A man in his 70s with neuropathy, arthritis, a tethered spine and fused ankles.
Prescription: A mainly floor-based practice, with some sitting and standing. As the tethered spine creates a pronounced forward stoop, exercises to lengthen the spine and open the chest are paramount (cobra, locust, bridge, knee-to-chest). Leg strengthening and knee mobilisation (such as chair pose variations) are also key. Supported Yin postures (particularly with sandbag) for relaxation. Mindfulness and breath awareness to deal with chronic pain.
A man in his 50s with a frozen shoulder.
Prescription: Soft, gentle shoulder movements such as arm swinging, shoulder rotations, moving the arm through the four planes (front, back, in, out), strengthening the arm by pressing it to the wall and mobilising it using a strap. Pain-free practice is the aim at all times. As excessive physical tension is being held in the body, Supported Yin postures (particularly chest openers) take up half the session. Focus on exhale to induce relaxation.
A woman in her 60s recovering from spinal surgery whilst dealing with acute bouts of vertigo. Possible thyroid imbalances suggested.
Prescription: As this client's needs change quite dramatically from session to session, a variety of approaches are required. When the vertigo is present, the practice stays upright – sitting and standing only – with a focus on creating stability (warrior, mountain) and balance (tree, eagle). Side stretches, forward bends and circular movements are out. However, when the vertigo is less, some practice can be on the floor and will focus on lengthening and releasing tightness in the back (knee-to-chest, twists). Poses that stimulate the thyroid (bridge, shoulderstand) are also employed when the vertigo allows. Visualisation meditations are used for relaxation.
A woman in her 90s suffering depression following bereavement and chronic pain from curvature of the spine/arthritis.
Prescription: As the client is frail and restricted with mobility, the session is chair based and involves gentle movement of joints and limbs, all coordinated with breath. Giving the client space to talk and be heard is a significant part of the treatment. Basic breath awareness meditation is used as relaxation.
A morbidly obese man in his 50s suffering from chronic anxiety and depression brought about by autism.
Prescription: As this client has an unusually well developed sense of interoception, body scanning and awareness of energy flow dictate each session. There is a high level of verbal communication and dialogue. Movement follows inner prompts and conventional yoga poses are sidelined in favour of anything that helps the client express the richness of his inner experience with a sense of freedom. Complex hand gestures (mudras) and gentle rocking motions are used to calm the mind. Grounding through the feet and strengthening of the core are employed to create emotional stability. The philosophical aspects of yoga are discussed: non resistance, self acceptance, being in the present.
A woman in her 60s wanting ways to manage the chronic pain and 'brain fog' of fibromyalgia.
Prescription: As this client already has a comprehensive, twice-weekly yoga practice which helps keep her muscles active, the aim of a private session is to acquaint her with detailed breath and restorative exercises that are not covered in a general class. Moon breath is given to calm the mind, alternate nostril breath to balance the mind and supine three-part breath is given as a way to relax the whole body. Simple restoratives such as legs up the wall, half shoulder stand and supported relaxation pose are also suggested, in conjunction with breath awareness and emphasis on exhalation to help relieve pain.
Two friends in their 50s dealing with menopausal symptoms, including uterine prolapse, urge incontinence
Prescription: Clear, anatomical description of the pelvic floor and its openings. Explanation of relationship of pelvic floor to diaphragm (and thus breath). Instructions to engage pelvic floor in specific ways during general yoga practice. Importance of inversions (such as supported shoulderstand) to realign uterus. Gentle weight-bearing exercise (cat, dog, plank) to increase bone mass. Usefulness of breath exercise to regain emotional balance (alternate nostril breath) or release the excess heat of flushes (cooling breath). Rest as spiritual practice.
A woman in her 50s with rare lung condition Bronchiectasis.
Prescription: Long held, supported inversions to drain lungs (forward bend, dog, fish, bridge). Side stretches (triangle, swaying palm), both dynamic and long-held. Upward stretches. Chest openers. Three-part breath. Retention at end of inhalation to give power to the exhalation (which the condition renders difficult). General focus on diaphragmatic or 'yogic' breathing in all postures. Relaxation in an inversion rather than lying supine to inhibit 'pooling' in the lungs.
A woman in her 50s suffering severe anxiety following a contentious divorce.
Prescription: Integration of mind and body through general practice, supported by themes pertaining to the flavour of the moment (strengthening sense of self, for example, or finding balance). If the client presents with a lot of nervous energy, then the session comprises flowing sequences (sun/moon salutations), powerful postures (goddess, warrior) and lengthy yoga nidra. If energy levels are low, then the practice is mainly restorative. A variety of breath exercises help to settle an uncalm mind. Chakra meditations are also useful.
A woman in her 60s with a history of brain tumour surgery and mobility issues as a result of arthritis in the knees.
Prescription: As standing creates significant pain in the knees, practice is either chair-based or lying supine, with just a small amount of supported wall work. Joint mobilisation is the focus, as arthritis is throughout the body. The release of tension through neck and shoulders is also important, as brain surgery has left a feeling of ongoing pressure in this area. Cross body work and alternate nostril breath is employed to promote balance in right / left brain hemispheres and to encourage lost neurological pathways to reemerge. A variety of relaxation techniques are useful, including visualisation, mindfulness and explorations into Presence.
Some of these clients come for 2-3 sessions only, others maintain ongoing weekly appointments. In all cases, the relaxation techniques (including breath exercises) are often the most revelatory and effective.