Chronic pain, pain in evident in the expression on client’s face. Joint stiffness contributing to limited range of motion. Fear of movement in hands and right shoulder. Symptoms of plantar fasciitis: standing for very long is painful. Client loves to dance and will “pay for it later” when they do.

Chronic fatigue related to pain and poor sleep quality. They do not have a consistent sleep hygiene routine, have a hard time falling asleep and their sleep is not restful. They begin to fully wake up in the afternoon, 2-3 pm and are most energized in the evening. Their rajasic energy is evident as their mind is very busy, they talk a lot, and they exhibit agitated gestures when they speak. They take medication that suppresses their seizures.

The client is frustrated by and annoyed with the pain and fatigue they live with. The unpredictability of symptoms and novel pain they experience is disturbing to them, especially as they are “doing all the right things.” They are angry with some health care providers who are dismissive, do not listen, and misguide them. They are under financial stress and emotional stress as they build a new client base and care for their father. The client has a support network and belongs to several support groups.

. The client regularly connects to a higher power for spiritual guidance. They enjoy ritual and frequently consult oracle cards.

The client is well informed about mindfulness techniques, has taught meditation, and does not seem to have a consistent meditation practice of their own.

o Patanjali’s Yoga Sutras: 1.14, “Practice becomes firmly grounded when well attended to for a long time, without break, and with enthusiasm.” (Rev. Jaganath Carrera) Share this teaching with the client. 2.49-2.53, Pranayama as a means of becoming more established in sattwa. 3.32 By samyama at the kurma nadi (divot of the throat), motionlessness in meditative posture is achieved. Rather than samyama, adapted to concentration on kurma nadi. 3.41 By mastery over the samana nerve current (equalizing prana) comes radiance that surrounds the body. Include practices that gather prana into the navel center and contain prana.

o Include exercise guidelines and/or contraindications where relevant. See client care plan above.
o Antunes MD, Marques AP. The role of physiotherapy in fibromyalgia: Current and future perspectives. Front Physiol. 2022;13:968292. Published 2022 Aug 16. doi:10.3389/fphys.2022.968292
 To backup statement that physical activity is advised for those with Fibromyalgia.
o Curtis K, Osadchuk A, Katz J. An eight-week yoga intervention is associated with improvements in pain, psychological functioning and mindfulness, and changes in cortisol levels in women with fibromyalgia. J Pain Res. 2011;4:189-201. doi:10.2147/JPR.S22761
 Incorporate guidelines for offering yoga to this population: slow transitions between postures, include restorative postures, introduce yoga philosophy. Good resource for use of measurement tools.
o Lazaridou A, Koulouris A, Dorado K, Chai P, Edwards RR, Schreiber KL. The Impact of a Daily Yoga Program for Women with Fibromyalgia. Int J Yoga. 2019;12(3):206-217. doi:10.4103/ijoy.IJOY_72_18
 Shows that “pain reduction was inversely correlated with a greater amount of home practice.”
 Includes specific yoga practices offered over six weeks. Some of the practices described in the study such as Ujjai, cow/cat, and joint movements are included in the client’s care plan.

Thank you Sue.

• 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.