Teaching Tai Chi for Chronic Pain

I have been asked by a number of Energy Arts instructors who teach Tai Chi and Chi Gung (‘Qigong’) about the work we do with chronic pain patients in the National Health Service, especially relating to the uses of Tai Chi for Chronic pain. Here is a short overview…

How teaching tai chi for chronic pain started

It started in 1997, when the inimitable Brian Cookman marched up to the local hospital in Canterbury and declared, to anyone who would listen, that he wanted to teach Tai Chi there. He was lucky enough to find a receptive ear in Val Conway, who was the head of the Pain Clinic at the time.

So we began to teach Tai Chi to chronic pain patients, unpaid at first. Initially, all the patients who wanted to do Tai Chi were referred by Val Conway. It took what seemed years, but it was probably eighteen months for the doctors at the pain clinic to begin to refer patients to us for tai chi. The doctors were initially very skeptical of using tai chi for chronic pain, but gradually came around when they saw the change in patients on whom no other treatment had worked. A year or so after that they started to pay Brian for tai chi teaching. It was a real breakthrough.

Early in 2003 Brian moved up to Cambridge and handed the running of the

Pain Clinic Tai Chi to me. I ran it until 2007 when there was a restructuring of many services in the NHS including Chronic Pain. I was then asked to design and co-ordinate the Tai Chi for Chronic Pain Service throughout East Kent.

My long term students and I are now teaching tai chi for chronic pain at six sites and there are plans for further expansion. Part of the expansion will be into the local prisons to teach tai chi to prisoners. It will be the first Tai Chi ever taught in the British prison system – another real breakthrough…

Who we teach

While the majority of patients that we teach tai chi to have back and joint problems (injuries, arthritis, sciatica), we have been able to help people learn tai chi as a way to combat a broad range of chronic illnesses including: circulatory problems (heart function, hardening of veins and arteries, lack of circulation in the hands and feet, high and low blood pressure), breathing problems (Asthma, Bronchitis, Emphysema), nervous problems (MS, nerve damage), lack of energy (Chronic Fatigue, low immunity), digestive problems (IBS), stress related illnesses and Fibromyalgia.

What we teach first for tai chi

The core of what we teach is Energy Gates Chi Gung: Standing, Cloud Hands and the preliminary exercise of the spinal stretch (pp.217-18 of the 2nd edition of

Opening the Energy Gates of Your Body), usually done sitting. We slowly and gently work our way through the layers of the Cloud Hands movement, spending more time on the legs than the arms.

We generally finish each class with five to ten minutes of Longevity Breathing, emphasizing circularity of the breath to let go of tension and release the nervous system. Once the patients can shift and turn stably and comfortably we apply it to walking with the stepping without weight practices of Tai Chi. The application of these exercises to daily movement is very important to this group.

During the Energy Gates Chi Gung Instructor Training in 2001, Bruce Frantzis, the systems creator, said that 80% of the people that we teach will need Energy Gates first before they do Tai Chi. This is because Energy Gates Chi Gung teaches people the fundamentals of alignments, balance and energy flows in a simple movement set rather than Tai Chi sets that are more complicated.

I have found this to be absolutely true, with the caveat that everyone needs Energy Gates Chi Gung and a smaller proportion also needs other nei gungs, chi gung or Tai Chi. But the success of the other practices is built on the foundation of Energy Gates Chi Gung.

How we teach tai chi

As important as which tai chi exercises we teach is how the tai chi exercises are taught. The Water Method, a method that focuses on relaxation and gradual development, truly shines in the teaching of tai chi to chronic pain patients. Here less is most definitely more. Over the years we have cut down radically on the amount of Tai Chi that we teach. At first we taught the whole Tai Chi form (initially the Cheng Man Ching Short Form, then the Wu Style Short Form), we then reduced it to just the Grasp Bird’s Tail section of the tai chi form. Now our main form is Energy Gates, which captures movements from Tai Chi, but is not as complicated.

With each step that we have taken in learning to teach Tai Chi to chronic pain sufferers, we continue to soften both the way we present the material and amount of tai chi movements that we teach. We have seen a concomitant increase in the proportion of patients who stay in the tai chi for chronic pain program and an increase in effectiveness for even the most severe types of chronic pain with which we have been able to help people cope.

We repeatedly emphasize to the patients that they stay within their comfortable range when learning Tai Chi movements, which usually means the range of movement where they feel no increase of pain. In this group that range is often frustratingly small for them. It is quite a challenge to convince them of the benefits of using Tai Chi within such a tiny range of movement.

The 70% rule when learning Tai Chi is the hardest and most important thing for them to learn. It is the only way that they can begin to let go of their often chronic tension, which is so vital. I have not met a chronic pain patient who was relaxed and who did not try to push through their pain. These habits die hard.

