Friday, April 29, 2011

Tai Chi to Treat Knee Pain?

While living in Hong Kong, I would sometimes see small groups of older Asians doing an odd kind of exercise. They would slowly move their arms and hands back and forth, while standing in a partial crouch. It looked sort of like martial arts in slow motion. Inside I would chuckle, thinking, "C'mon now, you call that exercise?" Because at the time I was getting what I thought was a real workout -- sweaty, intense, lung-busting -- by racing about on my bicycle for two and a half hours at a time, chasing golf carts up inclines and sprinting up mountain slopes.

Then came my battle with knee pain (chronicled in my book Saving My Knees). It was a humbling and frightening experience. At times I thought maybe my doctors were right, and I simply would never get better. Finally I dedicated myself to a long, slow program of recovery, based on what I'd learned about what joints need to become healthy again. And it worked.

During my struggle to save my knees, sometimes I would see the tai chi exercisers I had scorned. Instead of smugly passing by, I would pause and watch them. The more I saw, the more impressed I became. Because the new me -- the me that understood that going slow can make sense when your condition is hard to heal -- perceived tai chi in a new, positive light.

Since then, what I've read about this activity has only served to make me more curious about its possible benefits.

For instance, tai chi has a reputation for being "meditation in motion," as a Los Angeles Times article this week reminds us. That's a winning combo for chronic joint pain.

In saving my knees, I learned the importance of motion to ensure, and restore, joint health. My first of four golden rules for bad knees is "use it or lose it." Scientific studies (I cite them in my book) have found repeatedly that cartilage in joints starts going bad with immobility.

Meditation too is helpful, calming the troubled mind of a chronic pain sufferer. For a while, when negative thoughts constantly colored my thinking, I meditated daily, trying to find a peaceful space where my body didn't hurt all the time. The mind can be a very powerful force in healing.

Tai chi appears to have other benefits too. It may improve balance. And, more relevant for this blog, a study showed it helped with knee osteoarthritis.

WebMD has a short piece about tai chi here touting the activity as "low-impact, weight-bearing and aerobic." That also sounds like a winning combo to me. The weight-bearing part may not make it a preferable exercise for all knee pain sufferers, but low-impact is what your damaged cartilage needs for a while, until you can sufficiently strengthen it.

Okay, there are some of my rambling thoughts about tai chi. Has anyone out there tried it who wants to share a story?


  1. I'm a 29 yr old female and have been running 12+ yrs. I've been on a long layoff for about 7 months due to other injuries. At the end of March I began a very conservative walk/run program, but within 2 weeks I began having knee issues for the first time– intermittent catching, popping/crunching, and mild pain on stairs. The pain went away after a few days of advil, but the other things did not. Last week I was diagnosed with grade 2-3 chondromalacia. I'm shocked because I've never had problems before and I have no idea how I go this much damage!
    Of course my doctor told me it will never heal, that I should get a synvisc-one shot, and I can continue doing whatever doesn't hurt. Let "pain be my guide". Well, apparently, pain isn't a very good guide for me since I got all this damage before the pain even started!
    I love running more than almost anything but I want to be able to walk when I'm 40. I'm afraid I'll have to give up running. Yet I also fear that by doing so my knee could actually get worse. It's almost like being on this long layoff triggered my problems. I have remained active but not doing the running my body was used to.
    I've scoured the internet for info– you and Doug Kelsey are the only ones who talk about healing cartilage. But the info is a little vague. I'm not sure what I'm supposed to do to heal. I'm supposed to stay active but do I run? walk? bike? Nothing hurts but the knee is not the same. I can't tell if what I'm doing is making it worse or not. I also have 3 kids. I am committed to a long recovery, but I can't be doing PT for 2 hrs a day plus finding time for cardio fitness (to keep the weight off, etc).

    I'm getting a 2nd opinion soon but I fear it will be more of the same old info.

