The client is a 68-year-old female analyst (now retired) with a history of multiple conditions and injuries, including a neural tube defect at the 3rd spinal process (spina bifida), injuries to C5, C6 (car accident, 1996), torn meniscus (right knee, surgery 2009), broken right hand (surgery 2022) and foot, currently dealing with significant back and neck pain (musculoskeletal, neurological, rated 7/10 at intake), knee and foot pain, snapping hip syndrome (coxa saltans) in right hip.

Re-assessed pain level at the beginning of assessment, using the defense and veterans pain rating scale where she reported 10 out of 10 pain levels impacting her daily activities, mood, and stress, with 6 out of 10 for pain affecting her sleep. Suffering from pain in right knee, stating "it is always at a 2," impacting her mobility and confidence walking down stairs "I am always careful," hip pain on right side, tightness in right leg (reports tight IT band), “in and out problems" with her back; cramps at bottom of feet (arches) on R side ("Always had it. Nothing new"); limited movement in spine (C5, C6; since 1996), reported and observed difficulty twisting to left when in the seated easy pose (“it is not as relaxing"); limited lateral flexion on L side; unable to turn head to L when in advasana. Reports history of
spina bifida in the 3rd spinal process (lumbar spine; L3) which presents as an incomplete closing of the vertebrae over the spinal cord, stating: "my back feels clunky." Said she has "snappy hips" with a snapping sound and sensation around right hip ("tenderness in the groin area)," and reduced hip movement on right side. Able to come into the sunbird (Dandayamana Bharmanasana) on both sides, though hip movement on right side appears visibly reduced. Stated that it takes effort to move the right hip: “I feel it in my brain.” Observed that left side felt "easier," noting: "It does not talk to me as much. It does not hurt my brain." Able to sense and feel what is comfortable in the body and what is not (interoception); for example, she noted that she is more comfortable practicing the pigeon pose on her back (Supta Kapotasana) then practicing the seated lotus pose (padmasasa). Reported history of osteopenia; says the will schedule mammogram and bone density test (DEXA scan) in 2025. Non-threatening physical presence; faces carries lines of vulnerability and compassion.

Effortless and deep breathing when standing in the Mountain Pose, transitioning to Warrior Two, balancing on one leg in Half Mountain, and when seated in the Easy Pose with the ability to control both inhalation and exhalation. States that she enjoys belly-breathing. Her breath appeared labored with chest breathing when lying on her abdomen, on all fours in the Sunbird, and in the pidgin pose on her back and when she was struggling to get physically comfortable; there was a disconnect between her body and her breath when she was physically uncomfortable; her energy levels increased with movement. Allergies did not impact her.

Hyper-vigilant and hyper-emphatic, in that she is always on alert and helping others. Reports that she recently saved a cat from drowning, and helped a woman who got attacked; carries pepper spray with her at all times for self-defense. Client reports being separated from her sister, died two days before we met, stating: "It's okay. I was not fond of her." Sense of separation from father (now deceased) who told her at age 13 that her sister was her half-sister, and not her biological one. Got emotional when talking about her family: "I hate being lied to-everyone lied." Sense of separation from family reflected in separate sense of body and mind: “I am all in my mind. I am so analytical. I am mostly in my head.” Self-medicates with medication (gabapentin, aspirin and wine "to take it [the pain] away]. Using the gunas as a framework work, KvB has tamas-type tendencies (emotional numbness, lack of energy, chronic pain) as well as rajas-type tendencies (hyper-vigilance; hyper-empathy).

At the end of the practice, KvB stated that she felt "less anxious." Exclaimed that she was "very" hungry. "This is good for me!," indicating ability to regulate her autonomic nervous system and reconnect with her appetite, energy, and joy.

KvB feels connected to children and animals, stating “children and dogs love me.” She feels connected to her community on the water.

