JAPA (joint activation practice for all) gently moves the joints of the body within a comfortable range of motion while activating major muscle groups. This helps to increase the range of motion, and strengthen the joints, tendons and ligaments. Using breath awareness will increase the above benefits, breath work is a good tool for pain management

The goal is to help my client regain his range of motion by practicing JAPA and managing his shoulder pain through breathing practice. This 60 mins weekly session runs for 3 weeks, the progress will be monitored by the numerical scale and ROM assessment.

John is a male in his late 50's. He has a frozen shoulder and labrum tear causing him difficulty of daily activities. He has been working with 3 different physical therapists, but he sees a little improvement. Also he has a limited range of motion on his left hip due to a bike accident 4 y ago.
It is difficult and painful for him to perform daily activities such as opening the door, driving a car or putting on/off clothing. His goal is to reduce the pain, anxiety
and improve ROM.

I envisioned working with this client 60 minutes weekly session for 3 weeks. Each session started with breath awareness and a quick body scan. Then JAPA practice for about 30 minutes, deep relaxation followed by a brief meditation.

The branch of Yoga I used is Hatha Yoga for the practice of joint movement and breathing practice.
Breath awareness enables us to be at the present moment, body awareness is activated when we pay attention to our breath. Nadi Suddhi helps to calm the mind and reduce stress and anxiety.

According to Jon, he has been practicing yoga for many years, he practiced Hatha, power yoga and he meditates as well. He was very active until recently, but he has less mobility on his right hip and ankle after bike accident. Also he has pain on his shoulder due to frozen shoulder. I noticed his breath is very shallow, I think this may be related to his condition. He came to my restorative yoga class, and I found the condition of his shoulder by watching his movements. He repeated saying “I was able to stretch more, I could do this pose easier”. He admitted that he is frustrated with his condition and it is affecting mental state as well. He agreed to try JAPA practice to regain his range of motion and keep his mind calm.

I would advise my client to continue a daily morning practice of JAPA. This will help not only increase his ROM, also lower his anxiety level by focusing on the slow joint movement and being at the present moment. He can also try simple affirmations, as an example, silently repeating “LET” at inhalation and “GO” at exhalation to alleviate pain while he is moving the joint.

My intended plan was applied, and the goals were met specifically for my client to learn how to practice JAPA, breathing, and meditation. I believe the client benefitted from the sessions. He can now practice JAPA at home, he said this gentle movement helps him regain range of motion gradually, also he feels less pain by focusing on breathing and being at the present moment.

I originally planned all JAPA movement on the mat, we tried using a blanket or block to make him sit comfortably. But I changed to practice on the chair after observing his movements because he seemed to be uncomfortable sitting on the mat.

Lesson Learned: I learned that I should have performed the ROM assessment both sitting on the mat and sitting on the chair so that I could plan the movements most suitable for my client.

I will approach in the same manner if I face the same situation. It is important that the program should be very simple and short so that my client can practice easily at home or the office. I may add guided visualization at the end of the session, it will help my client to
reduce stress and decrease pain, guided visualization is a very strong tool for pain management and creating positive feelings.