Tai Chi for Prevention of Falls

Principle One – Relaxation

In any true Tai Chi you must always be relaxed. This brings many benefits but from a falls point of view it is particularly important. When you are mentally tense you hold tension in muscles and tissues. This tension (now known as postural hypertension) has a number of implications:

• First it causes changes in the body that raises the center of gravity. The

higher your center of gravity the more difficult it is to maintain balance. You do not have to believe me on this just stand on your toes with your hands over

your head and see how much harder it is too balance. Postural hypertension

creates a similar but not as extreme effect.

• Second, these muscular tensions act to reduce the ability of the muscles to

make the hundreds of small adjustments necessary to keep our body posture

balanced. To remain upright and walk the body must keep over 120 muscles

working in a balanced and co-ordinated form.

One of the most important techniques for achieving relaxation is the diaphragmatic breathing used in Tai Chi (this means use of the muscular sheet lying between the chest and abdominal cavities to initiate the breathing action). You should always check that your Tai Chi course includes instruction in this technique. Diaphragmatic breathing will also act to lower the center of gravity. The more you tend to use diaphragmatic breathing and stay relaxed the less likely you will be to fall.

Principle Two – Posture

The center of gravity needs to be maintained not only from a vertical but also a

horizontal viewpoint. That is from a horizontal viewpoint the further the center of gravity is from the center point between the feet the harder the muscles must work to maintain the balance. This is also easily demonstrated by keeping the body straight and leaning forward or backward. You will soon come to a position where you cannot maintain your balance.

You should look for a Tai Chi form that emphasizes the straight back with the head in the "riding the wind" position and the tailbone tucked under. The "riding the wind position" is often called "the suspended head top" and is where you feel as though the head is being lifted up through the crown of the head (Bai Huai point if you want to be technical).

 Principle Three – "Silk-like movement"

Tai Chi teaches a form of movement that avoids jerky, angular changes in direction and speed. This requires the avoidance of any situation in which the joint is "locked" or at full extension. This is important because such locking reduces the available ranges of movement reducing the opportunities for correcting balance. One is also taught not to come to a jerky stop at the end of an extension of leg or arm movement. Such jerky stops are situations where the momentum of a limb may act to throw the body off balance. In a sense what is being taught here is one aspect of kinesthetic awareness. That is the development of body awareness. Obviously when you are aware of how your body is moving and what its position in space is you are more likely to become aware of any loss of balance before it becomes extreme enough to be a threat.

One practical example of the importance of not having the limbs extended is in

walking. If you stand with the knees in the lock position and extend one foot you will find that it does not reach the ground in front. Only when you bend the supporting leg does the other leg reach the ground. So how do those people who habitually walk with their knees almost in the lock position walk? Basically they fall forward onto the front foot! Apart from damage to joints this is a very high fall risk maneuver. In Tai Chi you should be taught to "Walk like a cat" that is the foot comes forward first and the weight is only transferred when the foot is safely on the ground.

Principle Four – Unity of movement

The Tai Chi classics teach that all movement is rooted in the feet, powered by the legs, directed by the waist and expressed through the hands. As you learn this form of movement you learn techniques that avoid movements of the limbs that pull the torso of the body of balance. It is another aspect of kinesthetic awareness.

Principle Five – Base of Balance

Tai Chi teaches what is called the square stance and square stepping techniques. What this does is too teach movements that expand the base of balance that we use. If you place your feet side by side and wiggle your hips around you will find it much harder to keep your balance than if you stand with your feet shoulder distance apart. Similarly if you step with one foot directly in front of the other foot and wiggle your hips around you will find it much harder to balance than if you have your lead foot to forward but shoulder distance to the side. This may seem obvious but you would be surprised how many people habitually walk by placing their feet almost directly in front of the other thus exposing them to a high-risk fall posture.

Other aspects of Tai Chi training that may impact to reduce falls

While Tai Chi is often regarded as a gentle exercise, and should be pleasant and pain free to perform, the various bio-mechanical techniques that it uses does build muscular strength and physical stamina. These benefits are primarily due to the slowness of the movement and the fact that it is performed with bent knees (this increases the muscular and cardiovascular loading).