The counter-cultural nature of the Water Method quickly becomes clear with this type of tai chi teaching. We are saturated by a ‘no pain, no gain’, ‘you must try harder’ culture. I am regularly looked at by chronically ill patients as if I am ‘out of my mind’ when I suggest that they consider ‘not pushing’ against their limits when using tai chi for their chronic pain. It has never occurred to them that their ‘pushing’ is a major factor in their chronic pain condition.

My first piece of advice to any prospective teacher of Tai Chi for chronic pain is that whatever they teach, they want to go so slowly and gently that they begin to think that what they are teaching cannot possibly be doing any good and that the students must be getting bored. Ironically, once they get to that stage they will probably still be teaching too much but it will be heading in the right direction.

This gentle approach to teaching Tai Chi for chronic pain does require trust in the material and principles that you are teaching. Energy Gates Chi Gung as a practice set rewards that trust in going slow because a solid practice foundation starts to develop over time. You learn a great deal about the efficacy of these exercises when you teach them to people with very damaged bodies who are in chronic pain.

We have found that focusing on releasing the nervous system through Tai Chi or Chi Gung is much more effective for chronic pain sufferers than stretching muscle. Everyone that we see has lost the natural space inside their body. Repetitive muscle tensing and stretching exercises do not address this problem and often will exacerbate the chronic pain condition. It is through releasing the nervous system and regaining natural body alignments that our patients recover this internal space and, consequently, are able to let go of their chronic pain through their Tai Chi practice.

Regular breaks are also very important when learning Tai Chi. Our patients’ comfortable duration of any Tai Chi or Chi Gung exercise is usually less than five minutes and sometimes much less.

The emotional side of tai chi

There is a significant emotional component to chronic pain. Not doing too much when learning tai chi is equally important in this regard. If someone does too much, pushing themselves to learn movements or to go faster while doing a Tai Chi form, they can quickly become overwhelmed as the emotions that are bound up with their pain begin to release.

We encourage the chronic pain patients to chat while resting (the best way to do that in the UK is to give them a cup of tea). As well as a time to relax and absorb what they have done, it is a great opportunity for them to interact and make friends, a side benefit to taking up a Tai Chi practice.

Chronic pain is isolating. The social side of the Tai Chi classes is very important in giving them a way back into society, where they open up conversations and develop meaningful relationships.

We spend much of our time in teaching Tai Chi doing very gentle partner exercises that support learning. Jack Kenny, who has been teaching Tai Chi and chi gung chronic pain classes since 2003, points out that, “Whether massaging a hand or stroking a shoulder, the partner exercises offer a form of touch-therapy, which is quite profound.”

For many of our patients, being touched has become an ordeal rather than a pleasure. Light touching and stroking helps their often stressed and overburdened nervous systems to let go and returns to them the comfort of touch. It also helps to break through their isolation.

It is not unusual to have someone refuse to be touched at first. We put no pressure on the patients learning Tai Chi to do anything that they do not want to do.

Actually, we encourage them to listen carefully to their bodies when learning Tai Chi and only do what they are happy doing. What we have seen is that just by being around people touching each other who are also pain sufferers, those who at first refused to be touched gradually join in of their own accord. It happens slowly over many months as they go deeper into Tai Chi exercises. Given the time and space, they are able to relax into Tai Chi, thus allowing the benefits to emerge naturally.

Pain creates fear and a sense of powerlessness by its very nature. These Tai Chi classes give sufferers a sense of doing something to help themselves. Tai Chi equips them with a set of tools that they can use whenever they need them.

This has an immensely positive effect on their self confidence.

It is worth pointing out that learning Tai Chi can be a slow process. We work in cycles of twelve weeks, with the first cycle being the minimum period that the patient must agree to attending in order for the benefits of Tai Chi to be seen. It takes twelve weeks for the patient to get an idea as to how Tai Chi can help their chronic pain. Those who stay through this initial period tend to stay for at least a year.

The question of whether teaching tai chi will help a certain person or chronic pain condition is primarily a question of whether that person is willing or able to take on board the radically different way of engaging with their body, emotions and mental attitudes that we offer. Everyone who can make that change benefits through the Tai Chi practice.

Our message to those who have chronic pain and wants to learn Tai Chi is fairly simple: let your body open up, gently and slowly, by doing these Tai Chi exercises within your comfortable range. Learning to do Tai Chi takes time and patience.

Acknowledgements

The Tai Chi for Chronic Pain Service is the legacy of my late mentor and friend Brian Cookman. Without his compassionate leadership we would not be doing this work.

I teach with my long term students Jack Kenny, Dave Willis, Gary Short, Alia Short, Ellie Cooley and Monica Tobon. Only through their hard work and commitment are we able to reach the hundreds of people each year who are benefiting from the Tai Chi for chronic pain service.

I offer my sincere thank you to Lineage Master Bruce Frantzis, for so generously sharing these profound Tai Chi healing practices. His teaching has made all the difference. It has transformed every aspect of what we do.

Matthew Brewer.

©Matthew Brewer, 2009.