MLA is a strong and solid man with pretty good joint mobility and body control from years of practicing and teaching martial arts. He moves with grace and has good balance. According to his intake and our conversation, he is slightly overweight and could stand to clean up his diet. He gets weekly exercise through his martial arts classes, which he attends 2-3 times a week in addition to his teaching of martial arts.

MLA has been dealing with low back pain more and more recently. He reports no prior surgeries or physical limitations. Client has very few physical concerns aside from his occasional low back pain and tightness, though no obvious limitations were observed during the physical assessment. Client reports no physical factors disrupting his sleep at night. He finds the physical demands of his martial arts teaching job to be within his current capacity, though he does worry about his ability to continue in the future.

His gait is balanced, stable, and generally seems healthy, which he credits to his years of karate. His posture, however, could use work: he sems to have at least a slight anterior pelvic tilt. Based on my observation of his standing high lunge, he has tight hip flexors, along with a slightly excessive kyphotic curve in the thoracic spine.

Client has been working on his breathing awareness more since he started practicing yoga with me at the addiction treatment center where we met. He says that breath awareness was something he always took for granted with his martial arts practices and has enjoyed the simple pranayamas I have taught him during our classes at the treatment center.

His breathing tends to be shallower when conversing. He does breathe more into his belly during yoga practice. He says he does not feel that he has any breathing restrictions. Client deals with fatigue in the morning (perhaps due to poor sleep) and energetically peaks around midday. He can hold his breath for 30 seconds without issue or anxiety, though not for much longer than that. Anxiety affects his breathing patterns, which is the concern he acknowledges the most. Client does not feel that he has a sense of his vital energy or deeper life purpose.

Client feels that he has struggled with regulating his emotions in a healthy and adaptive way. Although he is sober from alcohol now, he used it to reduce his anxiety and became addicted. He has acknowledged some problems with “people pleasing” and worries about disappointing his family and students. Generally, he feels that he still has "anxious tendencies" and would like to improve upon them.

He said his stress is low-moderate on the intake form, but during our subsequent conversation he acknowledged that he is quite stressed with their newborn baby. He dismissed concerns about his family’s health (past cancer) and was very short with me when we touched on the subject. He never had cancer himself, it was his oldest son that had a benign brain tumor.

Client has difficulty letting go of his worldly duties during savasana and feels like he must always be doing something productive.
He has trouble sleeping at night, though listening to sound bowls on youtube is helping him. He feels that he has good focus. He does feel like he has been struggling with depression more lately. He feels that he needs to work on observing his thoughts neutrally and being aware of how his mental states affect his breathing and body.

Client generally feels that he has been developing a growing interest in spiritual matters since he quit drinking alcohol. Our conversation about the connection between spirituality and willpower and discipline really resonated with him; and he has mentioned that he has been going through the ‘refuge recovery’ book about a Buddhist path to addiction recovery.

He can tell that he feels less stressed when he is going to AA meetings and making attempts to pray and mentioned again that he sleeps better when he listens to the sound bowls. He is open to trying practices like chanting.

He really came to life when he was talking about addiction, which leads me to believe there is a potential therapeutic opportunity for Karma Yoga or other service work. He seems to lack community beyond Karate, which is his job and is not very inspiring to him anymore.

Client feels that he is in a transitory phase of his life and generally seems self-aware based on the general flow of our assessment. That said, awareness of his actions is not translating to self-control. He does feel a general sense of “emptiness” and a general and near-constant discomfort. He is not clear about his deeper values beyond family life and householder responsibilities.

He is open to new perspectives and said that he has been interested in yoga philosophy since our discussions about it at the treatment center.

I have been having success with using the yoga sutras as a framework for the wisdom teachings and would like to continue to work with the yoga sutras, especially with this client. A good starting point would be sutra 1.2, with a discussion on how vrittis create mental turbulence that keep us stuck in cycles of pain and craving.

A discussion about sutra 2.1, which gets into the “kriya yoga” niyamas of tapas, svadhyaya, and Ishvara pranidhana, would also be relevant for this client, as commitment/self-discipline, Self-study, and surrender will be key to reducing stress and depression as well as pain and addictive behaviors.

Another sutra that could potentially be of early use to this client is sutra 2.46; “asana should be steady and comfortable”. His low back pain could be an indicator of an issue with stability, grounding, and safety. His stress, addiction, and depression can also be dissociating, especially when considered in tandem with his broken sleep.

The ultimate goal will be to work with the client through the yoga sutras, and to guide him on the path towards inner peace, willpower, detachment from suffering, and self-compassion.

MLA has been mentioning that he wants to improve his core strength since we met at the inpatient treatment center, and I could tell during the physical assessment that there seems to be a neglect of the belly in general. He does not naturally breathe into his belly – though he is capable of breathing deeply when his attention is on the task – and he seems to have at least a slight anterior pelvic tilt.

He also mentioned he feels that he has tight hips, which I did observe when he was in a standing high lunge. He has an observable kyphotic curve in the thoracic spine, though it doesn’t seem extreme, and it seems everyone has some kind of “text neck” these days. I plan to do more research and consult with my mentor before developing a care plan to tackle his low back pain, which I believe is related to this. I would appreciate guidance from Brahmi in developing the LBP care plan.

Contraindications would include deep forward folds with straight knees and no support, excessive backbends done in a non-gentle manner, extreme twists, and rapid, jerky movements. The guidelines for this client will be slow and steady wins the race, with a focus on gentle movements that both strengthen and lengthen with ease and peace.

https://www.physio-pedia.com/Low_Back_Pain_Related_to_Hyperlordosis

Would you like to meet to discuss this client before I go about developing the care plan?

• 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.