Tai Chi is a holistic exercise that works on more than bio-mechanics. Positive thinking is encouraged and developed. If you do not think that your state of mind has any influence on your propensity to fall consider walking across to planks. Both are 40 centimeters wide and 5 meters long. Both are completely rigid. The only difference is that one is lying on the floor and the other is connects to buildings 40 stories high. Which one do you think you are going to fall off? The one that you have the most negative thoughts about!

Tai Chi also works on balancing the Chi or vital energy of the body in Chinese terms the more unbalanced this energy the more likely you are to be unbalanced from a mental, emotional and physical viewpoint and the more likely you will be to have a "fall" in each of these areas.

Could other exercises achieve what Tai Chi does?

To date despite considerable efforts there is no scientific evidence that other

exercises can achieve the fall benefits that can be achieved by Tai Chi. Attempts are being made to show that sets of exercises in which individual exercises may work on such things as posture, muscular strength or relaxation can when added together achieve the same effect as Tai Chi but so far without success. I tend to suspect that it is the fact that so much is going on within each movement of Tai Chi that contributes to the development of fall prevention skills. Also, surely the point is that we have a scientifically proven way of reducing falls so why not use it? The case is strengthened when we realize that Tai Chi is not just exercise that prevents falls. It has also been shown to be beneficial to the immune system, arthritis, asthma, osteoporosis, stress management, cardiovascular development and so on. Tai Chi offers an exercise system that is fun that is well within the range of most of the population and that is relatively "risk free" to learn.

Tai Chi for Elderly

Balance

Balance is the key to healthy, full life. In older people, balance prevents falls and and provides confidence to sustain physical and social activities. For younger people, better balance often translates into better performance in sports. For everyone, balance contributes to a grounded sense of well-being.

Balance and your relationship to gravity involve many interacting factors such as strength and flexibility, sensory perception, neuromuscular coordination or synergy and cognitive processes. Understanding these components, how they degrade with age or disease, and understanding how Tai Chi affects them will help you appreciate why Tai Chi is often so effective at improving balance.

One of the primary reasons you should be concerned is about fall-related fractures. Some 50 million Americans over age 50 have low bone density, and fractures in this group often result in great suffering and medical expense. Tai Chi offers a twofold effect of reducing fracture risk not only does it improve balance and reduce falls, but also, preliminary studies, suggest Tai Chi may also reduce rates of mineral density (BMD) decline, particularly in post menopausal women.

In addition, elderly, frail, and deconditioned people who often have poor balance have found Tai Chi to be very safe. Since falling is a common and sometimes fatal problem for the elderly, the balance and postural control gained in Tai Chi could help to reduce the incidence of falling.

The proportion of older people in our population is continually increasing. As a result, the health of the elderly should be of growing concern to our society. If you are elderly, Tai Chi is a slow and gentle form of exercise which can be practiced with safety. Even those who consider themselves less fit than their friends at the same age can practice and enjoy the benefits of this art.

The most common and most noticeable effect of old age is poor posture, which is the result of lifetime of bad postural habits. Tai Chi proves highly beneficial in correcting this problem. Along with good posture come all the benefits which are related to it.

An important aspect to note, is revealed in a study titled 'Tai Chi for Postural Control in the Well Elderly'. It showed that elderly people who practice Tai Chi performed significantly better on tests of Balance than those who had not practiced Tai Chi.

As our population begins to age and we live longer and longer we are beginning to
recognize a growing cost from falls. By falls we are not talking about falling off buildings or over cliffs but loss of balance situations which cause us to move quickly from a vertical to horizontal position during simple acts like walking around or climbing stairs. In our earlier years such falls generally means a bruise or two and a few minute’s pain, if we are very unlucky we might break a bone or suffer more serious damage. In our later years such falls are fraught with danger often resulting in hip replacements and extended periods of incapacity. Such falls can rob us of our independence.

