Gentle movements of the ancient Chinese exercise tai chi are one of many alternatives to help elderly people find pain relief.
By Jeanie L. Davis
WebMD Feature
Reviewed by Charlotte E. Grayson Mathis, MD
The movements of tai chi are gentle, graceful, mystical -- and, for elderly people, a very safe way to relieve arthritis pain and gain balance, strength, and flexibility. Tai chi is one of many alternative therapies that can provide relief from pain, possibly letting you cut back on pain medications.
Early mornings in large and small cities in China - and increasingly in America's parks, hospitals, and community centers - people are practicing tai chi. It is an ancient tradition said to have developed in medieval China, to help restore health of monks in poor physical condition from too much meditation and too little exercise.
Chi (pronounced chee) is the Chinese word for energy. In the healing arts, tai chi is used to promote the movement of energy through the body -- similar to blood being pumped through the body, explains Cate Morrill, a certified tai chi instructor in Atlanta. Morrill spends much of her time in teaching classes for seniors, many of whom are unfamiliar with this practice. "But after five, 10, 15 minutes of tai chi, they report having pain relief," she tells WebMD.
Virtually all major health organizations - including the Arthritis Foundation -- recommend tai chi as an activity for seniors because it provides balance of body and mind.
"The movements of tai chi keep the body fresh and allow the person to find a freer range of motion in the joints, greater flexibility, better balance," Morrill explains. Tai chi is often called "moving meditation," because it is relaxing, because the focus is on breathing and creating inner stillness -- quieting the mind, relaxing the body. When people focus on breathing and on the movements, they aren't focused on their worldly worries.
Older adults who try tai chi find the benefits flow into their everyday lives in surprising ways, Morrill tells WebMD. "Everyday stuff like gardening and cleaning the house -- even basic moves like getting in and out of a bathtub - are easier when muscles are strong and flexible, when there is proper balance and body alignment."
What Happens in Tai Chi Class
Tai chi movements are full of natural symbolism - "Wind Rolls with Lotus Leaves," "Brush Dust Against the Wind," and "White Crane Spreads Wings."
Yet the application of these moves is very practical: "Folks with arthritis in the knees tend to not bend their knees very much when they walk, so they tend to have a stiffer gait. Some tai chi exercise work to increase the knee flexibility," says Morrill.
For example, in the movement "Wave Hands Like Clouds," the focus is on the hands, which seem to drift like clouds in the air. But as the hands wave, the rest of the body is in continual slow motion, Morrill explains. The hips are driving the body motion -- as one leg bends, the other stretches, then the motion switches to the other side of the body. The arms rotate at the shoulder to strengthen shoulder muscles, which encourages the arms to stretch out fully. As weight is shifted, the body is slightly turned to produce flexibility in the waist and strength and flexibility in side muscles.
This movement may last only two minutes or so; during the hour-long class, seniors will complete at least 20 different sets of movements, says Morrill.
Seniors should not try learning tai chi from a video or DVD, she adds. A class setting, with qualified instructor who has worked with seniors, is essential. "Elderly students need an instructor who can correct their posture. If someone has severe arthritis in the left knee, they may not be able to do moves like someone who has a light case of arthritis. It's the instructor's job to modify movement to make it as safe and painless as possible for each student ... to select moves that are most appropriate."
Also, there's the camaraderie that comes from a class, Morrill tells WebMD. "People with arthritis tend to not get out much, but tai chi classes let them realize there are others in the same situation, so friendships develop, people support each other, they find other people they can share skills with. One might do the grocery shopping because the arthritis in her legs isn't too bad - and her friend does the cooking."
Gain Back 8 Years of Youth
According to legend, "if you meditate and do tai chi 100 days in a row, you gain back eight years of youth," says Morrill.
While many of today's tai chi movements have roots in martial arts, the goal is indeed therapeutic. Progress is measured in terms of coordination, strength, balance, flexibility, breathing, digestion, emotional balance, and a general sense of well-being.
Tai chi and other types of mindfulness-based practices "are intended to maintain muscle tone, strength, and flexibility, and perhaps even spiritual aspects like mindfulness - focusing in the moment, focusing away from the pain," says Raymond Gaeta, MD, director of pain management services at Stanford Hospital & Clinics.
Parag Sheth, MD, assistant professor of rehabilitation medicine at Mt. Sinai Medical Center in New York, saw the popularity of tai chi on a visit to China 15 years ago. "We saw it every morning - thousands of people in the park doing tai chi, all of them elderly," he tells WebMD.
