The client will experience a personalized hatha class with asanas modified to take into account injuries and physical limitations so the client can still reap the benefits of the practice without aggravating the body.

Using the tools of Adaptive Yoga, we will create a class that can help the client stretch and strengthen the body without pain, while incorporating restorative work to help with her stress and increase energy. Stress, energy level and pain will be measured on a 1-10 scale before and after the yoga series.

The client is a female in her late 40s with a diagnosis of osteoarthritis in her right knee. She has been experiencing significant, continuous pain from her knee in the past few weeks. The pain is strong enough that it makes it difficult to accomplish her tasks as a working parent of young kids. Frustrations at the difficulties of managing her daily tasks, such as driving and sitting in front of a computer for an extended amount of time, along with lowered energy has increased her stress level.

We had planned on meeting 4 times over 2 weeks. The idea was to incorporate asanas that would help stretch and strengthen her body to primarily reduce her knee pain and aid in mobility. I also wanted to include breath work and something restorative at the end to help increase her energy, lower stress and to aid in the healing process. Each successive session would build on the work of the previous one to hopefully provide greater ease of movement as well as more calm and peace for her mind.

I used the Kosha model from Raja Yoga to help in the assessment. This allowed me not only to get a sense of where she was physically, but also get a sense of her energetic and emotional state.

Since the first session was the base from which I was building, we focused on opening her body and relaxing her mind. Adaptations included using primarily lying or tabletop poses so that she wasn’t working against gravity and to avoid causing pain. (e.g. supta padangusthasana with strap—it was supine to save energy and the strap allowed gravity to help with the stretch; also using cushioning under the knee for anjaneyasana with hands on thigh vs. overhead.) I continuously asked for feedback to know if something hurt or was too intense; if so, we modified immediately and found another pose that had the same benefits but was not as extreme. Before we started meeting, the pain was unceasing at 7 on a scale of 1-10. She only had half her usual energy at 5 and her stress level was at 5. After just the first session, the pain diminished significantly and relief lasted for several days.

We’re hoping to have one last call where I can describe more asanas she can use for strengthening her legs as well as her whole body.

In our last session, we talked about her being more mindful in her movements. In this way she could notice right away if she was moving (or not moving) in a way that could cause pain later. Lastly, we talked about the importance of doing a restorative pose sometime during the day to help with stress, engage her PNS and to help her body continue to recover.

We ended up reducing the number of planned sessions, since my client canceled rather than try to reschedule a session. I had hoped to introduce more strengthening postures by the last session, but progress in that direction was slower than anticipated. Even though strengthening poses were minimal, the poses for stretching and relaxation were extremely beneficial over the length of the visits. Both my client and I were pleased at the end because pain reduction was significant even after the first session. After 3 sessions over 2 weeks, her pain level was intermittent (vs. continuous) at 3-4 with occasional flareups (4-5) when she sat for long periods. Her energy level increased to 6-7. “So much easier to do things when not in pain!” And her stress level reduced to 3-4 since she was feeling less worried in general and specifically had less worry about her physical mobility.

In working on stretches that opened up her hip area, we discovered that they also benefited her abdominal area where she had scar tissue from previous surgeries and had lost some sensation. As a result, we included those in each subsequent session. Also, a comment my client made about sensations in her knee led me to suggest that her final resting pose include feet on a chair. She said that pose helped reduce feelings of heaviness in her legs.

The biggest takeaway for me was just to keep an open mind and listen to whatever the client had to say about their body or anything else they brought up. Listening to comments made offhandedly brought extra information that helped guide my suggestions in fine-tuning the care plan during each visit.

I would approach the situation the same way in the future. Taking a thorough assessment using the Kosha model was helpful in dictating what needed to be addressed in the care plan. Talking to the client determined the main focus. Lastly, just listening and being present to the client throughout the session aided and guided me in their healing process.

Knowing that the body moves at its own pace and proceeding without expectations helped us move through this time smoothly. I observed where the client was physically and mentally at the beginning of each appointment and we moved forward from there. Using the tools of Adaptive Yoga, I was able to modify poses fairly easily to get the benefit we were looking for without any pain or strain.