  2. In brief (I have to run to work!):
    1. Yes, doctors can be frustrating -- they don't understand well how to heal knee joints (I'm hopeful that will change in the next few decades, because there is a way to get better, as I discovered)
    2. Pain will RARELY be your guide for initial cartilage damage. Revelation #1: cartilage has no nerve endings! This has HUGE implications (as I discuss in my book).
    3. Running probably did somewhat protect your joints (partly because it stiffened up your cartilage which, with inactivity, will maybe start to soften and cause problems).
    4. Which activity? I know little about your case, but if I were you I'd think about a high-repetition, low-load exercise to begin with that your knees like. Do they tolerate riding a bike? I think this is a good activity to restore joint health (IF your knees can do it happily).
    Standard disclaimer: Discuss this with a good doctor of course ...
    Good luck!

  3. I purchased Doug Kelsey's "runner's knee bible" and am trying to figure out how to fit it all into my life. I know it requires a lot of consistency. I started the low load squats last night.

    My knee does tolerate the bike as far as I know. But of course, since I have no pain, it's really hard to tell. My knee doesn't hurt while running either because, as you said, it has no nerve endings. So I'm really not sure what will be my cue that my knee is better– should I expect all popping, clicking, etc to disappear? I'm trying to figure out what to expect from this program. It's a lot of work and I'm willing to commit, but I want to have a realistic idea of what I'm getting– am I expecting my cartilage to heal or just limit the progression of the damage?

    I'm scared because I already have grade 2-3 damage. I want to return to running but I don't know if that's wise. Especially if I'm not going to have pain signals, how will know if my knee is better or worse until it's too late?

    I am going to a new doctor next week, but whether or not she will be "good" remains to be seen. I doubt she will have heard of your or Doug's theories as it seems no one has.


  4. Tai Chi is NOT beneficial for those with knee problems because it emphasizes the whole body's weight placed mainly on one bent leg. This can give rise to what is called `Tai Chi knee'. Tai Chi is a good martial art and moving meditation but not a health and fitness method.

  5. Thanks for the input, anonymous. I didn't realize that tai chi involves putting one's entire body weight on a bent leg (ouch -- hurts just to think about it). I've seen "tai chi" like exercises -- maybe tai chi, maybe not -- where groups of Asians seemed to be doing "controlled flow" movement, and those struck me as gentle and beneficial.

  6. Every time you take a step you are putting all of your body weight on a bent leg. There's nothing unnatural or harmful about that.

    "Tai Chi knee" arises from people who force themselves too low and push their knee out of proper alignment. As long as the knee is kept above the ankle and in alignment with the leg, Tai Chi should be perfectly healthy.

    It's a low impact, high repetition exercise. You can work very gradually on going lower as your strength improves but rushing it leads to problems - like any other exercise.

    So far I've found it to help my knee more than anything I've tried, including Yoga, since every single movement is working the legs.

    Also, it is actually a martial art. It's done slowly to work on perfecting the technique. Things that are difficult to notice when you move quickly become very obvious when you do them in slow motion. It's also much better for conditioning and balance. Very few people teach or practice it with combat in mind these days, though. Mostly they do it for health, both physical and mental.

    1. Normal stepping does not put as much stress on the knee as the type of transfer of weight we see in, say, Yang Tai Chi bow posture, when moving between left and right side parting wild horses main or brush knee. The knee is in front of the body when the whole body's weight is upon it. correct alignment helps but this type of weight transfer is not good for those with knee problems. It would be better to bring the front leg back under the body to transfer weight.

  7. T'ai Chi depends the level of intensity. There is low intensity for healing or higher levels for fitness. T'ai chi training increases awareness of the body. Without this awareness healing is impossible.

  8. There are a few styles of Tai Chi. In Sun style Tai Chi the legs are only slightly bent. Have a look at this "Tai Chi for Arthritis" developed by a medical doctor in Australia.

    1. But if you pause the video at 9:15 you will see Dr Lam, after having stepped about a foot forwards with the left foot, list the right leg off the ground so that the entire body weight is on the left leg (left knee in front of the body). This is knee loading. I appreciate that the steps in this style of Tai Chi are not as large as other forms but the loading still takes place.

  9. Watch this old lady do the Sun style Tai Chi