• Check in, centering, balanced hatha yoga set considering contraindications, relaxation (with imagery as appropriate),
• Balanced pranayama considering contraindications, meditation/centering.
• Include at least one suggestion from Karma, Bhakti, Raja, or Jnana Yoga tailored for this client.

Maintain the PT backbends. Incorporate spinal stretches throughout her day, including neck stretches. Start back with the Kirtan Kriya, 3-6 minutes. Record when she practices and the effects of the practices.

Center, ground, arrive, check-in. Awareness practice in raised supported reclining restorative shape. Offered choice of How to Love Yourself card. Reassessed client’s current goals, areas of interest in yoga therapy. Rate pain and fatigue scales. Gave printout of WHO quality of life questionnaire to be completed before next session. Standing spinal warm-up: cow to neutral, lateral bends, empty coat sleeves. Downward facing dog to plank at the wall and with hands on chairback. Prone, client’s PT series: sphinx to upward facing dog/seal. All fours, downward facing puppy. Supine, windshield wiper legs, supported relaxation shape. Guided relaxation: 61 points. Closing, reflections, scheduled session into beginning of October.

The client is maintaining an at home yoga practice, though with her new job, the consistency has diminished. On her one day off per week, she spends most of the day in bed. Her back pain persists. She finds self-reflection difficult. She is open to journaling with a prompt during our sessions. She has recently begun experiencing edema around her left ankle (the surgery side) and is consulting with a vascular surgeon after imaging. She’s feeling like so much is wrong with her. Another area belief to work with.

Fatigue, pain, and self-criticism are major factors to address with this client. The client appreciated the affirmation card. She is critical of her perceived lack of abilities, both physical and mental. The client’s areas of interest are to relieve back pain and practice meditation. It will be important to find practices that she enjoys, that bring some relief to her pain and suffering, that she will find the will to fit into her life, practices that are pleasurable to her. Incorporating a few restorative shapes in each session will give her an extra bit of needed rest. I don’t see a need to dramatically change the care plan, rather change some of the focus and tweak the practices collaboratively with the client.

Changes/additions to the original care plan. Discuss whatever the client would like to share from the awareness practice. Try Bhramari breathing, either seated or prone. Experiment with child’s pose using two chairs. Include the Kirtan Kriya version suggested by the client, leading into quiet meditation.