Reading this stuff . . . so you don’t have to.
A few months ago I launched the first in what I hope will become a recurring series: Pearls from Medical Science. As many of you know, I strive to provide high-quality, scientifically accurate medical information on Healthy Matters, both the radio show and this blog. As do most doctors, I get inundated with medical journals, which are the repository of what the medical science community has learned about our various medical conditions. Since nobody can read all this (or want to), every now and then I will present one thing I’ve learned from what doctors call (with apologies to Hemingway and Fitzgerald), the “literature.”
This week I’ll highlight a fascinating study about arthritis and the ancient Chinese practice of Tai Chi. If you have arthritis – no matter your age – read on. Oh yeah, at the end of the post I talk about the Minnesota State Fair. Don’t miss it!
Osteoarthritis
The first installment of “Pearls from Medical Science” was about high blood pressure. If you missed that post, check it out here.
This second installment comes from a journal that landed on my desk just this week. It is about the ancient practice of Tai Chi, and how it might be used to help people who suffer from osteoarthritis (the wear-and-tear kind of joint pain that so many people have).
Here’s the punch line and the reason I’m talking about it this week: there is actual scientific evidence from a recent study that regular practice of Tai Chi is as good, if not better, than physical therapy for relieving the symptoms of osteoarthritis. It was from one of the most-respected, peer-reviewed journals, the Annals of Internal Medicine. Peer-reviewed means a bunch of theoretically objective 3rd-party doctors read it and declared it to have some validity. It’s considered the standard to be met for legitimate research. And it really is not easy to get published in “The Annals” (as we dorky internist refer to it) so articles that appear there are usually pretty good. I should know. I once submitted what I thought was a piece of brilliantly insightful medical wisdom to the Annals and was rejected in a nanosecond. I guess my “peers” reviewed it and found it to be lacking in some way.
Tai-what and osteo-huh?
So without getting into too much detail, I think a few definitions are in order.
Photo: Stefan de Konink
Osteoarthritis is the condition that all too many of you know about. It is the degenerative condition of our joints which comes with a lifetime of . . . living. All of the joints in our bodies, and there are hundreds, are places where two bones come together to form a movable point in our skeleton. But if you have ever looked at a chicken drumstick after you gnawed all the meat off, you can see that the ends of the bones are rough since bones are mineralized and tough and hence – rough. If two bones rubbed together all the time, it wouldn’t be too long before the joint (your knee, say) was creaking and groaning and causing you all sorts of pain.
To prevent this, our joints have a smoother substance overlying the bone called cartilage. The cartilage, along with lubricating fluids, serve to keep that knee, or fingers, or spine, or whatever – moving freely and painlessly for decades. The above picture is an x-ray of a left knee. Notice the black space between the top bone (the femur or thigh bone) and the bottom bone (the tibia or shin bone)? That black space is actually cartilage which does not show up on the x-ray. You can easily see how the two bones are actually not in contact with each other – thanks to the cushioning cartilage.
Photo: James Heilman, MD
Osteoarthritis is the condition where that cartilage wears away. Lack of cushioning, lack of friction-relieving fluid, lack of smooth surfaces to pad the bones ensues, as does resulting pain and swelling of the joints.
Look at another x-ray of a left knee in the picture at left. Where’s the black space where the cartilage should be? It’s gone thanks to the wear-and-tear of osteoarthritis. The arrow points to an area of bone that is even whiter than bone usually is because it has reacted to the grinding of bone-on-bone. This person likely has significant knee pain.
One of the most frustrating things about osteoarthritis is that we have precious little with which to treat it. It’s a sad fact that when your doctor prescribes medications (NSAIDS like ibuprofen or other pain relievers like acetaminophen) for your arthritis, he or she is really only treating the current symptoms of pain. Medications do nothing to reverse the process of degenerative arthritis. (This is in contrast to the inflammatory arthritis conditions like rheumatoid arthritis for which medications do actually reverse the course of the disease. That’s a different condition completely.)
So you take the medications prescribed by your doctor, but you still can’t unscrew the cap off the pickle jar, or walk up a flight of stairs at home, or even get out of a chair without pain. So your doctor suggests a host of other remedies: physical therapy, pool therapy, massage, acupuncture, and so forth. All probably have some merit in my opinion.
