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Tai Chi Chuan and martial Qigong training may be a potent intervention
for people with low back pain syndromes including arthritis. The
posture and body mechanics inherent in this tradition is consistent
with current thinking on prevention and treatment of low back pain
via therapeutic exercise and neuromuscular reeducation. Likewise,
the calming effect attributed to
Tai Chi Chuan and Qigong is likely to give relief to people suffering
from
low back pain.
Disc degeneration is very common and
this tends to increase weight bearing at the facet joints located
in the back of the spine. This facet compression, in turn, may lead
to degenerative joint disease. This posterior spinal element (facet)
degeneration is particularly evident in the neck and low back. A
forward slumped, upper back exacerbates the postural dysfunction.
Tai Chi Chuan instruction begins with a standing exercise called
the Embrace Tree posture. By learning to flex the knees and "drop
the tailbone", tightness in the low back and chest are reduced.
Elongating the back of the neck and gently tucking the chin corrects
the forward head postural dysfunction. By lengthening the spine
between the coccyx (tailbone) and the skull, a forward slumped posture
is further addressed. Through learning to avoid bending backward
in the low back, people with spinal stenosis and low back arthritis
may experience significant pain relief immediately. A moderately
flexed lumbar spine (not arched back) probably protects the disc-vertebral
body unit by balancing the distribution of compressive force within
the discs. Also, this flattened lumbar spine stretches the lumbodorsal
fascia. Since this fascia acts on a longer lever arm relative to
the center of rotation (in the discs) than erector spinae, this
posture reduces the compressive force on the spine.
The body mechanics of this martial
art can be used for functional tasks like opening a door, soothing
a fussy child, and transferring a bottle of milk from the kitchen
counter to the refrigerator. A key component of Tai Chi Chuan is
to drive all movement in the horizontal plane via pelvic axial rotation
and translation in the horizontal plane. If the pelvis rotates,
the thorax rotates in the same direction and at the same time. When
the thorax stops rotating, the pelvis stops rotating. The pelvis
rotates on the femurs, driven by the hip rotators, including the
posterior fibers of gluteus medius. In addition, Tai Chi Chuan's
characteristic wide and deep stances afford a large base of support.
This stable base of support is consistent with correct lifting,
pushing and pulling and these stances will also tend to strengthen
the legs, facilitating lumbar stabilization. Furthermore, since
maintenance of postural control correlates with good outcome in
subjects with low back pain, the balance improvements expected with
Tai Chi Chuan training and practice should have a positive impact
on low back pain.
By minimizing segmental spinal rotation,
the lumbar spine is maintained in a neutral position in the horizontal
plane. One advantage of this neutral spine (in all planes) is to
balance the forces seen by the spinal elements. By curtailing segmental
rotation, the contact stresses in the zygapophysial (facet) joints,
and thereby the axial torque on the spine are decreased. One study
that examined low back rotation in elite golfers concluded that
subjects with low back pain tended to segmentally rotate the lumbar
spine while golfers without back pain rotated the lumbar spine as
a unit fixated to a rotating pelvis.
The minimization of segmental spinal rotation is facilitated by
Tai Chi's diaphragmatic breath pattern by allowing transversus abdominus,
the deepest abdominal muscle, to function in a more ideal length-tension
relationship. There is evidence that optimal lumbar stability requires
coordination between the diaphragm, pelvic floor, transvesus abdominus
and multifidus. Impaired diaphragmatic excursion found in thoracic
respiration may reduce movement in Quadratus Lumborum and Psoas,
increasing the tendency of these muscles to shorten. Tightness of
Quadratus Lumborum and Psoas is implicated in low back pain and
postural dysfunction. Thoracic respiration also increases sympathetic
arousal leading to a stress response.
By eliciting a relaxation response, neck and back muscles are likely
to carry less inappropriate tension, decreasing any tendency for
these muscles to spasm while reducing the compressive forces on
the spine. A relaxation response may also improve motor control
to optimize posture, alignment, breathing patterns, and muscle activity
to minimize mechanical stress on the spine. The relaxation response
from Tai Chi Chuan and Qigong practice offers people with chronic
low back and neck pain significant symptomatic pain reduction.
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