500hr &1000hr Case Study Homework

Updated: December 2015

This is the new, updated case study homework for the 500hr certification and will be the requirement for everyone from here on. It is similar to the previous but adds in some details to more clearly guide you along the way and an example at the end. The other change is that you will need to do one case study for every module or immersion you complete that is relevant to the information in that module. This is so that you can put the info to work right away and deepen your knowledge with that. This will be effective immediately, I know for a few that are finishing now that will make it a little harder as you will probably need to do a couple more than you thought but it is for your own benefit and we must stick to it for everyone going forward from today on. The 1000hr case studies will be the same but you will also be required to write up a final paper on a topic of study you have chosen, more details to come on that (this will be started when you are close to finishing the 1000hr program, if you are close to finishing your 1000hrs with Yoga Medicine please email us for the info)

Your homework assignment must be completed and turned in with your hours and your 200hr certificate when you have completed 270hrs in Yoga Medicine teacher training modules and immersions in order to receive your 500hr certification and to be eligible to register at the 500hr level with the Yoga Alliance. Please do not turn this in until you have completed your hours and can email them all in together to Jenna at info@YogaMedicine.com. This homework assignment is a key component to learning and integrating the material, especially the therapeutic information. For this reason, it is meant to be done throughout your training in conjunction with the information you learn on the retreats to help you better process and incorporate the information and give you a deeper understanding of the material. This is meant to be a starting point for your learning process that will continue for many years to come.

You are required to complete one case study for every module you complete toward your 270hrs. For example, if you completed the spine module you need to work with someone with pain or injury somewhere in the spine (cervical, lumbar, etc). For modules that are less straightforward like the sequencing module you can use anyone you like but it must be therapeutically focused and you must still complete one case study for that module and every module/immersion completed. We recommend starting the case study immediately after you finish each module instead of saving them all until the end.

Your case studies are meant to be like a research project where you collect info, process it with what you have learned and apply the appropriate techniques. Some parts will be written out and other will be lists. Please write out the evaluation (just a list is fine), and any pertinent info and what your focus was. Then describe what you did with them; please just list what was relevant to the focal point and any cues or anatomical alignment that was key. Then talk about how they responded and how you shifted the practice for them over time. Please use the following guidelines:

1) For each case study you must teach a minimum of 8 one-hour private lessons over the course of a minimum of 3 months addressing a specific issue (chief complaint pertinent to the module completed). If your client has several issues you can address more than one but make sure you distinguish the most important issue to your client as the focal point.

2) Include your intake and evaluation as outlined in the training and in the following format:

Subjective:
• General: name (don’t use their actual name just pick a name), age, location
• Chief complaint details: when did it start and how, when do they notice it, how does it limit them, does anything make it worse or better, what is their perception of how it feels, where do they feel it, severity, worse at certain times of the day (OPQRST)
• Other health concerns
• General overall health
• Water, diet, exercise habits, any illnesses or injuries, medications and supplements, current treatments, surgeries, stress level, etc.

Objective:
Posture, ROM, Tests

Assessment:
What you will focus on & why

Procedures:
What you did with them & any pertinent alignment points or cues
Any referrals or other recommendations
Notes:
A quick take away from the end of that session, what stood out or anything you want to work on the next session, anything that you re-tested at the end, etc.

3) Explain why & how you have chosen your prescription, including both relevant poses you did with them one-on-one and what you gave them to do on their own. Include any pertinent specific advice you gave them.
4) Include the home yoga practice you gave them and how you modified as needed as they progress, tracking their progress both in their practice and with their chief complaint.

Remember, the first session will be an intake and a very simple practice to gauge their ability. The second session needs to be soon after (within a week or two) where you will teach them the home practice and make sure they can do it on their own, modify as needed. Make sure you explain why its important for them to stick to it. Write down the sequence in detail with length of holds etc. and make sure the length is realistic for them to fit into their schedule and tell them how many times a week to do it on their own. The third lesson will happen a week or so later to check in and get feedback, then make sure they are doing it right and to modify as needed. Continue on and after the eighth lesson recap for your write up. Obviously you can continue to see this student on your own but that is all you need for your report.

