The motions appear gentle and fluid, accompanied by deep and slow breathing. The practice has been known as energy work or moving meditation. But what exactly is tai chi (pronounced tie jee)? And how does this dancelike activity relieve pain? Learn how using tai chi for pain relief can help reduce your joint pain and increase your endorphins in the process.
Known formally as tai chi chuan (tie jee chwahn), this ancient Chinese form of relaxation, healing, and martial art was developed for self-defense. It has been practiced to alleviate numerous conditions, including the relief of pain. In fact, tai chi has become the fastest-growing popular exercise around the world.
“Supreme Ultimate Fist” is the closest translation of the name, representing the expression of certain philosophical concepts — balancing the inner body’s yin and yang, our interacting complementary forces. The goal is to control the “chi” (or “qi”), the vital life power in the body. Movements of the art may seem strange at first, yet participants mimic nature’s components with postures such as “grasp the sparrow’s tail,” “needle at bottom of the sea,” and “white crane spreads its wing.”
Competing versions of the history of tai chi have circulated, but they all agree that the practice has a basis in Taoist philosophy and that it eventually evolved into exercise routines. Chinese legend reveals its beginning in the 13th century, when Taoist Chang Sanfeng observed a snake avoiding capture from a swooping crane’s beak by shifting from side to side. The crane raised its leg and lowered a wing to ward off the snake’s darting fangs aimed at its leg.
Hence, Sanfeng realized that surrendering to an enemy’s strong force and striking its weak part — or that “softness could overcome hardness” — may have practical application in the martial arts. He created tai chi, known as an “internal” style, in contrast to karate, one of the “external” styles that depend on muscular strength and speed. Sanfeng brought his concept to a temple, where Taoist monks began practicing tai chi for both self-defense and health benefits. After all, prolonged seated meditation had led them to become out of shape. During the past 800 years, the practice has developed into relaxed, smooth, and graceful movements.
Tai chi’s low-impact, rhythmic postures appear simple and deliberate. Breath control and meditation add to the mix, resulting in the mind-body exercise. According to traditional Chinese medicine, our “chi” moves through the “tan t’ien” (located two inches below the navel) and is distributed through the body’s “channels” or “meridians” (acupuncture pathways), creating a healing effect.
Tai chi training aims to foster “whole body” power. The human form — in a relaxed state — moves as one connected unit. The practice can also be adapted to a seated position for those with limited mobility or who use wheelchairs. “Yang” tai chi has become the most widely practiced of the five styles, suitable for all levels of ability.
Tai chi was developed as an extension of qigong (pronounced chee gung), which is frequently implemented into tai chi classes. Qigong is also an energy practice, and it shares the philosophy of balancing inner energy flow, plus yin and yang, to achieve harmony. Forms of qigong include “Shibashi,” “Eight Pieces of Brocade,” and “Five Animal Frolics.” The movements focus on correcting bio-energetic imbalances and blockages, creating personal energy for self-healing and well-being. Qigong is a form of healing or medicine, whereas tai chi is an art.
FACTS AND FINDINGS
According to John Starr, M.D., “One of the best forms of exercise on the planet is tai chi chuan.” The retired rheumatologist, now based in northern Arizona, transitioned from karate to tai chi almost 30 years ago. Starr experienced right arm paralysis that he thought resulted from a ruptured disc. Rather, an inflamed joint turned out to be the culprit, as he had sustained lumbar spinal stenosis and minor knee issues from prior karate training. After surgery to relieve the joint, he began Yang-style practice twice a week.
“When I first started [tai chi], if my knees were not in proper alignment, I experienced pain,” he says. “The structure of the spine in tai chi chuan is very similar to that which we prescribe in physical therapy, called modified Williams exercises; the configuration of the spine is similar.” He now experiences relief from low-back pain even after practicing just one session of tai chi. Starr has also trained in Chen-style tai chi in China, which is “more grueling, overtly martial.” He recommends Yang style for most people and teaches this at a recreational center in Prescott, Arizona.
A friend of Starr’s has rheumatoid arthritis (RA). “She was my partner’s patient; [her] hands were inflamed and bulging knees were visible through her slacks,” he says. The friend began practicing tai chi daily, and within six months her RA was under such better control that she discontinued medication. “She became much freer in her movements. The inflammation in her joints was greatly diminished.”
A patient of Starr’s with adult-type juvenile arthritis had received physical therapy on and off for years. “There had been no improvement,” Starr recalls. “She had frozen shoulders and no range of motion.” The patient began tai chi training, received guidance on technique from Starr, and regained full range of motion after one year.
Chenchen Wang, M.D., a rheumatologist based at Tufts Medical Center in Boston, led a controlled trial study of women with longstanding RA. Patients were arbitrarily assigned to 12 weeks of Yang-style tai chi or a control group of stretching plus classes in RA self-care. After the test period, half of the tai chi group experienced greater reductions in their disability and depression.
