My client is a female massage therapist at the age of 67. Has a very full, active and stressful life. She owns and operates her own massage therapy practice. Her husband has had extreme health challenges since 2023 though at this time he is doing better. Her husband was a lot older than she was.They have 2 grown sons and an adopted grown daughter. They are now raising their 4 year old grandson since he was 3 months old as her adopted daughter went to jail. She was very happy about raising her grandson and not resenting that for a moment. She finds joy in raising him.

No major illness. Diagnosed with neck arthritis - bone growth and degeneration a few years back due to aging. Has neck and shoulder tightness. Experiences vertigo not very often. Has knee pain due to lack of self care, sugar craving, not taking supplements as she used to, poor nutrition and weight gain. Notices knee pain lessening when the intake of sugar is less. She holds her stress in the neck and shoulder. She experiences vertigo and couldn’t really tell what triggers it. During vertigo she couldn’t bend forward, do inversions, or the lion's breath. She needs to rest well.

She attends yoga classes twice a week and walks outside every chance she gets. Her diet is improving and her digestion is always good. She uses supplements. Her meditation is more regular now. Uses “Waking up”, an app for meditation. She does meditation for half an hour in the morning. Wants to deepen her meditation and fortify her yoga asana practice.

Fluctuating energy level. More energy in the morning and midday and tired in the evening. Sleeps deeply for 8 to 9 hours daily and has a good quality sleep. Experiences fatigue 2 or 3 times a week and impacts her pretty seriously. She wants to sleep or eat when she feels tired. The afternoon fatigue is something she experiences in recent days. Once she started eating better, she feels better now.

In the intake form she described as no breathing challenges but during the assessment session, she said that she feels the breath in the lower chest and then abdomen while inhaling deeply and exhaling from the abdomen and then chest. She has a large frame and it was not easy for me to assess her virtually. I need to pay more attention in the future sessions. She drinks alcohol, coffee or tea infrequently.

She got very emotional while talking more about her goals. Her husband got very ill and bedridden in February and that put her in survival mode. In the intake form She mentioned that she was on autopilot during that time and experienced anxiety, depression and despair. She managed the stress by doing pranayama, walking, prayer and meditation. Now she rarely feels them. Financial stress and concerns about the future are her major stressors now. She is in a women’s healing circle and has some good support systems through her friends.

She reads the “I Ching” daily in the morning. She prays and meditates daily. She likes to be connected with nature (mountains), family, work, to her grandson, community and clients. Raising her grandson gives her more joy and meaning. She believes that that is what she was put here to do. She wants to be a trained yoga teacher to serve the group of community who are in the same situation like her.

She wants to take the yoga basic certification program when her town offers the next time. She likes to learn yoga to be a better women’s group facilitator. She likes reading books but her addiction to the phone and watching / reading using the phone impaired her focus to read. Now she is more mindful about using her phone and focuses on reading from a book.

Aging in the last year threw her in a loop. She felt younger than she was. Last year she was challenged in different ways. She wants to be respectful and honor that she is aging and not to feel disdain for it. She wants to honor that it's a privilege to get older. And that there are many gifts that come along with that. She wishes to use this gift in service of others who are in the same situation.

Panchamaya Kosha model
Kleshas (2.3): Ignorance, egoism, attachment, aversion clinging to bodily life are the five obstacles
Understanding stress
stress relieving techniques

Scientific Research: Effectiveness of vestibular rehabilitation therapy and yoga in the management of chronic peripheral vertigo: A randomized controlled trial (https://pmc.ncbi.nlm.nih.gov/articles/PMC11406116/)

Long-Term Effects of Cognitive-Behavioral Therapy and Yoga for Worried Older Adults (https://pubmed.ncbi.nlm.nih.gov/35260292/ )

Yoga Asana guidelines:

Centering: Body awareness (Going through all the koshas)
Setting intention : I intend to listen to my body, min and spirit.

Asana: (Chair yoga)
Netra vyayamam - Holding fist with thumb out in front. Eyes still and moving head side to side & up and down
Warmup full body standing joint activation practices
Back bend - Standing warrior1 using chair for balance
Forward bend - standing pyramid stretch progression
Inversion - Standing downward dog
Twist - Seated spinal twist

Relaxation
Quick stretch and relax with imagery (An angel, saint, beloved person or higher power putting hands on you to heal. )

Breathing Practices
Breath awareness
Extended exhalation

Meditation
Mantra meditation

Closing

I am not sure the client is a reverse breather or not. How to make sure that? How can I proceed with her breathing practices?

• 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.