th, Mandl LA. Complementary and Alternative Medicine Use in Psoriatic Arthritis Patients: a Review. Curr Rheumatol Rep. 2020 Sep 28;22(11):81. doi: 10.1007/s11926-020-00956-x. PMID: 32989481. Complementary and Alternative Medicine Use in Psoriatic Arthritis Patients: a Review | Current Rheumatology Reports (springer.com)
- Silva DR, Meireles SM, Brumini C, Natour J. Effectiveness of functional training versus resistance exercise in patients with psoriatic arthritis: randomized controlled trial. Adv Rheumatol. 2023 Dec 13;63(1):58. doi: 10.1186/s42358-023-00342-y. PMID: 38093394. Effectiveness of functional training versus resistance exercise in patients with psoriatic arthritis: randomized controlled trial - PubMed (nih.gov)

• Yes

Check-in. Netra Vyayamama, JAPA movements for the whole body. Using breath to assist in getting up from the chair. Hip extension stretches, knee stretches, reclined shavasana with pillows underneath knees and neck. Tense and release, progressive relaxation and meditation on breath. Saying affirmations of “I am strong” and “I can do it” on inhale and exhale.
Introduced Bhramari pranayama for her to try, to go back to sleep when she gets up in the middle of the night.

Fitting the stretches in her daily life, whenever she can, even if it’s for 5 minutes. Noticing when she starts having negative feelings and thoughts, pause, take a deep breath and change it to affirmations that she decided on during the session- “I am strong”, “I can do it”.

She had taken the injectable medication just a week before, so she said her inflammation is less. We had a talk about taking the medication every four weeks and not wait till she needs it. She says she might have to file disability, which she doesn’t want to do. We had a chat about what she feels about that and what she can do to change her negative thinking about the disability to a positive one.

We had the session in the evening, so there were few people in her house. She has the sessions in her living room. She also takes care of her 12-yr-old great niece, after school, till her parents pick her up. During relaxation, her parents came to pick her up and there was a commotion while she was leaving, which disturbed my client’s relaxation. Will try to schedule her sessions earlier in the day, to minimize the environmental distractions.

Adding on to the physical practice, having a conversation on Asmita (Ego), and Fear & Anxiety about the medication and losing independence by filing disability (using motivational interviewing). Introducing pranayama to address Prana Vayu. Yoga Nidra

• Yes

Check-in. She said that she wanted to work with affirmations again, since it felt really good. She kept “I am strong” but changed the second one to “I am invincible”. Continued with the physical practice, introduced the breathing from the navel up towards the crown for Prana Vayu, and added a loving kindness meditation towards herself at the end.
She loves Bhramari pranayama, so ended with that. She says it brings calm to her and she feels that her mind quietens after that.

Sent her the link to my YouTube videos for her to practice at home. Being aware of her body when she’s walking up the stairs or around, taking breaks as needed and repeating the affirmations, whenever she’s feeling anxious. Listen to guided visualization meditation on Insight timer app before bed.

Says that her hands felt stiff and clumsy when she started doing the movements because they are not used to it. She said she’s going to take her medication at the prescribed time because she is feeling the effects of not taking it in a timely manner. Her left knee had a little swelling still.

I was really happy with the flow of the session today. She moved to the bed instead of the couch, which helped me observe her breath and movements more clearly and make adjustments to her alignment of breath and body. Right after the guided relaxation, the zoom glitched and stopped working. I had her cell number, and we finished our session on the phone.

Since we will be meeting after a break of almost two weeks between sessions, going over the stretches, pranayama and meditation.

• Yes

Check-in. Body scan. Breath awareness with breathing from the navel up towards the crown. Seated in chair- JAPA, standing behind the chair- Lunge, goddess and extended forward fold. Supine- hip extensions, Figure 4, bridge with a block in between the knees. Restorative side bend on the left side to address her C-curve. Supported, restorative shavasana, Yoga Nidra, breath awareness and neutral imagery meditation (which the brother didn’t participate in).
Bhramari to end.

Do the restorative side bed on the left side twice a day, holding for 5 breaths, to address her C-lumbar curve. Keep doing the stretches whenever she gets a chance and spread it out throughout the day.

During the break, she helped her friend move out from the hospital. She said she paced herself, took breaks and was aware of how her feet were while walking and taking the stairs. Left side of her lower back was hurting (the C- lumbar curve of her scoliosis). Said that she took her medication at the prescribed time. I asked how that felt and she said she’s still in pain but it’s manageable and not bad. It was her birthday. She shared that she shares her birthday with her older brother, and he’ll be coming over to take her to celebrate with the family. She also shared that her brother has Lupus and Gout and is also in constant pain. Her brother came over just as we were starting our practice. We were introduced and I asked him if he would like to practice along with my client. He agreed and participated in part of the practice.

After Bhramari, she told me that she wants to show me something. She sat in the chair and got up without any assistance. I felt so happy seeing her do that. She said that she feels confident and stronger in her quads. With this and her taking her medication on time and noticing that it helped, I would say that made my day!

I am definitely getting more confident in my work with my clients. This was an amazing learning experience, and it has solidified my path and my desire to work in this field. I have also narrowed down the population that I want to work with. 😊

Introduce walking meditation. Asanas for balance and proprioception. Introduce journaling for her emotions, feelings and wins.