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The content displayed in this transcript is the intellectual property of Patricia Lawson. You may not reuse, republish, or reprint such content without written consent. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by OA Action Alliance, Tai Chi for Health Institute, CDC/HHS, or the U.S. Government. This transcript was automatically generated in Zoom, and edited for clarity; however, the OAAA cannot guarantee there are no mistakes or errors.

November 17, 2021

Title: Walking Through Water: Tai Chi for Arthritis for Fall Prevention

Presenter: Patricia Lawson, M.S. Ed

Master Trainer, Tai Chi for Health Institute

INTRODUCTION

(Katie Huffman) Hello, and welcome to the Osteoarthritis Action Alliance Lunch and Learn webinar for November 17 2021, thank you for joining us this month, our presenter today is Pat Lawson, a formal martial artist and second degree black belt in shaolin Kung fu pat has been practicing TAI Chi since 1992. Having worked with Paul Lamb since 1999 and a current and currently a master trainer for the TAI Chi for health programs he designed, Pat also offers a variety of TAI Chi classes, including TAI Chi for arthritis TAI Chi for arthritis for fall prevention, TAI Chi for rehabilitation, TAI Chi for heart conditions, TAI Chi for back pain TAI Chi for diabetes, TAI Chi for kids, TAI Chi for life, and TAI Chi for energy. Pat has served on the coordinating Council, the state of Florida arthritis partnership and is a past president of the TAI Chi for health Community a nonprofit USA organization seeking to improve the quality of lives through TAI Chi for health programs. Before I turn it over to our speaker, I want to mention that she will be switching between her slides and video camera so that she can demonstrate some of the TAI Chi movements. For those of you watching live, you may want to adjust your zoom view so that you are in speaker view rather than gallery. To do this, there is a view icon in the upper right-hand corner of your screen, where you can change the view settings to speaker view. Now I’d like to welcome Pat Lawson who will be presenting walking through water TAI Chi for Arthritis for Fall Prevention.

PRESENTATION

(Pat Lawson) Thank you so much, and I’m so glad to have an opportunity to share a little bit about this program. I am passionate about it, it has helped me so much managing my own symptoms of arthritis and I just can’t say enough about the program you might be sitting there wondering why walking through water, what does that have to do with TAI Chi for arthritis and fall prevention? Well that term ‘walking through water’ brings up for me an image of having to push through, and there are days with my arthritis where I feel like I have to push through. It feels like an effort, if any of you have walked through a shallow lake or walked in the water on the beach, you know what I’m talking about. The water creates a resistance. Well, moving as if against a gentle resistant, but not to the point of is a basic principle of TAI Chi and we’ll talk about it later on. It’s not meant to be uncomfortable at all, but it does join the mind and body together to coordinate with the movements as well as all kinds of good benefits like better lymphatic flow and better blood circulation in and around the joints. The mind is very powerful and if we imagine that we’re moving through the water or walking through the water, the TAI Chi is even better. That’s why I titled this walking through water. But let’s begin with an overview of what is arthritis, since it’s TAI Chi for arthritis and fall prevention, and I know that you all, probably have a better grasp of this than I do, but basically you don’t have to know a lot about it to teach this program nor to do it. Arthritis is inflammation in and around the joints and there are over 125 types of varying degrees of severity, so only a professional could be up on all of those details and all the specific effects and symptoms of arthritis.

It is estimated that one out of every three people I know in Florida, and I have read it for other states to one out of every three people probably have arthritis whether they know it yet or not. Sometimes they just attributed to old age or “I’m stiff in the mornings”, but if they are tested or checked in a medical way one out of three would come up with arthritis.

