Pain, Injury, and Tai Chi

"No pain, no gain" is a well known exercise battle cry--thanks to Jane Fonda and her exercise videos of the 1980s. That motto takes on a certain macho quality when chanted in the local gym. When most people come to tai chi and qigong, they're often looking to get away from or avoid that mentality, and to embrace an approach to exercise that is much more gentle. 

Generally speaking, pain is your body's indicator that you are about to cause yourself injury, if you continue to do what you're doing--holding your hand over a fire, for instance--or that you have received injury--bashing your finger with a hammer. In class, I advise people that if they feel pain while performing a tai chi or qigong move, it's a sure sign that they are doing the movement incorrectly. The body is sending a signal that the movement needs correction. 

However, there are exceptions to this rule. There are times when you might feel pain during a tai chi or qigong workout, and it is not only perfectly okay, but it is a step in the process of healing. 

I've used tai chi to heal from serious and semi-serious injury--more than once. The first time was when I first started tai chi, to try to deal with the consequences of two broken arms, and the surgery I received to fix them. (Plates, pins, screws, scar tissue.) By the time I started tai chi, about two months after the accident, I was in chronic pain with these injuries. Although I'd done a lot of healing, and I was no longer in danger of damaging anything with simple daily movements, everything I did hurt, which was intensely irritating, and affected my mood. 

I had been assured that because of the plates and pins and screws, I couldn't really re-injure myself just by performing normal arm movements, so I sought a workout that wouldn't put pressure on my arms, but would allow me to move them more. Hence tai chi. Initially, learning to stretch my arms was painful, but over a few months, I really noticed an improvement in my overall pain levels, strength, and mobility.

Later, when I started training with a more experienced (and hardcore) teacher, I stretched out much of the scar tissue from these injuries. Again, that was a painful process--scar tissue does not like to stretch! That pain was a deep, searing ache that I would feel during the stretch, which would ease immediately afterward, and eventually led to a greatly increased range of motion. Because I'd already learned to distinguish between pain that was likely to cause injury, and pain that probably wouldn't, I was fine with going through this process. I am convinced that regularly performing this deep tissue stretch, which eased a lot of tension on my joints, is the reason I do not have arthritis today. (The doctors told me that because of my injuries, I would develop it by the time I was thirty. I'm forty-five now.)

The Sensitized Nervous System

I've since learned that the state I was in during my initial tai chi sessions are signs of a sensitized nervous system. Some of my pain was based on genuine signals from the body--it took a long time for my tendons and ligaments to adjust to some of the plates, for example. But much of it was a kind of false signal. Sometimes pain creates a feedback loop that causes the body to go on high alert, so any movement of an area causes a high degree of pain, even movements that are not going to cause injury.

This is a radically different state of being than when you are experiencing an injury. Nervous system sensitization comes along with a host of signs that this is not normal pain. Check this list, compiled by Dr. Bahram Jam, in his booklet The Pain Truth, and Nothing But to see if any of the following applies to you:
  • Pins and needles
  • Burning pain
  • Increased pain by small movements; e.g. slightly bending or turning
  • Increased by sustained postures: e.g. sitting, lying
  • Increased by no particular reason: e.g. the pain has a mind of its own, unpredictable zaps
  • Trivial incidences cause flare-ups that last days: e.g., getting out of a car, walking in a mall
  • The pain is increased by stress and anxiety
  • The pain gradually spreads, even to the opposite side
  • The pain may move around the body
  • Night pain
Many people with sensitized nervous systems end up not moving much at all, for fear of experiencing more pain. This seems like a reasonable strategy, but it in fact tends to create a worsening of this condition, as the nervous system becomes more and more sensitized to any type of movement, and the body produces aches and pains as a result of stiff and weak muscles. If this list resonates with you, and you've confirmed with your doctor that there is no physical reason why exercise will cause you injury or exacerbate your pain, it is a good idea to reconnect with the body and begin a program of gentle movement. 

NOTE: panic and anxiety in the absence of physical pain are also symptoms of a sensitized nervous system. All of the tips in this essay apply to people with anxiety and panic disorders. The key is to use tai chi and qigong to practice in a way that does not cause an attack or an increase in anxiety. Apply all of the tips listed here to help you slowly acclimate your nervous system back to normal. 

