MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

Tai Chi, as we know it in the West, is said to promote the smooth flow of “energy” throughout the body by performing postures, slow meditative movements and controlled breathing. Tai Chi is also supposed to help increasing flexibility, suppleness, balance and coordination. According to enthusiasts, the smooth, gentle movements of Tai Chi aid relaxation and help to keep the mind calm and focused.

Tai Chi has become popular in Western countries and is being considered for a surprisingly wide range of conditions. The patient/consumer is taught to perform postures, slow meditative movements and controlled breathing. The concepts underlying Tai Chi are strange, but that does not necessarily mean that the treatment is not effective for certain illnesses or symptoms.

There has been a surprising amount of research in this area, and some studies have generated encouraging results. A recent study which is unfortunately not available electronically ( Wu, WF; Muheremu, A; Chen, CH; Liu, WG; Sun, L. Effectiveness of Tai Chi Practice for Non-Specific Chronic Low Back Pain on Retired Athletes: A Randomized Controlled Study. JOURNAL OF MUSCULOSKELETAL PAIN 2013, 21:1, p.37-45) tested the effectiveness of Tai Chi for chronic back pain. Specifically, the researchers wanted to determine whether regular Tai Chi practice is superior to other means of sports rehabilitation in relieving non-specific chronic low back pain [LBP] in a younger population. They randomized 320 former athletes suffering from chronic LBP into a treatment [tai chi practice] and several control groups [regular sessions with swimming, backward walking or jogging, or no such interventions]. At the beginning, middle, and end of a six-month intervention, patients from all groups completed questionnaires assessing the intensity of LBP; in addition, a physical examination was conducted.

After 3 and 6 months, no statistically significant difference in the intensity of LBP was demonstrated between the Tai Chi and swimming. However, significant differences were demonstrated between the Tai Chi and backward walking, jogging, and no exercise groups.

The authors’ concluded that “Tai chi has better efficacy than certain other sports on the treatment of non-specific chronic LBP.”

This is only the second RCT of Tai chi for back pain. The first such study consisted of 160 volunteers between ages 18 and 70 years with persistent nonspecific low back pain. The experimental group (n = 80) had 18 Tai Chi sessions over a 10-week period. The waitlist control group continued with their usual health care. Bothersomeness of symptoms was the primary outcome, and secondary outcomes included pain intensity and pain-related disability. Tai Chi reduced bothersomeness of back symptoms by 1.7 points on a 0-10 scale, reduced pain intensity by 1.3 points on a 0-10 scale, and improved self-report disability by 2.6 points on the 0-24 Roland-Morris Disability Questionnaire scale. The authors of this RCT concluded that a 10-week Tai Chi program improved pain and disability outcomes and can be considered a safe and effective intervention for those experiencing long-term low back pain symptoms.

My own team have conducted their fair share of Tai Chi research. Specifically,we have published several systematic reviews of Tai Chi as an adjunctive or supportive treatment of various conditions, and the conclusions (in italics) have been mixed.

DIABETES: The existing evidence does not suggest that tai chi is an effective therapy for type 2 diabetes.

HYPERTENSION: The evidence for tai chi in reducing blood pressure in the elderly individuals is limited.

BREAST CANCER: the existing trial evidence does not show convincingly that tai chi is effective for supportive breast cancer care.

IMPROVEMENT OF AEROBIC EXCERCISE CAPACITY: the existing evidence does not suggest that regular tai chi is an effective way of increasing aerobic capacity.

PARKINSON’S DISEASE: the evidence is insufficient to suggest tai chi is an effective intervention for Parkinson’s Disease.

OSTEOPOROSIS: The evidence for tai chi in the prevention or treatment of osteoporosis is not convincing.

OSTEOARTHRITIS: there is some encouraging evidence suggesting that tai chi may be effective for pain control in patients with knee OA.

