Tai Chi for OA Knee Pain

Regular Tai Chi exercise can improve physical function and reduce pain in patients over age 65 with knee osteoarthritis (OA), a study has found.

“Tai Chi is a mind-body approach that appears to be an applicable treatment for older adults with knee OA,” said lead author, Dr. Chenchen Wang.

Compared to a control group, individuals practicing the traditional martial art of Tai Chi showed a significant reduction in knee pain, recording a 118.80 mm drop in pain from baseline using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scale (P=0.0005). Improvements were also seen in physical function, self-efficacy, depression and health status for knee OA. [Arthritis Rheum 2009;61(11):1545-53]

“These findings are promising because there are few efficacious long-lasting treatments for knee OA,” write the authors.

Participants were randomly assigned to receive 60-minute sessions of either Tai Chi or attention control sessions twice weekly for 12 weeks. Control sessions included wellness education – comprising instruction on diet, nutrition and therapies to treat OA – and stretching exercises.

Overall, the Tai Chi group showed a 75 percent improvement of WOMAC pain over baseline, and a 57 percent improvement compared to the control group. A further 72 percent increase in WOMAC function over baseline was also observed in Tai Chi-practicing participants, equating to a 46 percent improvement compared with control individuals.

Moreover, according to the authors, the “significant benefits” observed in measurements of depression and self-efficacy appear to be “durable for participants who continued to practice Tai Chi beyond the 12-week intervention period.”

Physical therapy such as aerobic and muscle strengthening exercises are already recommended as core treatments for knee OA. The appeal of Tai Chi, however, lies in the embodiment of a mental element in addition to its physical component. This lends a complete mind-body approach to managing knee OA, which can potentially influence the patient’s psychological well-being, health perceptions and life satisfaction, suggest the authors.

As to exactly how Tai Chi exerts its effects on knee OA, the researchers refer to theories cited in both Eastern and Western literature. Physically, Tai Chi appears to improve muscle strength, balance, coordination and physical function as well as offering cardiovascular benefits. Furthermore, its mind-body component has also been suggested to impact immune, endocrine, neurochemical and autonomic functioning, while the controlled breathing and movement “promote a restful state and mental tranquility,” write the authors. “These influences may help break the arthritis pain cycle,” they add.

The benefits of Tai Chi for knee OA have been documented previously in a small number of studies and randomized clinical trials. However, due to methodological and adherence limitations, the evidence has so far been somewhat inconclusive. [Clin Rhematol 2008;27:211-8; Arthritis Rheum 2007;57:407-14]

Although only a small study – just 40 patients were enrolled – lead researcher Wang said that the findings of their prospective, single-blind, randomized, controlled trial “emphasize a need to further evaluate the biologic mechanisms and approaches of Tai Chi to extend its benefits to a broader population.”

References

Alger, L. Tai Chi for OA knee pain. Medical Tribune. Retrieved from http://www.mims.com/Page.aspx?menuid=RecentHL&RecentHeaderID=430&HT=74d87bda53b83a03b5bd55f019b64e8b&utm_source=MimsCom+MailingList&utm_medium=email&utm_campaign=MimsCom+ENews+SG+Dec+09+(1)

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Arthritis News: Effectiveness of Tai Chi for Musculoskeletal Pain Reviewed

Arthritis News: Effectiveness of Tai Chi for Musculoskeletal Pain Reviewed

Tai Chi, a popular form of exercise involving stylized and controlled movements, has been advocated as a way to manage pain, maximize function, and improve quality of life for a variety of chronic musculoskeletal conditions, including osteoarthritis, rhematoid arthritis, and fibromylgia. However, the evaluation of its efficacy in these conditions has been limited by the small samples sizes of many of the trials performed. Here, Hall et al (Arthritis Care & Research 2009; 61: 717) analyze the pooled effectivenesws of Tai Chi in a variety of musculoskeletal conditions across the literature of published studies.

Conclusions

Although drawn from generally low-quality studies, Tai Chi appears to have modest but statistically significant favorable effects on pain, disability, and quality of life in individuals with chronic musculoskeletal conditions.

