Working with a client that has limited mobility to develop a chair-mat yoga therapy plan to reduce pain and increase mobility.

We will develop a chair-mat yoga therapy plan that will reduce pain and increase mobility. The client will keep a pain journal, measuring daily pain on the FPS-R 1-10 pain scale before and after yoga practice. The goal is to decrease the amount of daily pain they experience over 3 months, while practicing 3-5 times every week.

Female, 64, had bilateral ankle reconstructions in 2019. History of active lifestyle, in general good health. Suffers from anxiety disorder. Looking to use yoga therapy to help with ankle pain, getting up and down from the floor, walking, and going up stairs.

I want to offer chair-mat practices that will specifically help the client with pain and mobility. I chose each of the practices in the order I did because they will decrease pain and allow the client to feel more confident in her movement. The pain journal was a great suggestion, I think it will help her to remain focused on exactly why she is doing the yoga therapy practices.
I plan to explain how and why different asanas could be adapted to meet her where she is and how the practices would increase confidence, energy, and mobility while decreasing pain and suffering. I also will encourage her to keep record of how she feels about going up stairs, getting up and down to the floor, and moving about in her daily life for a minimum of 3 months but will encourage her to do so on a longer-term basis.

We were certainly oriented towards a Raja Yoga approach, as the asana practice was adapted to lessen her pain and allow her to achieve greater focus and deeper levels of meditative-type states in her daily life. Hatha Yoga was also used in terms of the physical postures.
The client has a deeply emotional and devotional temperament; they appear to be a Bhakti Yogi at heart. As such, we discussed the importance of fusing emotion into the practices by way of various affirmations and a devotional focus. We briefly discussed the neuroscience of emotion to give greater weight to the idea of the kind of 'bottom-up' healing that an embodied therapy such as yoga can bring about.
From a Jnana Yoga perspective, we also discussed a few medical articles that show how meditation and yoga can decrease pain, which we used as a bridge to talk about deeper yoga philosophy.

I really enjoyed working with this client because they already had been interested in yoga and practicing on their own. I feel like I got a great chance to apply what I learned in the adaptive yoga module in a more professional yoga therapy setting. After our sessions, there was a lot of deeper discussion, which was fantastic in this case but might have to be somewhat limited in the future due to time constraints.

I plan to continue to work with this client as they are very close to me both relationally and geographically. We will continue to add adaptive practices that are related to the key teaching of using yoga therapy as a way to reduce pain and increase mobility. I will continue to encourage her to use the pain journal and help to keep her accountable by asking about it.
As her pain decreases, I would encourage her to start to keep notes on her general mobility as well, which will help her to remain focused and give her direct feedback that the practices are working.
I would also encourage her to deepen her Bhakti Yoga practice through continued engagement in the spiritual activities (praying, writing, channeling) that give her fulfillment and peace, and remind her that these will also help to give her meaning and purpose and decrease her pain.

We were able to apply the intended plan, and I do believe the goal was achieved. I was able to meet with her several times and review the pain journal with her, which she shared had made her more committed to doing the practices on her own. Because she wanted more to do, we did wind up adding several movements in the later sessions. We also did some self-massage which I think was very relevant to her goal of decreasing pain and increasing mobility.

I did have to adapt some things based on how our sessions went. I would've added a plan to measure her mobility to the pain journal from the start, since seeing that the ankle joints are becoming more mobile would be a powerful encouragement to continue with the practices.
The biggest lesson that I learned is that I will have to be more thoughtful about the long-term and not load everything onto the front end. The client and I have only met a few times and I have already gone into many other asana options, the neuroscience of emotion, and medical articles on how meditation and yoga decrease pain. Even though the client was constantly asking for more, I will have to learn to control the therapy flow and make sure that I am not overwhelming people by making this the norm. I also learned that I need to study the lymphatic system more!

I do think that the therapy sessions went well, and that I happened to be a good fit for this client. I think the sequencing was good and the transition between the char and the floor was very practical and helped her to connect the practices to real-world experience. I would approach the situation mostly in the same way, except I would be more careful to maintain professionalism and set a more firm boundary in terms of time, I just won't have the time to talk for another hour after every session. I also think some clients would've been overwhelmed by anything more than what I initially offered.

With the benefit of hindsight, I would've picked one medical article, philosophical concept, or a few additional adaptive movements for each yoga therapy session that we could discuss briefly.

I really love the idea of using a pain journal for the clients that have the goal of using adaptive practices to decrease pain. I need to do some more thinking about how I can use journals and metrics to assist with clients that will be using yoga therapy for other, less tangible issues - like those related to mental health.