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Tai Chi for back pain (published in www.rvita.com)

Posted Jul 13 2009 11:50pm

Back pain occurs at some point in almost everyone's lifetime. The American Pain Foundation revealed that more than 26 million adults suffer from some or the other form of back pain in America alone. A survey done by the National Institute of Health Statistics indicated that low back pain is the most common ailment, followed by migraine pain, neck pain, and facial pain. Further, chronic back pain conditions account for ninety percent of the healthcare expenditures and amount to 50 to 80 billion dollars annually.

Back pain can be produced by many different structures present in the back, such as the large nerve roots that go to the legs or the smaller nerves going to the spine itself. Back pain also occurs when the back muscles are strained, or the bones, ligaments and joints are injured. Moreover, pain need not necessarily mean that there is tissue damage. Most pain syndromes are due to inflammation and last for a couple of weeks to three months.
Tai chi, an ancient form of Chinese martial art, is fast gaining attention for its health benefits, especially where back pain is concerned. Tai chi is a gentle art. It involves more movement than yoga but less movement as compared to the traditional martial art. Thus it can be practiced by the old and the infirm, as well as, people with poor health.

A 48-week, single-blind, randomized, controlled clinical trial was performed by Dr. Greenspan and his team, from the National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, USA, to determine whether tai chi exercise could improve perceived health status as compared to wellness education, in older adults who were transitionally frail. Participants included 269 women who were in their seventies. Results suggested that older women who are frail and participate in intensive Tai Chi demonstrate perceived health status benefits.

Tai chi isn't just a feel-good workout; it’s a therapy, a preventive measure and a remedy for most of the musculo- skeletal disorders including back pain. The tai chi exercises help in improving flexibility and build muscle strength gradually. Its holistic approach is designed to exercise body, mind, and spirit. The exercises involve shifting body weight through controlled rhythmic movements, where each movement flows into the next with a slow graceful gesture. The whole body is used in the exercises. The body exercise in Tai Chi is accompanied by concentration on breathing and inner stillness. Tai chi requires lot of concentration; distracting thoughts should be put aside and breathing should be relaxed and focused.

Thus, Tai Chi entails three components: 1) movement— this improves the posture, strength, flexibility, coordination, balance, and stamina of the body; 2) breathing— it improves blood circulation and allows the oxygenated blood to flow to the muscles and brain; and 3) meditation— it helps in dissipating stress and anxiety, which helps relieve pain caused due to psychological factors.

Tai chi can also be called the “internal” martial art. It teaches the ability to gather, focus, and utilize the “chi” energy. Chi is the natural force that is present everywhere and is circulated throughout the body in chi meridians. Proper chi flow is essential to general health. The practice of Tai Chi balances and increases chi power, bringing excellent health benefits to the individual. It is important to note that Tai Chi cannot cure degenerative diseases but it can help prevent injuries by increasing general health and well being. Also, it can help in relieving back pain by increasing oxygen to the injury and clearing out metabolic waste products in the muscles.

A structured review of eight different mind-body interventions for older adults with chronic nonmalignant pain was conducted by Dr. Morone and Dr. Greco, from the Department of Medicine, University of Pittsburgh, USA. They evaluated the feasibility, safety, and evidence for pain reduction in these adults. After reviewing twenty clinical trials, they concluded that tai chi, yoga, hypnosis, and progressive muscle relaxation were significantly associated with pain reduction.
Stephanie Levin-Gervasi in her book "The Back Pain Sourcebook" states that everything in nature including the 'life force' shows the balance of two energies - yin and yang. Tai chi uses the names of animals to describe the movements and their relationship to the universe and brings these two energies in harmony to benefit mental as well as physical health of the individual. For example, movement like "the crane" reflects the yin or retreating energy, while "carry the tiger to the mountain" reflects the yang or strong forceful forward energy.

Based on different interpretations of Tai Chi theory, the five main styles of Tai Chi are Yang, Wu, Chen, Hao, and Sun. In addition, there are numerous sub-styles. Each posture form is given a different name. Peter Lim Tian Tek translated “The Thirteen Posture Form” which includes the following:

  1. Grasp Sparrow's Tail
  2. Single Whip
  3. Lift Hands Upwards Posture
  4. White Crane Reveals Wings
  5. Hand Play The Lute Posture
  6. Apparent Closure
  7. Embrace Tiger Push Mountain
  8. Repulse Monkey
  9. View Hands (Yun Shou - same pronounciation as Cloud Hands)
  10. High Pat Horse
  11. Part Wild Horse's Mane
  12. Chicken Standing On One Leg
  13. Bend Bow Shoot Tiger

A Tai Chi class may follow any one style or a variation on a style or even one that combines several styles. One should select the style that can be done easily, that does not involve forceful movements, and that does not stress the joints or muscles. Certain precautions need to be taken before starting a Tai Chi program:

  • It is best to learn from a teacher who ensures corrects movements. It is not advisable to learn Tai Chi from a book or a video.
  • The instructor chosen should have experience teaching people with back pain.
  • Warming up before class and cooling down afterward is essential, so that stress or strain is not laid on the muscles and joints.
  • The movements may be modified if necessary.
  • The exercising must be stopped if it hurts or if there is pain two hours after the class.

Since Tai Chi is not yet an established form of therapy, accepting its teachings is a matter of belief or faith rather than evidence-based science. However, many doctors in the US recommend Tai Chi for back pain and there are numerous cases where Tai Chi helped overcome back pain especially where the cause indicated psychological factors such as stress.

REFERENCES:

  1. www.nlm.nih.gov/medlineplus/backpain.html
  2. www.healingchronicpain.org/content/backpain/diag_home_med.asp
  3. www.spine.org/articles/backpain_pregnancy.cfm
  4. http://ww2.arthritis.org/resources/arthritistoday/2000_archives/2000_07_08_taich
  5. http://www.spine-health.com/topics/conserv/taichi/taichi01.html
  6. http://www.cure-back-pain.org/tai-chi-for-back-pain.html 
  7. http://www.martialtaichi.com/Tai%20Chi%20Classics%20-3.htm

Greenspan AI, Wolf SL, Kelley ME, O'Grady M.: Tai chi and perceived health status in older adults who are transitionally frail: a randomized controlled trial. Phys Ther. 2007 May; 87(5):525-35. Epub 2007 Apr 3.
Morone NE, Greco CM.: Mind-body interventions for chronic pain in older adults: a structured review. Pain Med. 2007 May-Jun; 8(4):359-75

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