People with osteoarthritis are at a high risk of injury due to a fall higher than people without osteoarthritis, in addition, they may be more likely to have a fall. So, falls are really big problem related to arthritis and it could be more severe, as well as more likely, and then there are some other problems of arthritis in addition to falls. It could be pain, stiffness, fatigue, difficulty with activities of daily living, medical expenses, depression, lack of socialization, isolation and, if you look at the list, this is a really only a partial list it could go on. But if you look at this list some of these feed into each other if you have pain you’re probably not sleeping well you’re going to be more fatigued and pain itself makes us more fatigued. If you’re stiff that’s not going to help with this, it’s going to be harder to get through the activities that you need to do every day. If you’re having trouble sleeping you’re having trouble getting through your day you may not want to go out, you might not want to be with a group, maybe you can’t keep up with the group activities. Meaning you may have a lack of socialization, and that leads to be more depressed and feeling more isolated and all of these will contribute to higher medical expenses. So, there’s a whole cyclical set of problems and unless we can break the cycle along the way, break the pain part or break the stiffness part lessons some of these symptoms it’s hard to improve any of them. One out of every three people over the age of 65 fall each year that’s according to the CDC and on the CDC website, they have down. They counted 52 million older adults 65 and over there were 36 million falls and 8 million injuries from those falls.

They’re estimating in 2030 73 million older adults 52 million falls and 12 million injuries, the medical expenses per fall are very high, and this is to me a staggering statistic. The medical costs due to non-fatal injuries is 50 billion, and what really alarmed me on the CDC site medical costs related to fatal falls, what I just hadn’t stopped to think about is fatal falls cost $754 million, a very high medical cost, and this is in one year.

Falls are the leading cause of injury in older adults and balance exercises, moderate intensity muscle strengthening, and moderate intensity walking can reduce fall rates by up to 30%. Interestingly, the first time we fall the injury rate is not that high it’s relatively low because we’re caught by surprise, we don’t have time to tense up. The second fall is the whopper, and the injury rate is much higher, often requiring hospitalization. People with arthritis have an even higher risk of injury the CDC and 2014 issued a statement saying, the only thing more effective than TAI Chi exercise is an individual appointment with a PT. So, we know that moderate intensity muscle strengthening exercises and moderate intensity walking-both of these are part of TAI Chi. In addition, the CDC studied all of the research out there on TAI Chi, and our program is in more than 30 studies that have been published in medical journals. They came up with the statement that the only thing better is individual work with a physical therapist, and they have never come out with a statement naming any particular type of exercise for any health benefit before.

Another interesting fact is that fear of falling is the biggest contributor to false once people fall, the first time, when they’re caught by surprise. As I said, injury rate not too bad, but what happens is they’re afraid of it happening again. That not only leads to stiffening up upon the fall and injury, but it also makes us more prone to fall because we’re not walking as naturally and as relaxed where we’re anticipating a fall. So, the jump that conclusion of in some of the studies is that, therefore, if people undertake an exercise program like TAI Chi for fall prevention that is evidence based and shown to reduce falls, just the fact that they’re taking it and know that it is effective ought to make them less likely to fall. That is really interesting to me it’s almost like you just have to be there and believe. Of course, is better to be fully committed and be doing the exercises. But the researchers feel that just being in the class will reduce the fear of falling, and that is the biggest contributor so you’re eliminating that or decreasing it.

So, what is TAI Chi anyway? Sometimes people ask me how much wood break or they say “I can’t do that, I can’t break wood”… but that’s a different martial art, that’s taekwondo. TAI Chi is a very soft gentle exercise, it originated in ancient China from a need to preserve self-Defense techniques, as well as improve health. And the fighting monks, when they lost and were overtaken by invaders, had to keep up practice but hide it and do this slow motion. The invaders thought it was a dance they were doing, like a slow motion dance, but they were actually improving their health, lining up energy points according to traditional Chinese medicine, as well as practicing some sequences that if done quickly could be used in self Defense today. We practice it mainly for health, and Dr. Lam the designer of TAI Chi for arthritis and fall prevention likes to point out that in ancient China, the biggest threat to people’s lives was being robbed on the road killed by a brig end or killed in battle or by an invading force. Today, the biggest threat to our lives is inflammatory disease chronic conditions, but Tai Chi is still being used for self Defense, we’re just defending ourselves against these environmental onslaughts and what’s happening in our own body. It’s important to know that there are different styles of TAI Chi and you sometimes see it written out as Taiji or Tai Chi Chuan. There’s five major style, so, if you just go online and Google it a lot is going to come up some are older styles that are a little bit more rigorous or a lot more rigorous, some have very slow slow weight transfers, so that the joints like the hips and the knees bear the weight for a longer period of time before it’s transferred to the other leg. So, these are not necessarily the best for people with arthritis, of course, it all depends on the individual, but in general, Dr lam chose this style as being better for most people with arthritis because it has some qualities that make it work really well. I’ll get to those in a minute and it’s very rich in internal energy work that is shown to reduce inflammation. Some word of caution that you will see TAI Chi presented all different ways. In general, it has been shown to strengthen muscles improve balance reduce inflammation and improve our sense of well-being.