References

1. http://www.hopkins-arthritis.org/arthritis-news/2009/effectiveness-of-tai-chi-for-musculoskeletal-pain-reviewed.html

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Sports Injuries

There are increased in participation in sports and there are also incresed in sports injuries (24%) as compare to the same period last year. According the the newspaper, these's a need to create awareness to general public on sports injuries prevention and treatment.

Top injuries are:

1. Knee (34%)

2. Ankle

3. Low Back Pain

Some of my clients (runners, cyclists, swimmers, tennis, golfers, pilates, yoga, tai chi, non-exercisers etc.) faced the similar problems and the appropriate preventive and treatment protocols which normally used are conditioning and corrective actions for poor biomechanics. These including soft tissue therapy, physical therapy, corrective motor movements etc.

Courses for People Association (PA) - Taichi for Musculoskeletal Dysfunction

Courses for Community Centres/Clubs (CCs) and Residents' Committee (RC) Centres:

1. Multi-Racial Harmony Taiji
2. Taichi for Musculoskeletal Dysfunction
3. Taijiquan

Taichi for Musculoskeletal Dysfunction has been introduced by SE Tan to the Community Learning quite recently to improve general public and existing Taichi practioners' musculoskeletal acute and chronic problems. This also helps to address most of the issues that the practioners faced during their practices like weak muscles, poor movement patterns and poor biomechanics causing lower back pain, knee pain, ankle sprain, foot pain, carpal tunnel syndrome, golf/tennis elbow, dumbness on upper/lower extremities etc.

Introduction
-------------
Training Tai Chi with good biomenchanics and motor control principles to improve neuromuscular control and prevent musculoskeletal dysfunction. This type of training not only improves health and fitness of the practioners but also enable continuous lefelong mind and body learning and positive skills transfer to Activity of Daily Living and other sports such as pilates, yoga etc.

There are three common musculoskeletal imbalances namely:

1. Foot over-pronation (foot collapses inward the midline of the body)

As the foot pronates, the leg also rotates inward the midline of the body, affecting the knee and hip alignment. When the leg internal rotates inward, the pelvic usually moves an anteriorly rotated position.

2. Anterior pelvic tilt

The pelvic rotted naturally forward about 10 degree. An excess of more than this angle usually accompanied with excessive lumbar lordosis which is over-arching the low back

3. Excessive Thoracic Kyphosis

The thoracic spine is naturally forward, forming a slight kyphotic curve. When this curvature is excessive and the shoulders round forward, it can cause various clinical issues. The overly rounded position causes the shoulders blades to move away from the spine and slide forward on the rib cage. This can affects the functioning of the shoulder joints and arms. Excessive thoracic kyphosis usually accompanies excessive anterior tilt.

Training Format
-----------------
There is 10 minutes warm-up followed by about 10 minutes of anatomy train stretchig and mild body weight resistance training at the beginning of the session. 30 minutes on Tai Chi practices using current 18 or 24 steps (Go Back to Basic) applying the principles and finally 10 minutes for relaxation.

The trainees attires are sports pant and white T-shirt with collar. Trainees are require to bring along exercise mat and wrist weight (0.5kg per hand) for training.

Number of sessions: 10

Training Duration: 1 hour per session

Research Supported Benefits of Hatha Yoga and Tai Chi

References

1. Forge, R. L. (2009, April). Mindful Exercise and Chronic Disease, Fitness Journal, 72-75.

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Tai Chi Breathing Method - 太極拳的呼吸方法

Tai Chi Equipment for Training

The Tai Chi weapons like fan, sword, broad sword, long stick and spear (not shown) are for advance stage of Taichi when the practioners perfect the basic art.

The ankle and wrist weights are extremely useful for increasing the intensity of the training (improve the effectiveness of cardiorespiratory fitness, the heart rate monitor can be used to assess the exercise intensity) and strengthen the myofascial lines (kinetic chain) and function or locomotor slings (function for Activities of Daily Living, ADL), refer to January 2009 article for the lines which create "stretching on the lines" and "opposing of the lines" in Tai Chi. If there are any restriction in the lines, there will be musculoskeletal dysfunction, that is the reason why the therapist doing massage, manipulation or acupuncture helping to release the musculoskeletal pain of the specific restricted line.