RHEUMATOID ARTHRITIS: Collectively this evidence is not convincing enough to suggest that tai chi is an effective treatment for RA.

Finally, an overview over all systematic reviews of Tai Chi suggested that the only area where the evidence is convincing is the prevention of falls in the elderly.

I think, this indicates that we should not pin our hopes too high as to the therapeutic value of Tai Chi. In particular, for back pain, the evidence might be optimistically judged as encouraging, but it is by no means convincing; the effect size seems to be small and two studies are not enough to issue general recommendations. On the other hand, considering that there is so little to offer to back pain patients, I concede that this is an area that should be studied further. Meanwhile, one could argue that Tai Chi can be fun and is devoid of risks – so, why not give it a try?

40 Responses to Tai Chi is based on strange concepts – but is it helpful?

  • Tai Chi may well be good for improving balance and muscle control when practised regularly, like any sport. Some of this may indirectly help, if not to alleviate, at least cope better with LBP and so on. It’s suitable for the elderly or people with chronic heart or pmulmonary problems because it doesn’t involve brusque movements or sudden effort.

    As an activity; it’s better than nothing and does help socialise people who may otherwise find themselves left out due to health problems.

    But it is really, reallly, really boring.

    • I suppose that depends on whether you are the sort of person dependant on a constant high level of stimulation. Or not.

    • But it is really, reallly, really boring.

      I find it a much less boring approach to meditation than sitting gazing at a wall. It’s amazing how much there is to feel, when attempting Tai Chi, if you can control your focus enough to perceive, and relax enough to not blot out the signals. Fail in those respects, and it might be boring. I happily recommend it to skeptics generally, and those who thrill in finding hitherto unnoticed properties of themselves will find it fascinating.

  • What was the period of time and level of individual practice in your teams studies?

  • Based merely on my experience it makes less sense to expect it to help repair existing injury, than to make it less likely for injury to arise. It’s partly about acquiring habits of posture and movement that keep your fragile bits out of harm’s way. I suppose it would require longitudinal studies to test this.

    Have there been good studies of any affects on mental health? It’s a shame I missed this event which would seem to be relevant to that.

  • Lower Back pain is usually caused by an overall tension in the muscles of the body. Muscles that should be at rest when they are not required are constantly engaged. The result in this excess of tension, prevalent in modern society, can be lower back pain and many other forms of ‘dis-ease.’ What Tai Chi will do, is relax the muscles of the body on a deep level. This will also have a profound effect on the mind.

    If we look at a tiger, the muscles of the body are very relaxed. When the animal strikes its prey, the muscles continue to be relaxed throughout the whole movement, until the very end where there is a massive explosion of power. These are the principles of a Kung Fu punch(Tai Chi is based upon Kung Fu) as well as what the best modern sports people are utilizing. Correct muscle recruitment and alignment.

    If Tai Chi is practiced correctly for a prolonged period of time, this deep relaxation of the excess muscular tension will occur and lower back pain, as well as many other ailments, will be significantly reduced.

  • The ‘strange concepts’ you refer to really aren’t that strange. You don’t get into specifics, but I’m guessing that once again (like many other Asian science concepts) it’s a language issue. Taijiquan (tai chi) is based on structural and mental alignment, like athletes and martial artists all over the world. Only the language varies. Taijiquan uses the language of classical Chinese medical science.

    The concept that is actually strange, is applying taijiquan to various health issues. (Taijiquan is a martial art, and over the years folks have found that the side effects of study and practice are that you get healthier.) It would make more sense to look at some basic qigong practices – out of the thousands of varieties out there, many are geared toward health issues. In general, many qigong sets are easier to learn than taijiquan, and health related results are seen quicker.

    Qigong, like taijiquan, uses the language of classical Chinese medical science – basic anatomy and physiology, but it can seem a bit odd if you’re coming from a modern western science viewpoint.

