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Tai Chi for Osteoarthritis

 

Health Report by: Eric L. Zielinski 

Introduction

Osteoarthritis (OA) is one of the most insidious musculoskeletal disease processes the world deals with. Complicating matters is the sedentary lifestyle we have adopted making OA the most common cause of disability in the U.S. Among the natural solutions to managing and preventing OA is weight loss, eating an anti-inflammatory diet, stretching and exercise; particularly Tai Chi.

 

Osteoarthritis

Osteoarthritis is the most common form of arthritis, affecting millions of people globally. According to the Centers for Disease Control and Prevention (CDC), over 30 million Americans are affected. Known as the “wear-and-tear arthritis,” osteoarthritis is commonly referred to as degenerative joint disease or DJD. Primarily, DJD occurs with aging and subsequent overuse of joints. Repetitive use of joints damages cartilage and ultimately causes inflammation. Subsequently, people experience pain, swelling and restricted joint mobility. As cartilage damage progresses, the body’s natural safety mechanism includes creating bony spurs known as osteophytes to help prevent damage to the bone. Signifying more advanced stages of OA, osteophytes can become a serious problem if they imping spinal nerves or other soft tissue structures.

 

According to the Mayo Clinic, the following factors increase the risk of developing osteoarthritis:

 

  • Older age. The risk of osteoarthritis increases with age due to normal wear-and-tear of the joints, particularly with people who lived a sedentary lifestyle. In fact, it has been reported that nearly one in two people will develop knee OA by age 85 years and one in four will be affected in the hip in their lifetime.
  • Sex. For reasons unknown, women are more likely to foster DJD.
  • Bone deformities. Being born with malformed joints or defective cartilage will disrupt proper biomechanics and will cause disproportionate wear-and-tear of joints; thus, increasing the risk of OA.
  • Joint injuries. Sports injuries and accidents damage the joints and will cause the insidious cascade of wear-and-tear that will only progress unless managed properly.
  • Obesity. Excess body weight is becoming the number one cause of DJD in the U.S. because it puts abnormal stress on weight-bearing joints like knees, hips, and ankles that were not designed to carry so much weight. Researchers have concluded that, “Two in three people who are obese may develop symptomatic knee OA in their lifetime.”
  • Certain occupations. Repetitive stress jobs like factory line work will over stress joints and sedentary positions like office work will cause joint-supporting muscles and ligaments to atrophy; both of which will likely cause OA.
  • Other diseases. Other than obesity, some common diseases that generally lead to DJD include diabetes, rheumatoid arthritis, hypothyroidism and gout.

 

In summary, any misuse, disuse or overuse of joints will put people at risk of developing DJD.

 

Medical Management

While DJD can occur in any joint in the body, it most commonly affects hips, knees, hands and the spine. Gradually worsening with time there is no known medical cure, however common osteoarthritis treatments are believed to slow the progression of the disease, relieve pain and improve joint function. The Mayo Clinic outlines the following as the most common medical treatment options for people suffering from DJD.

 

  • Acetaminophen. Acetaminophen (Tylenol, others) is used to relieve pain, however, it is completely ineffective in reducing inflammation. Thus, regular use of acetaminophen is not advised as it has been linked to several side-effects including the following: dizziness, nausea, headaches, blurred vision, heart damage due to hypotension, liver damage, and kidney damage leading to urinary retention, pneumonia and withdrawal symptoms.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs are heralded for their role in inflammation reduction and pain relief. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin, others) and naproxen (Aleve, others). Stronger NSAIDs are available by prescription. The side effects of NSAIDs are raising some serious eyebrows in the medical community as research has proven that they cause heart attacks, internal bleeding, ringing in your eyes, upset stomach, liver and kidney damage. It is reported that older people have the highest risk of complications.
  • Narcotics. These types of prescription medications typically contain ingredients similar to codeine and may provide relief from more severe osteoarthritis pain. These stronger medications carry a risk of dependence, though that risk is thought to be small in people who have severe pain. Side effects are the same as those associated with acetaminophen.
  • Physical therapy. Physicians may prescribe working with a physical therapist to create an individualized exercise regimen that will strengthen the muscles supporting the affected joints and to increase range of motion. One common regimen includes hydrotherapy (exercising in the water) as it allows people to strengthen muscles and tendons without putting gravitational stress on the joints due to the buoyancy of being in the water.
  • Occupational therapy. An occupational therapist may be employed to help with proper ergonomics and useful tips to mitigate the risk of repetitive stress at work. For example, using a toothbrush with a large grip could make brushing teeth easier for people with DJD in their hand, and utilizing a bench in the shower could help relieve the pain of standing for OA in the hip or knee.
  • Braces or orthotics. More doctors are advising orthotics, splints, braces or other medical devices to help immobilize affected joints in an effort to help keep the pressure off of damaged areas.
  • Cortisone shots. Injections of corticosteroid medications are oftentimes used to temporarily relieve pain in joints. Due to causing further damage to the joint over time, however, the number of shots someone can receive each year is limited.
  • Lubrication injections. Injections of hyaluronic acid derivatives (Hyalgan, Synvisc) are believed to offer pain relief by providing cushioning to the knee. These agents are similar to a component normally found in joint fluid.
  • Surgery. Surgeons attempt to realign bones to reduce pain by shifting body weight away from damaged areas.
  • Joint replacement. In joint replacement surgery, surgeons remove damaged joint surfaces and replace them with plastic and metal devices called prostheses. The most common joints replaced are the hip and knee. Risks to surgery include blood clots and infection. Also, artificial joints have a limited lifespan and oftentimes wear out or come loose and may need to be replaced.

