• 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.

Centering in Chair
Grounding, lengthening, using a neutral spine in- and outside of practice to avoid further compression
Find the alignment that alleviates symptoms instead of being overly focused on the traditional form of the pose*
Letting go of the past, the future, remaining in the present moment
Breath expansion in chest then adding back - 360 breath w/ Dirga Swasam
Jnana yoga's path of wisdom and self-inquiry, pairing it with Svadhyaya & reflecting on wisdom teachings or
affirmations like “I am not my illness, I am the observer of my experience.”
Affirmation
Chanting

Chair asanas - gentle and slow
neck, shoulders, stretch, side bends, hands, wrists, torso, hips, feet, ankles, legs

Supine

* https://yogainternational.com/article/view/adapting-yoga-for-lumbar-spinal-stenosis/?srsltid=AfmBOorl1huTGjBXyyLI32OUtwQqleTIIMdgZb2dEuO4rFFWCO0lbSh-

Check-in: We had a gap 2.5 months while PAM sought second opinions. She needed to pursue other avenues since her pain was becoming increasingly worse. In April of 2024, PAM was doing less PT (every two weeks, stopping on 4/30/24). She continued going to the pool weekly, implementing her own form of aqua therapy. She had at least five in-person and Telehealth visits with the new internal medicine doctor. This is the 'pain doctor' she'd mentioned in an earlier session. This doctor was adjusting medications, exploring psycho-somatic reasons for the pain, a mind-body connection, when she decided to talk to the technologist again.

Whereas the technologist who originally read the hip x-ray (MRI?) had said it 'was normal for a woman of her age," when the internal medicine doctor/pain doctor who focuses on chronic pain asked him to look again for perhaps a congenital reason (as suggested by PAM's PT since there was no improvement), the technologist replied, " I couldn't see if there were a congenital reason due to the number of bone spurs on her hips." This was the first time bone spurs on the hips were ever mentioned. She'd been treated for LSS for nearly a year. This doctor who had told her at the first in-person visit that it wasn't her back, now was able to diagnose, and recommend hip surgery. Fourteen days laters, she'd researched then provided PAM with the name and number of a surgeon who could perform the surgery.

PAM voiced pain in her left shin and hip during leg movement in the chair so we immediately stopped those. She appeared relieved yet nervous about planning her upcoming surgery. I noted that many people find that doing some gentle strength and mobility work before surgery can help them feel more confident and prepared. Would you be open to talking with your provider about what might be appropriate for you? When she pondered and decided she could ask her doctors, I told her that I admired how proactive she was being in thinking ahead about her recovery, and t hat takes strength in itself.

Client has changed the way she does things, learning to reposition her body to take stress off her lower back. Suggesting to take breaks to sit down and lean forward, perhaps place her elbows on her thighs as a means to relieve pain. She agreed that taking breaks and breathing is helping, as is slowing down which she's had to do to avoid pain.

I had touched base with PAM over the 2 1/2 months regarding her progress towards finding a solution for her pain and healing. She briefed me as things changed. I was so happy to hear that she'd found someone who listened to her and collaborated with the PT, who questioned the fact that her pain was increasing. I am grateful for the perseverance I show in finding answers for my daughters' illnesses. I think it has taught me to not give up, and to motivate others to keep trying as well.

Easeful practice with a check-in, relaxation, and whatever the client says she needs in the moment. This is an on-going process as she moves toward her surgery. There may be more mental health check-ins due to the upcoming surgery that is still to be scheduled.