Gentle asana and pranayama for osteoarthritis and asthma

Meet with client for three sessions beginning April 14th. Spent 20 minutes with supported backbend, 3-part breath, and gentle reclining twists. Repeat this plan for the remaining two sessions to see how this helps the client with pain, tension, and breathing issues.

Client is 81-year-old female, mostly sedentary and overweight. Client has been diagnosed with osteoarthritis and asthma. Client complains of back pain, tightness in chest/shoulders, and rapid, shallow breathing. Client used to participate in restorative yoga classes at a fitness center but has been homebound due to the pandemic.

I worked with the client by greeting her and giving her some time to settle in and tell me about her current health issues. Then, I used a bolster and three blankets to set the client in a comfortable reclining backbend. We started with her hands near her hips, and gradually worked the arms away from the torso as I helped her open and expand the chest area while sliding the shoulder blades down her back. After this, I removed the props and used one blanket for head support as I set her lying on her back for gentle reclining twists with her arms in a T position. For each session, I varied the types of twists by changing leg positions to find whatever felt appropriate to her each time. Finally, I placed the bolster behind her knees and coached her through slow three-part breathing.

Hatha Yoga - The practice of asana and pranayama to help the client manage her osteoarthritis and asthma.

The client was prepared for our sessions but a bit breathless each time I arrived because she was trying to "get one more thing done" before I arrived. For example, she had been paying bills or she had just returned a phone call regarding the care of her brother who lives in a nursing facility. The client was very interested to try out the interventions I was offering her, and she willingly participated in each activity. I was able to modify the backbend, the twists, and the pranayama to suit the client's needs each time. For example, I used different leg positions for the twists (such as feet apart on the floor, or the ankle crossed over the opposite knee) depending on what felt best for the client each time.

The client is continuing the three-part breathing on her own twice a day: first thing in the morning while still in bed, and again in the afternoon just before lunch. The client would like to continue meeting with me twice a month to review these interventions (passive backbend, reclining twists, 3-part breath) and to add asanas to stretch her hamstrings and lower back.

Yes, I applied the intended plan for the three sessions. The client stated she felt improvement in her body and breathing - so much so that she wishes to continue working with me regularly. The client reported that her chest and shoulders now feel more open and flexible which helps her breathing become fuller and deeper.

Yes, I adapted the plan by varying the arm positions in the passive backbend because the T-position arms were initially too challenging for the client. Also, in the first two sessions, the client had trouble with the 3-part breath practice, so I taught her the "blowing out a candle" pranayama with slow arm movements (a type of "remedial pranayama" as Swami Vidyananda calls it). After this, the client had an easier time relaxing into the 3-part breath practice. The client practiced this breathwork every day between our sessions, so it was clear to me when she was progressing. I learned that clients who are very interested in the yoga therapy will be happy to work with the interventions every day on their own. This is something that tends to concern me because I assume people will NOT want to do homework assignments. However, I know that if clients fail to do "homework," this becomes an opportunity to explore with them ways to make the assignments more interesting or fun - or whatever each client needs.

If faced with the same situation with another client in the future, I can imagine using the same type of interventions because I saw that they worked very well. Tightness in the chest and shoulders makes deep breathing very difficult, so it makes sense to me that stretching and opening the chest and shoulders can help clients breathe more freely and feel more relaxed which aids symptoms of asthma. These are also important points for dealing with the pain that often accompanies osteoarthritis.