 

Alternative treatments recommended by the Mayo Clinic include:

 

  • Acupuncture
  • Glucosamine and chondroitin supplements
  • Tai Chi and yoga.

 

Research showing Tai Chi’s ability to help people with OA

Among the many models of complementary and alternative medicine (CAM), mind-body therapy is one of the most popular approaches in the U.S. By far the most researched of all mind-body approaches to DJD treatment, scientific journals are filled with studies outlining Tai Chi’s ability to help people not only manage the pain associated with OA, but also prevent it.

 

  • In 2003, the Journal of Rheumatology published a very ambitious study in which South Korean researchers from Soonchunhyang University tested the “effects of Tai Chi exercise on pain, balance, muscle strength and perceived difficulties in physical functioning in older women with osteoarthritis” on 72 women over a 12 week period. They found that the experimental group perceived significantly less pain and stiffness in their joints and reported fewer perceived difficulties in physical functioning, while the control group showed no change or even deterioration in physical functioning after 12 weeks. In the physical fitness test, there were significant improvements in balance and abdominal muscle strength for the Tai Chi exercise group. Interestingly, no significant differences were found in flexibility and upper-body or knee muscle strength. Nonetheless, the researchers concluded that, “Older women with OA were able to safely perform the 12 forms of Sun-style Tai Chi exercise for 12 weeks, and this was effective in improving their arthritic symptoms, balance, and physical functioning.”

 

  • In 2011 the journal Arthritis published a study with the expressed purpose of reviewing “the evidence provided by published randomized clinical trials (RCTs) for the effect of [Tai Chi], qigong, or yoga on various clinical and quality of life outcomes among people with OA.” The researchers discovered that Tai Chi was used extensively to lower a person’s risk for DJD by addressing the following risk factors: “Improving physical condition, muscle strength, coordination, flexibility, and balance, decreasing risk for falls, pain, stiffness, and fatigue, and improving sleep, cardiovascular and respiratory function, and overall wellness.” Thus, by showing that Tai Chi can reduce these common risk factors, people are much less likely to experience osteoarthritis.

 

  • Aerobic capacity (ability to perform activities of daily living that require sustained aerobic metabolism) is a primary marker for those who may develop OA. It is common practice, therefore, for physicians and physical therapists to recommend that their patients exercise in the water as a conservative step toward overall functional ability and proper respiratory strength. However, a 2011 study in The Journal of Science of Medicine in Sport published a systematic review of 20 studies concluding that Tai Chi delivered better outcomes in functional aerobic capacity than hydrotherapy programs. Like many things in science the reasons for this are not “altogether clear,” according to researchers, but the fact remains that for people to keep up their “wind” Tai Chi is a fantastic way to do it.

 

  • In light of the fad to “diversify” workouts to maximize productivity, a systematic review of 30 articles was published in 2010 in the Journal of Back and Musculoskeletal Rehabilitation from the same authors. They main conclusion was that although physicians continue to recommend exercise regimens for their DJD patients, there is little evidence supporting this practice. However, of the research available, “exercise programs based on Tai Chi have better results than mixed exercise programs” for people with OA. This was based primarily on aerobic resistance, strength, and flexibility training in reducing pain in adults with lower limb OA.

 

  • To evaluate the effects of Tai Chi training on the quality of life and physical function of patients with osteoarthritis of the knee, the journal Clinical Rehabilitation published a study in 2009 in which Korean researchers recruited forty-four elderly participants with knee OA and had them perform an eight week Tai Chi program lasting 60 minutes per session twice a week. Not only did the training group report more than a 50 percent improvement in the quality of life compared to the non-training group, participants doing Tai Chi experienced an increase in a six-meter walking test of up to eight times faster than that of the control group.

 

 

Conclusion

The research on Tai Chi can be summed up in the authors conclusion from a 2011 meta-analysis published in the British Medical Journal.

 

“The results are encouraging and suggest that Tai Chi may be effective in controlling pain and improving physical function in patients with OA in the knee. However, owing to the small number of RCTs with a low risk of bias, the evidence that Tai Chi is effective in patients with OA is limited.”

 

Just because the evidence is “limited,” however, does not mean that it’s not accurate. This point is vital to consider because – like most “alternative” therapies – research is scarce as there are few companies willing to contribute toward the significant financial costs associated with random control trials.

 

In conclusion practicing Tai Chi is quite powerful in helping people with DJD. Its effect in reducing inflammation, decreasing pain and improving joint mobility is paramount for people suffering from osteoarthritis.

 

Medical Studies and Resources

British Medical Journal

http://bmjopen.bmj.com/content/1/1/e000035.full

 

Clinical Rehabilitation

http://cre.sagepub.com/content/23/6/504.abstract.

 

Arthritis

http://www.hindawi.com/journals/arth/2011/364319/

 

Journal of Rheumatology

http://www.jrheum.org/content/30/9/2039.abstract

 

Journal of Back and Musculoskeletal Rehabilitation

http://www.ncbi.nlm.nih.gov/pubmed/21079296?dopt=AbstractPlus

 

The Journal of Science of Medicine in Sport

http://www.ncbi.nlm.nih.gov/pubmed/21111676?dopt=AbstractPlus

 

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