Tai Chi as a form of exercise has the attention of the medical community as an important alternative therapy for dealing with chronic pain. In the May/June, 2017 edition of Scientific American Mind, an article entitled, “Rethinking Relief” the author talks about chronic pain sufferers such as those with fibromyalgia and osteoarthritis. The traditional approach to dealing with this chronic pain has been to dispense pain-killing drugs. But with the explosion of cases revolving around opioid addiction, the medical community is searching for alternative methods of helping those with chronic pain. “To treat people more effectively ‘will require an important shift in how we think about pain,’ says David Shurtleff, the deputy director of the National Center for Complementary and Integrative Health . . . ‘We now understand that pain is not just a sensation but a brain state,’ Shurtleff explains. ‘And mind-body interventions may be particularly helpful.’”
Let’s take a look first at the studies surrounding a relatively new condition called fibromyalgia. Fibromyalgia is a whole body syndrome that affects about 2% of the population. Most of those affected are women. It is characterized by chronic musculoskeletal pain, poor sleep quality, muscle tenderness, fatigue and even cognitive dysfunction. These symptoms obviously affect quality of life and can result in significant overall disability. Exercise is often recommended for people with fibromyalgia, just like it is for people who suffer from arthritis. But many people in these groups complain that exercise is too intense and makes them hurt more instead of relieving symptoms. In my own experience with clients with fibromyalgia, they are concerned with the “rebound” effect that occurs after exercise. While the exercise might feel good at the time, the symptoms of fatigue, pain and sleep disturbance all increase significantly afterwards and continue for days. In a paper entitled, “Exercise Therapy for Fibromyalgia,” the authors state, “Several exercise studies over the past three decades demonstrated that persons with fibromyalgia are able to engage in moderate and even vigorous exercise; however, in many studies, participants experienced difficulties performing and adhering to vigorous and even moderate-intensity regimens because of increased fibromyalgia symptoms.” In an article in The New England Journal of Medicine, a similar comment begins the review of a study regarding Tai Chi and Fibromyalgia, “Although exercise is beneficial for fibromyalgia and has been advocated as a core component of its treatment, most patients continue to be in considerable pain years after the original diagnosis and require medication to control symptoms; they also remain aerobically unfit, with poor muscle strength and limited flexibility. New approaches are needed to reduce musculoskeletal pain in patients with fibromyalgia and to improve their physical and emotional functioning and quality of life.” (see the article)
Tai Chi is an excellent option for people with fibromyalgia because it is comprised of gentle, flowing movements and is easily progressed or regressed depending on the symptoms of the participant. As the study in the NEJM describes Tai Chi,” It is considered a complex, multicomponent intervention that integrates physical, psychosocial, emotional, spiritual, and behavioral elements. Because of its mind–body attributes, tai chi could be especially well suited to the treatment of fibromyalgia.” This study assigned participants to either one of two exercise interventions. One group took 2 classes each week of Tai Chi and the other group took 2 classes each week which consisted of wellness education surrounding fibromyalgia and included at least 20 minutes of gentle stretching. Both of these interventions lasted for 12 weeks. The participants completed the Fibromyalgia Impact Questionnaire (FIQ) which has been validated to accurately assess the overall severity of symptoms along with other self-evaluation tools and evaluation by staff and physicians who were unaware of group assignment.
According the study, the Tai Chi group had significant improvement over the control group.
In the discussion section of the study, the authors conclude, “The observed benefits exceeded the specified thresholds for clinically significant improvement in the FIQ score and in the measures used to assess pain, sleep quality, depression, and quality of life, and these benefits were sustained at 24 weeks. No adverse events were reported in the study participants, indicating that tai chi is probably a safe therapy for patients with fibromyalgia.”
I currently have a client with severe arthritis, scoliosis and fibromyalgia. Two of her physicians recently wrote letters that state her practice of Tai Chi is “medically necessary” for her overall care. Her rheumatologist wrote that Tai Chi, “should help her improve her balance and decrease her risk for falling. . . Improvement in strength should allow her to be more independent and exercise more, improving her overall health. It should also help reduce pain that she experiences from fibromyalgia and help improve joint mobility, decreasing limitations from osteoarthritis.” The other physician who specializes in women’s health states that our common client has, “functional goals that include walking at a pace equal to her peers, walking more than one mile prior to needing to discontinue, going up and down stars without having to rely on the railing so she doesn’t lose her balance and putting on her pants without having to hold onto something.” (Side note: This client and her husband enjoy traveling immensely and hiking and sight-seeing are especially important to the enjoyment of their retirement.) This Dr. concluded that, “Tai Chi would improve her balance and muscle strength that would lead to a decreased risk of falling, allow her to walk further and improve her endurance. Her posture would improve with the rotation that Tai Chi helps to improve. Tai Chi can also decrease her fibromyalgia pain and improve her joint mobility.” Wow. Knowing that my client desires to maintain her active lifestyle despite her disabilities, it’s wonderful to see that by simply adding this gentle form of exercise, she can continue to travel and enjoy seeing the world.
The NEJM article also mentioned that while the study itself lasted for 12 weeks, the researchers redid the questionnaires and evaluations at the end of 24 weeks and the improvements for the Tai Chi group had been maintained. This is an important point that is sometimes overlooked when examining exercise therapy. The activity must be one that the patients will continue to be involved in and actually make it a part of their lifestyle. Because Tai Chi is such a gentle form of movement, and yet challenges both the body and the mind, it is particularly suited to long-term adherence which is crucial for continued improvement.
The researchers in the study stated that the actual biological pathways for the improvements shown are unknown. Their explanation of why Tai Chi is so beneficial to fibromyalgia patients combined the physical and the mental aspects of this form of exercise. “Physical exercise has been shown to increase muscle strength and blood lactate levels in some patients with fibromyalgia. Mind–body interventions may improve psychosocial well-being, increase confidence, and help patients overcome fear of pain. Furthermore, controlled breathing and movements promote a restful state and mental tranquility, which may raise pain thresholds and help break the “pain cycle.” All these components may influence neuroendocrine and immune function as well as neurochemical and analgesic pathways that lead to enhanced physical, psychological, and psychosocial well-being and overall quality of life in patients with fibromyalgia.”
And like my client’s physicians observed, Tai Chi is not only helpful for pain relief in those with fibromyalgia, but also in the bigger subset of people who suffer from osteoarthritis. In a recent article on WebMD entitled, “Tai Chi: A Gentle Way to Help Your Joints,” one of the physicians explained the benefit of Tai Chi this way: “When you repeatedly compress the joints, the synovial fluid flows in the cartilage better. That nourishes it, which makes the ends of joints slippery so they can move smoothly.” The article also cites an 8-week study completed by the Arthritis Foundation in which they found that the participants, “improved their ability to balance, and reported less pain, fatigue and stiffness.” In the aforementioned article in Scientific American Mind, the author references a review of clinical trials that concludes “Tai Chi proved most helpful for those with chronic pain resulting from osteoarthritis.”
So as the medical community has begun to embrace Tai Chi as a non-pharmacologic alternative therapy, perhaps you should consider including it in your exercise regimen. As a form of exercise, Tai Chi is very accessible. The movements are gentle and not difficult to learn. There is no special equipment or even apparel necessary. If you are interested in learning Tai Chi and maybe even learning to teach it to others, please visit www.taichisystem.com. The Open the Door to Tai Chi system is dedicated to helping the everyday person incorporate this amazing form of exercise into their life.
Dianne Bailey, CSCS