When 45-year-old Karen visited her doctor about her aching hip, the last thing she expected was to be diagnosed with arthritis. Didn’t that only affect old people? She was surprised to learn that at least half of arthritis sufferers are working age and it can even affect children.
Arthritis
Arthritis is Australia’s foremost cause of pain and disability, according to Arthritis Australia. In 2011–2012, say statistics from The Australian Health Survey, about 3.3 million people had been diagnosed with the disease — or 14.8 per cent of the population. Prevalence is higher in women than men, at 17.7 per cent and 11.8 per cent respectively.
Access Economics predicts that, if current trends continue, there will be 7 million Australians suffering some form of the disease by 2050.
While arthritis is commonly seen as a normal part of ageing, it is not a natural consequence of growing older. It is a disease state affecting the musculoskeletal system, especially the joints.
However, the likelihood of developing arthritis does increase with age. In the under-25 age group, incidence is less than 1 per cent, increasing to 52.1 per cent in those 75 years plus. Women aged 45 and up are considerably more likely to have arthritis than men. In particular, at ages 75 and over, 59.9 per cent of women have arthritis compared with 42.3 per cent of men, Australian Health Survey figures show.
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Another misconception is that arthritis is a single disease. Arthritis is actually an umbrella term covering over 100 different conditions. The most common of these are osteoarthritis, rheumatoid arthritis and gout, which account for about 95 per cent of cases, according to statistics from Arthritis Australia. Some people can even suffer more than one form of arthritis.
These conditions are grouped together because of their similar effects on the body, including pain, stiffness, inflammation and damage to the joints. This can lead to weakness, instability and joint deformities. There may be increased difficulty with everyday tasks such as dressing, walking, driving and preparing meals. Quality of life is affected as sufferers find it difficult to do things they previously did with ease.
Some types of arthritis are more likely to affect the large, weight-bearing joints, like the hips and knees, causing difficulty with activities such as walking and getting on and off chairs. Other forms tend to affect smaller joints in the hands and feet, causing problems with dexterity and co-ordination as well as walking. The spine can be affected, resulting in neck and back pain. There are also other autoimmune disorders that cause arthritic changes in the joints.
If your joints are painful, swollen, hot, red or stiff, it’s possible you have arthritis. Morning stiffness is another common symptom. Your doctor will likely order blood tests, X-rays and possibly other imaging to confirm the diagnosis.
Managing arthritis
While arthritis is not curable, it is usually manageable and many options are available to help you deal with the condition. Often, a patient visiting their GP will be prescribed medications such as non-steroidal anti-inflammatories or paracetamol. In the types of arthritis that involve joint inflammation and the immune system, other classes of drugs are available to help slow the disease process and reduce joint damage associated with it.
If you have recently been diagnosed with arthritis, or suspect you may have the condition, it’s important to start management as early as possible. Research suggests that early intervention can slow the onset of the disease and may reduce the number of cases of osteoarthritis by about 500,000 within 15 years, according to Arthritis Australia.
Learn as much as possible about your condition so you can make informed choices about treatment. Advocate for yourself and seek alternative opinions if you’re unsure about anything. It’s a good idea to take a trusted friend or family member with you to appointments, as you may be bombarded with questions and information, especially at first. A team approach is best for managing the disease, including people like your GP, physiotherapist, occupational therapist and dietician. Alternative and complementary therapies can be a vital part of your management plan.
One alternative option that is proving to be effective in managing arthritis is tai chi.
Tai chi for arthritis
Tai chi is an ancient Chinese martial art form with a variety of different styles. It is now practised around the world as a gentle exercise. When performed this way, it involves slow, controlled movements and postures combined with breathing and mindfulness.
A program known as Tai Chi for Arthritis was developed in 1997 by Dr Paul Lam with a team of medical and tai chi experts. A general practitioner for 40 years, Dr Lam has designed the program with the specific needs of this population in mind. “Tai Chi was originally a martial art,” he says, “so you need a program designed for people with arthritis, and instructors who take care of people. The movements are modified and especially safe.”
With only 12 moves from the Sun style, it can be learned quickly. The program focuses on good posture, abdominal breathing, gentle movements and relaxation. As Dr Lam says, “When people are using abdominal breathing they are more relaxed and feel better; their pain improves. Tai chi gently exercises all parts of the body, makes the fluid circulate in the joints and stretches the joints gently.”
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There are now more than 30 research studies that have shown improved health outcomes in arthritis patients from the practice of tai chi.
A major study was conducted in 2010 by Professor Leigh Callahan from the University of North Carolina. It showed significant health benefits for people with all types of arthritis. In the study, 354 participants were assigned either to the tai chi group, who received eight weeks of lessons, or to a control group, who were placed on a waiting list. Results in the tai chi group included significant pain relief, reduced stiffness and better ability to manage daily living. They reported a greater sense of wellness and improved balance.
A study led by the same author and published this January reached similar conclusions. In it, 343 people were randomly allocated to tai chi classes or the control group. Balance, sense of helplessness, sleep, and role satisfaction improved significantly in the tai chi group. There were also improvements in pain, fatigue and stiffness. At one year review, the improvements in pain, fatigue, stiffness, helplessness and role participation satisfaction were maintained.