    A superficial study/practice of either taijiquan or qigong will yield superficial results. Going deeper will involve digging into the concept of qi (which is more in line with quantum physics than mythology…but people like to mystify the idea in the west). In my experience, people that are superstitious about the concept of qi would be better off taking an aerobics class, or something like that. Walking is good.

  • Qi is often translated poetically as “life force” or “the energy that flows through all things” or something like that. You could also use that definition for electromagnetism (one of the four fundamental forces in quantum physics). It also often gets translated as “air” or “wind”…which in traditional sciences means “movement”, or even “the potential for movement”.

    Energy that holds subatomic particles together isn’t that mythological. Neither is movement. But it seems that the easy thing to do is dismiss the idea as “magic”.

    If you want a better understanding, Dr Yang Jwing-Ming has a good writeup in his book Qigong Massage, or Embryonic Breathing. Ted Kaptchuk’s Web That Has No Weaver has a good description as well.

    For taijiquan and qigong, we’re looking at renqi (human qi, usually translated as bio-electricity) – and using only what is needed to do whatever it is we’re trying to do. Throw a punch, a kick, let the legs support the body weight, or just breathe. Using the body’s energy as efficiently as possible. Understanding the Chinese medical model, including their organization of anatomy and physiology is quite helpful in that process – for taijiquan and qigong anyway. If you’re studying and practicing an art that developed under the western anatomy & physiology paradigm (western boxing, for example – Jack Dempsey’s book is wonderful)…best to use their language, theories, and organizational structures. Mixing and matching adds unnecessary complications.

    • jm said:

      Qi is often translated poetically as “life force” or “the energy that flows through all things” or something like that. You could also use that definition for electromagnetism (one of the four fundamental forces in quantum physics). It also often gets translated as “air” or “wind”…which in traditional sciences means “movement”, or even “the potential for movement”.

      I’m not at all interested in what the word qi translates as, more what it actually is. Are you saying that qi is electromagnetism? If not, what is it?

  • If you’re not interested in translation, read the books I listed. Qi is not descibeable on a blog comment.

    • A translation says nothing about what it actually is. Comments here can be quite long, but please feel free to give a simple explanation of what qi is and particularly how it can be measured.

          • C’mon Alan, now you’re just being silly. I told you how to measure qi on one of the other posts.

            Again, the simple explanation is electromagnetism. Better, more thorough explanation is in any of Dr Yang’s recent books.

            Qi is a belief system in exactly the same way electromagnetism and gravity are belief systems. Some people like to believe they are magical…more power to them. It’s just a way of codifying the world we live in.

          • jm said:

            I told you how to measure qi on one of the other posts.

            If you mean this comment, then no, you explained nothing.

            You did talk about using a tyre pressure gauge to somehow measure qi, but you never provided a link to any video unless I missed it – can you provide one now? I’ve had a search of youtube, but nothing comes up.

            the simple explanation is electromagnetism

            A simple explanation is always a good place to start – unless you are trying to use electromagnetism only as some kind of analogy? Assuming you’re not, and, given that you’ve already said a tire pressure gauge can measure qi, can you say whether it’s the magnetic or electric components (or both) of electromagnetism that can be measured?

          • Here’s the video:

            http://www.youtube.com/watch?v=uZkkBvYHSJw&sns=em

            Tire pressure would be a particular type of qi, and easily measured.

            Temperature is another type of qi, also easily measured. Household electrical current is another type of qi – slightly harder to measure, unless you have a volt meter laying around.

            Electromagnetism is qi – not an analogy. Electromagnetism is not yet “proven”, but I’m sure people are working on it.

            The type of qi I’m most familiar with measuring is xieqi. The evidence of which shows up as cupping marks. Or scraping (gua sha) marks.

          • jm said:

            Here’s the video:

            http://www.youtube.com/watch?v=uZkkBvYHSJw&sns=em

            Tire pressure would be a particular type of qi, and easily measured.