The TAI Chi for arthritis for fall prevention program was designed by a team of medical experts, as well as TAI Chi experts Rheumatologists. MDS physical therapists all participated with TAI Chi experts to design the program and handpick movements. Sun style was chosen, because it has a higher stance and what we call a follow step and I’ll show you what I mean in a minute. It’s very rich and contains breath and movement to cultivate our energy and some Wu Tang who designed some style in the early 1900s. It was designed specifically for health prior to that time the TAI Chi forms were written in order to preserve fighting techniques, but to do them slowly and help health. Sun Lutang, who created this program, was all about health, he was a martial artist who turned 50 and realized that he had to do something for his health. So, it’s very rich in energy work according to traditional Chinese medicine. It’s easily adapted to different levels of ability, it can be done seated It can be done in a wheelchair, it can be done if you’re using a Walker, and it can be done in and out of the chair. People can move freely, if they get tired or feel anything uncomfortable, they sit down and continue upper body, as long as it’s comfortable. It is evidence based and more and more research coming in. It seems like every month, there is another published study. It is short, simple to learn, and it has a lot of depth, so people don’t get frustrated learning it. My first TAI Chi form in a traditional school took me three years to learn, it was 108 movements. But this is only 12 movements, and yet it has a lot of depth, so as people get comfortable with the movements. We can talk more about deep breathing coordinating breath with movement relaxing letting go of inner tension there’s always more to look at in TAI Chi.

Before I go on to the next slide I’d like to show you what I’m talking about. Some styles having a longer slower transfer of weight and salute tangs use of nimble footed TAI Chi and lively step, so if you stay on speaker view I think and I’m going to stop the screen share. So, the most popular style meaning practiced by the most people in the world is yang style and it is the one you see most often in TV and films right now. It’s just been around longer and in the 1950s China required it of all people. It was the National Health Insurance program. They knew that if people did it every day, they would stay healthier so the government required this from the youth up. The yang style stepping involves putting all the weight on one leg, then move the other leg out and slowly, slowly transfer the weight. Then, take the weight off the front foot are the other leg out I’m holding, holding, holding on my left, and now I transfer the weight. So you can see that this is an even pace, but it’s slow and there is a value placed on working low to the ground.

Suddenly Tang said we don’t have to work low to the ground, he realized energy arcs can be this way, but they can also be this way. So, his design was an upright techy with no value on being low to the ground. In fact you’re not supposed to go low at all because it can increase inflammation. His full step is putting the weight on one foot, briefly, while you place the next and then bring it and settle, and bring the other one and settle. So, you can see that this is at a faster a little faster pace and i’m not holding the weight. Then you take a nimble step one foot ahead, the other one just comes right away under my hip but doesn’t catch all the way up. Now I have stepped back in a very nimble way. I tell people I think about Happy Feet, the penguin movie where they’re tapping their feet all the time, as this movement stimulates the soles of the feet. It’s good for people with neuropathy it moves limph up from the feet, nothing else pumps, the limph but our muscle movement so it’s good to keep stepping and to use this nimble footed idea. Either half or full step is very good for people with arthritis, we don’t have to strain our knees, and it is a hallmark of the Program.

