The balance between mobility and stability is important for joint health.

The goal for implementation is to conduct two 30 min sessions that includes JAPA (Joint Activation Practice for All) and hip muscle strengthening.

The client is a 40 years old female who had been diagnosed with chronic bursitis with snap hip since she was a teenager. However, the condition has gotten worse after she had her second child. The client experiences IT band snap during extension and external rotation of the right hip. The symptom is worse a few days prior to her period and ovulation. Recently, her knees and ankles start to 'pop' and sometimes can be very painful. The client has done IT band stretch on a regular basis.

I planned to use a chair during the first session of JAPA practice (standing for hip and sitting for knee and ankle joints) and without the chair during the second session (sitting with leg extended for all movements of the hips, except extension and lying down for hip extension as well as movements of knee and ankle joints). I also planned to teach yoga poses that focused on strengthening her gluteal, adductors and core muscles to help stabilize the hips. The hip snap that leads to pain mostly happens when the client abducts and then externally rotates the hip. I also noticed that her adductors are super flexible, and therefore strengthening the muscles would likely be beneficial (Yoga for Bendy People by Libby Hinsley; HBED lecture). I would only offer a few simple poses so that the client can practice on her own.

I used Hatha and Raja yoga to support my goal. The JAPA and yoga poses incorporate physical movement and breath (JAPA handout, HBED class), both of which are part of Hatha and Raja yoga (Yoga Sutra, Book 2, Sutras 46 and 47) branches. During the practice, I also asked the client to be aware of her body and be very gentle by starting with small movement, then slowly increasing the range of movement without pushing to the point that would cause pain (Ahimsa, yoga sutra, Book 2, sutra 35).

First session: I checked in with the client on how she was and explained the goal of the practice. I explained to the client about what JAPA is and what the benefits are before teaching the movements focusing on the hips, knees and ankles. Then we paused to discuss the goal and benefits of the yoga poses that I would teach her. The poses that I chose were hip extension while the client is on the hands and knees and fire hydrant pose with knee bent). I used a block for strengthening the adductors (squeeze it during the Mountain and Bridge poses). Second session: I checked in with the client on how she had been doing and whether she had difficulties in the home practice. I then taught a few more poses as an alternative for the one I taught in the previous session or as an add on to her home practice.

I suggested that the client practices JAPA and strengthening poses regularly and perhaps, incorporate them into her daily activity, e.g., squeezing a block between the thigh while watching TV. The client reported that she did practice regularly, at least as much as she remembered from the first session. Her knees and ankles still pop, but there is no pain. She also has not experienced any hip snap since the first session which was 2 weeks prior. I did mention to her that strengthening muscles takes time and encouraged her to continue with her home practice. The client reported that she felt slight discomfort when she did the fire hydrant and abducting the hip (standing and lift the leg out to the side). I offered clam shell exercise for an alternative to those poses. I also showed her different way to incorporate a block into other poses (e.g., boat).

I applied the intended plan in the session one and felt that the goal was achieved. The poses and practices that were offered were simple and there were not many of them. This way the client was able to practice most of them on her own until we met for the second session. I did not apply the intended plan during the second session though. I planned to offer a different way of doing JAPA (sitting or lying on the floor). However, we did spend time on checking in and discussed the client's home practice (what work and what not) and then provide alternatives for the practices that may not work as well. She forgot some of the poses that I taught during the first session. So, we repeated it plus a couple more poses. The goal was achieved even though I had to modify the plan for session two. This is because the client now has tools that she can incorporate into her daily routine.

As mentioned above, I had to adapt my plan for the second session. I learned that the session is about the client and what she needs rather than about my plan (i.e., me).

Yes, I would approach the same way because it is important to check in with the client and work with her on what she needs at that moment. I think that both sessions went well; I was able to offer her tools for her practice and then followed up with suggestion on how to modify things that did not work. By explaining the reasons and benefits of JAPA and yoga poses, the client feels motivated to establish a daily practice that will support her physical and mental health overtime. If I have to change the plan, I would use the session 2 as a follow up session instead of planning a new set of practices. I would offer the same practice as the first session to reinforce the practice that the client has already learned and provide modification for a certain movement that she does not feel comfortable with.