            OMG! I assumed you were using the tyre pressure gauge as some kind of analogy, but you seem to think that air pressure is qi of some sort? Please explain.

            Temperature is another type of qi, also easily measured. Household electrical current is another type of qi – slightly harder to measure, unless you have a volt meter laying around.

            Electromagnetism is qi – not an analogy. Electromagnetism is not yet “proven”, but I’m sure people are working on it.

            The type of qi I’m most familiar with measuring is xieqi. The evidence of which shows up as cupping marks. Or scraping (gua sha) marks.

            It looks like you are calling so many things qi that it becomes meaningless. And many things that we can already explain without the need to invoke the word qi. But please choose one of your meanings and explain further – I’m particularly interested in how it might be measured, so one that can easily be measured would be good.

            Perhaps current would be a good one? And perhaps you could say what you mean by ‘household’ electric current and whether you believe there are other sorts?

  • If you’re not interested in translation, read the books I listed. Qi is not describable on a blog comment.

  • “OMG! I assumed you were using the tyre pressure gauge as some kind of analogy, but you seem to think that air pressure is qi of some sort? Please explain.”

    My opinions one way or another have nothing to do with it – the term for air pressure (in tires) is 空氣壓力. The second character is qi. A tire pressure gauge measures that aspect of qi. Simple. Measure qi. If there’s too much, let some air out of the tire. Not enough? Add some more. Your tires will last longer, and your car will move more efficiently.

    “It looks like you are calling so many things qi that it becomes meaningless. And many things that we can already explain without the need to invoke the word qi.”

    Again, not me calling anything qi. It’s a basic concept, and used in many words/terms. Like temperature, weather, electricity, and many others. I think the Chinese would disagree with your assessment of their vocabulary being meaningless.

    “And perhaps you could say what you mean by ‘household’ electric current and whether you believe there are other sorts?”

    By ‘household’ I mean: those little holes in the wall, that you would plug things into (like lamps, a television, a vacuum cleaner)? They provide a type of qi (dian qi) that makes these things work. It’s not mysterious – so I wonder, when Bjorn links to “belief system”…does he think that tooth fairies make the lamp work? Or will power, or the gods smiling upon household devices? It’s basic physics. In the west we call it “electricity”. In Chinese, “dian qi”.

    I’m not sure why you’re having such a hard time with this concept…it almost seems like you’re doing qi “research” by watching martial arts movies. That would be like researching aerodynamics by watching Star Wars.

    • jm

      We seem to be getting nowhere here and you are putting words into my mouth that I did not say.

      You would appear to be defining qi so broadly as to become meaningless. You also say that air pressure in a tyre is qi. That would appear to have nothing whatsoever to do with qi as it is postulated as being capable of manipulation by acupuncture needles to beneficial effect, which is, I thought, what the topic of Prof Ernst’s article was and what we were trying to discuss.

      I am interested in actual, physical measurements of qi in a human: can you provide a single method by which I could measure qi in a human?

      • What words am I putting in your mouth (other than the direct quotes, of course)?

        Yes, qi is a broad term. As we’ve discussed, hardly meaningless.

        When you say “That would appear to have nothing whatsoever to do with qi as it is postulated as being capable of manipulation by acupuncture needles to beneficial effect, which is, I thought, what the topic of Prof Ernst’s article was and what we were trying to discuss.”…I’m curious as to what you’re talking about. I did a brief re-scan of his post, and I don’t think acupuncture or needles are mentioned at all. Which is good, because taijiquan (the subject of Edzard’s post) has nothing to do with acupuncture, or needles.

        If you’re interested in qi in a human, that would be renqi (人氣). Usually when people talk about qi, they are talking about renqi. However, in my original comment, I said “the concept of qi (which is more in line with quantum physics than mythology…but people like to mystify the idea in the west)”.

        You asked for an explanation. Since you quoted me, I assumed you were asking for an explanation of “the concept of qi”, not specifically qi in humans.

