tai chi vs. stretching and education for knee pain

[everything]

lots of these out there but here's one

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3023169/

Abstract
Objective
To evaluate the effectiveness of Tai Chi in the treatment of knee osteoarthritis (OA) symptoms.

Methods
We conducted a prospective, single-blind, randomized controlled trial of 40 individuals with symptomatic tibiofemoral OA. Patients were randomly assigned to 60 minutes of Tai Chi (10 modified forms from classical Yang style) or Attention Control (wellness education and stretching) twice-weekly for 12 weeks. The primary outcome was the Western Ontario and McMaster Universities OA (WOMAC) pain score at 12 weeks. Secondary outcomes included WOMAC function, patient and physician global assessments, timed chair stand, depression index, self-efficacy scale, and quality of life. We repeated these assessments at 24 and 48 weeks. Analyses were compared by intention-to-treat principles.

Results
The 40 patients had mean age 65 years and BMI 30.0 kg/m2. Compared to the controls, patients assigned to Tai Chi exhibited significantly greater improvement in WOMAC pain (mean difference at 12 weeks = −118.80 mm; 95% confidence interval [−183.66 to −53.94]; P= 0.0005), WOMAC physical function, −324.60 mm (CI, −513.98 to −135.22; P= 0.001), patients global VAS, −2.15 cm (CI, −3.82 to −0.49; P= 0.01), physician global VAS, −1.71 cm (CI, −2.75 to −0.66; P=0.002), chair stand time, −10.88 sec. (CI, −15.91 to −5.84; P= 0.00005), CES-Depression index, −6.70 (CI, −11.63 to −1.77; P= 0.009), self-efficacy score, 0.71 (CI, 0.03 to 1.39; P= 0.04) and SF-36 physical component summary, 7.43 (CI, 2.50 to 12.36; P=0.004). No severe adverse events were observed.

Conclusion
Tai Chi reduces pain and improves physical function, self-efficacy, depression and health-related quality of life for knee OA.

[everything]

another one that just says brush knee twist step puts less stress on the meniscus and other knee cartilage while having greater ROM than walking or jogging

https://pubmed.ncbi.nlm.nih.gov/30861671/

[cloudz]

not sure what the message is here ?

recently came across a clip of a young lady - quite nice looking - doing some tai chi, kung fu looking movements on insta
I had to comment about her knee position as when she leaned back her knee was collapsing inwards. I was feeling pain just watching it

hopefully she appreciated that I was looking out for her really
I'm super nice and warm hearted like that, letting little old ladies across the street, getting up for pregnant ladies on buses. beating up muggers
you name it, like a regular Batman really

[everything]

not sure of the messages, maybe notes to self:

* do tai chi
* do more tai chi
* don't do stuff like collapse knees inward
* don't be satisifed with just walking and stretching (though i badly need those too)
* do more tai chi
* tai chi is king

[origami_itto]

not sure of the messages, maybe notes to self:

* do tai chi
* do more tai chi
* don't do stuff like collapse knees inward
* don't be satisifed with just walking and stretching (though i badly need those too)
* do more tai chi
* tai chi is king

what you need to be doing more of is tai chi

[everything]

all kidding aside, i feel much better if i do, so why is it that i seem to not do enough of it? strange.

[Giles]

What the cited study doesn't state, and probably no comparable studies state, is how expert/qualified the tai chi trainer was. In this case the trainer probably knew what they were doing. But there are so many active tai chi trainers/teachers around who clearly have no idea of what constitutes good (= healthy) knee and hip and lower back alignment - as you can see from the videos they post of themselves (and their students). If these alignments are not sound, then the tai chi won't probably won't ameliorate knee pain and may well make it worse. And if the people conducting each study don't understand this either - which they probably won't, even if they are orthopedists - and hence are unable to tell whether the involved tai chi trainer is doing a sound job, then this affects the quality of the findings.

[everything]

what is interesting to me, yes, is that we should likely under-value these findings (meaning those of us with a lot of experience can have larger overall benefits (but not necessarily more to gain ... newbs probably have more to gain)).

[Steve James]

Yep, there's no way to generalize about "tcc" because there are so many variations in practice and teaching, not to mention that every body is different. That said, some form of tcc is probably helpful to most people. That's only because, in general, it doesn't need to be more demanding to walking. Of course, it can be.

I guess the key here is how to avoid injury. When you're young, you might ask "What's the benefit in that?" Later on in life, you learn the answer.

