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Tai Chi & Pain

Some Thoughts on Pain Management using Tai Chi & Chi Gung.

This article was written for us by

Brian Cookman, and published

with his full permission.

Sadly Brian died on the 18th

of February 2005. We have

elected to keep the article

as originally written.

By Brian Cookman, of Cambridgeshire, a player of Tai Chi Chuan since 1980 and a teacher for fifteen years, I have been running six classes per week at Kent'scounty hospital for six years. Beginning with the long-term pain sufferers at the Pain clinic, I worked with a variety of patients and staff. I also lecture at the Royal College of Nursing and to Post-graduate MDs.

These notes are for Tai Chi instructors, so may be a bit esoteric for most tastes! They are quick ideas and thoughts I have formulated over the years and may sound opinionated and pedantic, but if you read them in the light of what they are trying to achieve and who they are for a bunch of know-nothing instructors then you may find it more palatable!

Tai Chi and Chi Gung are superb ways of improving health and fitness. As long as you teach your patients the essentials of Yin and Yang and the energy contained in the Forms, they will benefit. They will derive benefit from the exercise anyway, but it is amplified by the proper development of Yin and Yang energies in the body by using the precise body alignments contained in the forms. Patients should be introduced to these fundamentals from the start. I try not to make the explanation cranky, keeping the explanation light and humorous. That way they will accept it as a slightly eccentric but interesting way of looking after their health. The Forms will initially strengthen their constitution and then enlarge it, as we shall see later.

Chi Gung just moves energy through the body but it is not attached - like electricity. It teaches you to move the 'hardware'. Good Chi Gung will move a lot of Chi but not the soft tissue. It moves the Chi through the body.

Nei Gung puts energy to all systems of the body. If you raise the level of energy everything works better. Nei Gung mixes the 'hardware' and 'software'. It makes your insides integrate. It organises the inside of your body to work better.

Tai Chi is a form of Nei Gung - the tissues and Chi move together. But first get the tissue to loosen or the 'electricity' won't move through. You will not alleviate pain until the nerves have re-learned to relax.

Tai Chi and Chi Gung are beneficial to

Back problems

Heart circulation

Post-stroke recovery

Post-traumatic recovery

Joint problems

Weakness

Strengthening internal organs

Balance

Improving posture and range of movement

What is pain?

My teacher, Bruce Frantzis of California, who has experienced more pain than most after his terrible accident, can be thought of as an expert in this field. He said "Pain is energy not completing itself". Meditating on this simple fact will help you and your patients to cope with their distress. The Chinese view pain as two causes. Firstly, from the blockage of Chi or blood to an organ or energy meridian which is called the "excess type of pain". Secondly, a deficiency of Chi or blood so the local organs cannot be nourished, which is called the "deficiency type of pain".

To establish the cause of the pain takes a lot of questioning about the location, the severity, the frequency, the accompanying symptoms. When the body is ill, it is due to weakness. If you can overcome the weakness, you get rid of the illness. If their system is weak - say, by eating poor food - you can heal them by improving their Chi. When the body is damaged by trauma or poisoning - not weakness - you must transform their body and energy thereby overcoming the damage. The body is one thing when it is growing and another when it stops. When the body is young and growing, damage can be corrected or re-grown. This slows in the mid-teens and stops by the time we reach our twenties. If no healing occurred, then older patients are suffering from the injuries of their youth.

Physiological

There are various levels of pain. There is a difference between "Oooh" and "ARRRRRRGH"! Get them to go where it is bearable. Working through a level of pain to just behind the next one. The patient should not feel any more pain than normal. Whenever it hurts, that's 100%. Come back to 70% and work slowly. Any trauma or injury needs increased blood flow to the area rather than movement. The nerves release the muscles, the ligaments must also release. A lot of emotional memories are kept in the ligaments so be prepared for the emotional releases too. The body retains trauma unless released. However, nothing is going to appear unless it was there before. We don't create this stuff with Tai Chi. Releasing tensions releases toxins as well. Ask "Are you comfortable?" otherwise the nerves will clench up. The purpose of nerves is to defend the body and that is what they are doing stopping you from harming yourself further.

Only make their bodies do what is possible, otherwise frustration will result. The body is a matrix which remembers what was 'normal' or healthy until it has been suppressed for too long. Keep your patients trying to remember what they were like, through these precise movements and thus bring the body memory back. Don't let it get suppressed or it will take a long time to release. Like wet cement - it gets harder. Get them to use smaller motions at first.

