Taiqiquan, tai chi, falling

Older people have a justified fear of falling. A broken hip often leads to disability or death. That’s why it is so important to prevent falls. A new study published in JAMA Internal Medicine suggests that tai ji quan (also spelled tai chi chuan) may be an effective strategy.

Studying Tai Ji Quan:

The researchers recruited 670 older adults in seven Oregon cities (JAMA Internal Medicine, online Sep. 10, 2018). They assigned the volunteers randomly to tai ji classes, multimodal exercise classes or stretching classes. Each group had two hour-long classes every week for six months. The tai ji program used the basic movements of this slow Chinese martial art modified to improve balance. The multimodal exercise program is one that has previously been shown to reduce falls and includes aerobic, strength, balance and flexibility exercises.

All the participants were at least 70 years old and had fallen during the year prior to the study. They kept track of their falls outside of class. At the six-month mark, there had been 85 falls in the tai ji group, 112 in the multimodal exercise group and 127 in the stretching group.

The tai ji students were significantly less likely to be injured in a fall than those who were in the stretching class.

The investigators concluded:

“Among older adults with high risk of falling, a 24-week therapeutically developed tai ji quan balance training intervention resulted in a significant reduction in the incidence of falls compared with a stretching exercise modality and a multicomponent exercise program.”

This is not the first study to find that practicing tai ji quan could reduce the risk of falling. A Spanish meta-analysis of 10 randomized controlled trials found that tai chi significantly reduced falls among elders (Lomas-Vega et al, Journal of the American Geriatrics Society, July 24, 2017).

What Is Tai Ji?

Tai ji (sometimes written tai qi) is an ancient Chinese martial art that features very slow controlled movements. Consequently, practicing tai chi improves balance. Even the concept of tai chi involves balance between the elements of yin and yang.

How Much Tai Ji Helped:

In the Spanish analysis, people practicing tai chi were 43 percent less likely to fall in the short term than people who did physical therapy or other low-intensity exercise. Injuries from falling were cut in half during this short term.

Long-term follow-up showed that tai ji practitioners were 28 percent less likely to suffer a serious injury if they did fall.

Other Benefits of Tai Chi Practice:

Tai Chi Improves Balance in Parkinson Patients:

People with Parkinson’s disease are more prone to falls and other complications from poor balance. A study showed that practicing tai chi can help patients with mild to moderate disease improve their stability and reduce their risk of falls (New England Journal of Medicine, Feb. 9, 2012).

The study included nearly 200 people with Parkinson’s disease who were randomized to hour-long exercise sessions of stretching, resistance training or tai chi twice a week. The training sessions lasted for six months and resulted in better directional control, stride length and reach, even three months later. There were no serious adverse events.

Tai Chi Helps Ease Arthritis Knee Pain:

People practicing tai chi may do more than improve their balance and reduce their chances of falling. A study from Tufts University in Boston found that tai chi worked just as well as physical therapy to ease pain and improve function for people with osteoarthritis of the knee (American College of Rheumatology meeting, San Francisco, Nov. 8, 2015).

Tai Chi Compared to Physical Therapy:

In the study, approximately 200 volunteers were randomly assigned to physical therapy or tai chi classes. Those in the tai chi group did two classes a week for 12 weeks to learn classical Yang style tai chi. Those in the physical therapy group had sessions twice a week for six weeks and practiced the exercises at home for an additional six weeks.

Evaluation Showed Both Approaches Help:

The scientists used WOMAC scores, a standardized arthritis symptom questionnaire, to assess progress and found that both groups had improved by the end of the 12 weeks. Both groups had also reduced the amount of pain medication they took.

The group practicing tai chi also reported lower depression scores, and the researchers recommended that tai chi be considered as a therapeutic option for treating knee osteoarthritis.

This is not the first study to show that tai chi can help soothe pain. Other studies have shown that this practice can be useful for people with fibromyalgia or congestive heart failure.

