Tai Chi – Skillfully Well & Painfully Aware

Does just seeing another article about exercise make you want to turn the page? It often makes me want to. When I got diagnosed with my chronic condition all the information about exercise seemed so out of touch with the reality of my life. If I’m already tired, sore and busy then I’m not going to be able to go to the gym. I can’t afford a personal trainer. With my back pain there is no way I can participate in the group yoga classes I used to take in university. Even more frustrating was the fact that all the research I came across proved how beneficial exercise is to health. I knew that I should exercise but I felt like I couldn’t.

But what if I could?

One day I came across an(other) article reporting on research that showed yoga could improve fibromyalgia, my chronic condition (OHSU, 2010). The results were impressive – pain was reduced by 24%, fatigued by 30% and depression by 42%. Great, I thought, another thing I can’t do that would help. But in this case I also found that two of the researchers were part of a nonprofit organization that produces exercise DVDs for fibromyalgia, including one on yoga and Pilates (link below). I ordered the DVD and skeptically waited for it to be delivered. I was surprised and excited to find that I was able to do the routine – which was shown at three different intensity levels so I could modify the poses as needed. I found that the at-home instructional DVD format was affordable, convenient and accessible – I could do it when I was able, for as long as I could and without wasting energy traveling somewhere and back.

Photo by Steven Depolo

During my health coach training I learned that yoga, tai chi, qi gong, and stretching are all range-of-motion or flexibility exercises. These types of exercise can also build strength and promote balance, but primarily focus on lengthening tight muscles and moving joints through the full span of movement they are intended to achieve. “Limited flexibility can cause pain, lead to injury, and make muscles work harder and tire more quickly (p. 92, Lorig et al., 2013).

My positive experience with the yoga/pilates DVD encouraged me to find other programs with a similar format. One of my favorites is the Tai Chi for Health series by Dr. Paul Lam (link here), especially the Tai chi for Arthritis program that was designed in conjunction with the Arthritis Foundation. This instructional video that takes you step-by-step through 12 lessons until you have the movement sequence memorized. I enjoyed learning an entirely new way of moving and began to feel more confident that I could include exercise in my weekly routine.

I also started seeing a physiotherapist who put together a thorough stretching routine for me to do daily. Without doubt, this is the single most effective thing I tried to improve my health and well-being. My pain has decreased and my daily functioning has improved, along with my quality of life.

Many flexibility/range-of-motion exercises programs also share a second common feature as mind-body movement practices. For example, “Yoga is a set of theories and practices with origins in ancient India. Literally, the word yoga comes from a Sanskrit work meaning “to yoke” or “to unite”. It focuses on unifying the mind, body, and spirit, and fostering a greater feeling connection between the individual and his/her surroundings” (Moonaz, 2015). Greater body awareness, stress reduction, emotional balance, and improved energy are all benefits of mind-body exercise programs (Moonaz, 2015).

Flexibility/range of motion exercise programs are a great starting point for anyone who has not exercised for awhile, or who has a health condition that makes movement challenging. They are easy to do at home or you can find many classes offered in your community. Gradually incorporating these routines 2-3 x/week and practicing daily stretching is how I was able to actually begin to move more. Below is a quick primer on what these kinds of activities are so you can pick the right one for you and a link to programs that I have tried:

Yoga: “Yoga involves directing your attention and breath as you assume a series of poses, or stretches” (Gaiamlife, n.d.).

Excellent at-home instructional videos for people living with fibromyalgia. Includes modifications at three different intensity levels (from seated to standing). The yoga and pilates DVD is particularly recommended. http://www.myalgia.com/VIDEOS/Video_Introduction.htm
Overcome Pain with Gentle Yoga is recommended by health professionals (note- more challenging than yoga from myalgia.com). http://www.lifeisnow.ca/product-category/pain-management-products/#products/
Free mindful yoga routine, including a chair yoga option http://palousemindfulness.com/disks/yoga1.html
Yoga for Arthritis presented by the Arthritis Foundation http://arthritis.yoga/store/products/arthritis-friendly-yoga/

Qi Gong and Tai chi: “The term qi gong (or chi kung) describes the complete tradition of spiritual, martial and health exercises developed in China. Tai chi is one of the most common of these. Practicing qi gong involves performing a series of movements while paying attention to the body and staying aware of the breath. The exercises are especially effective for developing balance, focus, coordination and graceful, centered movement” (Gaiamlife, n.d.).

