Slow tai chi classes matched physical therapy for sore knees

Method of the week

Last spring, Carol came home from the library in Camden and said she had joined a class where no one breaks a sweat.

It was tai chi. Tai chi is a slow form of exercise that comes from China. You shift your weight from one foot to the other and move your arms in wide, soft arcs. All the while, you breathe slow and deep. Carol’s left knee has bothered her for six years. Stairs are the worst, and so is the first walk of the day. I am sorry to say my first thought was that it sounded like a fine way to waste an hour.

I kept that thought to myself. Good thing. Two months in, she was taking the stairs at our house without the rail. She does not claim tai chi cured a thing. But the knee feels less stuck, she says, and she trusts it more on the wet rocks by the water. That last part caught my eye. A knee you trust is a knee you use.

So I did what I always do. I went and read the studies… and one of them was much better than I had expected.

The Boston trial

In 2016, a team at Tufts Medical Center in Boston put tai chi up against physical therapy. Physical therapy, or PT, is a plan of moves that a trained therapist builds for you, one on one. The study ran in the Annals of Internal Medicine, a top journal for doctors. It took 204 adults with painful knee arthritis. Arthritis here means the wear-and-tear kind, where the smooth pad on the ends of the bones thins out.

Half went to group tai chi, two one-hour classes a week for 12 weeks. The other half got PT. That was two 30-minute visits a week for six weeks, then six more weeks of the same moves at home, with the staff checking in. So both groups were asked to keep at it on their own, out to a full year.

Both groups got a lot better. Their knees hurt less, and they could do more with them. Tai chi came out a bit ahead on paper. But the gap was too small to count… too small to call it a win. In other words, it was a tie. And the gains held at 52 weeks.

There was one place tai chi pulled ahead. The tai chi group had a bigger drop in signs of depression. And they rated their quality of life higher. That is a long phrase for how good your days feel, all in all. I can guess at why. A class is a room full of people who will notice if you don’t show up. PT at home is you and a rubber band.

What the guidelines say

One trial is one trial. So I looked for the big picture. In 2019, the American College of Rheumatology wrote new advice on arthritis, along with the Arthritis Foundation. Rheumatology is the branch of medicine that treats joints. Their panel gave tai chi a strong vote for knee and hip arthritis. That is their top grade. Only a short list of things got it, like regular exercise and, for those who need it, weight loss.

Bear in mind the size of the effect. A summary of that advice in American Family Physician, a journal for family doctors, says exercise and tai chi slightly improve pain and function. Slightly. I like that they wrote it that way. It is honest… and it means no one should walk into a class and expect a new knee.

The weak spots

You should see the soft parts of this, too. The Boston group was young for this crowd. Their average age was 60, and seven in ten were women. Most of you are older than that. Also, you can’t hide tai chi from the people doing it. They knew which group they were in, and that can tilt how they score their own pain. And it was one center with one set of teachers. My guess is that a good teacher matters a lot. I have no proof of that.

Carol’s teacher has one rule for knees. Keep them soft, and keep them over your toes. Don’t let the knee cave in toward the other one, and don’t drop too low. If the knee aches for more than an hour or two after class, she says you went too deep. Back off a bit the next time.

The National Center for Complementary and Integrative Health is the arm of the NIH that studies practices like this one. It calls tai chi generally safe. Even so, if you have had a fall this year, or your knee gives way on you, check with your doctor first. That is not me being timid. A slow class is still a class on your feet.

Me? I went with Carol twice. My back liked it more than I thought it would. But my pride liked it less. There is a woman of 84 in the front row who moves like water, and I move like a file cabinet. I will keep going… if only to find out how she does it.

Here is to a knee you can trust,
Walt

The Health Brief is for education only. It is not medical advice. Always check with your own doctor about your own situation.