The key teaching is a restorative yoga pose held for 15-20 minutes. Time and gravity will allow the client's body to open and gently stretch the targeted areas, while the stillness in the pose will permit the body to actively rest and heal. Gentle yoga is performed beforehand to prepare the client's body to comfortably hold the pose for the suggested amount of time without strain.

Analysis I believe that there is tightness in the lateral and anterior portion of her body that is inhibiting full ROM in her shoulder area, particularly with the arm flexion when she is supine. Also, the client has less ROM while performing an external rotation of her arm in a supine position vs. standing. I suspect that when she is standing, the deltoid is powering the motion, allowing her to make the movement. When she is supine, the deltoid is no longer active and her supraspinatus is not strong enough (compared to her other muscles) to complete the motion. Goal Given the analysis, my goal is to gently open and stretch her front body (especially pectorals) to allow for a greater range of motion than she currently has. The gentle yoga will help to articulate the glenohumeral joint while allowing synovial fluid to flow and lubricate the area before the restorative pose.

The client is a 47 year old female requesting help with reducing stiffness in the shoulder/arm area on both sides. She can raise her arms overhead (by her ears) as well as bring her hands parallel to her body when doing cactus arms in a standing position. However, she is not able to get the same range of motion while lying down. (There is no pain when she performs these motions.) Additionally, she has pain in her right Achilles tendon and right knee, which we will not be addressing at this time. She practices yoga, Qi Gong and meditation on a regular basis. She is extremely busy and is likely under quite a bit of stress.

The outline for each session was to do:
a) gentle stretching combined with breathwork to expand and loosen the rib cage/respiratory area.
b) stretching/release of fascia with therapy balls targeting the pectoralis major, latissimus dorsi, teres major and anterior serratus. (This was one of the preparatory techniques demonstrated in TY2.)
c) various gentle yoga to further release the chest area and strengthen muscles in the back body. The asanas were chosen based on the final resting pose.*
d) final therapeutic pose with guided meditation, held for approximately 15 minutes. The three poses we used were Resting Star, Supported Bridge and Elevated Resting Butterfly. All of these poses are chest openers that also stimulate the immune system. Not only should these help with range of motion, but they should also help keep her body healthy and address some of her secondary issues (stress, injured knee/ankle).

*Some of the gentle yoga simultaneously offered stretching and strengthening to allow for more stability in the shoulder girdle area and to balance out uneven strength/flexibility. (e.g. see Nicole DeAvilla pp. 67-68 setu bandhasana variation)

Technical: We worked over zoom. I asked her to adjust the camera as needed so I could see what she was doing whenever we practiced. In this way I felt comfortable seeing how her body was positioned. I was able to ask her to make adjustments to her posture or props to make sure the poses were done safely and properly.

Note: It was important to me to incorporate enough gentle yoga to loosen her body beforehand so she could stay in the final pose comfortably. I have had experience with people saying they were “fine” in a pose, and then having their bodies complain when coming out. Usually it was because their body was not ready for the pose (body not warmed up enough or pose held too long) and they didn’t have the body awareness to notice their discomfort in the moment, even though I would repeat that they could come out early whenever something didn’t feel good.

Raja: We used a prerecorded guided meditation during final resting pose. This allowed her mind to be focused so that she could keep her body still in the final resting pose.
Hatha: We used yoga to gently stretch and open her body so she could comfortably rest for an extended time in the final therapeutic pose we had chosen.

She was very amenable to try out new things. Since we are friends and she knows what I am studying, there was a level of trust at the beginning that was really nice and helped with the sessions. She knew she was in a safe space.
Over the course of the sessions we figured out which types of stretches and gentle yoga a) felt good in her body, b) allowed for more independent movement of her arm/shoulder from her ribcage, as well as c) helped prepare her body enough for the final resting pose. If she tried an asana and didn’t like it, we would drop it and try something else that offered the same benefit. She really liked one of the variations and will use that for her yoga studio classes.
I made sure to reiterate she should be comfortable during the final resting and nothing should hurt, create tension, etc. As a result, we adjusted Resting Elevated Butterfly slightly by changing her leg position and didn’t use the strap for Supported Bridge.

I asked her to continue doing the targeted therapy ball stretches we practiced to release her fascia. (She takes a therapy ball class, so this was an easy add-on.)
She also knows that if she has time after a regular yoga class she can substitute one of the therapeutic poses we did for the savasana. I reminded her that she could contact me at any time for refreshers on how to do the therapeutic yoga poses and gentle yoga, if needed.

We stayed pretty close to the original sequences during our meetings. There was always room for adapting and dropping exercises that weren’t helpful or didn’t feel good in her body. We both felt that she gained benefit from doing the sessions—with a feeling of ease in the shoulder area as well as a greater range of motion than when she started. She also said she felt good after a session, which could suggest that she was gaining a recuperative benefit from the longer time spent in the final resting pose as well as the immune system stimulation.

I learned that every day is different. We pushed back one of our session dates because her shoulder didn’t feel good and we wanted to give it enough time to calm down. I also practiced aparigraha with these sessions. Even though a particular movement I researched looked promising on paper, it didn’t always translate well when applying it to her shoulder, so I had to let it go.
Communication throughout the whole process was so important. Through continuously checking in we made sure to avoid overstretching muscles, removed or replaced asanas that weren’t working and made adjustments to the final resting poses. We also figured out together that using a guided meditation during the final resting pose made a huge difference in allowing her to focus her mind so her body and nervous system could benefit from the pose.

I was actually very pleased with how these sessions turned out. Both the client and myself kept open minds about what to expect, so there were no major disappointments and we were pleasantly surprised with the results.
In the future I would make a point of letting a new client know that we don’t know how their body will react to the sessions and that we will move forward based on trial and error. Also, we may have to remove or replace parts of the sequence if it’s not helpful in the moment and make adjustments dynamically. The hope is that there will be some ease to their issue, but there is no guarantee.

• ijyt_17_1_8617114557751147.pdf
• ijyt_16_1_l3p3u261u8522451-2.pdf