T’ai Chi, Falls and Balance

by Mike Tabrett & Sandra Core published in TCC Magazine summer 2005

As the age of our population increases so does interest and research in age related health problems such as falling. This is understandable as the problem of older people falling and the resultant complications occupies a huge amount of money; 1 in 3 people over the age of 65 are at risk of falling; resultant problems such as fractures, long term disability and loss of independence can mean that an older person can swiftly become very dependant on health care services.

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In the last few years, there has been considerable interest from the medical professions in using T’ai Chi as a practise to help older people with maintain health and specifically as a therapy to help those with a falling problem to regain balance and mobility. Much of this interest is due to a study carried out by Dr. Stephen Wolf in U.S.A. that showed that T’ai Chi was one of the most effective forms of response available Wolf, Archives of Medical Rehabilitation, Vol 78, Aug 97). Since then Doctors and Physiotherapists all around the world have been have begun to take notice of what is happening in the T’ai Chi world; a growing number of people are now beginning to teach in specialised situations like hospital based rehabilitation centres. Aside from this, many T’ai Chi teachers will have elderly people in their classes and many of these will be experiencing problems with their balance. As more research is carried out it is becoming more likely that we will be asked to produce targeted programmes for people with these issues

Why Do We Fall?

Wolf and others have defined a number of factors that contribute to the likelihood of a person falling. Changes that take place in our bodies as we age mean that all older people (i.e. those of 55 and over) will become more likely to fall; a general slowing down of sensory and motor functions; changes is muscle performance and an increase in the number of medications with unbalancing side effects (for instance some of those used to treat high blood pressure) are amongst these. In addition, as our bodies become frailer and perhaps more likely to develop conditions such as osteoporosis (softening of the bones) then the consequences of a fall become more serious.

In some cases, there can be other more specific problems. Environmental factors both in the home (e.g. a poorly fitted rug) and outside (e.g. an uneven pavement) can cause trips. Certain manoeuvres are also more likely to lead to a fall; extending and turning in particular are hazardous. Poor gait (walking technique), which itself has a multitude of causes, is also a common cause of falling

How Can T’ai Chi Help

The first and obvious answer is that T’ai Chi is good for us! Not only that but the wide range of training methods that we employ – from very soft and slow to more demanding, martial drills – mean that we can offer something to a wide range of people of all ages and abilities. Being able to remain active goes a long way to alleviating many of the health problems that accompany ageing.

However, we can also offer more specific responses to some of the defined factors that can cause falls. For instance:

• One of the core qualities sought after by T’ai Chi players is of course Rooting and its’ accompanying principles like alignment. Although we may argue about how we might achieve this and exactly what they mean, still it is central to our art. Our experiences in seeking to root better are directly relevant to someone who has a problem with falling and balance. From our root we try to move from our centres and integrate energies like Pung and Liu, Expanding and Contracting through the various postures of the forms we learn and push hands and martial drills. With a little imagination we can find applications of these energies in everyday activities of the sort that are relevant to an elderly person who is unsteady on their feet.

• We use a number of methods to improve stance and walking; emphasising a ‘heel toe’ action as we move forwards and remaining in alignment and rooted. We encourage a slow increase in range of movement without compromising basic alignment.

• The emphasis of the mind and our awareness is also important for older people. We can use our breath and general awareness of our bodies to help us become aware more widely – the raised paving slab that could be the downfall (literally) of someone a little unsteady on their feet need not be a problem for someone with a degree of awareness. Further, that gentle growth of awareness can help a person who has fallen feel more at ease and gradually recover confidence.

• Although arguably T’ai Chi does not focus on strengthening muscle groups it still does have this effect in key areas of the lower body and around the pelvic girdle that are important in maintaining balance. We can also help a person to retain suppleness and flexibility so that key muscles are not tight and pulling joints out of alignment.

Targeting Exercises

All of the ideas outlined above are of course present in the traditional forms and exercises that we teach; interpretation and approach may differ from style to style and even from teacher to teacher but one way or another they are all central to the art. Clearly then simply teaching what we always teach will mean that we are providing a good practise that can help older people remain on their feet and healthy. Indeed most of the studies that have been made are based on the teaching of traditional forms.

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However many older people will find these traditional form difficult or even impossible to learn. There are a number of reasons for this; many old people suffer form debilitating conditions like Arthritis or Parkinson’s Disease that make standing for longer than a few minutes uncomfortable and painful. Even without these, learning a form can be an unrealistic proposition in the short term where memory and co-ordination are a problem. In these circumstances, we often need to adapt our traditional movements to make basics available. This might involve simplifying sequences, using a range of appropriate Chi Kung exercises and/or adapting standing movements for chair based activity. In doing this we are forced back to our foundation principles to enable us to re-interpret external patterns for the new environment. We have to be careful here; it is tempting to simply encourage people to ‘wave their arms around’ but while this may well help people feel better it may also remove the very things that are important for people to be able to understand. There can be no fixed rules here; just as in some areas of the traditional practise – free style push hands for instance – there are too many variables to enable fixed rules to be written. We can only remain aware and flexible ourselves and trust that our own practise of basics will provide a foundation to work form. The T’ai Chi and Chi Kung Forum for Health offers help and support for T’ai Chi and Chi Kung teachers wishing to work in this way including written guidelines and a comprehensive training programme. For details contact the Forum at admin@taichiforum.co.uk or by writing to PO Box 163, Manchester, M20 6UG. The Forum website at www.taichiforum.co.uk contains information about forthcoming courses.

Mike Tabrett teaches T’ai Chi in Cambridge, including in his work specific health based classes focussing on key issues such as falls and balance. He is vice-chair of the T’ai Chi and Chi Kung Forum for Health.

Sandra Core lives in Leeds where she practises T’ai Chi and works as a Physiotherapist specialising in Falls rehabilitation. She is a member of the steering group of the T’ai Chi and Chi Kung forum for Health.