An Australian study, reported in 2007, looked into tai chi and hydrotherapy for people suffering hip and knee osteoarthritis, with 152 people randomly allocated to a group receiving either 12 weeks of hydrotherapy, tai chi classes or position on a waiting list. The hydrotherapy group and the tai chi group achieved significant improvements in pain and physical function scores. These improvements were sustained at a 24-week follow-up.
Enhancing your chi
According to Dr Lam, the immense power of tai chi in improving health derives from a set of essential principles based on enhancing the life force, or chi (also qi). When performing tai chi, the movements are practised in a slow, fluid manner, like the flow of a stream. You move as if against a gentle resistance, like moving through water. Emphasis is placed on upright posture and body alignment, and on the controlled transfer of weight through the legs. Joints are kept loose, as if they are being expanded from within. Mindfulness is focused on the body and how it is moving.
The physical movements are the external form of tai chi, but this ancient art is about much more than movement.
According to Phil Pointon, who teaches tai chi on Queensland’s Sunshine Coast with the Australian Academy of Tai Chi and Qigong, it’s the internal aspect that harnesses the body’s power for healing. “My philosophy in tai chi is bringing into balance the mind, body and breath,” he says. “We have a saying in tai chi that where the mind goes the energy flows, and where the energy flows the blood flows. That’s what happens. By bringing those things into balance, it becomes an internal work. Once you’re doing tai chi in an internal way, you can heal almost any discomfort or disease in the body.”
Pointon should know. He was diagnosed with arthritis in his right shoulder, related to repetitive overhead strain on the arm from his work as a painter. It became so severe he was unable to continue working. Doctors told him pain killers were the only answer. Not satisfied, he tolerated the pain until he found a tai chi teacher in 2006. Although he found it painful at first, Pointon persisted. “I’m now in my tenth year of doing tai chi and I don’t get any pain in that shoulder at all,” he says.
He was so impressed by the result, he pursued training as an instructor. “I’m a fine example that it works. I’ve come across many friends in tai chi who’ve had similar things happen to them,” he says.
The Australian Academy of Tai Chi and Qigong was established in 1976 by Grandmaster Gary Khor, who believes Chinese health arts should be made available in practical and useful ways to improve the quality of people’s lives. The Academy focuses on the teaching of tai chi from a health and relaxation perspective suitable for the average person. Their website contains this warning: “Tai chi and qigong have been known to cause increased energy levels, health and happiness.”
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As mentioned, chi is the Chinese term for life force. Physically, a person with strong chi will be healthy, vibrant and energetic. Weak chi leads to fatigue, sluggishness and illness. Beyond the physical level, the concept of chi refers to the subtle energies flowing through the body, affecting emotional and spiritual wellbeing. If your chi is well balanced, you will experience clarity of thought, enhanced creativity and stable emotions. Unbalanced chi leads to agitation and clouded thinking. Spiritually, strong chi is associated with religious experience and achieving higher levels of consciousness.
For optimal health, chi should be flowing smoothly and powerfully throughout your body. Blockages of chi result in illness. Chinese medical arts, such as acupuncture, aim to remove blockages and restore the smooth and balanced flow of chi. The practice of tai chi helps you to discover, develop and harness the healing power of the subtle chi energy.
Dr Lam espouses the many benefits of tai chi. An arthritis sufferer himself, he commenced tai chi to help deal with his symptoms and discovered several additional health advantages. At 68, he has the pulse rate of an athlete and is more flexible than people half his age. “All I did was tai chi and my fitness level improved. I’m really fit for my age. I feel really well, especially considering I’ve had arthritis for more than 50 years. I attribute it all to tai chi,” he says.
Based in Sydney, Dr Lam now travels the world training instructors in his Tai Chi for Health programs. These programs have been endorsed by arthritis foundations around the world, including Arthritis Australia and the Australian Rheumatology Association.
Getting started
When you decide to commence tai chi, there are some important things to look for. First, your instructor should understand arthritis and be trained to teach tai chi in a way that is safe and comfortable. You should be allowed to progress at your own pace and never feel pressured to keep up with a group or perform movements that are painful. Your instructor should be able to modify movements if required due to your condition.
Listen to your body. Mild discomfort and feelings of stretching are usually fine, but never force your body into pain. As with any form of exercise, perseverance is the key. Start slowly and progress at a pace that is manageable for you. It takes time for joints to loosen and muscles to lengthen and grow stronger.
For maximum benefit, a daily practice is recommended, even if it is only for 10 minutes. A longer session can be performed once or twice a week, either in a class or following an instructional DVD. Aim to build up your practice to 30 minutes most days. Try putting the principles into practice in daily life. Good posture, abdominal breathing and mindfulness are excellent health practices in their own right.
A diagnosis of arthritis may be frightening, but it is not a sentence to a lifetime of disability. Remember, you are not defined by a disease. With a good team approach and some determination, it’s likely you will be able to manage your arthritis. Tai chi is an excellent weapon in the arsenal of strategies for achieving wellbeing and a healthy, balanced life.
