Can Tai Chi Truly Help Those With Knee Arthri­tis?


Tai Chi, an an­cient Chi­nese ther­apy used to re­duce stress and fight anx­i­ety, is as ef­fec­tive as stan­dard phys­i­cal ther­apy in pa­tients suf­fer­ing with os­teoarthri­tis of the knee, ac­cord­ing to re­sults of a new study.

The re­search is pub­lished on­line in An­nals of In­ter­nal Medicine.

But in this study, Tai Chi go one step fur­ther than tra­di­tional phys­i­cal ther­apy: Tai Chi not only pro­duces greater im­prove­ments in de­pres­sion, but also phys­i­cal as­pects of qual­ity of life.

Knee os­teoarthri­tis is a ma­jor cause of chronic pain and dis­abil­ity in the U.S. as well as glob­ally. In sim­ple terms, arthri­tis de­vel­ops from wear and tear to joints over the years, or due to in­jury, as car­ti­lage that helps cush­ion joints is eroded, leaving bones to rub to­gether and ul­ti­mately pro­duc­ing bony growths known as os­teo­phytes. Os­teo­phytes, which are the end re­sult of pro­gres­sive arthri­tis, lead to re­stricted mo­tion, pain and swelling of joints, re­sult­ing in deficits in mo­bil­ity and bal­ance, plac­ing suf­fer­ers at a higher risk for falls.

Obe­sity is also a well known risk fac­tor that may help fuel the pro­gres­sion of arthri­tis, mak­ing weight loss an im­por­tant part of a com­pre­hen­sive plan to re­duce its dis­abling con­se­quences.

Over-the-counter pain med­i­ca­tions such as ibupro­fen and ac­etaminophen of­ten fail to re­lieve symp­toms and, in some cases, may be as­so­ci­ated with se­ri­ous ad­verse ef­fects in­clud­ing liver dam­age, gas­troin­testi­nal bleed­ing and kid­ney dam­age.

Phys­i­cal ther­apy is typ­i­cally pre­scribed by health­care providers, but the ben­e­fits are not con­sid­ered to make

a ma­jor im­pact in the de­gree of pain and gen­eral qual­ity of life. As a re­sult, it would be highly use­ful to iden­tify in­no­va­tive and ben­e­fi­cial ap­proaches for those who suf­fer with de­bil­i­tat­ing knee arthri­tis.

Tai Chi is a mul­ti­fac­eted yet tra­di­tional Chi­nese mind-body prac­tice that com­bines med­i­ta­tion with slow, gen­tle, grace­ful move­ments, deep breath­ing and re­lax­ation. While it has been demon­strated to re­duce pain in pa­tients with knee os­teoarthri­tis, no tri­als have di­rectly com­pared Tai Chi with stan­dard phys­i­cal ther­apy.

In this study, in­ves­ti­ga­tors com­pare Tai Chi with stan­dard phys­i­cal ther­apy to as­sess its abil­ity to re­duce pain, im­prove phys­i­cal func­tion, fight de­pres­sion, re­duce med­i­ca­tion use and im­prove qual­ity of life in pa­tients with knee os­teoarthri­tis.

In the study, 204 par­tic­i­pants (age 40 and over) are ran­domly as­signed to one of two treat­ment groups: Tai Chi or stan­dard phys­i­cal ther­apy. Pa­tients in the Tai Chi group per­form Tai Chi with a trained in­struc­tor two times per week for 12 weeks. Pa­tients in the phys­i­cal ther­apy group have stan­dard phys­i­cal ther­apy two times per week for six weeks, fol­lowed by six weeks of mon­i­tored home ex­er­cise.

Af­ter 12 weeks, pa­tients in both groups show sig­nif­i­cant im­prove­ments in pain. Pain is as­sessed and mea­sured us­ing the Western On­tario and McMaster Uni­ver­si­ties Os­teoarthri­tis Index (WOMAC) score. The im­prove­ment in pain in both groups lasts up to 52 weeks. But com­pared to those in the phys­i­cal ther­apy group, pa­tients in the Tai Chi group have sig­nif­i­cantly greater im­prove­ments in the phys­i­cal as­pects of well-be­ing, along with re­duced lev­els of de­pres­sion.

“Tai Chi pro­duced ef­fects sim­i­lar to those of a stan­dard course of phys­i­cal ther­apy in the treat­ment of knee os­teoarthri­tis,” says Chenchen Wang, MD, MSc, lead au­thor, di­rec­tor of the Cen­ter for Com­ple­men­tary and In­te­gra­tive Medicine in the Di­vi­sion of Rheuma­tol­ogy at Tufts Med­i­cal Cen­ter, and pro­fes­sor of medicine at Tufts Univer­sity School of Medicine. “Stan­dard­ized Tai Chi should be con­sid­ered as an ef­fec­tive ther­a­peu­tic op­tion for knee os­teoarthri­tis.”

Wang ex­plains that “Tai Chi may sys­tem­at­i­cally pro­mote health by its ef­fect on both the body and the mind by in­te­grat­ing phys­i­cal, psy­choso­cial, emo­tional, spir­i­tual and be­hav­ioral el­e­ments.”

Re­search in­di­cates that Tai Chi has the abil­ity to mod­ify and su­per­charge the mind-body con­nec­tion. “It may elicit be­hav­ioral re­sponses by ac­ti­vat­ing neu­roen­docrine and au­to­nomic func­tion­ing and nav­i­gat­ing neu­ro­chem­i­cal and anal­gesic path­ways, which in turn may mod­u­late the in­flam­ma­tory re­sponse of the im­mune sys­tem and mod­ify sus­cep­ti­bil­ity to chronic pain,” says Wang.

