The client has hyper mobility of the joints and is experiencing undiagnosed shoulder pain described as pinching. Client described this as a “frozen shoulder” but physical assessment appears more consistent with shoulder impingement/rotator cuff tendinitis. In the physical assessment, I observed the client bracing for pain while doing movements with the shoulder and also observed pronounced hyper mobility of both shoulders combined with restriction in the trapezius muscle and pectorals. The client is an experienced yoga teacher and practitioner, but was unaware of the hyper mobility. They have slight supination of the feet with slight external rotation of the knees and hips while standing.

Client self-reported agitation as a result of work and construction in the apartment above them. This is consistent with my assessment. Client’s energy was rajasic but also tamasic at the same time.

Client displayed clear signs of distress, including pronounced anxiety, frustration, and sadness. Sadness was palatable while discussing health conditions that led to hysterectomy and interpersonal relationships at work and with home co-op. Client has PTSD from Hurricane Sandy that is connected to their condo. Client Is taking two medications to assist with mental health—-Wellbutrin and Effexor.

Client has yoga philosophy training and sadhana practices, but admittedly they only practice these consistently when they are in Yogaville. We discussed the possibility of creating.a more accessible sadhana practice that could be used at home, including a shortened mediation and shortened daily asana practice.

Client self reports that they ruminate a lot, often about their judgement and criticism of self. They describe themselves as an empath and a person that supports others often. My assessment also found hyper vigilance and I suspect based on client’s self-reported history that their PTSD is actually complex-PTSD.

I read Sutra 1.30 in the Yoga Sutras about the nine types of interruptions that prevent us from having mental clarity to free ourselves from suffering. I would like to offer this in conjunction with the Bhagavad Gita “bandhur atmatmanas tasya yenatmaivatmana jitah anatmanas tu satrutve vartetatmaiva satru-vat” which means, “If one has successfully controlled the mind, it is the best of allies; nevertheless, if one has not, the mind itself will be the greatest foe.” I believe that this will prompt some discussion about how the shows up in the client’s life and emphasize how critical the daily sadhana practice can beneficial towards addressing the mental modifications.

I utilized this study to come up with some yoga asanas and exercises that would assist with the upper back and left shoulder pain. Chawla JK, Chandra I, Sharma R, Verma S, Kumar P, Sharma V, Singh G. Integrating Physio-Yogic Exercises for Rotator Cuff Tendinopathy in Indian Overhead Athletes: A Comprehensive Approach. J Lifestyle Med. 2024 Feb 29;14(1):46-53. doi: 10.15280/jlm.2024.14.1.46. PMID: 38665318; PMCID: PMC11039439.

I searched for a study specifically about the herniated discs in the cervical spine but was unable to find one that utilized yoga interventions. This study was the closet that I could find and it supports that Hatha yoga would be a good intervention for reducing neck pain. Michalsen A, Traitteur H, Lüdtke R, Brunnhuber S, Meier L, Jeitler M, Büssing A, Kessler C. Yoga for chronic neck pain: a pilot randomized controlled clinical trial. J Pain. 2012 Nov;13(11):1122-30. doi: 10.1016/j.jpain.2012.08.004. PMID: 23117107.

I looked for more resources about the cervical herniated discs and I’m familiar with many of the contradictions, but do you have any suggestions for a pose that might be good for stimulating the thyroid without applying compression on the neck?

• 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.