She identifies with the suffering of others: “I can take everybody's pain." She is able to recognize that her need to help others may affect her own well-being. "I am way too empathetic." She attends Hatha yoga classes twice a week, a weekly ballet class, and walks on a regular basis. She also practices with a hula hoop on her boot with her cat besides her.

Sutra I.2 yogas citta vritti nirodhaḥ (Yoga ends the misperception that the Seer/Self is the same as the mind's usual tangle of whirling excursions of thought (vrittis).

My client has gone through traumatic experiences and her nervous system appears to be overwhelmed. She is constantly alert and on guard, her thoughts appear scattered and it is hard for her to focus. I chose this sutra because yoga (slow breathing, gentle movements, and meditation) can help calm her mind and help her feel more centered. These practices can also reduce her pain and help soothe her nervous system.

Sutra 2.28: By integrating the limbs of Yoga into daily life, impurities - all born from the root causes of suffering (klesas) - dwindle away. The
mind becomes illuminated with the light of wisdom, culminating in unwavering discriminate discernment (viveka).

Sutra 2.29: The Eight Limbs of Yoga — Yama, Niyama, Asana, Pranayama, Pratyahara, Dhrana, Dhyana, Samadhi.

Yama/Niyama (ethical observances, self-care) can help her rebuild a sense of inner safety and integrity after trauma.
Asana and Pranayama (poses and breath) provide gentle mobility and nervous system regulation, especially important given her chronic pain and reduced mobility.
Pratyahara, Dharana, Dhyana (sense withdrawal, concentration, meditation) can help her move from hypervigilance toward a calmer inner focus, supporting her emotional and cognitive goals (focus, energy, emotional reconnection).

I chose this sutra because it emphasizes the interconnection of body, breath and mind and supports healing for the physical (pain, mobility), emotional (numbness, vigilance), and mental (focus, energy) and spiritual (peace) layers of my client's body.

Practices from: Lutz J. Trauma Healing in the Yoga Zone: A Guide for Mental Health Professionals, Yoga Therapists and Teachers. Jessica Kingsley Publishers; 2021.

Fishman LM. Yoga and Bone Health. Orthop Nurs. 2021;40(3):169-179.

Research indicates that a 12-minute, 12-pose yoga routine—including Vriksasana (Tree Pose), Utthita Trikoṇasana (Triangle Pose), Virabhadrasana II (Warrior II Pose), Parsvakoṇasana (Side-Angle Pose), Parivṛtta Trikoṇasana (Twisted Triangle Pose), Salabhasana (Locust Pose), Setu Bandhasana (Bridge Pose), Supta Padangusthasana I (Supine Hand-to-Big-Toe Pose I), Supta Padangusthasana II (Supine Hand-to-Big-Toe Pose II), Maricyasana III (Seated Twist), Ardha Matsyendrasana I (Seated Twist or Half Lord of the Fishes), and Śavasana (Corpse Pose)—can support bone health by improving bone density and may help prevent or reverse bone loss in individuals with osteopenia or osteoporosis.

I chose this reference because it pertains to Osteopenia, aligns with my client's goal of improved mobility, balance, and gentle strength-buildingand accommodates her trauma-sensitive needs. Given her history of spinal injuries (cervical, thoracic, lumbar), knee, foot, hand surgeries, trauma history, and mobility considerations, I will adapt the above regimen: 1. start with chair or wall support for stability and balance; 2) Focus on alignment and control, rather than depth, emphasizing elongation of the spine; avoid rapid twisting or deep forward flexion: 3) Use props (blocks, blankets, strap, bolster, straps) to reduce lumbar strain, honor her spine and past injuries (hand, foot, neck); 4) modify timing by holding poses for 15-20 seconds and a few breaths (instead of 30 seconds recommended in protocol), then gradually increase to 30 seconds, if tolerated. Given my client's history of trauma, I will 5) offer pauses and grounding breaths between poses to help regulate her ANS; 6) select adequate poses and monitor how each pose affects her pain, stiffness, energy and adjust if a pose increases discomfort.

• 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.