5) At the end you will write up all the information including the intake, yoga prescription and an explanation of how/why you chose the poses/sequence, their progress and modifications along the way and the outcome. Include as much info as you need to make it clear what you did & why. You can simply write the sequence of poses and any important notes of specific things changes or modification needed. This does not need to be formal but it does need to be thorough.

Here’s and example, your case study will probably have more detail than this but this will give you a good outline of what to write out.

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Mary Sue, 63, Atlanta (for spine module case study)

Jane came in primarily for low back pain, she heard yoga could be helpful and one of her friends recommended me. She seemed like she was in more pain then she led on so I approached the practice with plenty of caution, modifying as needed.

Subjective
Intake:
CC- Low back pain

O- not sure, probably 10yrs or more
P- worse with sitting a lot & out of bed in the morning, better with heat & movement
Q- dull, achy
R- generalized lumbar area
S- 5/10
T- worse AM & end of day

No surgeries or medications, takes calcium supplement, no diagnosis or treatments yet
Water- not sure, not enough probably
Exercise- walks daily, 1-3 miles
Diet- good, not much sugar, no soda, likes herbal tea
Stress- not bad
Injuries- MVA 2001, ok now, back was sore after for a few years
EENT, HT, Lu, Digestion- normal
Sleep- wish could sleep more, 4-5hrs usually
Energy- 5/10

Objective
Posture: hyperlordosis & sway back
AROM: stiff/sore with flexion, rotation & lateral flexion, a little worse on the left but not significantly worse
Tests: Normal figure 4 test, normal leg length, countertop psoas test= bilateral tension with knee 5 degrees higher than table on both sides (no pain)

Assessment
Plan:
Focus on circulation and gentle movements
Check TVA stabilization
Stretch Psoas
Look for any other areas that stand out as tight or weak as we progress

Procedures
Began with these postures to look at muscle mechanics:
Transverse abdominis on back to test function
Bridge modifications to evaluate gluts and teach proper mechanics
Tabletop to bird dog to check core & glut function
Tadasana to teach alignment
Supine figure 4 to check rotators
Supine leg rocking to check tension on outer hips

Other: measure water with a bottle, aim for 70oz a day
Referrals: none at this time
Notes: Gluts were tense with bridge but no lower glut max contraction. TVA was difficult to maintain support. Continue work on TVA & psoas as well as posture & gluts in one-on-ones. In future work on glut strength and check QL, maybe rolling for hips. Watch sleep & energy as progress
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Second Visit:
Mary is still having pain but says she thinks she felt better after our session a few days ago.

Pain is in a similar place, 5/10, still in the AM & PM & with sitting, psoas & AROM tests are still the same

This time we spent more time working on her posture and gluts, which seemed very difficult for her to access. We did a similar routine looking at the subtle muscular activation within the postures and added some breath work at the beginning which seemed to help a lot. She was able to stick to her yoga routine daily.

Home Yoga Practice:
1- TVA with foot tap floor, neutral spine & hands on belly (4xs each side, 2 rounds with 1 min or so rest between)
2- Supine psoas (1 min each side)
Two times a day: First thing in the morning & anytime in the evening (but find a time to stick to)
3- Legs up the wall before bed for 5mins
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Third visit:
Mary seems very optimistic & happy with progress, with similar symptoms, 4/10 pain

This time we spent more time on breathing at the beginning and we added in some rolling on the gluts and some time at the end for a longer relaxation. She felt great when she left this time, pain was 1/10 at the end. I warned her this might wear off in a day or two and to make sure she continues her daily routine.