Readers Share Their Experience with Tai Ji to Avoid Falling:

Barbara wrote:

“I’m 82, have had a hip replacement and need a knee replacement. Tai Chi has been of great benefit to me. Besides the camaraderie of participating with women and men my age, Tai Chi has improved my balance and flexibility. Tai Chi is more than a physical exercise. There is a mental component that I found increases mental alertness. I have been fortunate in that the teacher, a certified Tai Chi teacher, is also a physical therapist who can offer some suggestions about exercise. It takes time to learn the Tai Chi movements but the calming effects and mental and physical coordination are well worth it, especially for those who can no longer do Yoga.”

Rita commented:

“Fifteen years ago I was given a video “Tai Chi for Seniors” by Mark Johnson to help with my arthritic pain, and I have been practicing it regularly all these years. I am now 70 years old. It has provided pain relief, stress relief, and I have no balance problems. I also practice beginners tri-yoga through an adult education program at our local community high school, which is a great help maintaining flexibility and which, I believe, also contributes to good balance.”

Richard added:

“I started studying Tai Chi in 1977 and made it a full time practice in 1981 when I was already a sho-dan in karate and ju-jitsu. Tai Chi Chuan appealed to me because it was easy, I was young and it looked cool. Now in 2017, I do not find Tai Chi Chuan easy, I am no longer young and I seldom practice Gung Fu these days. But Tai Chi Chuan still looks cool. I studied ju-jitsu to learn about falling and it saved me during the years I had to negotiate icy sidewalks.

“Most of my challenge with Tai Chi is about balance, relaxation, and flow. I have almost fallen several times performing Tai Chi and yes it helps the sense of balance tremendously. Patience, breath, relaxation, chi movement are all part of maintaining one’s balance inside and outside. One quality is no more important than the other, I do Tai Chi regularly on different surfaces and at different times of day. End of part one, now the knees.

Knees:

“I have read the research touting Tai Chi over PT for knee rehab. My day job is to teach Physical therapist and manual therapist cranial treatments, so I have many contacts and friends who are PT’s. I have had a double knee surgery for the meniscus medial and lateral aspects. I found acupuncture fantastic as a therapy. PT was painful and helped, but I plateaued in the stretching and was reinjured in strength building. But the Tai Chi Chuan irritated the discs with the rotational movements on the weight bearing leg. Fortunately, my Sifu (teacher) was well aware of the potential problems here. With excellent instruction, Tai Chi can help heal many injuries to the knee, hip and ankle. With typical instruction the injuries may get worse and the practitioner may not be able to perform any sport.

“So, I am very cautious about using Tai Chi Chuan as traditionally taught as a rehab for a disc problem. I am not as versed in working with the cruciate ligaments and rehab and will not comment on this pathology. Yes, Tai Chi is great but as an acupuncturist, naturopath and Tai Chi Practitioner, I have found most everyone will benefit from Tai Chi Chuan, in terms of inner and outer balance, but perhaps it is not for everyone’s knees.”

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  1. Susan
    Richmond, UT
    Reply

    I joined a Tai Chi class at the local senior center here on the recommendation of my acupuncturist after a severe ankle sprain and a later diagnosis of peripheral neuropathy. It has helped tremendously in regaining a sense of stability and balance. Senior Centers all over the US run this program which they call “Tai Chi for Arthritis and Fall Prevention”. It was developed by a physician and tai chi master who adapted several forms for just this purpose and has been certified by the CDC. You can see short presentations of his program on YouTube by typing in his name, Dr. Paul Lam or just simply “Tai Chi for Arthritis and Fall Prevention”.

  2. Dianne
    Houston
    Reply

    I agree with Richard about knees. I have been practicing Tai Chi, secret yang style, for about 10 years, and countined to do so after a torn meniscus. I think it aggravated my problem, and now I cannot do the movements as well as I once could, so I modify anything that hurts. I am 75 and would like to avoid knee replacement, which many of my friends have been having with mixed results. I find water exercise helps.

  3. Zeke and Jean
    Hilton Head, SC
    Reply

    We practice QiGong twice per week. We are in our mid 80s, are in good shape and have excellent balance. I imagine that Tai Qi and QiGong have similar benefits. What’s your take? Zeke and Jean

  4. Jay
    North Carolina
    Reply

    Kudos to Terry for using first the mainland Chinese romanization of the art “Taijiquan,” and secondarily the colloquial version, “Tai Chi Chuan,” of the Wade-Giles romanization (T’ai Chi Ch’üan).