"There's logic in how tai chi works," Sheth says. "Tai chi emphasizes rotary movements -- turning the body from side to side, working muscles that they don't use when walking, building muscle groups they are not used to using. If they have some strength in those support muscles - the rotators in the hip -- that can help prevent a fall."
The slow, controlled movements help older people feel secure doing tai chi, he adds. "Also, they learn to bend on one leg -- to control that movement - which is something you don't get to practice very often," says Sheth. "That's important because, as we get older and more insecure, we tend to limit our movements and that limits certain muscles from getting used. When people strengthen those muscles slowly, when they find their balance, they learn to trust themselves more."
What Studies Have Shown
A study published in 1997 found that seniors who took 15 tai chi lessons and practiced for 15 minutes twice daily were able to significantly reduce their risk of falls. Since then, several more studies have pointed to the physical benefits of tai chi for the elderly.
* One six-month study, a group of elderly people who took part in tai chi were about twice as likely to report that they were not limited in their ability to perform moderate-to-vigorous daily activities - things like walking, climbing, bending, lifting. The seniors in that study also reported better overall quality of life - in terms of bodily pain, mental health, and perceptions of health and independence.
* Another study of seniors with arthritis showed that those who took a 12-week tai chi course got around better and had less pain in their legs. Yet another study found that people with arthritis who took a 12-week tai chi class had stronger abdominal muscles and better balance afterward.
* A review of four studies on tai chi found that it does not appear to significantly reduce pain or lessen the severity of rheumatoid arthritis. However, it does significantly improve range of motion in the joints of the legs and ankles. Those who got the most benefit reported participating more in their tai chi classes and enjoying them more compared with those who were in a traditional exercise program.
"I'm an absolute huge fan of tai chi," says Jason Theodoskais, MD, MS, MPH, FACPM, author of The Arthritis Cure and a preventive and sports medicine specialist at the University of Arizona Medical Center.
Any type of motion helps lubricate the joints by moving joint fluid, which is helpful in relieving pain, he says. "Tai chi is not a cure-all, but it's one piece of the puzzle. What's good about tai chi is that it's a gentle motion, so even people who are severely affected with arthritis can do it. Also, tai chi helps strengthen the joints in a functional manner… you strengthen muscles in the way your body normally uses the joints."
More Alternatives for Arthritis Pain
Many more options can help relieve arthritis pain. These include:
Acupuncture: Acupuncture is another Chinese tradition that the World Health Organization has endorsed as a treatment for pain. In acupuncture, disposable, stainless steel needles are used to stimulate the body's 14 major meridians (or energy-carrying channels) to correct energy imbalances in the body, according to Chinese medical philosophy. When the needles stimulate these nerves, it causes a dull ache or feeling of fullness in the muscle.
Western doctors believe that since many acu-points are located near nerves, the needles help decrease pain by stimulating chemicals that block pain, called endorphins. The stimulated muscle sends a message to the central nervous system (the brain and spinal cord), causing the release of endorphins (morphine-like painkilling chemicals in our own bodies). This blocks the message of pain from being delivered up to the brain.
Radiofrequency ablation (RFA): This procedure can also reduce pain. An electrical current produced by a radio wave is used to heat up a small area of nerve tissue, thereby decreasing pain signals from that specific area. RFA can be used to help patients with chronic (long-lasting) low-back and neck pain and pain related to the degeneration of joints from arthritis, as well as some forms of cancer-related pain. The degree of pain relief varies, depending on the cause and location of the pain. Pain relief from RFA can last from six to 12 months and in some cases, relief can last for years. More than 70% of patients treated with RFA experience pain relief.
Acupressure: This technique is similar to acupuncture, but it uses fingertip pressure rather than needles. Acupuncture actually evolved from acupressure. The pressure of fingertips on tender areas can help relieve pain by dispersing lactic acid that builds up in target areas. It is a safe technique that you can teach yourself.
Chiropractic: A chiropractor treats diseases by manipulating the spine and other body structures, based on the belief that many diseases are caused by pressure, especially of the vertebrae, on nerves. Many people believe very strongly in this therapy because they do get pain relief from the manipulations. Check the credentials of anyone administering this therapy.
Massage Therapy: Massage is an ancient form of pain management and stress relief. Our lives today tend to be stress-filled, and massage is one way to help us relax our muscles and let our bodies be refreshed. As you read this you can probably identify areas of stress in your body. Are your shoulders tense? Is your neck stiff? Are you clenching your teeth? All this tension really aggravates the pain of arthritis. Massage is a way to help us relax and allow the blood to flow naturally through our bodies.