Tai Chi for Arthritis by the personable Dr. Paul Lam is an evidenced based at-home program that relieves pain, improves quality of life and prevents falls (also provides a seated program): http://taichiforhealthinstitute.org/programs/tai-chi-for-arthritis/

Stretching: Poses to lengthen muscles and increase range of motion in joints

Kate Lorig, Halsted Holman, et al. (2007). Living a Healthy Life with Chronic Conditions, CO: Bull Publishing. http://patienteducation.stanford.edu/materials/

http://www.mayoclinic.org/healthy-lifestyle/fitness/multimedia/stretching/sls-20076840

References:

OHSU. (2010). OHSU Research Suggests Yoga can Counteract Fibromyalgia. http://www.ohsu.edu/xd/about/news_events/news/2010/2010-10-14-ohsu-research-sugge.cfm

Moonaz, S. et al. (2015). Yoga for Arthritis. Johns Hopkins Arthritis Center. http://www.hopkinsarthritis.org/patient-corner/disease-management/yoga-for-arthritis/

Gaiam Life. (n.d.) How to Choose a Mind Body Exercise. http://life.gaiam.com/article/how-choose-mind-body-exercise

My husband and I decided this week that we need to focus on regularly doing stress relieving exercise. We came to this conclusion after one of those pointless arguments that you have in the middle of a stressful week, when you aren’t really dealing with what is actually bothering you. One problem with having chronic pain is that every week can seem like an especially stressful one – flareups can interrupt like mini crises, causing a flurry of last-minute adjustments to make sure all the necessary things get done. Life can start to seem like a giant game of whack – a – mole (that carnival game where the ‘moles’ pop their heads up faster than you can hit them with the hammer). We realized that if we just keep trying to react to all those inevitable stressors faster and faster, from forgotten pill refills to unexpected financial costs to family demands on our time, the only result will be that we are burned out, not that our to-do list will ever stop growing.

I think we need to try to get a little bit of control by managing our stress better, not doing our chores faster. I have an upcoming mindfulness-based stress reduction (MBSR) course happening at my hospital later this fall, which I think will be really helpful. However, another important thing to include is exercise. This is difficult for chronic pain and fatigue patients, for obvious reasons. It can also be hard for our spouses and caregivers because they often don’t have time between working and doing the household chores to fit in some exercise. I’m very lucky to have a man in my life who is willing to do so much for me – but he sometimes forgets to take care of himself in the process.

I think that it is very convenient to have an at-home option for your exercise. Walking and aqua fit are great, but if the weather is bad or you don’t have the energy to trek out to a pool somewhere, it can often mean no exercise at all. I think a really good resource are at-home DVDs.

I was excited to find a resource called Tai Chi for Arthritis by Dr. Paul Lam . I had never done tai chi before I got this DVD and I have to admit that I generally associated it as an exercise that was most appropriate for elderly people. Like a lot of other things that I’ve had to revise, I’ve learned that this stereotype is just not true. This is a really good instructional video that takes you step-by-step through 12 lessons until you have a movement sequence memorized.

I particularly like tai chi because the entire program involves standing, not transitioning from lying to sitting to standing which other exercise forms like yoga tend to do. There is also a seated tai chi DVD available on his website if that is easier for you. It is entirely possible to take rest breaks if needed between lessons. The DVD also includes warm-up and cool down segments. It’s nice to be learning an entirely new way of moving – it feels like a new skill rather than a simplified exercise protocol. Although it is very gentle, I can feel afterwards in my shoulders and mid back that I have been exercising. Dr. Paul Lam is also a very Zen individual, and watching him is just in itself calming!

This program was specifically designed by the Arthritis Foundation in the US and Dr. Paul Lam, who is a medical doctor and tai chi instructor. Some of the health benefits discussed on the Tai Chi for Health Institute website include:

Muscle strength is important for supporting and protecting joints. It is essential for normal physical function.
Flexibility exercises enable people to move more easily. Flexibility also facilitates the circulation of body fluid and blood, which enhances healing. Many arthritic conditions such as fibromyalgia, scleroderma and spondylitis are characterized by joint stiffness and impaired physical function. Tai chi gently frees up stiff joints and muscles.
Fitness is important for overall health and proper functioning of the heart, lungs and muscles. Tai Chi for Arthritis can improve all of these components.

Several studies of the program were completed and they demonstrated pain relief and improved balance for patients with arthritis. I’m going to focus on trying to do this program two to three times a week. Hopefully I will begin to feel more of the physical benefits, but especially the stress lowering effects of exercise in general and tai chi in particular!

My partner (who does not have chronic pain) is going to be doing a beginner yoga DVD by Rodney Yee which looks really good. It focuses on learning each posture correctly and then gives you a couple of routines to learn. It’s good to remind the people that we love and who take care of us to look after themselves once in a while!