Asanas to address structural limitations

Client practices one centering technique and 4 asanas, 3 times weekly, improving upper body flexibility and range of motion to create length in the spine, or to keep the length that still exists.

72-year old female with postural kyphosis, overall body stiffness, limited mobility in neck, spine, hips; altered gait/walking pattern. Also diagnosed: diabetes, high cholesterol and blood pressure, frequent need to urinate, low Vitamin D, allergies, obstructive sleep apnea, vertigo, tinnitus. Client has not seen doctor for kyphosis; is not seeing a physical therapist or chiropractor. Breathing is shallow; client is winded after walking up two flights of stairs. Movement is slow and deliberate. Emotionally, client seems content with lifestyle - works daily, no spouse, no children, five pets. Client spends evenings reading; weekends in the garden. Feels physical pain after outdoor work. Client shows interest in needing to be mindful of correct posture and stabile lumbar support when working at computer and while reading for pleasure. Also acknowledges need to engage abdominal muscles and be aware of motor control in active sitting. Generally, client is goal-oriented and motivated (Pitta-Kapha), and states interest in improving overall flexibility and walking pattern, a reduction in neck stiffness, an increase in spinal length (reduction of kyphosis if possible), and overall improved posture when sitting and standing.

In advance of each session, a proposed plan was sent via email to the client; it included a list of props and photos of props in place. Online, client was first led through options to find a comfortable seated position. Centering then began by teaching guided breath awareness. Client had set up first restorative pose props and was guided into it with advice on how to make it more comfortable. Each pose included guided diaphragmatic breathing, ending with guided imagery in deep relaxation.

Asana, Pranayama, Raja. Finding comfort in all poses was vital for this client who experiences underlying physical pain throughout the day. Each pose was selected with release and a deep letting go in mind. With moving client into stillness through the layers of the body, emotions, and mind, an overall reduction of physical and emotional tension and pain was reached. She felt she had a deeper understanding of her body & mind.
It proved more difficult to guide her through a reduction of mind chatter. Guided meditation with imagery helped with focus. Using soft blue to soothe, release pain, and calm. Gold for moving energy through the body; nature to rid the body of unease.
Sustained stress led to poor breathing habits. Guided breath awareness during centering, and guided diaphragmatic breathing retaught client how to release constrictions, increase oxygen, expand the diaphragm, etc.

It took weeks of interactions with the client to teach her where and how to find internal peace. She is cerebral, and voiced her disbelief in spiritual concepts so I was careful in my word choices. Calm was difficult for the client whose mind chatter she described as incessant. She was very amenable to the restorative poses (e.g. physical aspect), voicing discomfort then comfort once in place. I rephrased Raja yoga sutras to guide her into a calm place.
3-part breathing needed reteaching at each session; she responded well to physiological explanations. In a pose, guided breathing was successful. Teaching this in person would have been more beneficial so I could adjust props. I quickly learned that with centering and pranayama, two restorative poses with prop adjustments was enough for the hour since she liked to end with guided relaxation in an ongoing attempt to calm her racing mind

Schedule in-person sessions so prop adjustments would be easier.
Continue to practice diaphragmatic breathing on her own by scheduling five minutes in the morning; five minutes at her work desk; and five minutes in bed at night.
Using the photos I sent, and any readjusted positioning of props, set them up in a pose in the morning when she is feeling most energetic. Once home, before bedtime, rest in that pose for the proposed amount of time. Leave it there for 2-3 days, then switch to another pose.
Walk with her dog instead of using her golf cart. Start by walking around the block.
Join a chair yoga class at least once a week.
Practice mindfulness once a day when doing a chore.
Use recommended Yoga app for guided relaxation.
Smile at herself in the mirror each morning and say aloud, I LOVE YOU! You are beautiful."

The plan was incorporated with minor adjustments f.ex. number of poses, amount of time for set up.
Working with a client who is not spiritual required me to consider how to present yoga philosophy and teachings to someone who is led by their brain. Presenting the research-based physiological benefits, noting citations, and even sharing peer-reviewed articles helped us along the way.
The client expressed feeling better and more relaxed. She observed that once the props were in place, she was able to relax and sink into the poses, reaching deeper physical parts of herself. She stated she felt the guided breathing techniques created more space within her. She achieved a new calm through guided breathing and relaxation though she said she cannot quite get there yet on her own.
I feel that the overall goal was achieved.

More time was needed for online teaching so fewer poses were presented during each session. Requiring client to adjust props disturbs the tranquility of the session. It also takes too much time determine how many props are needed and how to place them when a client is not 'physically fit'. Although a variety of therapeutic poses were introduced, the repertoire was limited due to her kyphosis and arthritis. Getting up and down is difficult for her so it was important to have props at hand.
I learned that not being in-person can make setting up props and finding that sweet spot in therapeutic yoga poses for a client quite challenging. The goal is to glide as seamlessly from pose to pose with minor movement. When you're working with a client who has mobility issues and cannot lie on their back, this poses problems.

I would meet with the client in person in a 'pre-session' to not only assess on paper but to try out a few poses. It was not apparent upon sight that this client had physical limitations that would significantly limit the number of poses one could use in the beginning. In the future, I would want to know through hands-on work and in advance what they can and cannot do; what is comfortable, what is not. If I could not be there in person, I would refer them to someone else who was nearby, or ask if they had a friend who could attend to help with adjusting props. Kyphosis influences one's posture in walking, sitting, and lying on one's back. The arthritic stiffness also played a substantial role. In the future, during intake in a more mindful way, I would ask about physical limitations in at least those three areas.