Reflexology: This treatment is based on the concept that the muscles and organs of the body are affected by specific areas of the feet. When pressure is applied to these areas of the soles of the feet, other locations of the body relax.
Flotation Therapy: Floating in a pool filled with Epsom salts in a room with restricted light and sound is relaxing and therapeutic. The combination of relaxation, weightlessness, and the Epsom salts has been documented to relieve pain partly by stimulating endorphin production. Flotation tanks are used in clinics to treat persons with chronic pain, to reduce anxiety, and to treat addictive behaviors like cigarette smoking.
Heat Treatment: Perhaps the oldest known treatment for arthritis is simply a hot bath. People have been going to resorts with hot mineral springs for centuries. Heat can be found in a hot bath, hot pack, or a heating pad. Another method of heat application is hot paraffin. Paraffin baths are simply heated containers filled with melted paraffin and wintergreen oil. Beauty salons use them as a hand treatment, but for arthritis sufferers these baths are a way to get deep heat to the small joints in the hands or feet. After dipping the hand a dozen times to coat it with hot paraffin, you wrap it with plastic, cover it with a towel, and leave it until it is cool. The paraffin baths can be found at medical supply firms.
Cold Treatment: Cold, wet compresses or ice packs applied to the affected area work better than heat for soothing sharp, intense pain of an arthritis flare-up. Use cold treatment for 10 to 20 minutes but not longer or there could be damage to the skin.
Biofeedback: Biofeedback is being taught today by physicians, psychiatrists, psychologists, and many types of therapists. You learn several types of relaxation techniques and by attaching sensitive monitors to your body you can see immediately how your body is reacting to your efforts to relax, lower your blood pressure, diminish your pulse rate, change your temperature, or relax your muscles. Biofeedback reinforces your efforts to control your involuntary reflexes. The monitors let you know if your attempts to "tell your body" what to do are working. Eventually people are able to control these bodily processes without the use of the machine. In Raynaud's phenomenon, for example, you may be able to increase blood flow to your hands or feet. By reducing stress and relaxing tight muscles you may reduce the level of pain and the need for medications.
Transcutaneous electrical nerve stimulation (TENS): This involves the use of electrical stimulation of the nerves to block the pain signals to the brain. It is performed by a professional and is usually done after other methods have been tried and failed. It seems to work best when the pain is in a specific area, such as the lower back. Electrodes are placed on the skin with some gel in the area to be treated. The electrical current is low level and produces a slight, tingling sensation. As with most treatments for pain relief, it does not always work, but it is frequently helpful.
Visualization: Visualization has been shown to eliminate or reduce pain. Hypnotherapists use it to help patients come up with images that help pain become more tolerable or detract attention away from it. Close your eyes, breathe deeply, and imagine that you are in a place that is particularly restful. Bringing up this image at times of stress can be soothing and refreshing.
Meditation: Like visualization, this method can bring about relaxation and reduction of stress. It can slow the heart rate and breathing, thereby reducing stress. Those who practice meditation regularly are physiologically younger than their chronological age and report decreased anxiety, depression, and tension, and increased concentration and resilience.
Deep Breathing: Deep breathing is an effective way to relax. Try to find a time when you will not be disturbed. Find a comfortable, quiet place with as few distractions as possible. Lie down, letting your body be as limp as possible, and close your eyes. Begin breathing very deeply, slowly, and rhythmically. Clear your mind of all your problems and distractions. You can concentrate on a word, any word that will help you relax. Pretend that you are inhaling all the positive energy around you, then exhale all the negative. Try it for five or 10 minutes at first and work up to20 or 30 minutes.
Positive Imagery: This is a variation of deep breathing. The basic idea is to put yourself in a quiet place with minimal disturbances, close your eyes, relax, and breathe deeply several times. Then imagine that you are in a place where you are happy and relaxed; it might be the beach, the mountains, a cabin in a storm, a boat in calm waters, or whatever place makes you happy. In your mind look carefully at the entire scene. Imagine the smells, the temperature, the sounds, anything you can observe about this happy place. It might mean going back in time to a point in your life when you felt safe and happy. Positive imagery helps you to relax, subdue tensions, and lessen pain.
Self-Hypnosis: This is a way to put yourself into a state of deep relaxation. There are audiotapes available in most bookstores to help you with most of these types of deep relaxation, but a therapist can also be very helpful in teaching the technique.
Tai Chi for Arthritis Relief
