First and foremost (just in case this is news to anyone), the knee is a hinge-joint, meaning it ONLY goes backwards and forwards. It is NOT a ball-and-socket joint, although many people treat it as such!
We’ve been told for many years that we only have two knees and to take care of them. However, there has been an increase in the number of people who have had knee replacements in the past decade or more. It’s still a good idea to take care of the two you were born with, as well as any replacements you have had! Experts have said for years that exercise is important in order to keep your bones, muscles, and joints healthy. Without exercise, the joints stiffen and become more painful. Tai Chi can help with knee pain and flexibility now and may even prevent future knee issues!
Research
We’ve known for years, and experts have agreed, that Tai Chi is a gentle, low-impact workout that is gentle on the joints - including the knees. Unfortunately, the knees are one of the most common places to have osteoarthritis. A 2010 study published in the Journal of Alternative and Complementary Medicine, compared women with Osteoarthritis who practiced Tai Chi (Sun-style) and Qigong versus those using a self-help education program. The results were “improved bone density, greater endurance of knee extensors” and less fear of falling in the Tai Chi/Qigong group. That group also noted improved balance control and fall prevention.
A 2008 study conducted at the University of Florida enlisted patients with Rheumatoid Arthritis (RA). One group practiced Tai Chi, while the other group received medical treatment only. The Tai Chi group showed greater joint mobility, along with less pain and stiffness. A larger Atlanta study showed improved flexibility, improved muscular and cardiovascular strength, and a 47.5% decrease in falls in the Tai Chi group! In fact, there are studies that show that Tai Chi practice can also increase muscle strength by 15-20%.
Research published in 2016 (Annals of Internal Medicine) noted that Tai Chi may be as effective as physical therapy (PT) for knee osteoarthritis (OA). Both groups improved in physical function and a reduction in pain. However, the Tai Chi group noted less depression and an improvement in quality of life, according to author Chenchen Wang, MD, Tufts Medical Center (Boston). According to Dr. Wang, Tai Chi “uses functional movements to increase strength, balance and flexibility. Tufts recent study also indicated that Tai Chi increases mind/body awareness, which also helps to alleviate knee pain.
According to the Osteoarthritis Foundation International, Tai Chi improves discomfort in people affected with arthritis or any other condition that causes joint pain. It also helps prevent and/or delay the onset in “healthy people”.
Tai Chi is one of the most powerful mind-body exercises. One benefit that may be overlooked is that Tai Chi teaches the student that they possess internal energy. This energy can be used to experience greater self-control. It can also be used to increase both physical and mental strength! What’s not to like about that?
Does that mean that when you practice Tai Chi you won’t experience knee pain?
No, it does not mean that. Like any exercise you perform, even walking, there is always a danger of injury, if it is NOT done properly. You should never “expect” to have knee pain from Tai Chi. There are valid reasons why you might and we will discuss those below. If your instructor says to expect knee pain, advice is to find a new instructor!
According to a Tai Chi Instructor who is also a Physical Therapist, the old masters had a high level of understanding when it came to “biomechanics and kinesiology”. Every position or form in Tai Chi is a “combination of structure and position which results in strength, balance, and effective distribution of external forces (eg: gravity) acting on the body”. Therefore, no form of Tai Chi (when done correctly), should cause pain or dysfunction.
It is not surprising that several reasons for knee injuries exist. Most are the result of lateral forces, twisting forces, or both. When your knee is rotated with your feet on the ground (or floor, etc), if the femur turns even slightly over the tibia, torque can be created. Flexing on one side or the other, would stretch the knee on one side and compress it on the other. Even though the movement is minimal, wear and strain on the knee can occur.
Several other common reasons for knee pain: incorrect alignment of the knee, using body weight on the knee when changing position, attempting to move in one or more positions that a person’s musculoskeletal system has not been conditioned to do. Two examples: performing movements that are too deep or too long.
The Knees
Knees should be soft, not locked nor tensed.
Let’s talk alignment: your knee should be aligned with your foot and should not fall inside or outside your foot or hip joint. How about when you are turning your foot? Shifting the weight to the full (non-moving foot), allows the foot to turn easily and avoids knee torsion. If you can’t move your foot freely, it is very likely that your weight distribution is incorrect. Be sure to remove the weight from the leg first, then turn the empty foot by using the waist and hips. It is then safe to return the weight to the leg.
It’s important to keep your knee over your foot to avoid allowing the knee to collapse inward, outward, too far forward, or too far back. In other words, the center of the knee joint is over the center of the foot. Obviously, the knee should also be facing in the same direction as the foot! Keeping the kneecap aligned with the toes will also avoid knee twisting.
Important Points
Students and practitioners can also run into knee problems when they over-train, use poor or incorrect posture and alignment, their knees are not in alignment with rest of the body (spine, hips, feet), or they perform knee bends that are too deep for their strength and body. When the knees are too far forward or the knee tracks to either side of the foot, ligaments may get overstretched or strained. Remember that it’s the role of the hips to rotate, not the knees. Therefore, it’s important to work on and practice opening the hips and keeping your knees stable!
New (or fairly new) students should be encouraged to work up to keeping their knees bent during Tai Chi. In the meantime, they should stand up when they feel the need or feel any discomfort. Once their hips and legs (muscles, tendons, etc.) become stronger, they can keep their knees bent for longer periods of time.
An experienced Tai Chi instructor will begin by teaching you how to properly position your body during each movement. Unfortunately, not all do this. Each pose requires proper alignment of the spine and hips. Your instructor should demonstrate how to properly align the knees as you shift your weight. Improved biomechanics helps prevent injuries to the knees, hips, and back.
A reminder to new students or those practitioners trying/learning new positions or forms: always stay within your comfort zone and your abilities. Be sure to talk to your instructor when you are having discomfort or some movement just doesn’t feel right. Listen to your body!
Bottom line: Pay attention to and become familiar with your knee position! Proper alignment and good form will keep them healthy and strong.
No, I did not forget……..practice, practice, practice!
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