ITM is a strong, active, and engaging female that is very lean and clearly works out. Upon observing her standing posture, it is immediately apparent that she has kyphosis of the upper back and neck. She seems to have ROM limitations in every anatomical movement at the neck. Her shoulders and upper back are very tight as well, as she is barely able to touch her hands together behind her back, and she is limited in her seated twist.
Besides these issues, she seems very coordinated, and has no limitations in her squat, knees to chest, or butterfly posture. Her balance is solid; she was able to hold a 30 sec tree posture on each side with ease, and could step back from stork to high lunge with relative ease.
She reports that her pain is centered in the neck near the occipital region, more severe on the right side. Also on the right side she has pain in the rhomboid region and towards the posterior region of the scapula. Both shoulders cause soreness on and off. She also mentioned that she gets some pain in the lower back and back of the hip on the right side and had sciatica when she was pregnant, which she feels can flare up sometimes.

ITM is aware that she really needs to work on her breathing. She said she knows that she holds her breath sometimes, because she catches herself holding her breath and tensing her entire back when she is thinking about something stressful or commuting to and from work in DC every day. I was observing that she was mostly breathing into her chest. When I mentioned this to her, she agreed that she has noticed that she doesn’t breathe deeply, especially when she is working out and her breath catches her attention.
She was able to retain an outward breath hold (Bahya Kumbhaka) for about 10 seconds before she felt the urge to breathe. She mentioned wanting to push herself to hold the breath longer, which clues me into a rajasic vikruti. This is in addition to other clues: self-proclaimed workaholism, frustration, fast patterns of speech, competitiveness, stress, and anxiety.
When we worked on Dirgha pranayama, she seemed to be really pushing herself to breathe extremely deeply, and she did not seem very relaxed. I let her know a few times that she could relax her shoulders and her jaw. Pranayama and relaxation techniques will be crucial for this client to allow her prana to flow – Dirgha, Kapalabhati, Nadi Shodana, Librarian breath, Brahmari, and box breathing will be the techniques we will plan to utilize.

This client readily acknowledges her passion, which can turn to frustration, restlessness, anger, and anxiety when negatively channeled. Positively channeled, her passion becomes excitement, motivation, determination and feelings of power. The client does not report feeling depressed when she is fatigued; she feels that her depressive episodes are well controlled with her psychiatric medications. However, she does report feeling fatigued fairly often, especially in the afternoon and after work.
We tested a two-minute period of silence; afterwards she reported feeling very restless. She almost immediately thought of something that she had to do and found it almost unbearable to sit quietly without making a note of what it was she had to do. She found herself thinking about it and what else she had to do until the two minutes was over, after which she immediately got out her phone to add the task to her to-do list. She then said she constantly feels pulled into the future and what she has to do next.
I feel that this client would really benefit from mantra, affirmation, chanting, and related practices to stabilize the mind even while it tends to be active. I love Brahmi’s idea of practicing a mantra during her crochet work, which she tends to do at night after her son is in bed.

This client was not raised in the church and has never had a spiritual orientation beyond a general belief in the Universe. She believes in the “interconnectedness of all things” but adamantly denied belief in a kind of bearded father figure in the sky.
She does not pray or meditate besides occasionally doing guided meditations when she can’t sleep. For this client, I feel that practices that are more secular and practical in nature, like breathwalking, loving-kindness meditations, forest bathing, gratitude practices, and sangha. I also still plan to introduce the client to the concepts associated with Bhakti, Jnana, Karma, and Raja yoga, doing so with plain-language teachings at first ala stress management module, perhaps moving into more explicit discussions of deeper yogic philosophical concepts if the plain-language teachings go well.

This client is extremely passionate about her interpreting work; it gives her a sense of purpose and connection. There is certainly an opportunity for Karma Yoga for her in the Deaf community, she has already volunteered in the community in the past, and has done pro bono interpreting. She said she feels most like herself when she is interpreting or crocheting. She also feels connected to her pets and family. That said, she seems to be lacking a connection to nature, and she works almost constantly in office buildings and commutes for 2-3 hours a day. She also does not feel that she is able to detach herself from troubling situations, and does not have any kind of witnessing practice, which are opportunities for growth.

This is a client that needs balancing practices. She will benefit from a detailed discussion of the three mahagunas and their parallels in western thought and medicine in the context of stress reduction and resilience.
Witnessing will also be potentially very useful for this client, especially as she commutes daily and finds herself being stressed and/or anxious. Mantra/affirmation will be key as she can bring herself to a state of peace/sattva through activity; even through a practice as simple as practicing breath awareness as she drives to and from work, repeating “let go” on the exhale and trying to allow her shoulders, neck, and jaw areas to relax upon each repetition.

Yoga Sutra 2.18 – https://yoginisadhaka.wordpress.com/2012/02/18/yoga-sutra-2-18/ - our focus will be on the gunas themselves and the purpose of nature, which is to allow us to have the experiences that lead us to liberation from suffering.
Yoga Sutra 2.46 https://yogainternational.com/article/view/sthira-and-sukha-steadiness-and-ease/ - I feel that the concept of finding effort and ease in varying degrees and within various activities to different degrees throughout the day will be very useful for this client. She seeks challenge and likes to put forth effort, which is great, but I think she needs to be able to find more ease throughout her day without slipping into inertia.
Yoga Sutra 1.12 - https://www.yogapradipika.com/yoga-sutra-12 - practice and detachment are concepts that inevitably come up with all my yoga therapy clients. This is an extremely important concept, and I think it’s indispensable for a client that has a tendency towards constant action like this one. Do your best and leave the rest.

Considering that this client has a heart murmur, we will not be overdoing the Kapalabhati or bringing too much heat into the practices. Long breath holds and extreme inversions would also potentially be contraindicated.
https://journals.lww.com/ijoy/fulltext/2018/11020/yoga_for_heart_failure__a_review_and_future.2.aspx - although I could not find any studies specifically linking yoga to improved outcomes for heart murmur, it is generally well accepted that yoga is beneficial for heart heath in general, with proposed mechanisms of action including improved vagal/parasympathetic tone, improved baroreflex sensitivity, reduced cortisol, and improved HRV among other potential mechanisms.
Reynaud’s manifests itself as cold extremities for this client, so it will be important for us to avoid cooling pranayamas and make sure the client is comfortable and warm as we practice.
Face yoga appears to have value for clients who have TMJ:
https://www.sciencedirect.com/science/article/abs/pii/S1550830724000065?via%3Dihub – although I did not purchase the full article, face yoga for TMJ seems promising, which also intuitively makes sense.

https://www.yogajournal.com/practice/beginners/asanas-for-tmj/ - Gentle inversions seem to be a good idea in addition to TMJ, though contraindications likely include postures that might increase facial pressure too much, like shoulderstand and plough.

Would you like to meet to discuss this client before I develop her 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.