Tai Chi for PTSD A Rational:
Tai Chi For Health Can Decrease Stress, and Improve Functional Outcomes for Post Traumatic Stress ( PTSD )

by Dr. Paul Lam and Jef Morris, Master Trainer

On our many visits to the Miami Veterans Health Care Center, we recognized the overwhelming needs of this population and became very interested in a collaborative effort for physical therapists to care for these individuals.

The Veterans returning from the wars in the Middle East pose many post traumatic stress related and physical mobility challenges for physical therapists involved in their care.

One of the keys to effective outcomes for these clients may be the incorporation of modified Tai Chi exercises to help to effectively manage the time spent in rehabilitation, to re-focus these clients in the tasks at hand in spite of stress, pain, stiffness and fatigue.

Dr. Paul Lam, a family physician, in Sydney Australia, suggests Tai Chi practice will lead to better health and harmony. Health means improved balance, flexibility, strength and fitness or cardiovascular respiratory functions 1, 2, 3, 4, 5, 6, as well as improvement of mental concentration and reduction of stress.

Dr. Paul Lam, lives with Arthritis, and is a Tai Chi gold medal winner. Dr. Lam created the Tai Chi for Health program over 10 years ago. Today, Dr. Lam, and his team of Master Trainers, have certified more than 8,000 Instructors, in 11 countries.

Dr. Lam's Tai Chi for Health instructor certification workshop series provides the foundation for our program. For more information visit Dr. Lam's website: www.taichiproductions.com

Dr. Lam's collaboration with physical therapy and Tai Chi for Health requires an understanding of the Tai Chi modified exercises, the health benefits, and the effectiveness of Tai Chi exercises.

The key to effective outcomes is in the application of the Tai Chi movements, in the method of teaching, and how the physical therapy client learns.

Tai Chi For PTSD: A Rational

Tai Chi originated from ancient China as a martial art. Most of its forms are slow, with continuous, circular movements while maintaining a greater sense of balance thorough out the sequence.. To move in this way, one moves from a state of balance, and transitions to another state of balance. When the essential Tai Chi Principles are applied, the focus shifts to a greater awareness of one's posture, breathing, and perception of the moment to articulate each joint and to move in harmony 7.

To practice the art of Tai Chi, the client learns how to progressively relax. In general, one of the intentions of Tai Chi exercises is to move the body in such a way the clients mental focus shifts from random thoughts to focus on how to relax their muscular skeletal structure, to maintain a sense of balance both mentally and physically.

Combined with the breathing control, clients' breathing pattern shifts to a deeper state, which induces a chain reaction of the nervous system, the brain functions, and the hormones of the participant.

Consistent practice of the Tai Chi can improve the strength and flexibility of the body, while dispersing mental activity for moments of time to relax. This window to relax, and to simply focus on what you are doing, while you are doing it, creates a foundation to increase one's ability to focus, and experience calmer physical states.

Tai Chi Benefits for PTSD Tai Chi practice leads to better health and harmony. Harmony means a better self-perception and self worth, and a more balanced mental state or a sense of serenity.

Studies have shown Tai Chi not only decreases self-assessment scores of these cognitive emotions (anger, depression, anxiety), but also increases a subject's confidence in balance and movement. Another important effect of Tai Chi is its training of the mind 5. Tai Chi improves relaxation as well as mental concentration, to facilitate a positive mental attitude 8, 9, 10, and relaxation.

Tai Chi achieves this through applying its essential principles, by controlling the movements to be slow, continual, together with precise body co-ordination, posture and breathing. All this leads to mental focus or being mindful in the terminology of Tai Chi body, mind and spirit integration.

3 Keys to Effective Tai Chi Collaboration

Dr. Lam recommends to apply Tai Chi Essential Principles to collaborate with physical therapy, there are three key aspects to consider when planning your sessions:
. safety;
. efficacy
. adherence

Safety If the physical therapy client becomes injured as a result of the session, it would not have benefited either the client or the reputation of Tai Chi. This is why you need to know what type of clients will benefit from Tai Chi. Dr. Lam has outlined safety precautions for the Tai Chi for Health program in his book, Teaching Tai Chi Effectively.

Efficacy Almost all Tai Chi studies are focused on confirming its health benefits. What you going to teach, how you teach it, and over what period of time are crucial.

Allow half the session time for learning new movements, and half of the session time for practice and consolidation. During the learning phase, people are moving slowly and often clumsily. They cannot gain much of Tai Chi's benefits because they are not yet doing real Tai Chi.

The great health benefits of Tai Chi come from following its essential principles, such as moving smoothly, being well-balanced and having a serene mind. You cannot achieve these during the learning phase. Plan your sessions so that there is adequate time to practice the movements, so that the subjects can gain health benefits, strength and flexibility.

Allow adequate time to teach the exercise movements well. If you try to cover too many exercises and rush through your teaching, you will get worse results rather than better. It is better to learn fewer movements, and practice them regularly than learning many exercise movements poorly.

Different health benefits may take different periods of time to generate. For example, for people with arthritis, two separate studies 11, 12 have shown that 3 months are required to deliver the benefits of less pain, better ability to perform daily activities and better balance.