The practioners that having over-pronation (foot collapses inward toward the midline of the body) need to correct and understand how to get their feet and ankles into neutral position for all standing poses. On dynamic movement, by changing the body weight from one leg to another or changing poses that demand the body to balance on one leg (either in Tai Chi movement or walking/running gait) need to caution that the foot and ankle complex are stronger. When transfer of the body weight onto the foot, the big toe need to push down eccentrically (windlass mechanism) and act as a braking mechanism, giving the arch of the foot more stability and preventing the foot and ankle from collapsing incorrectly. Other areas to note are the pelvic anterior tilt and excessive thoracic kyphosis. These are some of the reasons why peoples exercise walking, running, other sports and even in Tai Chi faced issues like ankles, knees, lower back pain etc.

One point to take note when using the ankle weight, practioners must able to control well the above motor movements.

The TRX and Mat work are very good for conditioning and many of the myofascial line restrictions can be surfaced and corrected here. The short stick and medicine ball are used for physical preparation to maximize positive skills transfer into Tai Chi movements.

Flat shoes like court shoes are highly recommended and preferably with orthotics for flat floot. The orthotics will help to raise the collapsing foot and has ability to assist the foot to neutral position.

The MP3 player (refer to my past articles for the physiological and psychological benefits) with speaker option (or handphone) can be used for small practioner group and with ear piece for individual. Tai Chi and relaxation musics can be loaded into the player for your exercise program. You can also download meditation music from my site to wrap up your exercise program after cool-down followed by meditation.

Lastly, do ensure that you are properly hydrated before, during and after the practice session.

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Warm Up Activities and Stretching Exercises

The warm up activities are a crucial part of any exercise regime or sports training. The importance of a structured warm up routine should not be under estimated when it comes to the prevention of sports injury.

An effective warm up has a number of very important key elements. These elements, or parts, should all be working together to minimize the likelihood of sports injury from physical activity.

Warming up prior to any physical activity does a number of beneficial things, but primarily its main purpose is to prepare the body and mind for more strenuous activity. One of the ways it achieves this is by helping to increase the body's core temperature, while also increasing the body's muscle temperature. By increasing muscle temperature you're helping to make the muscles loose, supple and pliable.

An effective warm up also has the effect of increasing both your heart rate and your respiratory rate. This increases blood flow, which in turn increases the delivery of oxygen and nutrients to the working muscles. All this helps to prepare the muscles, tendons and joints for more strenuous activity.

Keeping in mind the aims or goals of an effective warm up, we can then go on to look at how the warm up should be structured.

Obviously, it's important to start with the easiest and most gentle activity first, building upon each part with more energetic activities, until the body is at a physical and mental peak. This is the state in which the body is most prepared for the physical activity to come, and where the likelihood of sports injury has been minimized as much as possible. So, how should you structure your warm up to achieve these goals?

There are four key elements, or parts, which should be included to ensure an effective and complete warm up. They are:

1. The general warm up;
2. Static stretching;
3. The sports specific warm up; and
4. Dynamic stretching.

All four parts are equally important and any one part should not be neglected or thought of as not necessary. All four elements work together to bring the body and mind to a physical peak, ensuring the athlete is prepared for the activity to come. This process will help ensure the athlete has a minimal risk of sports injury.

Lets have a look at each element individually.

1.) General warm up
The general warm up should consist of a light physical activity. Both the intensity and duration of the general warm up (or how hard and how long), should be governed by the fitness level of the participating athlete. Although a correct general warm up for the average person should take about five to ten minutes and result in a light sweat.

The aim of the general warm up is simply to elevate the heart rate and respiratory rate. This in turn increases the blood flow and helps with the transportation of oxygen and nutrients to the working muscles. This also helps to increase the muscle temperature, allowing for a more effective static stretch. Which bring us to part two.

2.) Static stretching
Static stretching is a very safe and effective form of basic stretching. There is a limited threat of injury and it is extremely beneficial for overall flexibility. During this part of the warm up, static stretching should include all the major muscle groups, and this entire part should last for about five to ten minutes.

