Two surgeries to repair multiple breaks in left femur and hip bone in spring and fall of 2023. Hardware: two rods, a plate, and screws were implanted to repair the injuries. Her left leg is now 1 ½ inches shorter than the right. Limited ROM in left hip joint. Imbalanced gait, shifting down to left side. Fall risk. Has fallen multiple times since hip surgeries. Chronic pain in sacroiliac joint area and side body along lower ribs. Scoliosis. No details on C or S curve, or location. Double knee replacements in 2020.

Takes 3-4 gentle yoga classes each week, adapting as suitable to her needs. She is a 200 hour trained yoga instructor. Physical therapy regularly, every 3-4 weeks. Current PT home exercises are prone backbends and seated twists. Swims occasionally.

Rajasic mind. Takes medication to sleep, otherwise, as she says, “I’m up all night.” Client is active, alert, and fatigued by chronic pain.

Under the care of both a psychologist and psychiatrist. History of suicidal ideation, after her “botched” first hip/leg surgery; living with intense, unrelenting pain. Short- and long-term memory challenges. Difficulty with word retrieval. Client suspects she has early onset cognitive impairment. Grief and loss are pervasive.

Attends weekly Sunday Krishna spirituality group gatherings during which wisdom teachings are presented and discussed. A meal among attendees is shared. The client finds these gatherings fulfilling and uplifting. She is reading sections of the Bhagavad Gita.

Social support. The client is actively working to reconnect with old friends and build new friendships.

Financial stress and strain. Client lost her full-time job with pension benefits after hiking accident. She is now on disability. Loss of social connection and purpose. Sense of loss of her prior, physically active, socially engaged, gainfully employed self. Psychologist suggests journaling. She has not yet tried it. Many wounds across the koshas.

o Bhagavad Gita. Translation by Eknath Eswaran.
o 2.49 Seek refuge in the attitude of detachment and you will amass the wealth of spiritual awareness. Those who are motivated only by desire for the fruits of action are miserable, for they are constantly anxious about the results of what they do.
o 2.50 When consciousness is unified, however, all vain anxiety is left behind. There is no cause for worry, whether thing go well or ill. Therefore, devote yourself to the disciplines of yoga, for yoga is skill in action.
o 6.23 The practice of meditation frees one of all affliction. This is the path of yoga. Follow it with determination and sustained enthusiasm.
o 6.24 Renouncing wholeheartedly all selfish desires and expectations, use your will to control the senses.
o 6.25 Little by little, through patience and repeated effort, the mind will become stilled in the Self.

The Bhagavad Gita was selected over Patanjali’s yoga sutras, that has similar sentiments, since the client in studying the Gita. Specific slokas were chosen to motivate client to practice yoga steadily with enthusiasm, with a sense of acceptance, free of expectations. To remember the rewards of our yoga practices such as abiding in the true Self.

o Mantras. Moola/base mantra. “Om Krishnaya Namah.” Shri Krishna accept my salutations. Krishna mantra for success. "Om Sri Krishnah sharanam mamah". I request dear Lord Krishna to take me under your protection; O Lord, I surrender my all to you.

o Include exercise guidelines and/or contraindications where relevant. No seated postures on the mat. No spinal flexion upon advice of physical therapist.
o Colgrove YM, Gravino-Dunn NS, Dinyer SC, Sis EA, Heier AC, Sharma NK. Physical and Physiological Effects of Yoga for an Underserved Population with Chronic Low Back Pain. Int J Yoga. 2019;12(3):252-264. doi:10.4103/ijoy.IJOY_78_18
o Grzenda A, Siddarth P, Milillo MM, Aguilar-Faustino Y, Khalsa DS, Lavretsky H. Cognitive and immunological effects of yoga compared to memory training in older women at risk for alzheimer's disease. Transl Psychiatry. 2024;14(1):96. Published 2024 Feb 14. doi:10.1038/s41398-024-02807-0
o Innes KE, Selfe TK, Khalsa DS, Kandati S. Meditation and Music Improve Memory and Cognitive Function in Adults with Subjective Cognitive Decline: A Pilot Randomized Controlled Trial. J Alzheimers Dis. 2017;56(3):899-916. doi:10.3233/JAD-160867
o Saper RB, Boah AR, Keosaian J, Cerrada C, Weinberg J, Sherman KJ. Comparing Once- versus Twice-Weekly Yoga Classes for Chronic Low Back Pain in Predominantly Low Income Minorities: A Randomized Dosing Trial. Evid Based Complement Alternat Med. 2013;2013:658030. doi:10.1155/2013/658030
o Saper RB, Sherman KJ, Delitto A, et al. Yoga vs. physical therapy vs. education for chronic low back pain in predominantly minority populations: study protocol for a randomized controlled trial. Trials. 2014;15:67. Published 2014 Feb 26. doi:10.1186/1745-6215-15-67

Chose Kirtan Kriya to improve memory, sama vritti, down dog at the wall, single leg extension, and Warrior I from intervention protocol in these studies. Saper study protocol will be shared with the client.

Any suggestions are most welcome.

• 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.