TodayinPT.com “results are clinically significant: Parkinson’s Disease patients also benefit from tai chi,”
Physical therapists who are integrating tai chi part into their practices say the ancient Chinese martial art is more than an adjunct.
The University of Connecticut has incorporated tai chi into its physical therapy program, according to Deborah Bubela, PT, PhD, PCS, clinical assistant professor. “Tai Chi is introduced to students in the PT curriculum as a movement exercise option,” Bubela said. “Tai chi incorporates many of the foundational elements of movement: weight shift, rotation, modulation and control. The dynamic nature of tai chi affords people the opportunity to develop or improve balance and controlled movement through space; it helps people move better, which is what PT is all about.”
“For a given patient, tai chi … may be the most important intervention that I offer,” said Bill Gallagher, PT, director of the East West Rehabilitation Institute, master clinician in Integrative Rehabilitation, Mount Sinai Medical Center, and clinical physical therapy instructor at Columbia University, New York. Gallagher, who practiced tai chi before becoming a PT, said he cross-references tai chi and other types of Eastern practice with biomechanics, anatomy, pathology and conventional physical and occupational therapy interventions.
Sometimes called “meditation in motion,” tai chi might better be labeled “medication in motion,” according to an article about health benefits of tai chi in the May 2009 Harvard Women’s Health Watch. Tai chi has been shown to reduce falls, improve balance and more.
Volkert de Weijer, DPT, MScPT, a private contractor who practices in various settings in Palm Beach County, Fla., introduces the slow, mindful movements of tai chi to all his patients, including those with low back, neck and shoulder pain, as well as Parkinson’s disease. “Tai chi is a movement philosophy that embraces nature and developmental movement patterns. A lot of tai chi movements are animal-like. It is the mother form of all movements … optimizing movement efficiency,” Weijer said.
But whether tai chi is growing in acceptance among traditional therapists is debatable.
Bill Douglas, cofounder of World Tai Chi and Qigong Day, which is celebrated around the world each year on the last Saturday of April, said the mounting evidence that tai chi works is attracting a growing number of healthcare providers. “On one level, tai chi has been a part of PT for many, many years … but it’s starting to happen a lot faster now,” said Douglas, who has been teaching tai chi for nearly three decades.
Weijer said healthcare providers and patients are more likely to accept tai chi if it comes from a Western perspective. He’ll approach the topic with colleagues and patients as motor development or body motion training, for example. He documents and bills for sessions incorporating tai chi as proprioceptive neuromuscular facilitation in motion. “When you do PNF upright and move with it, then, suddenly, everybody will agree that it looks like tai chi,” he said.
Tai chi in practice
Some PTs incorporate tai chi movements in practice, while others refer patients to tai chi classes in the community. “Given the amount of time we have with patients and all the other interventions that we have to offer, it makes sense to teach snippets of the tai chi form that directly relate to functional impairments that we see in a given patient,” Gallagher said.
Laddie Sacharko, a tai chi instructor at Starfarm Tai Chi and Qigong Search Center, in Chaplin, Conn., said PTs who consider community tai chi as a complement or alternative treatment should look at the Centers for Disease Control-recommended Tai Chi: Moving for Better Balance program, designed by Fuzhong Li, PhD, Oregon Research Institute, Eugene. “It is a protocol for delivering training. Anything less is not evidence-based,” Sacharko said.
While tai chi is relatively safe for people of all ages, according to the National Center for Complementary and Alternative Medicine, there are cautions, including the potential for sore muscles and sprains. “Tai chi should never hurt,” Douglas said. “Because it is done so slowly, you can be cognizant, when going through a movement, if a particular movement or posture needs to be modified. [And be] aware of the knees. When you move in tai chi, you move with the knees bent, but you don’t want them to be over-bent because that puts strain on the knee.”
The evidence base
Studies indicate tai chi strengthens muscles, enhances cardiorespiratory fitness, treats osteoarthritis and rheumatoid arthritis, as well as elicits a relaxation response, according to Gallagher. Studies are particularly positive for tai chi in the area of elderly fall prevention, he said.
“In the biggest, best study done to date, tai chi prevented 47.5% of the falls that were predicted to happen [ncbi.nlm.nih.gov/pubmed/14687360]. Tai chi group classes even beat individualized physical therapy, which came in second,” Gallagher said.
When people lose their balance, they might try to recover with a cross-over pattern, use a side step, and ankle strategy; then, go into a dynamic protective phase with a cross-over step and hop, according to Weijer. All these fundamental movement patterns are part of tai chi, he said. “Instead of having a patient move statically on a foam pad to improve balance, we will have them move [using tai chi],” he said.
According to Bubela, published studies have demonstrated that experienced tai chi practitioners had better knee joint proprioception and standing balance than control subjects similar in age and activity level. And improvements have occurred in practitioners’ control of voluntary weight-shifting and balance in perturbed stance under visual- or vestibular-challenged conditions.
Parkinson’s disease patients also benefit from tai chi, according to a study ORI’s Li had published in the Feb. 9 New England Journal of Medicine. Li and colleagues report that a tailored program of twice-weekly tai chi training resulted in improved postural stability and walking ability, and reduced falls in the participants. “These results are clinically significant because they suggest that tai chi, a low-to-moderate impact exercise, may be used, as an add-on to current physical therapies, to address some of the key clinical problems in Parkinson’s disease, such as postural and gait instability,” Li stated in an ORI news release. •
Lisette Hilton is a freelance writer.