Static stretching is performed by placing the body into a position whereby the muscle, or group of muscles to be stretched is under tension. Both the opposing muscle group (the muscles behind or in front of the stretched muscle), and the muscles to be stretched are relaxed. Then slowly and cautiously the body is moved to increase the tension of the muscle, or group of muscles to be stretched. At this point the position is held or maintained to allow the muscles and tendons to lengthen.

This second part of an effective warm up is extremely important, as it helps to lengthen both the muscles and tendons which in turn allows your limbs a greater range of movement. This is very important in the prevention of muscle and tendon injuries.

The above two elements form the basis, or foundation for a complete and effective warm up. It is extremely important that these two elements be completed properly before moving onto the next two elements. The proper completion of elements one and two, will now allow for the more specific and vigorous activities necessary for elements three and four.

3.) Sport specific warm up
With the first two parts of the warm up carried out thoroughly and correctly, it is now safe to move onto the third part of an effective warm up. In this part, the athlete is specifically preparing their body for the demands of their particular sport. During this part of the warm up, more vigorous activity should be employed. Activities should reflect the type of movements and actions which will be required during the sporting event.

4.) Dynamic stretching
Finally, a correct warm up should finish with a series of dynamic stretches. However, this form of stretching carries with it a high risk of injury if used incorrectly. It should really only be used under the supervision of a professional sports coach or trainer. Dynamic stretching is more for muscular conditioning than flexibility and is really only suited for professional, well trained, highly conditioned athletes. Dynamic stretching should only be used after a high level of general flexibility has been established.

Dynamic stretching involves a controlled, soft bounce or swinging motion to force a particular body part past its usual range of movement. The force of the bounce or swing is gradually increased but should never become radical or uncontrolled.

During this last part of an effective warm up it is also important to keep the dynamic stretches specific to the athletes particular sport. This is the final part of the warm up and should result in the athlete reaching a physical and mental peak. At this point the athlete is most prepared for the rigors of their sport or activity.

Stretching is one of the most under-utilized techniques for improving athletic performance, preventing sports injury and properly rehabilitating sprain and strain injury. Don't make the mistake of thinking that something as simple as stretching won't be effective.

For an easy-to-use, quick reference guide of 135 clear photographs of every possible stretching exercise, for every major muscle group in your body, get a copy of The Stretching Handbook. You'll also learn the benefits of flexibility; the rules for safe stretching; and how to stretch properly. Click here to learn more about The Stretching Handbook.

The above information forms the basis of a complete and effective warm up. As individual, you must become responsible for assessing your own goals and adjusting the warm up accordingly.


Copyright © 2008 The Stretching Institute™Article by Brad Walker. Brad is a leading stretching andsports injury consultant with nearly 20 years experiencein the health and fitness industry. For more free articleson stretching, flexibility and sports injury, subscribe toThe Stretching & Sports Injury Report by visitingThe Stretching Institute.

Water and Hydration

Water is accounting for 50% - 60% of the body mass. Water contains no calories and has several electrolytes including calcium, chloride, fluoride, magnesium, potassium and sodium. Water is intricately involved in numerous functions of the body:
1. Regulate body temperature
2. Carries oxygen and nutrients to cells
3. Lubricates joints and protects spinal cord
4. Cushions organs and tissues
5. Promotes digestion and helps prevent constipation
6. Flushes out waste products through kidneys and liver
7. Serves as the medium for all energy reactions in the body
8. Transports mineral throughout cells of body

Water is stored in the intracellular fluid (ICF – 65% of body water) and extracellular fluid (ECF is make up of blood plasma and lymph – 35% of body water). Chloride, potassium and sodium participate in maintenance of ICF and ECF levels. Hypothalamus in the brain regulates the fluid levels in the body.

Daily Water Intake

An average amount of water expenses in a day:
· Lost from breathing, perspiring and bowel movement – about 1 litre
· Average urine outputs a day for adult – 1.5 litres
The Institute of Medicine (IOM) published its Dietary Reference Intake for water in February 2004 (Above Table). Note that the 8 glasses a day is equivalent to 1,893mL Myth has no scientific evidence.

Hydration and Health

Kidney stones
To prevent kidney stone, moderation intake of calcium oxalate (beverages such as beer, chocolate milk, teas and fruit juices), protein, sodium and alcohol, while increasing the intake of water and fiber (Hughes & Norman, 1992).

