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Tai Chi & Qigong for Mental and Physical Tension

Tai Chi & Qigong for Mental and Physical Tension

Bill Gallagher PT, CMT, CYT

Tai Chi & Qigong for Mental and Physical Tension

By Bill Gallagher, PT, CMT, CYT

Are you stressed? Stress plays an important role in the diseases, pain syndromes and subsequent disability addressed by physical therapy. The effects of mental stress are insidious and affect the structure and function of the entire body. When the “fight-or-flight” response is triggered, the body’s long-range, optimistic projects are put on the back burner. These “projects” include muscle building, learning and immunity. Excess muscle tension brought on by anxiety tends to exacerbate pain, impair function and decrease endurance. A frightened patient is less likely to participate fully in therapy and therefore is less likely to make functional gains. In much the same way, a more relaxed (within reason) physical therapist or PT assistant is going to be a more effective clinician. This month’s column will focus on the benefits in terms of relaxation (both for our patients and for ourselves) of integrating Tai Chi & Qigong into a physical therapy program. An important element of Tai Chi Chuan and Qigong practice is to release unnecessary tension in the muscular system.1 Muscle tension is an excellent mental stress indicator because increased anxiety consistently amplifies it.2,3 Jacobson taught that neural input in conditions of elevated muscle tension significantly increases mental tension.4 Consequently, learning to release excess muscle tension has a calming effect on not just the muscle, but also on the mind. Furthermore, the ability to notice a stress response as it occurs, and consequently to reverse it, allows the individual to return more quickly to a relaxed state, thus counteracting the tendency of mental stress to cause disease.1 By encouraging diaphragmatic breathing, Tai Chi Chuan and Qigong reduce both sympathetic nervous system stimulation and the inefficiency of upper thoracic respiration. Diaphragmatic respiration is calming.1,5,6,7 Focusing the mind on the body and breath while scanning for unnecessary muscular tension decreases the frequency and persistence of troubling thoughts. Maintaining focus on the body and motion, and letting go of distracting thoughts, meets the definition of a relaxation technique developed by the National Institutes of Health8 and by authorities on relaxation techniques.1,6,9 Tai Chi Chuan has been shown experimentally to elicit key aspects of the relaxation response. Jin found decreased salivary cortisol and less anxiety after Tai Chi Chuan practice.10 In a second study, Jin tested Tai Chi Chuan’s efficacy in post-stressor recovery and found the approach superior in reducing anxiety as compared to reading a neutral passage.11 Brown compared the psychological effects of 16 weeks of Tai Chi Chuan training to walking, and walking plus relaxation instruction.12 Only those in the Tai Chi Chuan group experienced significant reductions in mood disturbance and improvement in mood. Wang compared 10 regular practitioners of Tai Chi Chuan to 10 sedentary adults, having all the subjects perform a graded exercise test on a bicycle ergometer.13 Blood flow to the skin, cutaneous vascular conductance, skin temperature and plasma nitric oxide levels were higher in those accustomed to Tai Chi Chuan both at rest and while exercising. Tai Chi Chuan is a particularly good choice as an intervention to reduce anxiety and its potentially ill effects in elderly patients who fear falling, because it directly addresses postural stability. Evidence suggests that excessive fear of falling degrades both balance and gait.15,16 The degradation, in turn, may cause more fear of falling. It is devastating when this syndrome becomes a downward spiral into frailty. Tai Chi Chuan and Qigong are closely associated with Taoism. In the Taoist view, anxiety is generated by an interfering and unappreciative mind.14 Taoism suggests the possibility of avoiding anxiety and emotions that deplete the body.15 This mindset is consistent with the contemporary cognitive-behavioral therapy approach to the treatment of anxiety. Taoists have a reputation for living long, healthy lives. Tai Chi Chuan masters are formidable martial opponents into old age. Rather than succumb to frailty, these venerable experts improve in skill as their understanding of the art deepens. The happy serenity that characterizes Taoist philosophy is especially pertinent not only to elders, but also to those of us who, one day, expect to be elders. This tradition can expose practitioners to an optimistic view of aging—and that optimism may in itself improve functional mobility.16 Of course, as in any discipline, Tai Chi Chuan and Qigong may actually heighten anxiety if it is taught in overwhelming detail, or in an egocentric, competitive atmosphere.1 Conversely, if relaxation of the muscles is overemphasized—to the exclusion of postural alignment and functional movement patterns—the potential for improving balance, strength, bone density and overall functional status, and for reducing arthritis, low back pain and incontinence, will be squandered. Whether your patients are brought to you primarily by the stress response (think of some of your patients with repetitive strain injury) or if the patient’s excessive fear of injury slows his progress, the stress response is clearly sapping an adaptive potential that could otherwise be invested in the long-term, optimistic project of rehabilitation.

