By both reducing the angle of wrist extension and eliminating weight bearing on the wrists whenever possible, the client can honor teaching commitments, model adaptive practices for her students, allow forearm extensors to rest, and most importantly, deepen her personal understanding of ahimsa as a yoga teacher and future yoga therapist.

1. To design a 20 minute adapted practice using blocks and a wedge to minimize wrist extension. The client can then use this practice as part of her personal practice, as well as in her weekly classes.

2. Encourage the client to journal at minimum weekly on her application of ahimsa in her personal and professional life.

The client is a 48-year-old female in overall good health. She is very active, teaching 10-15 group fitness and yoga classes each week, as well as working out for herself 5 days a week, approximately 60-90 minutes per session. After weeks of discomfort in her left forearm, she sought physical therapy and was diagnosed with lateral epicondylitis. Her therapist felt the cause to be overuse as well as changing her deadlift form. Client often knowingly overcommits and has a hard time saying "no."

I wanted to begin with a brief awareness practice and check in, followed by a review of sutra 2.35. I would then guide the client through the standing stretches for tennis elbow, with a focus on connecting movement with the breath, followed by gentle asana using blocks and a wedge for support. We would then check in again about how the practice felt, and I would introduce the journal assignment for homework prior to our next session.

To address primarily the annamaya kosha, I guided the client through adaptive asanas using hatha yoga. To undergird this practice and support the client’s health across all koshas, I used raja yoga, specifically sutra 2.35 on ahimsa: “In the presence of one who is firmly established in nonviolence, hostility recedes.” (Inside the Yoga Sutras, Reverend Jaganath Carrera) We discussed an insight for both personal and professional growth from Rev Carrera's Inside Patanjali's Words: “The practical and very real and powerful message of this sutra is that the mere presence - demeanor, words, and actions - of one firmly established in ahimsa generates a space for entrenched feelings and misperceptions to recede. This is no small feat.” (p. 206) The more she can abide in ahimsa through all her koshas, the more effectively she will support healing for her clients. For her it begins on her mat.

Since the initial plan submission, the client has completed several sessions with a physical therapist. She has faithfully incorporated the exercises, modifications in intensity and frequency of strength training, and recovery suggestions given by the therapist. Her tennis elbow is well-controlled.
The client arrived in good spirits and ready to “work,” which she defines as pushing herself to perform “better” across all koshas. As the client moved through asana practice I encouraged her to slow down and allow the breath to guide the movement. When she felt she had slowed down enough, I encouraged her to go even slower, which was uncomfortable in the sense of the transformational discomfort of tapas.
We invested time discussing sutra 2.35, specifically how “hostility” might exist in her relationship with herself. We brainstormed practices to reduce hostility.

I encouraged the client to continue her slow and mindful asana practice, and to include observations and noticed sensations in her journaling. She will also add into her personal practice asanas that increase shoulder stability and core strength. I also encouraged her to continue journaling about her learnings on ahimsa, as well as the other yamas and niyamas, with a focus on celebrating insights that will support her professional development as a yoga therapist.

As the client moved more slowly through the asanas, she became increasingly aware of the engagement - and at times the lack thereof - of muscles of her left shoulder complex. The roles of specific muscles she is still identifying, but enjoying the process and using the exploration as a practice of ahimsa and svadhyaya. In this I do feel the aspects of the goal to support healing in the annamaya kosha was achieved. The client’s willingness to humble herself in slowing down and redefine strength in terms other than heavy external resistance, increased speed and endurance is also achieving the goal across all koshas.

In addition to the standing stretches (from article attached), I guided the client through joint activation movements for the shoulders in a tabletop position, with a wedge under the palms to reduce the angle of wrist extension, allowing her to minimize discomfort through the elbow while focusing awareness on shoulder stability and mobility. We moved through internal and external rotation, scapular protraction and retraction, as well as elevation and depression. In exploring downward facing dog, we noticed a slight excess of scapular elevation and retraction, as well as external rotation in the shoulder, on her left side. We considered the possibility it could be connected to her mild scoliosis (16 degree thoracic curvature to the right), discussing it not from a mindset of finding blame in her body, but with the purpose of increasing interoception and meeting her body where it is.

Honestly I hope I am never faced with the same situation ever again of working with myself as a client, as I might be my most difficult one. When Satya initially approved the “wild card option” of using ourselves as a client, I mistakenly thought working with myself would be easy. However, for my own personal and professional growth, I must model ahimsa and self-love if I hope to encourage future clients to do the same.
In terms of approaching this specific condition with clients in the future, I would spend time during initial physical assessment to identify contributing factors to the condition, such as instability in the proximal joints and habitual or compensatory movement patterns in the body.