Cancer of the Bladder and Lower Urinary Tract
Decreased in water consumption is associated with bladder and lower urinary tract cancer which results in a greater concentration of carcinogens in the urine and prolonged contact with bladder mucous membranes (Altieri, La Vecchia, & Negri, 2003; Michaud et al., 2007). In some countries, the amount of carcinogens in the tap water is a concern.(Villanueva et al., 2006).

Colorectal Cancer
Low intake of water may risk the risk of colonrectal cancer by lengthening bowel transit time, thus increasing the contact of carcinogens within mucous membrances in the colon and rectum (Altieri, La Vecchia, & Negri, 2003).

Mental and Physical Performance
When there is water depletion exceeding 2% of body weight can reduce the mental (Grandjean & Grandjean, 2007) and physical (Murray, 2007) performance.

Mental Performance
· Reduce in visuomotor (visual perception by the brain)
· Psychomotor
· Cognitive performance

Physical Performance
· Motivation and effort
· Cardiovascular function (↓Cardiac o/p, ↓ plasma volume, ↓ heart filling, ↓ in skin blood flow, ↓ blood volume, ↓ blood plasma osmolality, ↓stroke volume, ↑heart rate, ↑blood viscosity)
· Metabolic reactions
· Thermoregulatory control mechanism.

Fluid Replacement and Endurance

Sweat is approximately 99% water and the rest consists of electrolyte sodium and chloride plus tiny amount of calcium, potassium, magnesium, iron, zinc copper and some water-soluble vitamins (Williams, 2005). The 3 heat syndromes related to dehydration are heat cramps, exhaustion and stroke and the effective treatment for dehydration is to replace lost fluids with cool water, and sports drinks containing electrolytes and a CHO solution scientifically proven helpful. The Table is the approximate guides (Cardwell, 2006; McArdle, Katch, & Katch, 2005). As a general rule, urine colour is a good “marker of water intake. Normal urine should be clear to amber (light yellow) and more yellow when takin vitamins and some medications. Dark yellow urine or a lower output than usual can indicate dehydration.

References

1. Altieri, A., La Vecchia, C., & Negri, E. (2003). Fluid intake and risk of bladder and other cancers. Eur J Clin Nutr, 57 Suppl 2, S59-68.
2. Cardwell, G. (2006). Gold Medal Nutrition (4th ed.): Human Kinetics.
3. Grandjean, A. C., & Grandjean, N. R. (2007). Dehydration and cognitive performance. J Am Coll Nutr, 26(5 Suppl), 549S-554S.
4. Hughes, J., & Norman, R. W. (1992). Diet and calcium stones. Cmaj, 146(2), 137-143.
5. Kravitz, L. (2008). The science of nature's most important Nutrient. IDEA Fitness Journal
6. McArdle, W. D., Katch, F. I., & Katch, V. L. (2005). Sports & Exercise Nutrition (2nd ed.). Baltimore: Lippincott Williams & Wilkin.
7. Michaud, D. S., Kogevinas, M., Cantor, K. P., Villanueva, C. M., Garcia-Closas, M., Rothman, N., et al. (2007). Total fluid and water consumption and the joint effect of exposure to disinfection by-products on risk of bladder cancer. Environ Health Perspect, 115(11), 1569-1572.
8. Murray, B. (2007). Hydration and physical performance. J Am Coll Nutr, 26(5 Suppl), 542S-548S.
9. Villanueva, C. M., Cantor, K. P., King, W. D., Jaakkola, J. J., Cordier, S., Lynch, C. F., et al. (2006). Total and specific fluid consumption as determinants of bladder cancer risk. Int J Cancer, 118(8), 2040-2047.
10. Williams, M. H. (2005). Nutrition for health, fitness, & sport (7th ed.): McGraw Hill.

Exercsie Intensity - Rating of Perceived Exertion (RPE)

Health-fitness practitioner is using alternative method which is Rating of Perceived Exertion (RPE) to measure exercise intensity and target for the training zone. RPE provides much the same information about exercise intensity as the physiological measures such as Heart Rate (HR) and oxygen consumption (VȮ2)(Brown, Miller, & Eason, 2006; McArdle, Katch, & Katch, 2006, pp. 492-493; Robertson, 2004; Scott & Edward, 2004, pp. 312-315; Wilmore & Costill, 2004, pp. 623-624). The client can use it as a guide for his/her aerobic conditioning program or for sedentary clients complying to physical activities guidelines (9th Jan 2009 article).