Putting aside for one moment the cost in pain and suffering and loss of quality of life the cost of falls is placing a tremendous burden on our medical infrastructure. This cost is not only huge but also rising at an alarming rate. Across the world studies are taking place to determine what can be done to reduce the incidence and impact from falls.

For some time the focus in falls prevention has been on the elimination or containment of situations in which falls are likely to occur. Non-slip floors and provision of proper hand holds in bathrooms. Placement of handrails, reduction of slopes and increases in tread sizes of stairs would be examples of efforts in these areas. The problem in this approach is first that the cost of securing all such areas is enormous and that second people persist in falling down in areas where such safeguards are not present. It is obviously most important that as well as eliminating fall hazards as much as possible is done to make the individual as "fall-proof" as possible. The question then is what can we do to an individual that will reduce the likelihood of falls?

Many studies have taken place in this are but so far only one form of exercise has been shown to have a significant and permanent impact in reducing falls. The name of this exercise is Tai Chi. The scientific study that was performed was carried out in the USA by Professor Xu and showed that a thirteen-week course in Tai Chi could reduce falls by 40%. Looking at this another way means that the practice of Tai Chi could in itself reduce the cost of falls to our society by almost half. A tremendous contribution.

Yin & Yang

Yin and Yang is the important principle underlying the movement of Chi within the body also traces its origin back to the ancient cultures and medical philosophies of the East. This is the celebrated pairing of Yin and Yang. One of the ways the Chi is able to move through the body is via the interplay of these two great polarities, which are considered to be at work within all of nature.

Yin and Yang describe the complementary yet opposing forces of nature, such as night and day, cold and hot, female and male, winter and summer. Their relationship has a harmony and balance. Both Yin and Yang are necessary, they are constantly moving and balancing each other and the interaction between them creates Chi. The Chinese observed that when the balance of Yin and Yang is disrupted in an Individual, so too will be body’s Chi, leading to ill health.

The ancient Chinese philosophers believed that in the beginning the universe was void and boundless, and they called this state Wu Chi. From, Wu Chi evolved motion, yang, and its opposite aspect, stillness, yin. The Universe was created through the interplay of yin and yang, and the state which included both these aspects was called Tai Chi.

The concepts of yin and yang also provide a means to understand and measure the qualities and characteristics of all things. The opposite and complementary aspects of each are as follows:

Yin - Passive Cold Soft Dark Moon Stillness Feminine Water Earth

Yang - Active Hot Hard Light Sun Movement Masculine Fire Sky

It is important to note that yin and yang are not labeled good and bad. Instead they have a creative relationship and are constantly interacting and changing, with one never existing in isolation from the other. From the interaction of yin and yang arose the five basic elements: wood, fire, earth, metal, water. These elements can exist in a helpful and complementary relationship to each other, or they can work against one another and destroy themselves.

A popular Chinese rhyme goes like this:

Wood Burns to produce fire, resulting in ash which becomes earth. From Earth there emerges Metal, which produces Water by condensation.

Also Wood occupies Earth and Earth soaks up the Water, Water douses Fire, Fire melts Metal and Metal cuts Wood.

These five elements feature in all Tai Chi movements, being represented as advance (metal), retreat (wood), shift to the left (water), shift to the right (fire) and central equilibrium (earth).

The art and philosophy of Tai Chi is based on the interplay and changeability of yin and yang. This creates a balance of movement and provides grace to the Tai Chi exercises. The harmony which results, promotes the holistic benefits of Tai Chi.

The Meridian System

In the human body, the chi flows through what is considered to be a collection channels, also known as meridians. These were mapped out thousands of years ago by the brilliant physicians of ancient China and they are still referred to and used today in clinical practice by thousands of acupuncturists, masseurs, herbalists and healers all over the world. Fundamental to Chinese philosophy, is the concept of energy or Chi. Chinese regard every phenomenon of the universe, including humanity, as a manifestation of this energy.