    Part of my dissertation on Taijiquan teaching in America focused on knee health. I found that many teachers are unaware of the dangers of rotational movement and movement that takes the knee beyond its base of support. Taijiquan is excellent for knee rehab and maintenance of knee function IF three parameters are observed:

    1. The knee should remain in the Plane of Support, defined by the center of the hip joint and the toe-heel midline of the foot. The knee is a hinge joint, not designed to rotate. When the knee is pulled inside this plane or twisted outside of it by lazy hips, the rotation can wear down the meniscus. To stabilize the knees, mobilize the hips!
    2. The knee should not exceed Dynamic Limit. For the front knee in the “bow (and arrow) stance,” this means not pushing the tibia beyond perpendicular. For those interested in long term knee health, the guideline should not be “knee over toes” but “knee over ankle.”
    3. Taijiquan is “mindful movement.” The mind must focus first on foot placement, taking great care with weight shifting in 90° angles, eschewing angles greater than 90°, and on conforming to 1 and 2 above.

    I came to Taijiquan in 1975 with injured knees due to several dislocations and congenital weakness. I attribute my current knee health to Taiji practice with close attention to the three points above.

  5. Bill
    91910
    Reply

    I have learned Tai Chi from a Master 25 years ago. I didn’t continue with it over those years. Now trying to get back to it my knees hurt as 76 year old. I can play tennis, walk and run without knee problems. It helps when I do Tai Chi by not bending my knees too deep (just slightly). Hope this information is helpful to others.

  6. Ruth A
    Minnesota
    Reply

    I just started a gym program: elastic bands, standing on individual legs for balance (have fallen 6 times this year, nothing broken), but I like the idea of Tai Chi which I used to do years ago. Is something available on a DVD?…and my earlier question about cracked lower lip, mainly left side. No amount of Bee Balm, etc. helps. Any ideas? Missing some vitamin?

  7. Jim W
    Fuquay-Varina, NC
    Reply

    I have been practicing tai chi here in Fuquay with a wonderful teacher, in a small class of folks in my age range. Wonderful! The flow of the practice helps my balance, but there is an equal mental, posture, and breathing component. It does take concentration and practice, but well worth the energy to continue.

  8. Bill G
    Pa and Florida
    Reply

    3 1/2 years ago I started a program developed by Dr. Mark Cheng and distributed by BeachBody. Based on Tai Ji and called “Tai Cheng.” I have been faithful averaging 5 days a week. A year and and a half into it I lost 22 pounds with a lot of help from Beachbody’s Breakfast drink.

    I hit the ball further on the golf course, experienced less lower back problems. Program takes me about 35 minutes a day. There is a series of 13 weeks in the program, I seem to have maxed out at the 4th DVD and that’s ok with me. I’m 80 with a history of lower back problems.

    I have Asthma and had increase of the symptoms the past couple of years and beginning this past February (Florida) my so called faithful Tai Cheng hasn’t been so faithful. It’s now Mid September (Pa) and I am back at it. Climate Change is real…hopefully I can get a handle on it and continue with the Tai JI. Also doing some treadmill averaging 4 +/- times a week. Fast walking using the incline.

    With Thanks to Dr Cheng,

    Bill

  9. Bill G
    Pa
    Reply

    3 1/2 years ago I started a program developed by Dr. Mark Cheng and distributed by BeachBody. Based on Tai Ji and called “Tai Cheng.” I have been faithful averaging 5 days a week. A year and and a half into it I lost 22 pounds with a lot of help from Beachbody’s Shakology. I hit the ball further on the golf course, experienced less lower back problems. Program takes me about 35 minutes a day. There is a series of 13 weeks in the program, I seem to have maxed out at the 4th DVD and that’s ok with me. I’m 80 with a history of lower back problems.

    I have Asthma and had increase of the symptoms the past couple of years and beginning this past February (Florida) my so called faithful Tai Cheng hasn’t been so faithful. It’s now Mid September (Pa) and I am back at it. Climate Change is real…hopefully I can get a handle on it and continue with the Tai JI. Also doing some treadmill averaging 4 +/- times a week. Fast walking using the incline.
    With Thanks to Dr Cheng,

    Bill

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