Now, I am going to go back to the slides. Alright, so we know that it’s going to strengthen our muscles improve balance reduce inflammation. And we know that this particular program Tai Chi for Arthritis for Fall Prevention (TCAFP) uses an upright posture and since dial in general, upright posture. In TCAFP we do step in all directions, we step forward, we step back when we step to the side and it’s a lively step. People who are unable to handle the stepping right away or ever we can easily modify it for Chair or Walker. And we can still work some muscle toning in the chair, we teach how to do that in the instructor training we want people to stay keep their muscles as strong as possible and support those joints. Let’s see what were those problems that I mentioned earlier, the problems of arthritis, pain, stiffness, fatigue, depression, medical expenses, and lack of socialization. What this program has been shown to do is reduce pain, relief stiffness, and improve sleep, and give people a greater sense of well-being. It can be done in a group-it’s not a contest. Everyone works to their own standard, but you get to be in a group of people with a shared interest in something to look forward to, so it’s an opportunity to get out and socialize. And all of that could reduce medical expenses. It all depends on the person and their doctor and we do refer people to their physician and healthcare professionals. We don’t get involved in any medical questions diagnoses or treatments, but this certainly has been shown to help reduce the problems of arthritis and the symptoms that we deal with.

If you’re doing Tai Chi movements, but you’re not applying the principles it’s not TAI Chi. That’s pretty much what the old classics say, that you could be doing any movement, maybe it hasn’t been written into a form, yet, but if you’re applying these principles, then it’s TAI Chi. These are what make TAI Chi TAI Chi. There are six major principles, two are for body structure, one being keeping supple and upright in posture. In Tai Chi we get used to where our perpendicular axis is in relation to the surface of the floor, or the earth, we like to stay upright. Second, we’re very conscious of weight transfer, even though it’s a nimble foot a nimble step we put it in place, but we make sure the floors there there’s no lumps bumps holes, then we commit the weight. And that’s practiced over and over again, as we practice the movements we’re building our awareness of where is the Center of gravity, for me, where are my feet and can I get my Center over my feet safely great for fall prevention. There are two principles that are about controlling the movement, keeping outward movements slow smooth continuous is the rule. So, no jerky or sudden movements, and that is often when people are thrown off balance so the mindful aspect of moving slow smooth continuously really supports fall prevention. And, moving as if against a gentle resistance this integrates the body and mind and it integrates keeping our posture in the right place, while we exert a little bit of force in the proper way without taking dangerous risks or moving dangerously moving as if underwater.

So these are the first four principles and then five and six are internal meaning they have to do with inside instead of outside. And they can’t easily be seen. The first one is in Asia called Song and Song means to loosen the joints from within and release the inner tension around each joint trying to let go let go of stress. Even this enables the fluids to lubricate the joint better and improves the condition of arthritis it includes reducing perception of pain and improving flexibility.

Song was a hard one for me to grasp, because I didn’t know why I would want loose joints that was how I was thinking of it loose joints it sounded like a broken doll you know when a doll’s arm won’t stay in the socket. But after I learned more about it through the physical therapists who know all about this, it helped me a lot with my TAI Chi and with my own arthritis. It’s not as esoteric a concept as it might seem. Sitting right where you are keep your shoulders, where they are if there’s a chair back and you feel it keep your shoulder on the Chair back and just raise one arm and imagine you’re in a jail cell unfairly and you have to escape and there’s a key, on the other side of the bars, but you can’t quite reach it and you can’t move your shoulder and you’re going to try to make your arm just a little bit longer and reach out. Do you feel that? Just a 16th of an inch more in your shoulder a 16 inch in your elbow a 16 inch in your wrist in each digit of the finger just a little longer. You can gain some length. That is joint loosening, just letting go and opening up letting the tendons and ligaments be a little more supple around the joints.