        As far as measuring – electrocardiography would be one way to measure renqi, reading a pulse would be another. There are also ways to measure lung capacity – that would be another way to measure renqi.

        And, electrocardiography, reading a pulse, measuring lung capacity…these things are not mythology.

        • jm said:

          What words am I putting in your mouth (other than the direct quotes, of course)?

          I was referring to your comments about getting my ‘research’ from martial arts movies: I am trying to understand what it is you are saying about what qi is. That is proving difficult.

          Yes, qi is a broad term. As we’ve discussed, hardly meaningless.

          When you use a word to cover so much, it loses its specificity.

          As far as measuring – electrocardiography would be one way to measure renqi, reading a pulse would be another. There are also ways to measure lung capacity – that would be another way to measure renqi.

          So qi is pressure, current flow, voltage, energy… is there anything qi is not?

          If I measure any physiological process, I’m measuring qi – is that what you’re claiming?

  • Alan – “I was referring to your comments about getting my ‘research’ from martial arts movies: I am trying to understand what it is you are saying about what qi is. That is proving difficult.” – True enough, my bad. I was confusing your comments with the comments of others. Sorry about that.

    “When you use a word to cover so much, it loses its specificity.” – The English word ‘energy’ has the same problem, and ends up being just as confusing. What can you do, other than add more specific terms. Like ‘kinetic energy’, ‘electrical energy’, piezoelectric energy’, etc. Same with ‘qi’ – renqi (bioelectricity in humans), xieqi (stagnating influence), ‘dianqi’ (electricity), etc.

    “So qi is pressure, current flow, voltage, energy… is there anything qi is not?”

    As far as I understand it, qi would only refer to all types of energy (kinetic, electrical, electromagnetic, bioelectric, etc), force (compressive, tensile, etc), movement, change, the force (electromagnetic) that holds matter together (electron, neutrons, protons, etc) and things of that nature. So…measuring height wouldn’t really be measuring qi, for instance. Or volume.

    “If I measure any physiological process, I’m measuring qi – is that what you’re claiming?” Yes, which is why it’s a bit strange when folks get hung up on “measuring qi”. What you would be measuring are specific qualities, functions, or effects of qi. Again, like electromagnetism – you don’t measure electromagnetism, you measure what it does.

    You wouldn’t “measure the weather”…that wouldn’t really give you any usable information. But, we all understand what is meant by an interchange like this:

    Me: How’s the weather in your neck of the wood?
    You: Quite lovely.

    Nothing specific, but I have a general understanding of what you’re experiencing in terms of the weather. Similarly, assessing someone’s overall health, you could say “That person has robust qi.” Not a lot of specifically usable information, but you have a sense of the big picture.

    If I wanted a bit more specific weather information, you could say something like “It’s sunny, not too hot, not a lot of wind”. If I wanted a bit more specific information on someone’s health, you could say “She has rebellious stomach qi.” That is a bit more specific, but not specific enough to know if the person is nauseous, or actively vomiting, or whatever. But you have a general sense of their physiological state at the time.

    If I wanted even more specific information, I’d ask you about wind speed, temperature, things like that. If we were talking about someone’s physical condition…then you’d have to talk to someone who has studied and is practicing Chinese medicine. And that’s definitely not me.

  • Electrocariography.

    • Yes, we can measure electrocardiograms, but other than calling by a different name, how does that get us anywhere?

      But the question we’ve not been able to reach so far is, whatever it includes in its so-broad-as-to-be-meaningless name, how can this qi be manipulated?

      • “Yes, we can measure electrocardiograms, but other than calling by a different name, how does that get us anywhere?”

        It doesn’t. If you’re practicing modern western medicine…it’s best to stick with the terminology of the system.

        “But the question we’ve not been able to reach so far is, whatever it includes in its so-broad-as-to-be-meaningless name, how can this qi be manipulated?”