“By im­prov­ing self-ef­fi­cacy, so­cial func­tion and de­pres­sion,” ex­plains Wang, “Tai Chi may help pa­tients bol­ster their self-con­fi­dence and over­come their fear of pain—the lat­ter of which of­ten leads to phys­i­cal mal­func­tion and de­bil­ity.”

Amy McGorry, who holds a doc­tor­ate in phys­i­cal ther­apy and prac­tices at Thrive In­te­grated Phys­i­cal Ther­apy in Soho, be­lieves that there is value in Tai Chi, by virtue of the fact that “it is con­ducted in a group set­ting in­volv­ing the fo­cus of breath­ing and move­ments with peo­ple not dis­cussing their ail­ments,” she ex­plains. “Breath­ing is shown to help de­crease the fight or flight re­sponse, thus alle­vi­at­ing stress.” But on the flip side, she ex­plains that peo­ple run the risk of fo­cus­ing ex­ces­sively on their par­tic­u­lar ail­ment or in­jury, with the risk of this be­com­ing a tem­po­rary iden­tity for them while they are un­der treat­ment.

But see­ing a phys­i­cal ther­a­pist, she ex­plains, also has the po­ten­tial to lead to an ex­ces­sive fo­cus on the chronic ail­ment or in­jury in some pa­tients—par­tic­u­larly re­gard­ing the way it dis­tracts them from their nor­mal rou­tines and ac­tiv­i­ties. The goal, McGorry be­lieves,

is to get them mo­bi­lized again, and this may in­clude in­te­grat­ing Tai Chi as a com­pli­ment to their in­di­vid­u­al­ized phys­i­cal ther­apy reg­i­men.

“Tai Chi can take the fo­cus off the in­jury with at­ten­tion spent on breath­ing and form,” ex­plains McGorry. But as the re­al­ity of in­sur­ance sets in as pay­ment for such ser­vices, she ex­plains that “while it is im­por­tant that phys­i­cal ther­apy clin­ics pro­mote health and well-be­ing, in­sur­ance com­pa­nies have vis­its mon­i­tored based on pain and dys­func­tion, so that can weigh heav­ily on the emo­tional com­po­nent of heal­ing.”

The real-world ben­e­fits of Tai Chi

Putting a real-world spin on the ul­ti­mate ben­e­fits of Tai Chi, an­other ex­pert ad­vo­cates for the ben­e­fits of stay­ing ac­tive as we age.

“It makes per­fect sense that Tai Chi should be of­fered as an ef­fec­tive modal­ity in the pro­mo­tion of joint health,” says Jeff Schild­horn, M.D., or­tho­pe­dic sur­geon at Lenox Hill Hos­pi­tal, North­well Health in New York City. “The two de­bil­i­tat­ing fea­tures of os­teoarthri­tis are pain and de­creased range of mo­tion. Some com­mon pieces of prac­ti­cal wis­dom in os­teoarthri­tis are ‘keep mov­ing,’ or even ‘use it or lose it.’ While pain of­ten in­hibits the ac­tiv­i­ties of those with os­teoarthri­tis, I en­cour­age my pa­tients to re­main very ac­tive within their own lev­els of tol­er­ance.”

“Tai Chi em­bod­ies fun­da­men­tal el­e­ments that pro­mote joint health,” adds Schild­horn, be­cause it leads to “con­trolled and fluid move­ment, which al­lows for bet­ter neu­ro­log­i­cal con­trol, oth­er­wise known as joint po­si­tion sen­si­tiv­ity.”

“Gen­tle strength­en­ing and im­proved flex­i­bil­ity re­main other es­sen­tial ben­e­fits,” he of­fers.

Value of med­i­ta­tion for pain re­lief

But it’s ul­ti­mately the em­bod­i­ment of med­i­ta­tion that can lead to re­lief of pain, ac­cord­ing to Schild­horn.

“The med­i­ta­tive as­pects of Tai Chi also help pa­tients to tran­scend the pain as­so­ci­ated with os­teoarthri­tis. Peo­ple be­come more mind­ful and un­der­stand that pain is a sen­sa­tion, but they are able to at­tach less neg­a­tive emo­tion to their pain,” he ex­plains.

But the true value of Tai Chi may ul­ti­mately be in its abil­ity to em­power pa­tients to help them­selves, con­nect­ing move­ment with pain re­lief and ul­ti­mately some de­gree of eas­ing of de­pres­sive symp­toms.

“Mostly, Tai Chi, among other move­ment arts, al­lows pa­tients to ac­tively par­tic­i­pate in the treat­ment of their os­teoarthri­tis—they are em­pow­ered to make a dif­fer­ence in their own con­di­tions, not sim­ply re­ly­ing on the treat­ments of oth­ers,” em­pha­sizes Schild­horn.

“Os­teoarthri­tis is a dis­ease that ex­ists on a con­tin­uum. For the worst cases, joint re­place­ment surgery is an ex­traor­di­nar­ily suc­cess­ful op­tion. But, for the mil­lions of pa­tients suf­fer­ing with the pain and stiff­ness of os­teoarthri­tis in its early and mod­er­ate stages, Tai Chi is an ideal treat­ment op­tion,” con­cludes Schild­horn.


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