When asked by a student “What is the most important reason to study Tai Chi Chuan?” Master Cheng Man Ching replied “The most important reason is that when you finally reach the place where you understand what life is about, you’ll have the health to enjoy it”.
PART TWO – ARTHRITIS
Although this series of articles is looking at the scientific evidence for health and Tai Chi I am going to start with a personal anecdote. When I re-started Tai Chi in 2014 after a 28-year gap (see Jan/Feb 2016 issue of the Newsletter for the story of what happened) I was seriously concerned that my right knee would prove to be my nemesis.
I have long been a very keen rambler and during the early 1990s, amongst many other excursions, completed several walks of 40 miles in a day as well as a three-week trek in Nepal. Around this time I started getting problems with my knee and an x-ray revealed quite significant loss of joint space – in other words the dreaded osteoarthritis. It became very apparent that there were limits to what I could expect from this joint, starting with needing several days rest between rambles which cut out walking holidays.
When I started Tai Chi again I was limited to a few miles for any one walk, and then not too frequently. The question in my head was, would the Tai Chi wreck my fragile joint? A question I have since been asked many times by others thinking of taking it up. Well, the answer, based on my personal experience is an emphatic NO. If it had, you can bet I wouldn’t be writing this. In fact – a few months before that little matter of a cardiac arrest interrupted my progress, last year, I had climbed a 3000ft Scottish Mountain from sea level and back covering 13 miles and not twinge to report – in either knee, or heart.
What does the above prove? In scientific terms, nothing, but for me… huge relief.
There are many types of conditions under the general banner ‘Arthritis’ but there are two that most of us are somewhat familiar with – Rheumatoid (RA) and Osteo (OA). The former is an autoimmune inflammatory disease, of unknown cause, producing symmetrical joint symptoms throughout the body, the latter can be thought of as the ‘wear and tear’ type affecting anything from one to many joints and is much more common than the former. Both produce joint pains and are currently incurable.
Tai Chi and RA
Here’s some info I have unearthed. A small randomised controlled trial was published in 2005 in which a preliminary study was conducted to evaluate whether 12 weeks of the classical Yang Style Tai Chi may be a safe and effective complementary therapy for patients with mild to moderate RA. 20 patients were divided into two groups, one practised Tai Chi and the other was provided with education on nutrition and medical information about RA for 40 min. The final 20 min consisted of stretching exercises involving the upper body, trunk and lower body, each stretch being held for 10–15 seconds.
Now, all readers will know that in 12 weeks you can barely scratch the surface of Tai Chi but, nevertheless, the results are interesting.
Overall, the Tai Chi group improved in all of the 25 outcomes measured, significantly in three of them, while the control group improved in only some and never by as great an amount. This suggests that Tai Chi is a safe and potentially promising complementary therapy for adults with functional class I or II RA (there are four classes indicating degree of severity).
The results also demonstrated that Tai Chi seems to be associated with trends to improvement in both symptoms of pain and the cognitive coping process, which in turn is related to physical and psychological disability. The results were also consistent with two other studies of Tai Chi for RA that reported that there was no significant exacerbation of joint symptoms over 10 weeks of Tai Chi.
And what about OA?
A study published in 2009 looked at 40 individuals with symptomatic tibiofemoral OA, that’s knees to you and me. Patients were randomly assigned to 60 minutes of Tai Chi (Yang style, short form) or attention control (wellness education and stretching) twice weekly for 12 weeks.
The measurement scale used was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score. This is used to assess pain, stiffness, and physical function in patients with hip and/or knee OA. It consists of 24 items divided into 3 subscales:
- Pain (5 items): during walking, using stairs, in bed, sitting or lying, and standing
- Stiffness (2 items): after first waking and later in the day
- Physical Function (17 items): stair use, rising from sitting, standing, bending, walking, getting in/out of a car, shopping, putting on & taking off socks, rising from bed, lying in bed, getting in/out of bath, sitting, getting on & off toilet, heavy household duties, light household duties
Compared with the controls, the patients assigned to Tai Chi exhibited significantly greater improvement in WOMAC pain and WOMAC physical function scores. That’s 22 out of the 24 on the scale. No-one in either group became worse.
Now, again that seems pretty impressive but it’s also a small study and much larger numbers would be needed to convince the scientific community but it certainly corresponds to my experience with my knee.
In both of the above studies for RA and OA the researchers also measure their subjects for psychological well being and again Tai Chi came out on top, which fits well with my previous article in the last Newsletter.
Role of Tai Chi in the Treatment of Rheumatologic Diseases
A review paper published in 2012 which analysed the results of a large number of studies looking at Tai Chi came to the following conclusions:
Rheumatologic diseases (e.g., fibromyalgia, osteoarthritis, and rheumatoid arthritis) consist of a complex interplay between biologic and psychological aspects, resulting in therapeutically challenging chronic conditions to control. Encouraging evidence suggests that Tai Chi, a multi-component Chinese mind–body exercise, has multiple benefits for patients with a variety of chronic disorders, particularly those with musculoskeletal conditions. Thus, Tai Chi may modulate complex factors and improve health outcomes in patients with chronic rheumatologic conditions. As a form of physical exercise, Tai Chi enhances cardiovascular fitness, muscular strength, balance, and physical function. It also appears to be associated with reduced stress, anxiety, and depression, as well as improved quality of life. Thus, Tai Chi can be safely recommended to patients with fibromyalgia, osteoarthritis, and rheumatoid arthritis as a complementary and alternative medical approach to improve patient well-being. This review highlights the current body of knowledge about the role of this ancient Chinese mind–body medicine as an effective treatment of rheumatologic diseases to better inform clinical decision-making for our patients. Wang, C. Curr Rheumatol Rep (2012) 14: 598
So, why did my knee get better when, at best, I hoped it would get no worse? To be honest I don’t really know. There is evidence in the studies referred to above that Tai Chi can help, but to the extent that mine has improved is questionable. There is a bit more for me to add. About 15 years ago I started having pain at the base of my left thumb – a common complaint for stringed instrument players. It got progressively worse to the point where I couldn’t even do a shirt button up or grip anything and had stopped playing my mandolin. An x-ray in 2010 revealed severe OA in the first carpo-metacarpal joint (base of thumb) which thrilled me with delight! By this time I had lost a lot of mobility in it too. Then, shortly after resuming my Tai Chi adventures in late 2014, I was diagnosed with an aggressive from of prostate cancer. Completely unknown to me it had progressed to stage three and was too late for surgery. As well as conventional therapy I researched the subject, scientifically, which led to my modifying my diet to completely vegan from March 2015. For those interested it’s the dairy products that are implicated in this sort of hormonal cancer. It was after this that I noticed my thumb was getting better and better. I have been able to resume playing the mandolin, the mobility has much improved and I have no pain at all in any daily activity. It’s still swollen and the arthritic changes must still be there. No proof implied but there’s something to think about. I’m touching wood as I type this.
And above all, watch with glittering eyes the whole world around you
because the greatest secrets are always hidden in the most unlikely places.
Those who don’t believe in magic will never find it.
From Roald Dahl’s last children’s story, The Minpins.
In fact it is the very last line of that very last story.