Tai Chi and Knee Pain

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In previous posts I’ve mentioned that over the past few years it’s become increasingly common for Tai Chi practice to be recommended as a form of physical therapy for patients suffering from an assortment of ailments. However, as with any form of exercise, Tai Chi practice can cause more harm than good if done improperly.

The American Academy of Orthopedics Surgeons has previously indicated that knee injuries constitute the largest category of injury in the US. In their book, Save Your Knees, Fox and McGuire estimate that 1 in every 4 Americans have suffered knee pain or injuries. Tai Chi’s slow measured movements and focus on relaxation would therefore seem to be the ideal cure for this rampant condition. That's why it's such a surprise then to find that there are claims and reports of a prevalence of knee injuries among American Tai Chi practitioners.

Most people who claim that there is such a rampant occurrence of knee injuries among Tai Chi practitioners cite Dr. Jay Dunbar’s 1991 doctoral thesis, wherein 60% of the 216 Tai Chi teachers surveyed stated that they, and/or their students, suffered from knee injuries. To date I have not found any other study to corroborate these claims, nor have I personally observed any such prevalence of knee injuries among experienced practitioners. However I have observed several Tai Chi demonstrations wherein students bend and move their legs in ways that are, without a doubt, causing them to strain their knees. In The Complete Book of Tai Chi Chuan, Wong Kiew Kit states his belief that this is a phenomenon unique to American practitioners, and one likely due to improper form and faulty teaching; I believe that he is correct.

Among my students many arrive to their first class complaining of different health problems, and yes knee pain is fairly common among them. However, after training for a few months these health issues generally fade away or drastically improve. One issue that has popped up occasionally is unexpected joint pain or soreness among students who’ve been practicing for a few years. They complain that their joints sometimes feel sore after pushing hands or forms practice. This is an immediate red flag; these are people who’ve over come joint injuries that plagued them for year thanks to their diligent Tai Chi practice. Suddenly feeling sore after class means something is very wrong.

I always remind these students that one of the most important parts of correct Tai Chi practice is listening, specifically to their own bodies. Any sudden joint pain or soreness is their body letting them know that they are doing something wrong. If they don’t listen and insist on trying to push past the pain they will only injure themselves, possibly permanently. So I have them run through their practice until they can pinpoint what movements or posture are causing them pain. I have them freeze in the position where is hurts and then take a look at themselves. Where does it hurt? What is supporting, or being supported by the body part in pain? They very quickly realize that the pain and soreness are being caused by either improper body alignment or excessive muscular strain. Once they correct this the pain suddenly disappears. In other words if they relax, listen and fix their practice the pain suddenly goes away; trying to push through the pain was only making things worse and going completely against the core principles of Tai Chi.

The most common problem I’ve seen is that students try to shift their weight while 1-straining their muscles to hold a low stance and 2- shearing their knees because their legs aren’t properly aligned. To address this:

1-Always remember the Tai Chi principle, “use 4 ounces to overcome 1 thousand pounds”. Simply put, if your body is relaxed and properly aligned you will never need to strain your muscles to generate or redirect great force. However this requires the practitioner to maintain muscular relaxation and mindfulness when they face heavy pressure. It’s hard to condition the mind to adopt this as a response to external pressure, so most students fall back into the habit of trying to use brute strength and hurt themselves in the process. Always remember: Song (Relax), when you face pressure relax your body and focus on maintaining proper body alignment. Any external pressure will slide right off you that way.

2- Speaking of proper body alignment, remember to rotate and shift your weigh with your hips. Make sure your knees are always aligned with your feet. Never let your knees bend past your toes, and preferably keep your knees bent directly above your metatarsals (the center of your foot). When shifting your weight rotate from the hip, never from your ankles or knees. (For a more in depth discussion refer to my post on the Six Harmonies principle).

These two reminders alone solve about 90% of my student’s complaints. It would also fix most of the problems I’ve seen with the demonstrations I previously mentioned. This all leads me to conclude that Wong Kiew Kit is correct in his assessment that too many students are failing to apply proper Tai Chi principles and their teachers are failing to correct them, either because they don’t know any better or because they are inattentive of their students. Either way as a student and a person always remember to be mindful of, and listen to, your body; ultimately it’s your responsibility and you are the one that will pay the penalty for any wrong moves you make. Relax and listen to what your body is trying to tell you, that is always your best guideline.