Hyperkyphosis, lower back pain, scoliosis. Forward head posture. Limited ROM in all neck movements. Delicate digestion related to effects of gastroesophageal reflux corrective surgery. Client lost 40 lbs after this surgery 2 years ago. Possible L1 bulging disc mentioned by her orthopedist. Client does not recall exact diagnosis. Hernias previously surgically repaired, now returning. Client is able to lower down to the floor and transition back to standing with use of chair seat.

Sleeps well. Afternoon fatigue. Throughout her life she has taken afternoon naps as her schedule has allowed. Vata dosha dominant: wispy physique, likes to keep moving, travels often. Kapha dosha secondary. Uphana and udhana vayus predominant, lacks integration. Collapsed, sunken in the heart center.

Death of her husband and son 8 years ago, six months apart. In both cases, the client conversed with the family member, hearing clues of their physical discomfort or mental distress, then exited the conversation, leaving the home. In the case of her husband, she returned to find he had died of a heart attack. In her son’s case, she returned to find that he had committed suicide. From childhood her son was depressed, later bi-polar, heroine addict, incarcerated. Client was very close with her son. She feels associated guilt. Appears jovial, underlying sadness.

Strong social support network of close, longtime friends. Visits surviving daughter and grandchildren often. Relationship with her daughter is tense.

Raised in the Catholic faith tradition, the client is not particularly spiritual. She is interested in meditation.

Caring for family and friends is fulfilling to the client. She values being a trusted companion.

For self-compassion to relieve guilt. Bring some of the compassion she offers to her friends toward herself.

• Patanjali’s Yoga Sutra 2.35. Ahimsa. Non-harm/harmlessness as compassion and self-compassion.

• Meta meditation. Bringing compassion toward a being she loves deeply, toward self, individuals and larger sphere of sentient beings.

For working with the mind, impermanence-positive change is possible, remembering that we are not our thoughts. “The mind is a wonderful servant, but a terrible master.” Reframe and share these teachings with the client.

“No problem can be solved from the same level of consciousness that created it.” Albert Einstein

Patanjali’s Yoga Sutra 2.3. The kleshas, in particular avidya: mistaking the impermanent as permanent, the unreal as real/impure as pure, painful as pleasant, the non-self as the self.

Patanjali’s Yoga Sutras 2.17 and 2.24. The cause of suffering is ignorance, or not discerning the difference between the Seer and the seen.

Bhagavad Gita Verse 6.5. Elevate yourself through the power of your mind, and not degrade yourself, for the mind can be the friend and also the enemy of the self.

Brihadaranyaka Upanishad, Pavamana mantra. Om asato ma sadgamaya, Tamaso ma jyotir gamaya, Mrtyor ma amrtam gamaya, Om shanti shanti shanti

Contraindications. Minimal to no spinal flexion to avoid further injuring the low back at L1. Keep spinal extension moderate, avoid overemphasizing this area. It may be a vulnerable area of the body. Hernias: no crunches, sit-ups or planks; supine or side lying gentle core strengthening allowed.

Scientific research.
Grief. These studies demonstrate the positive effects of moderate physical activity on subjective well-being, particularly in processing grief. Walking is one of the physical activities mentioned. Plan to include this in the client’s care plan.

Pamela Wicker, Bernd Frick, The relationship between intensity and duration of physical activity and subjective well-being, European Journal of Public Health, Volume 25, Issue 5, October 2015, Pages 868–872, https://doi.org/10.1093/eurpub/ckv131

Wicker P, Orlowski J. Coping with adversity: physical activity as a moderator in adaption to bereavement. J Public Health (Oxf). 2021;43(2):e196-e203. doi:10.1093/pubmed/fdaa059

Williams J, Shorter GW, Howlett N, Zakrzewski-Fruer J, Chater AM. Can Physical Activity Support Grief Outcomes in Individuals Who Have Been Bereaved? A Systematic Review. Sports Med Open. 2021;7(1):26. Published 2021 Apr 8. doi:10.1186/s40798-021-00311-z

Hyperkyphosis. The techniques used in this study demonstrated positive effects on reducing kyphotic curve. Thoughtful, progressive protocol with clear details of the yoga methods used in the study. Will incorporate some of the techniques in the client’s care plan.

Wang MY, Greendale GA, Kazadi L, Salem GJ. Yoga Improves Upper-Extremity Function and Scapular Posturing in Persons with Hyperkyphosis. J Yoga Phys Ther. 2012;2(3):117. doi:10.4172/2157-7595.1000117

Posture. Verbal cues to improve posture.

Cohen RG, Baer JL, Ravichandra R, Kral D, McGowan C, Cacciatore TW. Lighten Up! Postural Instructions Affect Static and Dynamic Balance in in Healthy Older Adults. Innov Aging. 2020;4(2):igz056. Published 2020 Mar 24. doi:10.10

Consulted mentor after client intake session during individual mentor meeting. 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.