Release means

Muscles are soft, all the way to bone, but strong.

The joints are soft but strong and allow the chi and fluids to move between them.

Then the mind relaxes and has a sense of space. First your mind lets go, then your muscles, then your nerves, then and your blood. This is not the same as 'relax', which is an overused word in Tai Chi and becomes a sort of meaningless mantra. 'Relax' won't make the Chi flow, release will. They must learn the difference.

Psychological

I believe some patients allow themselves to become ill or in pain so that they can have an excuse to relax or be cared for. Contentious, I know! Often they are people who have cared for others all their lives and subconsciously I think they say "My turn now". In effect, they give themselves 'permission' to be ill, and thus don't fight it effectively. Encouraging them to give themselves 'permission' to get better and heal themselves, makes a great deal of difference to the way they treat their illness and their Tai Chi.

Some people hurt themselves on purpose, because they cannot do something perfectly. The achievers. This must be looked out for when teaching. Some pain-sufferers over-do it (not 70%), high achievers don't understand that their bodies don't work like their intellect does. It can't be pushed.

Sometimes illness is to get control over people, to get sympathy. I don't offer emotional support in these cases; I just get them from here to there.

We are never taught how our bodies work or feel, apart from classroom situations. I believe it is better to be alive with a few problems, than dead with none. Patients need compassion with themselves.

Practising Tai Chi results, often, in a release of emotions which - once done - will not happen again. They are emotions, not sensations. They are experiencing a body memory - it is not real. They must let the energy complete itself. Shaking is often a manifestation of these emotions being released, as is a feeling of faintness or nausea. It means the emotions are joining the nervous system at last. Even the organs join in! I explain this to the patient and don't let them feel ashamed or embarrassed. I just let them to lie on the floor and let it drain into the earth. Let it go. I don't analyse - I just make it easy for them to let go.

What can Tai Chi & Chi Gung do to help?

Attitude

I find patients have got used to relying on others for their healing. My first task is to instil in them the understanding that they can do it themselves. They do not have to go cap in hand (hence the expression handicap) to a doctor or therapist and say, "Help me!" With Tai Chi & Chi Gung they can have control of their own healing. Teaching them pain control or dissolving is essential to their well being and feeling of self worth. A common problem with the sick is they feel a 'burden' and have low self-esteem, so with Tai Chi I notice a marked improvement in their confidence and self-reliance.

Most patients have lost touch with their bodies - sometimes because it hurts too much. I try to encourage them to re-connect so they can find the root causes of their problems and assess them, then watch the changes. Babies can feel the insides of their bodies and all their organs; we can as well, if we try. We have just forgotten so "WAKE UP".

All Tai Chi exercises give feeling from numb to "I've got it!"

Assessment

I observe their vitality, how do they move? Is it slowly? Do they hold themselves in a way to relieve their pain, and if so, where? I watch them sit, and once seated, how they sit. Do they slump? Do they perch on the edge? Are they immobile or agitated? I note what is their build? A strong body indicates a strong constitution and strong internal organs. Therefore obesity will indicate insufficient Yang and excessive Yin and vice versa in thin people. A patient who walks with a bent back may be suffering from the common lower back problem. One who hangs their head may be short of breath. Difficulty in speaking indicates insufficient lung-chi and kidney-chi. Sitting with their head up may mean an accumulation of dampness in the lungs - and so on.

Then I look at the complexion. It should look shiny and lustrous, meaning vital and full of Chi. How do the eyes look? Red and puffy can be liver problem, yellowish means retention of damp-heat. I consider their joints. How much space is there between the joints? This often depends on the body type and flexibility.

General Health

We have health as a right. It is ours if we want it but we must not take it for granted. It must be worked for and as we get older, we get lazy. This is partially due to loss of Chi and so we get weak which causes loss of Chi and so the downward spiral goes.