This time she seemed to catch on more to the TVA exercises and has stuck to her daily routine so we added bridge with low glut max awareness for 1 min before the psoas stretch.

Note: next time add home rolling maybe
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Fourth visit:
Mary felt great after our last session for about a day then it went back to 4/10, still feels better than when we began though. Today it is a 3/10

This time we did a similar session to last time but spent a little more time doing the rolling and explaining why & how to do it

Home practice stays but adding in 5mins of rolling for the hips at the end every 2-3 days
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Fifth visit:
Mary is doing well, 2/10 pain now, pain went away after last session for a day again. Rolling at home helps. Energy level is 6/10, sleep is 6hrs

Similar session looking at biomechanics and checking alignment in poses, added in triangle pose. QL seems tight & weak on both sides, will address in home practice later.

Same home practice.
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Sixth visit:
Mary looks more energetic, pain is 2/10 and sometimes goes away during the week. Energy is 7/10, sleep is 6hrs

Continue similar session but added in warrior 2 to look at rotators & activate thigh muscles.

Same home practice
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Seventh visit:
Mary reports feel great, she started hiking with her friends and feels like that is helping as well. Pain is 0-2/10, today is 1/10. Energy is 7/10, sleep is 6-7hrs

TVA is doing well and gluts are picking up the information. Hyperlordosis & sway back are doing better (via pics we took at beginning), AROM is pain free, still a little bilateral tension with the countertop psoas test= knee slightly below counter height on both sides (no pain). We changed her home practice to this:
1- supine breathing, equal count (3-5mins)
2- low lunge variation with glut & TVA activation, 3xs each side with deep breath
3- triangle pose with block at wall, 30 seconds each side with deep breath
4- roll hips & QL- 5mins every other day
5- legs up wall before bed- 5 mins
1-3 done daily in the AM
4-5 done in PM
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Eight visit:
Mary enjoyed the new poses and felt they were helpful. Pain is 0-1/10, energy is 7-8/10 (better than she’s felt in years), sleep is 6-8hrs. Psoas test is normal and AROM is pain free.

This time we looked more at movement patterns, we started with supine breathing and TVA to begin and then came back to her tadasana posture. Then we look at the mechanics of folding forward & back up from standing and the use of her TVA & gluts as she bends her knees. We looked at transitions from low lunge to lifting the arms & torso using the TVA & gluts and ended with some quick rolling on psoas, QL & gluts followed by figure 4 & supta padangustasasna with a strap and a nice long relaxation at the end.

She felt great at the end, no pain. Her home practice will continue for now with some awareness of the transitions as we worked on today.

I recommended that the next step now it restoring her normal movement and a fuller practice over the next 4-6 sessions, then she can continue as she likes or as needed.
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In conclusion:

Mary responded very well to our work together. The gentle movements & circulation to her low back were very helpful. Releasing her psoas and turning on her TVA seemed to be pivotal and the rolling gave her some instant relief along the way. I think this is just the beginning for her though, she will need to learn new movement patterns so that it doesn’t come back again. Now we will work on posture & movement and the subtleties within that. Its been a pleasure to see her nervous system respond so well and so quickly to some simple breathing & restorative work, her body was obviously craving it.

Comments

  1. Mid Merry

    This is really awesome info…thanks so much Tiffany, i will be starting my first Hip Case study shortly….Mid 🙂

  2. Ana Del Rosal

    HI Tiffany

    I attended the Spine Immersion last November and have found a client that I want to work with for my case study. Because of the time limitations in an immersion we did not learn any tests. Is it okay then for my homework that this is not included? I know I can still do the observation of posture, but not sure what else I should include in the initial assessment. This particular client has spinal stenosis in addition to a new diagnosis of Forestier Disease/Diffuse Idiopathic Skeletal Hyperotosis – eventually his thoracic spine will fuse due to calcium being created along the vertebrae. It may affect the cervical area, but not the lumber.

    Thank you!
    Ana del Rosal

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