T'ai Chi in the Treatment of Osteoarthritis
April 1998; Volume 1: 48
Source: Lumsden DB, Baccala A, Martire J. T'ai chi for osteoarthritis: An introduction for primary care physicians. Geriatrics 1998;53:84-88.
T'ai chi resembles a slow-mov-ing dance routine. The continuous softly-flowing movements are derived from animal postures, such as the snake, crane, dragon and tiger. The movements are done in a relaxed state, and deep breathing is continued throughout the routine.
Practicing t'ai chi may help those suffering with osteoarthritis by strengthening the joint musculature and increasing range of motion and flexibility. Preliminary studies have demonstrated the effectiveness of t'ai chi in increasing balance and reducing the risk of falls in the older population. Practiced alone or with a partner, t'ai chi may also reduce stress and promote physical and mental wellness.
COMMENT
T'ai chi looks beautiful and is easy to learn. Practitioners can be seen in parks, on beaches, and in their back yards, performing "forms," shifting their weight from side to side, and breathing deeply. Local hospitals are beginning to offer t'ai chi through their own fitness centers, and some seniors, whom many physicians might think would not be caught dead demonstrating flowing dance movements, are signing up, just to preserve their joint space.
Conversely, osteoarthritis or degenerative joint disease is deforming and alarmingly destructive. Pain occurs as the thickened cartilage splits and thins, exposing bone and its vascular and neural endings. Muscle atrophy comes with inactivity, and pain with resumption of activity. Eventually, pain occurs at rest, and osteoporosis follows.
A principal tenet of traditional oriental medicine is the concept of qi (pronounced "chee" in Chinese), or energy, which is said to flow through 59 meridians in the body. Everyone has qi; disease results when qi flow is disturbed or out of balance.
Without debating the underlying foundation of t'ai chi, actually a combat form of martial art which means, "the grand ultimate fist," the authors describe it as a low-impact exercise with little risk that improves range of motion, flexibility, strength, and balance.
They note that the movements "satisfy the basic rules of rehabilitation for the patient with osteoarthritis" and are easy to learn. They cite eight studies from Western peer-reviewed journals that show improved range or motion, excellent safety, balance training and control, and a reduced risk of falls in elderly patients. They do not stratify the studies by methodology, or tell how they were chosen. They do advocate t'ai chi as an adjunctive physical therapy early in the course of disease to lessen pain and dysfunction, and to improve strength and balance.
Recommendation
A meta-analysis of the existing literature on the effectiveness of t'ai chi in improving physical function of osteoarthritic patients is certainly needed. While t'ai chi appears to have few drawbacks and is likely to be beneficial in osteoarthritis, it is not possible to tell from this review whether there is greater biomedical benefit than risk.
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