I explain to my patients, young or old, to think of their pre-natal chi (this is the Yuan Chi that grows with us in our mother's womb and that we are born with) as a bag of gold coins, given by your parents for you to keep safe and used only in emergencies. From the moment of birth and as we continue through life, we have to create our own Chi or Zing Chi, mainly through food and breath, but also can be created through movement, sleep, meditation and sex. Unfortunately, we get ill or suffer trauma and our general health diminishes, so we may have to dig into our bag of gold coins (Yuan Chi) and spend some of it to keep alive. This lowers the level of this vital Chi and so unless we replace it via Tai Chi, Chi Gung, Tui Na or TCM, our general health drops again and so on. Eventually the bag of coins is empty and they pop you in a casket. I see a lot of people with nearly empty bags, because pain is an incredibly efficient way of emptying this bank account and spending your savings! And we don't have body credit cards in real life. Thus by improving your food intake, breathing properly and by taking this precise exercise, you increase your Chi and thence improve your general health and can then combat disease and pain more effectively.

Mental Health

A fearful, depressed person is feeling out of control, as if on slippery ice, therefore the physical balance of Tai Chi gives them balance in their minds as well.

However, stress is the killer. If your income = £1000 and you are spending = £2000 = STRESS!! Nearly all people of the West suffer from this killer and they can do nothing about it. Again, learning to breath properly and move correctly will restore the balance and eliminate stress.

As long as they do up to 70% of what they can do, they will recover their equilibrium, but at 100% they will go over the edge. People get addicted to working at 100% and then can't bend or open. Over 70% the nerves will not relax and stress occurs. I have patients who have damaged themselves in this way. It takes years to release your body again.

Breathing

The key to all Tai Chi and Chi Gung and in self-healing in general, is the breath. I get my patients into breathing exercises right from the start. Begin with breathing in the belly. All Westerners breathe with their shoulders, i.e. the top of their lungs, which is about 30% capacity. Keeping their chest still and filling and emptying their bellies with air have numerous benefits. Firstly, the downward motion of the diaphragm creates pressure in the lower cavity (belly) and gives a gentle massage to the organs. Secondly, this pressure squeezes the blood out of the organs and therefore, increases the blood flow and Chi movement. Thirdly, it lengthens the lungs downward and makes more air accessible to the body. The forward motion of the ribs in chest breathing does nothing.

Eventually this correct form of breathing will connect with the kidneys and even the spine, stimulating them both. I always use the analogy of us being given only a certain number of breaths in life, and if you breathe shallowly, and therefore quickly, you use them up faster.

The breath should be Long, Slow, Smooth, Relaxed, Soft, Circular.

Breathing goes to Hell when you are seated. It causes a big build up of Carbon Monoxide because the air is not circulating in the whole of the lungs. The lower two thirds stagnate and stale air is dangerous. You are in effect, poisoning yourself very slowly. Energy levels drop. Hence wheel-chair patients lack of stamina. I get them breathing.

Poor breathing creates emotional states. If you try breathing shallowly or puff for a minute - it causes anger. Breathing controls the glandular system, therefore moods. Mood swings can be controlled through the breath. Your breath can make you a prisoner or free.

Movement

Movement In all exercise systems comes from a muscle contracting and the opposite relaxing. Not so with Tai Chi. There must be no counter muscle work. I encourage patients in the 70% rule and keep all movements well within their capabilities. This way the nerves begin to say, "Hey, this is okay - I can manage this and I'm not being pushed or hurt" and they start to relax. With relaxation comes an improved blood circulation which means nourishment getting to the pain sites and this, compounded with the work of the Chi, will begin the healing process. I don't promise them miracles but a chance of miracles. Again, it depends on how much they are prepared to put in, as to how much they will get out. Anything is possible.

I work on the lower body techniques before the upper body. Like building a house - get the foundations right first. First Sessions begin by explaining that you are not teaching them anything, you are reminding them of something they already know. When babies, they moved and breathed perfectly, but as we get older - due to misuse, abuse or illness and trauma - we begin to develop bad posture and breathing habits. So, teaching them to stand correctly is essential. It is perfectly all right to sit in this manner as well, so wheel chair bound patients can join in too.

I get them to tuck their bum against the seat, where it joins the back, and then tilt the upper body back so it is vertical and gets proper support and doesn't slump. Once they can stand/sit comfortably for five or ten minutes in this manner, you can progress to simple movements. With standing patients I suggest the weight shifting exercises are the best strengtheners. If balance is poor, allow them to hold on to a chair with four fingers, then three, then two, until they can do it unsupported.