Knee pain is complicated. Ya need an accurate diagnosis first. Is it bone scaping bone? Are there strained ligaments or muscles? Is it caused by a hip or back issue? Could nutritional changes help (i.e., reducing inflammation)? Not to mention, how were your knees before? Were you a track star? Did you have any injury?

[everything]

I think you can generalize in your own study in the sense that the "treatment" group is same age group etc., who took some kind of "tai chi for seniors" class for X time. the "control" group is same age group who has not. you can try to control for keeping out "experts". we don't know how well designed the studies are, and they may be very dissimilar across studies. I make a large (but seems fair to me) assumption nobody in these studies is taught by "the world's greatest expert" (and nobody here on an enthusiast forum would even agree about that anyone). but there are quite a lot of positive findings seems to be the only generalization.

[BonesCom]

I don't think the control intervention in the first study is particularly useful as a comparator as it contains only stretching and no lower body resistance work. A more appropriate control would be one that includes loading bearing/resistance exercises that have been shown to improve knee function in the patient population in question, ideally matched in terms of time spent under load and loading intensity to the tai chi movements. While the authors call it an "active" control, it is not really.

The Attention Control Intervention
The wellness education and stretching program provided an active control for the attention being paid to the Tai Chi group (19, 22). The control group attended two 60-minute class sessions per week for 12 weeks. In the first session, research staff explained the program and procedures. A variety of health professionals provided nutrition and medical information in the following sessions. Every session included 40 minutes of didactic lessons on: (1) OA as a disease; (2) diet and nutrition; (3) therapies to treat OA; or (4) physical and mental health education (e.g., recognizing and dealing with stress). The nutrition education was based on “Dietary Guidelines for Americans” (23) and focused on general knowledge of nutrition, cooking and shopping but not on specific nutrients and supplements. The final 20 minutes consisted of stretching exercises involving the upper body, trunk and lower body, each stretch being held for 10 to 15 seconds. Participants were instructed to practice at least 20 minutes of stretching exercises per day at home. They were encouraged to maintain their usual physical activities, but not to participate in additional strength and mind-body exercise programs other than their stretching exercise. The stretching and health information was compiled using materials from our previous program (18) and the website of the National Institute of Arthritis and Musculoskeletal and Skin Diseases at NIH (24).

Throughout the 12-week period, we tracked the reasons for missed sessions and the number of missed sessions and asked subjects to complete daily logs indicating the amount of time they practiced Tai Chi or stretching exercise.

[Giles]

Knee pain is complicated. Ya need an accurate diagnosis first. Is it bone scaping bone? Are there strained ligaments or muscles? Is it caused by a hip or back issue? Could nutritional changes help (i.e., reducing inflammation)? Not to mention, how were your knees before? Were you a track star? Did you have any injury?

As a general principle, first expressed by my first TCC teacher who knew a lot about orthopedics and confirmed by my own experience and observations over the years: most cases of chronic or recurring knee pain are due less to any problems in the knees themselves and due more to problems in the hips. Meaning misalignment and/or limited flexibility in the hips. Stiff or misaligned hips prevent transmission of the bodyweight from the back and hips directly into the feet. Then part of the load tends to get 'stuck' in the knees, which will become increasingly irritated (in the medical sense) and inflamed. If the hips are flexible enough and well-aligned, the load tends to bypass the knees and go more through the soles of the feet into the ground. -- My language here is a bit casual but I guess you'll know what I mean.
And tai chi, trained properly, will very much promote flexible, aligned hips and loading of the feet instead of the knees.

I'd even guess that a fair proportion of actual knee injuries are also caused (in part) by hip problems. But I can't city any studies on this.

[everything]

it makes sense. hips and ankles should have a very large ROM. knees can only bend in one plane. any mobility issues at hips or ankles, and the knee is caught in the middle, which could be a big problem. underlying the popularity of the "kneesovertoesguy" exercises is "just" restoring mobility to (primarily) those 3 joints. having forces distributed all over instead of only hitting the knee joint. still, how much one's cartilage can heal is another question/issue. that is all very specific. vs. we can say tai chi is a sort of GPP that is helpful for many areas.

not sure how the studies should be done. seems like treatment A vs. B vs. control should be the pattern. you cannot really have a "placebo" in the sense of a pill and double-blind study. so there is always "softness" in the "science".

[Steve James]

I'd even guess that a fair proportion of actual knee injuries are also caused (in part) by hip problems. But I can't city any studies on this.

Yeah, fwiw, I agree. Often, the knee pain can be a symptom of another problem that isn't painful. I think the advantage of tcc is that it doesn't have to be painful. Of course, nothing should: i.e., if your knee hurts while doing something, stop doing it.