        I disagree with the meaningless part. Again, if you’re looking at things on a microscopic level, best to use western technical terms. Microscopes and looking at things at that level is a relatively new paradigm. As qi is part of all physiological process…food, exercise, herbs (including modern drugs), bodywork, thought, stress….they all manipulate qi. But you already know this. I think it’s common knowledge that stress will increase blood pressure, blah blah blah. That’s a manipulation of qi.

  • This is getting boring.

    The truth :

    Santa-Claus = fictional concept, regularly used to promote products and services for for commercial gain
    Fairies and elfs = fictional concept, regularly used to promote products and services for for commercial gain
    Zombies = fictional concept, regularly used to promote products and services for commercial gain
    Homeopathic remedy potentisation = fictional concept, regularly used to promote products and services for commercial gain
    Qi = fictional concept, regularly used to promote products and services for commercial gain

    ….and I could continue listing several hundred different fictional nonsensual things used to take money from people.

    Do we need to discuss this any further?

    • Björn Geir said:

      This is getting boring.

      Indeed.

      Do we need to discuss this any further?

      No.

      • Ah…it was comments like this:

        “Qi = fictional concept, regularly used to promote products and services for commercial gain”

        that makes me think the understanding of qi was gleaned from martial arts movies.

        • jm said:

          Ah…it was comments like this:

          “Qi = fictional concept, regularly used to promote products and services for commercial gain”

          that makes me think the understanding of qi was gleaned from martial arts movies.

          That was not my comment.

    • If you think that electromagnetism is fictional…this discussion may not be for you.

      • First Björn did not mention EM among the many fictional concepts!
        Second if you think about EM as those waves that we draw on paper, it is actually fictional 🙂
        Those are used to “represent” certain properties that we can measure!
        The BIG difference between oriental and western concepts is “operational definition”. Apart from the possibility to measure a property thence to associate a number and a dimension, even gravitation is a quite bizzare concept!
        (btw. all the various energies you mentioned have all the same dimension “Joule”, it isn’t the same with Qi).
        Moreover remember that in science (well at least in hard science) we never try to explain “why” something is in this way and not in another, even if we often question ourselves how different would be the universe in such a case.
        The target of science is to be able to describe as much as accurately can be the behaviour of nature, not its reasons!
        Of course this give us the possibility to predict future…well…+ or – sigma 😉

  • EM is qi — Bjorn said qi is fictional. Therefore, Bjorn is saying that EM is fictional.

    (I don’t think of EM as those waves we draw on paper either.)

  • “(btw. all the various energies you mentioned have all the same dimension “Joule”, it isn’t the same with Qi).”

    So, those types of qi can be measured in joules. Thanks for that!

    “Moreover remember that in science (well at least in hard science) we never try to explain “why” something is in this way and not in another, even if we often question ourselves how different would be the universe in such a case.”

    As far as I know, that is true for traditional medical sciences as well.

    “The target of science is to be able to describe as much as accurately can be the behaviour of nature, not its reasons!”

    Also true for traditional sciences. Emilio- I wish you would have jumped in earlier with this…

  • Hello everybody, I’m a student from Belgium and I study Fysiotherapy at the University of Antwerp. I’m writing a thesis about Chronic Low Back Pain and how to treat it. I’m very interested in the article mentioned ( Wu, WF; Muheremu, A; Chen, CH; Liu, WG; Sun, L. Effectiveness of Tai Chi Practice for Non-Specific Chronic Low Back Pain on Retired Athletes: A Randomized Controlled Study. JOURNAL OF MUSCULOSKELETAL PAIN 2013, 21:1, p.37-45), but I don’t seem to find it. Can somebody help me? Thank you in advance!

Leave a Reply

Your email address will not be published. Required fields are marked *

Gravityscan Badge

Recent Comments

Note that comments can be edited for up to five minutes after they are first submitted.


Click here for a comprehensive list of recent comments.

Categories