The use of RPE in health-fitness and clinical setting is based on Borg’s range model (shown in figure), which describe how RPE changes from a very low exercise stimulus (RPE response – Minimal of 6) to a very high level exercise stimulus (RPE response – Maximum of 20) (Borg, 1998).

The RPE is influenced by physiological, psychological, clinical, and performance event (Robertson, 2004). The physiological factors are classified as respiratory-metabolic, peripheral and non-specific.

Respiratory-Metabolic
1. Pulmonary ventilation
2. Oxygen uptake
3. Carbon dioxide production
4. Heart Rate
5. Blood pressure

Peripheral
1. Metabolic acidosis (pH, lactic acid)
2. Blood glucose
3. Blood flow to muscle
4. Muscle fibre type
5. Free fatty acids
Muscle glycogen

Non-specific
1. Hormonal regulation (catecholamines, β-endorphins)
2. Temperature regulation (core and skin)
3. Pain
4. Cortisol and serotonin
5. Cerebral blood flow and oxygen

And the psychosocial mediators include:
1. Emotion or mood – anxiety, depression, extroversion, neuroticism
2. Cognitive function – dissociation, self-efficacy
3. Perceptual process – Pain tolerance, sensory augmentation or reduction
4. Social or situation – music, social setting

References

1. Armstrong, L., Balady, G. J., Berry, M. J., Davis, S. E., Davy, B. M., Davy, K. P., et al. (2006). ACSM's Guidelines for Exercise Testing and Prescription (7th ed.): Lippincott Williams & Wilkins.
2. Borg, G. (1998). Borg's Perceived Exertion and Pain Scales. Champaign, IL: Human Kinetics.
3. Brown, S. P., Miller, W. C., & Eason, J. M. (2006). Exercise Physiology (Basis of Human Movement in Health and Disease. Philadelphia: Lippincott Williams & Wilkins.
4. McArdle, W. D., Katch, F. I., & Katch, V. L. (2006). Exercise Physiology (Energy, Nutrition, & Human Performance) (6th ed.): Lippincott Williams & Wilkins.
5. Robertson, R. J. (2004). Perceived Exertion for Practitioners (1st ed.): Human Kinetics.
6. Scott, K. P., & Edward, T. H. (2004). Exercise Physiology: Theory and Application to Fitness and Performance (5th ed.): McGraw Hill.
7. Wilmore, J. H., & Costill, D. L. (2004). Physiology of Sport and Exercise (3rd ed.): Human Kinetics.

Physical Activity Guidelines - baseline for health requirements

A summary for the physical activity guidelines in table form.

References

1. 2008 Physical Activity Guidelines for Americans [Electronic (2008). Version]. Retrieved 15 Oct 2008 from http://www.health.gov/PAGuidelines/.
2. Physical activity and public health guidelines [Electronic (2008). Version] from http://www.acsm.org/AM/Template.cfm?Section=Home_Page&CONTENTID=11398&TEMPLATE=/CM/HTMLDisplay.cfm.

Physiological Benefits of TaiChi Exercise

References

1. Armstrong, L., Balady, G. J., Berry, M. J., Davis, S. E., Davy, B. M., Davy, K. P., et al. (2006). ACSM's Guidelines for Exercise Testing and Prescription (7th ed.): Lippincott Williams & Wilkins.
2. Birch, K., MacLaren, D., & Geroge, K. (2005). Sports & Exercise Physiology (1st ed.): Garland Science/Bios Science Publisher.
3. Durstine, J. L., & Moore, G. E. (2003). ACSM's Exercise Management for Persons with Chronic Diseases and Disabilities (2nd ed.). Champaign, IL: Human Kinetics.
4. Roitman, J. L., Robertson, D. M., Lupash, E., Ruppert, K., Murphy, C., & Willson, B. (2008). ACSM's health-related physical fitness assessment manual (2nd ed.). Baltimore: Lippincott Williams & Wilkins