Client indicated that he is most aware of the pain when he has been inactive for some time - upon first waking, sitting for prolonged periods - and "feels it again" when he starts to move. In having him briefly explore asana in his regular practice, he experienced no pain in Virabhadrasana 2, Trikonasana, or Uttanasana. He finds apanasana with a block under his pelvis for slight elevation very soothing. He felt some tightness - more on the left side - scale 2/10 in Supta Matsyendrasana. As tightness seems to be more prevalent on left side of low back, suspect area of discomfort to be the QL. He recalls initial onset during removal of a tree stump, where he was swinging an ax with slight rotation in the body. Prolonged sitting with forward hip and spinal flexion during his 40 years of dental practice has contributed.

Client easily takes a deep diaphragmatic breath. During assessment his overall energy was very balanced/sattvic, and in previous settings (weekly yoga class) have observed this as well. No evidence of tension in his breath or voice when he speaks - easeful cadence, balanced facial expression.

Client has well-developed proprioceptive and interoceptive awareness. He is very creative - made the wedding rings for he and his wife, has handled all home remodeling projects for his home, enjoying these with his daughter - and assisting her with her own home remodeling. He plays the tuba and is active in four musical groups, each offering a concert 3-4 times/year, with rehearsals focused during the window of time prior to the concert - so that no group demands a high level of regular commitment - these are "for fun."

When asked what gives him purpose, the client's response was "wife and family." While he does attend church regularly, client did not indicate having specific spiritual practices as part of his daily routine.

Client has much applied wisdom from life experience. His most significant relationships are with his family, and maintains friendships with former faculty colleagues and fellow musicians. Client does not have a regular meditation practice, but uses his woodworking and love of music as forms of moving meditation.

While the client's goal is very much focused on the anamaya kosha, I would like to introduce sutra 2.46: sthira sukham asanam. "Asana should be steady and easeful." - Inside Patanjali's Words, Rev. Jaganath Carrera. I feel like this is a gentle and practical introduction into the wisdom of yoga. In doing some study with Indu Arora, I appreciate how she expands on this sutra, explaining that "asana is when the mind takes a seat in the body," so that as we fold, mold and hold the body in exploring a pose, we do so seeking to find that sweet, easeful (sukham) space for the mind.

I would also like to share an overview of the yamas and niyamas with him, as a foundation for asana practice that also translate well as guiding principles in everyday life off the mat (sutras 2.29-2.32).

While client states the inguinal hernia was successfully repaired, for core exercise would avoid excessive strain on the abdominal wall - focusing on core engagement and control of rotation and extension.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3276927/ - Effect of Yoga Therapy in Reversible Inguinal Hernia - this study included 19 males with reversible inguinal hernia, utilizing the following asana: "Vajrasana, ushtrasana, paschimottanasana, pawanmuktasana, utthanpadasana, matsyasana and sarvangasana were selected based on its effects to compress inguinal canal, strengthen the abdominal muscles and to reduce the intra-abdominal pressure, because weakness or flabbiness of abdominal muscles and elevated intra-abdominal pressure may be the causes for the hernia in non-congenital subjects included in this study." The study focused exclusively on asanas, with recommendations to further explore pranayama and other yogic tools.

Applied Yoga for Musculoskeletal Pain: Integrating Yoga, Physical Therapy, Strength and Spirituality, Jory Serota. There is a recommended practice of standing, chair supported, prone, and supine asana offered to address LBP in the lumbosacral region.

I do not want to impose any spiritual practices, but I want to introduce the panchamaya kosha model and awareness of the different layers to the client. Do you recommend any specific tools or practice to include for spiritual orientation and needs?

• 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.