When measurement was done after 6 weeks, no benefits were recorded. Health benefits like cardiovascular fitness, diabetes control and problems relating to chronic conditions may take even longer than 3 months. Therefore, studies with longer duration may have a much greater chance of demonstrating the many health benefits of Tai Chi.

Adherence

Dr. Lam advocates facilitating enjoyment leads to adherence. "If people don't enjoy doing something, they will soon stop doing it." Helping clients to enjoy their Tai Chi and its benefits are very powerful motivators for adherence.

For those of us who are enthused about Tai Chi, practicing Tai Chi gives us a wonderful feeling in our body and mind. Tai Chi intrinsically is an enjoyable exercise/art/sport. It is this enjoyment that urges us to practice and to share our enthusiasm with others.

Dr. Lam finds it helpful to tell beginners what to expect:
"I tell them that Tai Chi is very different from the western sports and lifestyle they are used to. Most western sports emphasize fast and strong movement in a straight line and, in our modern world, we often move too fast, and are always looking for short cuts to make it quicker.

With Tai Chi, we move slowly, and in a curve instead of a straight line, because these ways bring us back to harmony with nature and our body.

I tell beginners that Tai Chi is so different it will take them time to get used to it. I ask them to allow themselves and their teachers time so that they can get used to Tai Chi. I tell them that most people will become comfortable with it in three months and stress the enjoyment and health benefits they will get out of it if they persevere.

I want them to understand, without actually saying it, that if they do not achieve what they expect, in the time they want to, it is not their fault, it is the nature of the art. I also help them to appreciate and cherish any progression they have made.

Sometimes they don't see the benefits of exercise immediately, so if the teacher, or physical therapist, can help them understand how Tai Chi works to improve their health and why it takes some time to produce results, this could help them to stay in the class. It is our experience that most people will stick with Tai Chi if they keep coming to classes for around three months or more.

Many studies have shown the health benefits of Tai Chi after just three months of practice, which should provide more incentive for the clients to stay. When they know what to expect, they are less likely to feel incompetent and give up. Give them a goal and a time frame to help them to persevere with Tai Chi."

REFERENCES

1 Wolf SL, Huiman X, Barnhart, Kutner NG, NcNeely E, Coogler C, Xu T and Atlanta FICSIT Group: Reducing frailty and falls in older persons: an investigation of Tai Chi and computerized balance training. J-Am-Geriatr-Soc. 1996 May; 44(5): 489-97.

2 Song, R, Lee, E-O; Lam, P; Bae, S-C: Effects of Tai Chi Exercise on Pain, Balance, Muscle Strength, and Perceived Difficulties in Physical Functioning in Older Woman with Osteoarthritis: A Randomized Clinical Trail The Journal of Rheumatology; 30(9), pp 2039-2044, 2003

3 Li, J.X; Hong, Y; Chan, K.M: â?oTai chi: physiological characteristics and beneficial effects on healthâ? British Journal of Sports Medicine; 35, pp 148-156, 2001

4 Wong, A.M; Lin, Y-C; Chou, S-W; Tang, F-T; Wong, P-Y: Coordinated Exercise and Postural Stability in Elderly People: Effect of Tai Chi Chuan Archives of Physical Medicine and Rehabilitation; 82, pp 608-612, 2001

5 Hong, Y; Li, J.X; Robinson, P.D: Balance control, flexibility, and cardiorespiratory fitness among older Tai Chi practitioners British Journal of Sports Medicine; 34, pp 29-34, 2000

6 Jacobson, B.H; Ho-Cheng, C; Cashel, C; Guerrero, L: The Effect of Tai Chi Chuan Training on Balance, Kinesthetic Sense, and Strength Perceptual and Motor Skills; 84, pp 27-33, 1997

7 Dr Paul Lam and Nancy Kaye, Tai Chi for Beginners and the 24 Forms, published by Limelight Publication 2006

8 La-Forge-R: Mind-body fitness: encouraging prospects for primary and secondary prevention. J-Cardiovasc-Nurs. 1997 Apr; 11(3): 53-65

9 Kutner-NG; Barnhart-H; Wolf-SL; McNeely-E; Xu-T: Self-report benefits of Tai Chi practice by older adults.J-Gerontol-B-Psychol-Sci-Soc-Sci. 1997 Sep; 52(5): P242-6.

10 Jin-P: Changes in heart rate, noradrenaline, cortisol and mood during Tai Chi. J-Psychosom-Res. 1989; 33(2): 197-206. Jin-P: Efficacy of Tai Chi, brisk walking, meditation, and reading in reducing mental and emotional stress. J-Psychosom-Res. 1992 May; 36(4): 361-70.

11 Choi JH, Moon JS and Song R, The effects of Sun-style tai chi exercise on physical fitness and fall prevention in fall-prone adult. Journal of Advanced Nursing, 2005, 51(2), pp. 150â?"157.

12 Albert Bandura, Self-efficacy: The exercise of control, WH Freeman and Company, New York, 1997

13 Alexander Voukelatos, A randomized, controlled trial of tai chi for the prevention of falls: The Central Sydney Tai Chi Trial, JAGS 55:1185- 1191, 2007