Some of these channels are large, and flow through major organs of the body, from which they derive their names. So, for example, we have the liver channel, which originates in the toes and then flows up the body through the liver itself, finishing in the chest. There is a bladder channel, running along the back, and a lung channel that flows from the chest through the arms to the thumbs. Altogether, there are fourteen major channels. There are also numerous minor channels and many more even smaller, capillary-like ones, all of which help to circulate the chi around the body. The collective name for all the channel pathways is the meridian system, and through this special medium all the cells, bones, muscles and organs are constantly fed and stimulated by life-giving energy.

Our own vital energy, chi, is conducted through the body in these channels or pathways called meridians. These are not blood or nerve systems. Rather they make an invisible network that links together the fundamental substances such as chi, blood, fluids and organs. They connect the interior of the body to the exterior.

The meridian system is made up of twelve regular meridians that correspond to each of the five yin and six yang organs and to the pericardium (the outer muscle of the heart). There are two other major meridians, the governing vessel, the du mai and the conception vessel, the ren mai. The governing vessel is the central control meridian, which governs the yang organs. It begins at the hui yin point, runs up the spine to the bai hui point and terminates at the upper palate. The conception vessel governs the yin organs. It runs up the front of the body from the hui yin to the chin.

The yang organs include the heart, lungs, liver, spleen and pericardium. The yin organs include the stomach, gall bladder, bladder, small and large intestines. The kidneys are both yin and yang. In a healthy body, chi flows harmoniously through the meridians with a correct balance of yin and yang. If, for any reason such as stress, this flow is blocked, the balance is upset and illness results. The exercise of Tai Chi affects the whole body, not just the individual parts. The body and mind are regarded as an integrated unity and any imbalance of energy affects the whole body.

Tai Chi Principles

The essential principles in the practice of the art of Tai Chi are: 

Relaxation, concentration, meditation and harmony.

Relaxation – Be soft and yielding… exert no strength

Just imagine for a moment that you are about to lift a very heavy box from a table in front of you. Picture the action in your mind but the same time be aware of how your body feels as you imagine this activity. Even with no activity occurring at all, you probably tightened your muscles. Perhaps you took in a quick breath of air and then held it, tightening your chest. If you could have measured your blood pressure you would probably has found it rising slightly, with your heart rate increasing. All in all, almost a perfect description of the effects of stress – and achieved simply through imaging a muscular activity.

Now imagine yourself as you are sitting, standing or lying and your body becoming lighter and lighter. First your head seems to lift then your whole body almost drifts away from the ground. Focus on this image for perhaps a minute.

More than likely your muscles became relaxed. Your breathing deepened into continuous steady breaths, possibly your blood pressure fell marginally, quite a different scenario from the previous one. Yet, in fact, your body is probably much heavier than the imagined weight of the box. In both examples we imagined we imagined muscle power and became stressed; in the other, we simply relaxed and let something happen.

When you perform your Tai Chi, take this soft approach: allow the move to happen. In Tai Chi you should almost allow yourself to be moved rather than move yourself. The Chinese have many expressions to describe the movement of Tai Chi. To them it is like ‘riding the wind’ or the art of windblown willow’.

Concentration – let the mind direct the movement

As seen in the earlier examples, a task is more easily performed when you not only relax but also imagine yourself doing it – the key being to allow something to happen rather than to make it happen. This applies to movements of Tai Chi and assists you with performing them easily and with as little effort as possible.

To achieve the mental images of visualization, you need to concentrate. Concentration should not be thought of as mentally gritting your teeth: this would work against the principle of relaxation. The aim is of quieting the inner the inner chatter of mind, to free it from its daily worries and concerns, by focusing your thoughts on the Tai Chi move you are performing.

Through visualization, you will gain a keener awareness of the task at hand and not be distracted by what happened that day at the office or at home. This will enable you to concentrate your energy into what you are actually doing, using only the energy you require and wasting none. Take a camera lens as an example. The lens is no more strained when it is focused than when it is unfocused. It simply gives a clearer picture.

As well as visualization, concentrations on your breathing and the movement of the chi throughout your body, helps you to focus your attention on the totality of movement of, and within, your body – you are in control.