Jing is the sixth one, mental serenity, or focus on the moment being aware, but calm and it always with this one, I always think of a Jackie Chan movie. Where he’s running through a crazy scene every one of his movies, the bad guys are after him and everything looks really horrible like he’s going to lose in one scene, like a crowded hotel kitchen. And the bad guys are throwing pots Adam and Jackie Chan just make straight for the exit very calm running as fast as he can and blocking so he doesn’t get hit, but his mind is on where he wants to go and he gets there brushes off his suit and usually moves on to the next scene. To me, that’s jing, you’re not in a daze you’re not in a meditative trance but focused on the moment aware of what’s around you but very serene and accepting. Life is flow and TAI Chi is based on natural principles of life and harmony that everything is in motion, everything is seeking balance but as long as there’s life. There will be perfect balance because that’s what life is it’s the flow it’s the ups and the downs, and if we can just go with it and not fight it will be better off for it.

So those are the six principles, and you can see how these are really good for balance and fall prevention, knowing where we are in space where’s the Center of gravity being upright. Knowing where our feet are hitting the floor, and is there a whole they’re moving slowly smoothly not too harsh quickly or rashly falling into our step that’s how some falls happen releasing in our attention and staying really focused on the moment.

There was a large study done out of Australia on falls and fall prevention and they found that one of the riskiest activities with hanging the wash on the clothesline. And they noted it in the study results, specifically, and they said what was happening was that people were hanging their washout. But someone would call them or they’d be distracted by something happening outside turn their head move quickly whatever trip over a laundry basket of clothes pin bed walk into a clothesline and so much so that it showed up in their studies as a major risk. Jing would help with that whatever we’re doing if we can stay focused on that and stay calm and serene and mindful, it will contribute to better balance and fall prevention. Oh, and my favorite part of TAI Chi is that nothing should hurt. This is one of my classes and people have a variety of conditions here from arthritis through Parkinson’s through MS (see picture). But nothing should ever hurt, we don’t work through pain that’s a Western concept, “no pain, no gain”-if it doesn’t hurt you’re not getting any benefit. Not in Tai Chi, Tai Chi is based on Chinese medicine and the caveat is if it hurts it’s going to draw inflammation to the site so let up, you know, don’t do that movement, make it smaller. It’s enjoyable it’s fun, we all like it, and we feel better afterwards.

So, I’d like you to try the movement that we’re doing in this picture. And I don’t have to get up because we’ll do it seated. It’s an example of how these can easily be done seated as well as standing so if you’re seated comfortably feet on the floor back straight and just pick up both hands in front of your sternum about as wide as your face, open to shoulder wide and then close to face size. Breathe in and open. Exhale and close. Let’s do it again. Relax your hands. So, I want to say, it really is just shoulder wide to face wide more is not better-sometimes people think bigger is better. If you go too wide, the centers of your palms will not be facing each other, and in TAI Chi we learned the movements that we learned because they connect energy, so this move should be connecting energy between your palms…but if they are too far apart, you get away from this.  And as you breathe, then think of your rib cage expanding and breathe out let it relax so let’s do three more. Relax (repeat above). It’s called open and close hands, and it is the second movement in the sequence, and it repeats a lot through the sequence of 12. So that one, do anytime that you need to relax reducing anxiety or want more oxygenation it’s really helpful during these coven times to increase oxygenation into the lower parts of the lungs. So when you expand your lower abdomen breathing in and then squeeze it breathing out you’ll get deeper into your lungs and the respiratory therapists are using those exercises in their practice now to.

