Pain Management: Tai Chi for Older Adults With Back Pain
Low back pain (LBP) is the most common health-related cause of pain and disability in older adults. Studies suggest that 36% to 70% report chronic LBP, with approximately 12% functionally impaired or disabled by it.1,2 Older adults generally have more comorbidities and a greater risk of adverse effects from commonly prescribed therapies for LBP, such as pain medications and spinal manipulation. Effective, safe, nonpharmacologic therapies are ideal for older adults with chronic LBP. Research has shown that practicing tai chi has numerous health benefits for older adults, including relieving arthritis pain, alleviating symptoms associated with depression, improving balance and preventing falls, and helping recovery after stroke or heart attack. Several recent studies and a clinical guideline support tai chi as a treatment for chronic back pain. Its safety relative to other exercises makes it an attractive alternative for older adults with back pain who have other conditions, such as osteoporosis and arthritis.
Tai chi is a shortened form of the phrase t’ai chi ch’uan, which is loosely translated as “internal martial art” or “supreme ultimate fist.” Originating centuries ago in China, it’s practiced as a sport, as a martial art with or without weapons, and/or for its health benefits. After a 2009 Harvard Medical School report referred to tai chi as “medication in motion,” interest in its use as therapeutic exercise increased significantly.3
In the classification of exercise modalities, tai chi is considered a mind-body exercise, along with qigong and yoga. It involves slow, continuous whole-body movements linked together in sequences called “forms,” which are integrated with controlled breathing and mental focus. According to traditional Chinese medicine, movements and breathing are designed to stimulate the flow of qi (pronounced “chee”), or life energy, thereby improving health and vitality. (The word “qi” is different from “chi” in the word tai chi.) Tai chi is considered to be a type of qigong, translated as “energy work,” that involves coordinated breathing, slow movement, and awareness. The two types of practices are closely related and may be performed separately or together. Elements of qigong are included in tai chi training. Qigong, when practiced separately, focuses more on meditation and healing and includes exercises performed seated or lying down. Tai chi movements are all taught from a standing position, though movements can be modified for a seated chair practice for older adults with movement limitations.
It’s estimated that 250 million people worldwide and 2.5 million Americans practice tai chi for its mind-body benefits. Tai chi’s smooth, flowing upper and lower body movements are easy on the joints while simultaneously strengthening muscles throughout the body. Although not considered a traditional core strengthening exercise, tai chi improves abdominal strength by encouraging posture and spinal alignment and incorporating waist rotations in its movement sequences. Because body weight is constantly shifted from leg to leg with both knees flexed during tai chi, leg strength and balance, as well as joint stability, are increased. Coordinating breath with these movements provides muscular tension release, as well as meditative/stress relief benefits.
A Brief Summary of Research
A 2016 systematic review and meta-analysis of 18 randomized controlled trials found that tai chi significantly reduced chronic pain associated with arthritis, LBP, and osteoporosis.5
In 2017, the American College of Physicians published a clinical practice guideline on noninvasive treatments for acute, subacute, and chronic LBP. For those with chronic LBP, it strongly recommended nonpharmacologic therapies as a first-line treatment. Tai chi was included, along with traditional exercise and yoga, as a recommended treatment. The American College of Physicians noted that “low-quality evidence showed that tai chi had a moderate effect on pain and a small effect on function” and “low-quality evidence showed no reported harms or serious adverse events associated with tai chi.” In contrast, they noted that evidence showed mild to moderate harms reported with yoga and traditional exercise, including muscle soreness, increased pain, and injury.6
Since the publication of this guideline, the evidence supporting tai chi as a treatment for LBP has increased in amount and quality. A 2019 systematic review and meta-analysis of randomized controlled trials evaluated the safety and benefits of mind-body exercise—including tai chi, yoga, and qigong—for treating chronic LBP. The researchers found that these modalities reduced pain intensity when compared with traditional strengthening/stretching exercises, core training, and physical therapy. And tai chi was significantly superior to yoga and qigong in providing pain relief. In their analysis of safety, the researchers found that adverse events, including increased pain, reduced joint motion, herniated disc, and other injuries were reported in several studies of yoga. No safety issues were reported for tai chi in any study.7
Another 2019 systematic review and meta-analysis evaluated tai chi—alone or in combination with additional routine therapy (health education, massage, physical therapy)—to effects on pain and disability from LBP. Researchers found that tai chi significantly reduced pain and improved functioning whether performed alone or with other therapies. Disability measures related to personal care, walking, standing, lifting, sleeping, and other physical functions all improved significantly.8
All research studies included a range of participant ages, including older adults. A small 2020 randomized controlled trial specifically focused on tai chi’s benefits in in 57 adults aged 65 years or older with chronic LBP. Twelve weeks of tai chi sessions were compared with health education and usual care (eg, chiropractic, massage, doctor visits). The trial did not measure clinical outcomes; rather, it evaluated the feasibility of tai chi as a therapeutic intervention for older adults relative to commonly offered nonpharmacologic therapies. The researchers found that tai chi had high ongoing participation rates in comparison to health education sessions; of note, most participants attended classes, and then continued practicing on their home at home with video guidance. No safety issues were found to be associated with tai chi.2
Guidance for Geriatrics Professionals
— Jennifer Van Pelt, MA, is a freelance writer and health care researcher located in the Lancaster, Pennsylvania, area. She’s also a certified group fitness instructor, certified by the Athletics and Fitness Association of America.
Tai Chi for Health Institute. Information on programs for back pain, instructor training, and DVDs. https://taichiforhealthinstitute.org.
2. Sherman KJ, Wellman RD, Hawkes RJ, Phelan EA, Lee T, Turner JA. T’ai chi for chronic low back pain in older adults: a feasibility trial. J Altern Complement Med. 2020;26(3):176‐189.
3. The health benefits of tai chi. Harvard Health Publishing website. http://www.health.harvard.edu/newsletters/Harvard_Womens_Health_Watch/2009/May/The-health-benefits-of-tai-chi. Updated August 20, 2019.
4. Hall AM, Maher CG, Lam P, Ferreira M, Latimer J. Tai chi exercise for treatment of pain and disability in people with persistent low back pain: a randomized controlled trial. Arthritis Care Res (Hoboken). 2011;63(11):1576-1583.
5. Kong LJ, Lauche R, Klose P, et al. Tai chi for chronic pain conditions: a systematic review and meta-analysis of randomized controlled trials. Sci Rep. 2016;6:25325.
6. Qaseem A, Wilt TJ, McLean RM, Forciea MA; Clinical Guidelines Committee of the American College of Physicians. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017;166(7):514-530.
7. Zou L, Zhang Y, Yang L, et al. Are mindful exercises safe and beneficial for treating chronic lower back pain? A systematic review and meta-analysis of randomized controlled trials. J Clin Med. 2019;8(5):628.
8. Qin J, Zhang Y, Wu L, et al. Effect of tai chi alone or as additional therapy on low back pain: systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore). 2019;98(37):e17099.