January/February 2012: Tai chi, qigong, yoga and Pilates

Tai chi

Tai chi is an ancient Chinese martial art form that involves a sequence of smooth, fluid movements performed with an erect spine, abdominal breathing using a natural range of movement designed to improve the flow of ‘life energy’ – chi – through the body.  There are many differing forms of tai chi, but most are suitable for people with RMDs. Tai chi can help improve flexibility, coordination, endurance, stamina, strength, balance and has a meditative quality that helps with relaxation.  Tai chi can be practiced individually or with a partner, mirroring movements whilst ‘pushing hands’.

Yoga

Yoga is the practice of exercises, breathing techniques and meditation that started in India around 5,000 years ago.  There are a number of different forms of yoga which generally involve positioning the body into a pose whilst applying breathing and meditative techniques, which help with relaxation. Yoga can help improve flexibility, strength, balance and stamina, but some of the poses may need to be modified for people with RMDs and not all forms of yoga will be suitable for people with RMDs. Iyengar yoga is a gentle form of yoga where poses are held, allowing participants to go as far as they are able. Participants can also use chairs, blocks and other aids to help them. Other types of yoga, like Vinyasa, are more strenuous, involve transitioning from one pose to another and include supporting body weight through the hands, which would not be suitable for many people with RMDs.

Expert view

Christina Opava is a Professor of Physiotherapy at the Karolinska Institute, Stockholm, Sweden

Below is general advice for people with rheumatic and musculoskeletal diseases (RMDs), but individuals may have specific problems. Always check with your doctor or physiotherapist before you start a new form of exercise.

Performing slow controlled movements allows you to feel your way through each exercise so you can stop if you feel you are straining, or experiencing increased levels of joint pain. Movements can be adapted and modified to suit your individual needs, or alternative movements can be found for you.  As the course of many RMDs can be unpredictable, you may need to adapt what you are able to do from time to time. 

It is also recommended that you have periodic check-ups with your physiotherapist or physician, who can monitor your progress and advise you if you are experiencing any changes in your condition.

Ensure that instructors and teachers are fully trained and qualified before you enrol in a tai chi, qigong, yoga or Pilates class. Poorly taught technique can do more harm than good.

Let the teacher know about any specific problems you have, or movements you are unable to perform before starting a class.  This will allow the teacher to give you an alternative movement or to modify the way you perform a movement or adopt a pose. Your teacher should also ensure you are performing each movement correctly and with good technique.

Whilst a number of tai chi, qigong, yoga and Pilates mat work DVDs are available, it is important to attend classes where you are taught correct techniques, helped with your individual needs and given feedback on how you are performing movements before you use them. DVDs can be helpful to use at home between classes, once you are fully proficient.

Breathing control is taught in tai chi, qigong, yoga and Pilates. Breathing correctly is beneficial both physically and emotionally. 

Controlling and coordinating breathing with exercises helps you perform movements more efficiently and ensures you are breathing more deeply to expel carbon dioxide (CO2) and take in more oxygen. It is generally advised that you breathe out when your muscles are contracting and you are performing the strong part of an exercise, and that you breathe in as your muscles release. Being aware of your breathing whilst you exercise also stops you holding your breath and straining as you perform each movement. Breathing is controlled by your diaphragm and abdominal muscles. Learning to use these muscles correctly will help you to breathe more effectively whilst you exercise.
 
When we are stressed or anxious our breathing tends to become faster and shallower. Slow deep breathing, emphasising the out breath will help you relax and de-stress, and can be used to help control pain. Yoga employs a number of breathing and mediation techniques, but breath control is also an important part of the practice of tai chi, qigong and Pilates.

Body awareness is another important element of practicing slow, controlled forms of exercise. No one is perfectly symmetrical and it is easy to slip into poor postural habits that mean your muscles need to compensate to keep you functioning.  This can be exacerbated by the physical changes in your body when you have an RMD and lead to some muscles becoming weak and others contracted and tight.  You may not notice the adjustments your body has made and overtime these may feel normal, even though they are adding extra stress to your joints. Going through a range of controlled movements will help you discover weak muscles that need strengthening and contracted muscles that need stretching and releasing to help you realign your body.  Pilates exercises are particularly helpful for addressing problems with weak core muscles and helping improve body alignment.

Concentrating on what you are doing not only helps with your body awareness, but also activates the corresponding motor areas of your brain. It is better to exercise for a short time with full concentration and muscle control than over a longer period where you lose concentration and control. 

Equipment

Clothing: You need to be able to move freely and not be restricted by what you are wearing, so a T-shirt and leggings or tracksuit bottoms are ideal. Dedicated tai chi and qigong students may want to wear a classic Chinese martial arts uniform with a button up top and baggy Kung-fu trousers, but this is not necessary.

Shoes:  Some yoga and tai chi classes may recommend bare feet to prevent you slipping and to connect you to the ground. If you want to wear something on your feet choose soft flexible shoes with thin soles, such as Kung-fu slippers or socks with grips on the soles. Built up trainers may skew your connection with the ground, which is considered a vital source of energy and balance in eastern practices.

Mats for floor work: Classes involving floor work should provide mats, or you can use your own mat, if you prefer.    

Props for yoga: In Iyengar yoga props may be provided such as blocks and ropes, which are used to ease you into poses without causing strain or injury.  

Chairs and stools: Many exercises, including tai chi can be performed seated.

Exercise balls: Large inflatable balls are used in Pilates and other gentler forms of exercise and provide gentle support for a number of movements. 

Resistance bands: These stretchy bands are used to provide resistance for strength training and stretching.  They come in a range of different levels of resistance