However, seated patients must be encouraged by getting them to press with their feet one at a time. This simple pressure on the ground or even on their footrest of the wheel chair will tilt the pelvis and straighten the spine. It will also work the muscles of their legs. Once they are capable of balance and weight shifting, rotating at the Kwa or waist will stimulate the energy gates in the groin as well as the lymph nodes, which are in abundance in that area. Finally a simple silk-reeling movement with the hands will incorporate the upper body. Do stress, however, that the elbows must be pushed as far away from the spine as is comfortable. Always impress on them the 70% rule and stop before the pain kicks in, otherwise the nerves will panic and seize up. The nerves cannot relax if they are afraid. Tell them they must never lock a joint. This means open and closed. A joint when locked is at 100%, thus the fluid/Chi pumps stop working. You cannot activate your spine and will lose the sinovial fluid flow.

Second level

Begin with small rotations, first of the shoulder. I get them to imagine they are drawing a little circle on their thigh with their fingers. This will loosen their shoulder joint as well as their scapula and neck muscles. These are often tense due to pain and stress. Once these are opened up, the Chi will flow through and go to the arms.

Teaching

You should shift your patients from the "How many movements can I learn?" - which is a great BUY-BUY consumerism way of Western thought. They are not shopping, they are not a consumer. The faster you get them out of their heads and into their bodies, the happier they will be.

The eyes see but don't interpret, the brain interprets and usually wrongly! That's why we all see the same thing differently. Patients tend to drop out because of this problem. So, this is why it is vital to use partner exercises. Not only for the pleasure of interacting with fellow sufferer but a partner helps correct us by having another 'model'. I suggest you try saying 'front and back' rather than 'left and right'. Most patients can't tell their left from their right!

And finally remember the 70% rule.

The Energies in Tai Chi and how they heal

There are four basic energies in Tai Chi. All the postures develop one or more of them.

Ahn - causes the blood vessels to contract. Good for the kidneys, gently though, not too much

Ji - makes blood move away from the heart - arterial. Good for the liver. Release it, not excite it.

Pung - causes blood vessels to expand and encourages blood flow away from the heart. Good for all blood circulation.

Liu - returns the blood to the heart. Again, good for the circulation.

All these energies move and pump the blood. They are all good for the nerves and lungs. All postures that move the arms above the head are good for the heart. Raising the spine and sinking the chest is also good for the heart. When blood stagnates Chi stagnates and over time will cause illness. The patients must see that physical movement encourages the blood to move and thus the Chi and body fluids, bringing healing to their bodies. Nerves, Chi and blood flow slows down as we get older, so Tai Chi helps older patients to get it working again.

Working with the body

One side of our body is always more open than the other, we're always one-sided, especially when in pain. So, I teach the patient to move only as much as the weakest side, that is to say, use the weak link as a guide. People ignore their weak sides to increase their strengths. This is okay for making money or getting grades in exams, but bodies are different. You can't play to your strengths. If your body is damaged or in pain, you've got to live with it.

Say you notice a 70% strength or range of movement on their left and 50% on the right, this could be due to their illness or damage. So, I change them to working 50% left and 50% right. I lower their work rate to their weakest side. Once they can cope with that, I move them up to 55% on both sides, then 60% and so on.

If you are damaged or ill and work to the strongest side, the strong side will pull energy from the weak side. Doing the reverse, the weak side will pull energy from the strong side, thereby healing faster. This is the law of the body NOT the law of society, which is "play to your strengths".

Chi flows naturally on the dominant or strong side so look for a 'weak' or 'dead' hand. Both sides should eventually become even.

Remember, any soft tissue - muscles, veins, nerves, tendons, and fascia - moves. They twist, stretch, release. The bones do not move - they turn a bit but don't twist. They are best at being hinges, therefore vertical pressure is very good for them.

Soft tissue damage is usually in sections, some parts are okay, so try to get all the damaged bits together. This will show in uneven or jerky movements. I aim them towards smoothness. For example - bad knees. When your knee gets hurt, it will disconnect from the rest of the body. All 'cables' - ligaments, tendons, muscles, kwa and even the spine - pull on the knee, so when damaged or arthritic the whole system can be affected. I help patients to adjust their bodies to cope with the problem area. Working from the weakest part.

Find something that can be fixed, and fix it, which may cause other things to happen. You may not get to the original cause because it is being covered up by the secondary faults. You may have to get rid of these first, then get to the main problem.

Brian Cookman

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