“The practice is beneficial for anyone with joint pain,” says Starr. He commented on the “roundness” of the movements as opposed to angular or straight motions. “Those with osteoarthritis of the knees experience improvement when taught proper alignment of the knee.” He also mentioned that as a result of learning proper body mechanics, injuries can be prevented and worsening of existing injuries is slowed or halted. Starr stresses the importance of the quadriceps in helping with stabilization, because they serve as a brace for the knee joint. “These muscles become stronger by bearing weight on one or the other leg.”
Wang led trial studies in which patients with osteoarthritis were assigned to one hour of a modified 10-form Yang-style tai chi or a stretching plan plus wellness classes twice weekly. Participants in the tai chi group experienced greater improvements in pain and physical function along with less depression and higher quality of life. In addition, the Arthritis Foundation supports tai chi as a positive exercise for people dealing with joint pain.
Starr adds that tai chi is beneficial for those with osteoporosis. “The training becomes weight-bearing, which is why the quadriceps become stronger after training,” he explains. “As the upper body becomes relaxed, you give into gravity.” Several of the movements rely on the body’s weight on one leg.
Researchers at Harvard Medical School have found that lower-impact exercises such as tai chi may reduce the rate of bone loss, in contrast to high-intensity resistance and strength training. This applies particularly to women with osteoporosis. Tai chi’s impact on balance can also reduce the risk of falls that can result in fracture. Individuals who practiced tai chi for a minimum of seven years were compared to people of the same age who did not practice tai chi during a study in Taiwan. The tai chi group had more bone density in the hip and spine.
“The best results and the most consistent have been with balance in senior citizens,” Starr adds. He cites a study promoted by the National Institute of Complementary and Alternative Care showing 40 percent fewer falls in the population for those who practice tai chi under proper instruction.
Tufts Medical Center’s Wang reported in the New England Journal of Medicine that after 12 weeks of tai chi training, fibromyalgia patients experienced a general improvement in symptoms as well as isolated reports of pain relief, improved sleep quality, less depression, and overall life enhancement.
“In regard to neuroplasticity,” Starr says, “changes in the brain [appear] both anatomically and functionally on MRI scans.” A study led by the University of Arizona reported greater improvement in cognitive function, including attention, concentration, and mental tracking as well as balance after six months of tai chi, compared to either education or exercise.
Starr also says it’s worth comparing results obtained through tai chi with those of pain medications. People who take opiates often experience peaks and valleys. When short-acting opiates are discontinued, withdrawal symptoms occur more often than when longer-acting (slow-releasing) opiates are stopped. Blood levels are steadier from longer-acting opiates, producing less of a withdrawal. When we exercise, we can experience an extreme rise and fall of endorphins (our natural opiates) in our blood flow, especially with rapid aerobics, running, or other high-intensity workouts, and a post-activity depression may occur when the activity ends. “With moderate exercise such as tai chi chuan that also increase endorphin levels, there is a steadier, less-severe fluctuation [afterward], like with long-acting opiates,” Starr explains.
FLOW OF HEALTH
Arlo Chan of Prescott, Arizona, has been a tai chi trainer for 41 years. “I was hooked from the very first time.” Both a practitioner and teacher, Chan has had his own bouts of physical pain, including two herniated discs and spinal stenosis. “Two years prior [to seeing a doctor], in my tai chi practice, I noticed my left leg getting weaker than normal,” Chan says. It eventually became numb from the knee down.
After undergoing a laminectomy and two discectomies, the bulk of his pain and numbness were gone, leaving 25 percent functionality in his left foot. He returned to teaching one year after surgery.
While he was concerned about “conveying the proper form,” he says it was “motivating for me despite my limitations to teach again, so that made me work harder at it.” Six years later, he underwent rotator cuff surgery on his right shoulder. “The payoff seemed to be a much quicker than average recovery.” Chan’s surgeon “was convinced that 40 years of tai chi contributed to my speedy recovery.”
Within eight months, Chan had his left rotator cuff repaired and experienced an even quicker recovery. “Physical therapists were amazed at my progress both last year and this year,” Chan says. “It was so much quicker than anyone else they’ve seen with rotator cuff surgery.”
Chan feels he is in much better shape than if he had not been practicing. “Tai chi motivated me to become active again,” he says.
Chan recalled the presence of his teacher, the late Mary Chow, as “so profound and powerful” that he stayed with her as a private student for 25 years while in Los Angeles. Chow’s lineage dates back to Yang Lu Chan, the founder of Yang style. She began training with Tung Jin Chieh after the birth of her eighth child — when she could barely walk. After two years of practice, she regained full range of motion with the ability to walk, and ultimately she became a fourth generation master tai chi instructor.
To honor having studied with a “living master,” Chan teaches Yang style at no cost, as a way to “pay [her] back.”
“Tai chi is experiential,” he says. “You don’t talk about it, you do it.” As an instructor, he teaches students to experience tai chi on the physical, mental, emotional, and spiritual levels. “They’re inseparable.”
A version of this article was published in the February/March 2017 issue of Pain-Free Living. Subscribe.