Getting the clear picture in Tai Chi initially necessitates breaking the move down into smaller parts.

Visualize the positions where your feet start and finish, Visualize your hands move. Then put these two pictures together, discovering how your hands and feet coordinate.

Remember, your mental focus should be on picturing the movement, not on getting the movement right. If you focus on trying to get move right, you set yourself up for the stress of failure. A Tai Chi movement that bears little resemblance to the correct movement but that is performed softly, slowly, smoothly and with good posture can provide considerable health benefits. A Tai Chi move that starts and finishes in the right positions but that is performed stiffly, with force and gritted teeth, is unlikely to provide any benefits and may well contribute to stress.

Meditation - Balance the movements of the mind, the body and the chi

When you are quiet and focused on the movement you are performing, when the soft and slow motion is a reflection of visualization in your mind and you feel at ease with the movement, then you have reached the meditative state necessary for the proper performance of Tai Chi.

In this stage, not only have you achieved balance between your mind and body, but you have also tapped into and gained control of your chi, your vital energy. In the understanding of the Chinese, body, mind and spirit are one and you are at peace with the universe. This is when the healing qualities of Tai Chi begin.

In terms of technique, this balance will be reflected in the movements you perform. When we are stressed, we tend to move quickly in uncoordinated jerks. This is because excess tension within the muscles makes coordination very difficult. When we learn to move smoothly and evenly during times of stress we have, in effect, learned how to relax our tense muscles and undo the effects of stress.

To move in this way requires continual awareness which is meditative aspects of Tai Chi. The Chinese say that movement should be like the action of reeling silk: if you are not to break the delicate thread, you must be conscious of the manner in which you perform every movement. This alert awareness means that you are not focused on your daily worries and problems, and hence the mental as well as the physical side of stress is relieved.

In your Tai Chi practice, try to eliminate sudden changes in speed and direction. There should be no stopping or starting within the form, only circular changes in direction. To do this, keep the shoulders and elbows down and try to avoid sharp angles in the elbow joint. Do not be afraid to use space in your moves. The closer in that you draw your arms and hands, the more jerky the movement will tend to become.

Harmony – When thoughts and movement are in accord, you gain the power to heal.

Through the unity of mind, body and spirit you acquire in Tai Chi practice, you achieve harmony. This is when you reach an agreement, an accord, or a pleasing arrangement of the various parts of yourself.

Rather than making you oblivious to any tension or pain you may be feeling, your awareness of this unity allows you to identify any remaining areas of tension within your body, for in these places the wave of momentum does not flow.

When we focus on feeling our body as a unity, as a whole, we become aware that each move contains within it a wave of momentum usually starting in the feet, flowing through the body and being released through the hands. To encourage harmony of movement, follow this imagery in your Tai Chi move:

Feel your feet firmly rooted against the earth

Feel the power of the move come from your legs

Feel the power directed by the waist

Express the power in the hands.

Gradually you can begin to remove any blocked tension from your body and in this way bring your whole self into the balanced, harmonized state.

Breathing – Breathe naturally through the nose into abdomen. With the abdomen relaxed tranquility will prevail

Correct breathing is crucial to the proper performance of Tai Chi. Breathing is essential for life. Just as breath symbolizes life or the Spirit in Christian theology, so too does it to the Chinese. As we breathe in air, or spirit, it becomes an intrinsic part of us and all life is connected by this. In your Tai Chi practice, along with helping you to relax, awareness of your breathing helps you to focus the mind and gain control over this essential aspect of life.

Before beginning each session of Tai Chi, take a moment or two to bring your breathing in line with the following principles.

Breathe deeply but without forcing your breathing

Allow your rate of breathing to slow, reducing the number of breaths taken per minute.

Have your mouth gently closed and breathe in and out through your nose.

In fact you should not commence your Tai Chi set of movements until you are satisfied, that your breathing is comfortably relaxed and gentle. Once you start your Tai Chi set, forget about your breathing and let your body handle it.