References

  1. Everly, G., & Rosenfeld, R. (1981). The nature and treatment of the stress response. New York: Plenum.
  2. Hoehn-Saric, R., Hazlett, R., Pourmotabbed, T., & McLeod, D. (1997). Does muscle tension reflect arousal? Relationship between electromyographic and electroencephalographic recordings. Psychiatry Research, 71, 49-55.
  3. Hazlett, R., McLeod, D., & Hoehn-Saric, R. (1994). Muscle tension in generalized anxiety disorder: Elevated muscle tones or agitated movement? Psychophysiology, 31, 189-195.
  4. Jacobson, B., Chen, H., Cashel, C., & Guerrero, L. (1997). The effect of T’ai Chi Chuan training on balance, kinesthetic sense and strength. Percept Motor Skills, 84, 27-33.
  5. Chaitow, L., Bradley, D., & Christopher, G. (2002). Multidisciplinary approaches to breathing pattern disorders. Edinburgh: Churchill Livingstone.
  6. Kabat-Zinn, J. (1990). Full catastrophe living. New York: Dell.
  7. Yang, J-M. (1997). Back pain: Chinese Qigong for healing and prevention. Jamaica Plain, MA: YMAA Publications.
  8. National Institutes of Health. (1995). Integration of behavioral and relaxation approaches into the treatment of chronic pain and insomnia. NIH Technology Statement Online, Oct. 16-18, 1-34.
  9. Benson, H. (1975). The relaxation response. New York: William Morrow.
  10. Jin, P. (1989). Changes in heart rate, noradrenaline, cortisol and mood during Tai Chi. Journal of Psychosomatic Research, 33, 197-206.
  11. Jin, P. (1992). Efficacy of Tai Chi, brisk walking, meditation and reading in reducing mental and emotional stress. Journal of Psychosomatic Research, 36, 361-370.
  12. Brown, D., Wang, Y., Ward, A., et al. (1995). Chronic psychological effects of exercise and exercise plus cognitive strategies. Medicine and Science in Sports and Exercise, 27, 765-775.
  13. Wang, J., Lan, C., Chen, S., & Wong, M. (2002). Tai Chi Chuan training is associated with enhanced endothelium-dependent dilation in skin vasculature of healthy older men. Journal of the American Geriatric Society, 50, 1024-1030.
  14. Hoff, B. (1982). The Tao of Pooh. Harmondsworth, England: Penguin.
  15. Henricks, R. (1989). Te-Tao Ching. New York: Ballantine.
  16. Hausdorff, J., Levy, B., & Wei, J. (1999). The power of ageism on physical function of older persons: Reversibility of age-related gait changes. Journal of the American Geriatric Society, 47, 1346-1349. Bill Gallagher PT, CMT, CYT, is the director of the East West Rehabilitation Institute, Manhattan, NY where he sees patients at his office (88th & Broadway) and makes housecalls. He is also a Master Clinician in integrative rehabilitation at the Mount Sinai Medical Center, New York, and instructor in clinical physical therapy at Columbia University, New York. He can be reached at 800-297-3815 or .(JavaScript must be enabled to view this email address)