We will use JAPA™ (Joint Activation Practice for All) to increase ROM in the affected knee joint. (Based on Pawanmuktasana Classical Series as taught by Swami Satyananda Saraswati.)

We will work on increasing the ROM in her knees as well as other joints to help maintain optimal functioning so she can do her daily tasks. We will measure current extension and flexion and ask for her level of pain before and after the class.

The client is female and in her late 40s. Her main exercise was running, including marathons and other long distance races. After continued pain in her right knee, she was diagnosed with osteoarthritis and told she needed to stop running, or she would need a total knee replacement surgery in 5 years. This is a blow to her, as she identifies as a runner. Her activities are also affected, as the pain makes it difficult to get up and down off the floor as part of her job working with children.

We planned on working over 2 sessions due to our tight schedules. (We agreed that we may meet after the TCA for a last followup.) The idea is that we would perform joint freeing movements with the breath to loosen her joints to increase her ROM with the ultimate intention of reducing pain and allowing more functional movement throughout the day.

My client had a huge blow to her identity when the doctor gave the news that she could no longer run. During our first session, I spent more time talking about what that meant to her, so we incorporated some ideas of nonattachment and surrender from Raja Yoga in that session. Being more at peace with her current reality, will hopefully allow her to feel good about working with the body she has now. We also performed Asana to create a feeling of steadiness and ease in her body.

We spent more time talking during our first session to ease her mind, so less time for asana.

Session 1, her hip pain was 8 and lowered to 6 after the session. Knee pain was 9 and did not change. Extension = space under knee; Left = 1.5” before session -> 1” after; Right = 2” and no change. Flexion = heel to sitz bone; L = 9 1/4” -> 9”; R = 13” -> 12”.

Between the first and second session there was much improvement in her functional ability. She could get down to the floor without using the step stool and had more movement with less pain. She could also use the stairs more easily, though she still felt weakness in her right leg.

Session 2, hip pain was 4/5 and knee pain was 3/4 and did not change after the end of the session. However ROM improved greatly. Extension: L = 1” -> ½”; R = 1.5” -> 1”. Flexion: L = 9” -> 8.5”; R = 11” -> 9”.

We agreed that she would continue to do portions of our session or even just simple movement 3x/week. She was so impressed with how much her ROM improved and her pain reduced with our sessions as well as between sessions. Having concrete evidence gave her more confidence in the benefits of movement and making the the time to spend on her health.

I also wanted her to continue to work on hip ROM and ankle ROM as a way to spread out the force of movement throughout her entire leg so that the knee was not being overworked from her walking and other movements.

The goal was definitely achieved. She was able to reduce her pain and increase her ROM after just one session.

I did have to make some adjustments from what I originally had in my mind when I actually met with her. It’s described in detail below, but all of the physical movements I had planned for her were put aside so that I could hold space for her mental state and just allow her mind to go through the range of feelings and emotions that were coming up. I also had to take into account her body’s physical limitations due to pain and lack of movement over the last few months.

Due to the shocking nature of the doctor’s news, we spent more time talking and less on the physical. For our first session, she really needed to take the space to process what it meant to no longer run. We spent almost half the session talking things through and seeing what it meant for her to no longer call herself a “runner.”

I also noticed that her body was very stiff – she had been more sedentary because she was in so much pain. Even when we extended our original session time and ended later, we still had less time than I would have liked for asana, so we focused on stretching to release her joints vs. doing the JAPA. But these simple stretches were appropriate for what her body needed that day and helped with the pain and mobility.

I confirmed that working with the mental/emotional aspect is just as important as working with the physical in these sessions.

I would do the same thing. Her stated goal was to gain more mobility and reduce pain, so I came up with a plan that would make that happen. But when we met and I noticed her mental/emotional state, addressing that first became the priority regardless of what she had originally stated. It’s good to have an outsider’s perspective to see what a client might not see they need at that time. I was also glad that she was receptive to talking and considering other ways of thinking about her situation. If we had had more sessions, I would have continued to check in with her to see how she continued to process the emotional aspects of the news.

I believe it’s always good to have a plan on how to proceed, but be willing to let that plan go when faced with a different reality than what you expected. Be open to addressing the greatest need at that moment and know that it may not be a physical one. It’s important to take into account the whole person – mental/emotional/physical/spiritual and be prepared to work within any of those levels at any time.

• JAPAguidelines-220209-180810.pdf
• Knee-Osteoarthritis-Alternative-Range-of-Mo_2019_Orthopedic-Clinics-of-Nort.pdf