Physical therapy does work
The most promising of these may be physical therapy. Physical therapy attempts to strengthen the structures surrounding the joint in an effort to strengthen the whole thing. For instance, if you have knee arthritis, it is established in the medical science that more exercise, not less is probably best for your knee. This is probably because the surrounding structures – the muscles, tendons, ligaments – are recruited to provide more support to that ailing joint.
A qualified physical therapist can also help advise you on important things like posture and assistance devices should you need them. So I do often recommend things like physical therapy for people with arthritis. For more information about PT and arthritis, I recommend the Arthritis Foundation.
But somehow, it seems like we need more arrows in our quiver for this condition.
Introducing Tai Chi
Quick disclaimer. I know virtually nothing about Tai Chi personally. I am merely hoping to introduce it to you as well based on a few random encounters I have had with it and based on this scientific article. Please learn more about it yourself if you so choose!
Photo: Jakub Hałun
Tai chi is a type of martial arts. It was developed about 800 years ago in China, and involves the slow and gentle movement of the body, typically while attending to breathing and meditation.
I think it is graceful and calming. Even if you don’t look as graceful and calming as these folks in the picture!
How does Tai Chi work in health? I have no idea. And as much as I try to stick to scientifically-proven medical therapies, I have long been drawn to other practices that may have a great deal of benefit even if I do not understand how they work. In the case of Tai Chi, I recall my sister-in-law doing the practice out on the grass at a family reunion one time. She was out there waving her arms slowly, breathing, looking graceful. Yet I had no idea what she was doing or could not grasp the point of the whole exercise. Only now do I acknowledge that she was probably onto something! Live and learn.
Connecting Tai Chi and osteoarthritis
Now back to the hard science. For the original article, click the Annals of Internal Medicine article here. It is actually, as medical papers go, quite readable and not too sleep-inducing. You may need a login account to see the whole thing, but at least you can see the main part and look it up further if you like..
This recent study which was just published in July 2016 (BREAKING NEWS! as the cable networks would say) was conducted over a 4-year period at Tufts University near Boston. (Tufts is a great school and well-respected. Also, I think its mascot is a big ol’ elephant which right away makes it cool). They put people with arthritis into one of two treatment groups: physical therapy and Tai Chi. Each group did the treatment twice a week and the results were compared using the participants self-report of how much their pain improved. They measured the effect at 12, 24, and 52 weeks.
Study outcomes
Here’s the good news. people in both the physical therapy and tai chi groups reported improvement in their symptoms at 12 weeks. The improvement continued all the way up to 52 weeks – a full year later.
As far as medical interventions go, that is significant and the take home message should be, as far as I can tell, that patients with pain from osteoarthritis ought to be doing some kind of therapy, whether it be physical therapy (with a certified physical therapist) or a “moving meditation” program like Tai Chi (with a knowledgeable Tai Chi instructor, hopefully).
The surprising part
Both groups of arthritis-sufferers in this study were also given a short evaluation for depression. Not sure why they did that but the result really caught my attention. The people in the Tai Chi group showed a decrease in depression symptoms over the course of the study. Hmm. After thinking about this, I find myself completely believing it – there is something in those ancient Chinese practices that link the mind and the body that is absent in some of our western medical practices.
Lest you get too skeptical, I should note that this study was not done by some goofy fringe organization. It was funded by the National Institutes of Health (in other words, the US government – which is admittedly an often wacky and goofy outfit but one that is pretty good at funding legitimate science) and done a a premier research university (Tufts). So if you are ever going to set aside skepticism, this is the place to do so.
The bottom line
If you suffer from osteoarthritis, particularly of the knee since that is what this study looked at, I would strongly consider alternative and complementary therapies.
Like Tai Chi.
(I was going to include a video from the Interwebs of people doing Tai Chi, but after looking at them, I don’t want to be seen as endorsing one over another. If you are interested in seeing what Tai Chi looks like, you can find examples easily by searching for Tai Chi in your favorite search engine.
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Get ready for the Minnesota State Fair!
For 8 years in a row, I have done HealthyMatters, our radio broadcast, LIVE from the Minnesota State Fair. Please join me!
Sunday, August 28 and September 4, 7:30 a.m. at the WCCO radio booth (in the shadow of the Giant Slide and right next to Sweet Martha’s Cookies!). You may be surprised how awesome the Fair is at 7:30 in the morning. Not too hot, not too crowded, and everything is open and clean. Plus I’ll be there – I hope you join me.
Here is a picture from a past year at the Fair. That’s me in in the white T-shirt:
David