We do have a support system for TAI Chi for arthritis for fall prevention and all of our TAI Chi for health programs. TAI Chi for Health Institute is an international nonprofit setting standards and supporting the trainings and the spread of these programs https://taichiforhealthinstitute.org/ lots of free articles research. Tons of good information is available on that site, so I highly recommend it. Our instructors are certified for two year periods, and then they have to renew and this gives us an opportunity to update, to check in with them and, if anything has changed, if there’s new information indicating that a movement needs to be modified, were able to reach out to all the instructors and make sure they’re understanding that. They join the Institute for annual memberships but their certificates are good for two years and that’s a good thing keeps us all in touch and we develop a relationship. There are 26 master trainers in the United States, and I believe we have almost 80 senior trainers in different regions with senior trainers support the work of the master trainer and offer ongoing trainings for instructors we call them skilled builders and we have over 800 instructors around the country. So, we have a large network, but we have a support system built in for them in addition us GCC also supports instructors in North America with webinars scholarships, etc, it is a separate membership it’s not part of the Institute, it is a 501c3 and they do some really good work. There are annual week-long trainings, there are weekend trainings, and there are skilled builders so there’s lots of opportunities for people to continue on whether there were a student and instructor or a trainer. And my email is up here to feel free jotted down any questions put them in chat and, if you want to get in touch with me do keep my email. taichilawson at gmail.com

QUESTION & ANSWER

(Katie Huffman) Thank you so much Pat, that was lovely. Thank you for sharing your passion for TAI Chi and also sharing a lot of really helpful information about TAI Chi for arthritis for fall prevention. I really enjoyed the practice, so thank you for your time and for your expertise, if anyone has any questions I know we’re a little past our time but feel free to type your questions in pat has agreed to stay on the answer any questions for those of you who have to hop off, you can check the recording once it’s available. So we’ll look for some questions.

QUESTION: In the meantime, I was wondering pat if you could tell us how to know, like if you Google TAI Chi for arthritis a whole lot of different resources come up, how do you know you’re getting the real deal, how do you know what’s safe and appropriate for people with arthritis?

ANSWER:(Pat Lawson): That’s a great question because there’s so much out there, and if people are doing competitive TAI Chi for forms it doesn’t mean it’s not real TAI Chi it just might not be for us, I don’t do that anymore. I needed for health, so if someone is certified by TAI Chi for Health Institute that’s definitely an indication that they’ve had safety training they’ve learned how to modify that’s, the first thing to look for and to look at what the postures are like. Often, people will put pictures, even on a book cover but they’re hunched over I have a book, where the cover is like this well that’s not TAI Chi. Is perpendicular to the earth, the major energy channel is next to the spy we try to keep it Nice and up right, so you can tell like pictures and if something looks too challenging someone’s doing a half split, yes, it’s too challenging we don’t need to be doing that that’s competition stuff I compared sometimes to ice skating. If you want to compete, you have to do the triple Lutz and everything, but if you just want to have fun and skate you can go to the farmers pond and skate. So, we’re teaching TAI Chi to support health and looking for certifications is important and looking at how the postures look when you look at them, because we don’t need to be doing half splits or putting our knee over our toes or anything like that.

(Katie Huffman): That’s helpful. Thank you, and you can find classes, through the TAI Chi for health for the institute’s website, you can find local classes there.

(Pat Lawson): Thank you, yes, the instructors are listed and you can send an email through the site to the instructor and they will respond to you. So that’s the best way for a regular kind of local class and the Institute is now offering virtual classes as well. They’re limited right now, I think we were offering eight different series, but you can register for virtual class if you’re not near one, but there is an instructor listing by state, and you can go in and see where people are at.

QUESTION: I have one more question for you-you talked a lot about balance and flexibility and fall prevention, would you say TAI Chi is aerobic as well?

ANSWER:(Pat Lawson): TAI Chi is designated as an aerobic exercise, because we do work circulation, we just do not speed up the heart. So, we are not trying to speed up heart rate or pulse, but it is considered aerobic because we’re working circulation and we do tone muscles and sometimes people don’t even realize it’s happening until they go home. And they realize they’re a little sore and we say if you’re sore more than two hours after class, then you did too much and should cut back the next time because we don’t like soreness, but if we do more work than it would appear.

CLOSING REMARKS

(Katie Huffman) That does conclude today’s presentation, we hope that you will join us next month for our December 15th Lunch and Learn featuring Jason Franz, PhD who will present In Vivo Imaging, Muscle Neuromechanics and Rehabilitation for Osteoarthritis (OA) Prevention.