General Recommendations

Understanding the mechanics of the pain response and how the nervous system can become sensitized to pain can help you relax a little about your own pain. Click here to access a downloadable pdf booklet that offers more information about nervous system sensitization and some basic self-care information that can help

Any of my students know that I recommend magnesium supplementation as a necessary step to relaxing muscles and tendons, dealing with chronic pain, and accessing a better level of health. Most people are magnesium deficient. I recommend applying transdermal (absorbed through the skin) magnesium to the whole body as a soak on a regular basis, especially to the areas that cause the most pain. Magnesium is a necessary component of many body processes, including a healthy nervous system, and has been shown to reduce pain and increase mobility. I personally take Natural Calm internally, and use Ancient Minerals transdermally. Natural Calm is available at most health food stores. You can purchase transdermal magnesium at many health food stores as well. I buy Ancient Minerals online here. (Note: I'm not affiliated with either of these companies. I just really enjoy and have benefitted greatly from their products.) 

Read more about the benefits of magnesium supplementation on Dr. Carolyn Dean's extremely helpful website

Guided meditation can be a wonderful tool to aid relaxation and allow you to settle into the body more comfortably. Try this meditation by Dr. Robert Puff, designed to help ease physical or mental suffering

Using Tai Chi and Qigong to Address Nervous System Sensitization and Chronic Pain

When you do tai chi and qigong to address a sensitized nervous system, or any time you're working with pain (e.g., dealing with an injury), or okay, ANY TIME, really, the key is to go in soft. You are trying to change the way that you approach movement, and the way you experience being in the body. Your chronic pain / nerve sensitization is going to make it so that you need to be more rigorous about being gentle with yourself as you work. That's okay! It's good. Correct tai chi and qigong practice depends on being soft. 

Before you begin practicing, take a few moments to stand, align yourself correctly, and just feel your way into the body, focusing on each part in turn, from the feet up, and seeing if you can let go of any tensions that you are holding. 

Figure out an amount of movement you can comfortably do without sending yourself into a flare-up. This applies to the duration of the movement (how long you're doing it for) and the range of motion (how much you stretch). At first, low-ball this amount. Can you do three minutes of moderate range of motion? One minute of small movements? Thirty seconds of standing and breathing? Start with a tiny amount. You're going to be increasing this gradually over time, so don't worry if it seems like very little at first. 

Do that amount and no more. Take a break. Sit. Breathe. 

As soon as you start to move, check in with yourself. Are you suddenly clenching, holding, or guarding any area of the body? Are you holding yourself stiff or tight? Moving muscles that you are clenching or tightening will only reinforce that tension. Stop, relax, let go, and try again. 

Use correct form. Push from the feet. Channel the force up through the body. Remember, in tai chi and qigong, the muscles are channels of force, directing force from the ground and up through the spinal column and out through the hands. Because of the unique quality of movement in tai chi and qigong, you can move without creating further injury. When I tore my rotator cuff a couple of years ago, I could not lift my arm at all using the arm muscles, but I could push it through a full range of motion by using correct tai chi and qigong movement. Using these methods, I regained a full range of motion in two weeks after my injury, and rehabilitated my shoulder completely in 4-6 weeks. Correct technique, as correct as you can manage, is important when you're working with pain. The goal is to gently open and massage the body from the inside out. 

Take frequent breaks and relax. If you're practicing in a class context, let your teacher know that you are working with your pain, and ask for him or her to check your form for any areas of tension. Arrange for a chair that you can sit in as often as you need to. Move, relax. Move, relax. Relax when you move, and relax after you move. 

Pay special attention to an area that gives you extra pain. This is the area you are most likely to hold tight, and the area you MUST NOT hold tight, if you want to release your pain. Clenching around an area of pain is called guarding. It might help protect injured tissues at first, but it throws off your entire body and will prevent you from regaining range of motion. Make your exercises moderate enough and use correct form as you gently begin to allow the area to relax and move. 

Gradually increase the duration and range of motion of your exercise. This is key. If you want to desensitize your nervous system, you must train it to do more than you usually do. Tai chi and qigong are always gentle, but you should feel like you've moved more fully than you do in your day to day life, if you want your practice to be effective. If you're in pain, plan to increase slowly over the course of a month or two to regain full range of motion. A month or two, not one day. Pace yourself! A month or two, not six months or a year. Work persistently. A little bit every day will help your body become reacquainted with regular movement. You can do it! 

NEVER beat yourself up if you falter. If you have a flare-up, that is information, not failure. You did too much too soon. Try again in a day or two, being very gentle with yourself each time. If you are practicing and you find you are holding tension, take a deep breath, let it go, and see how long you can keep it relaxed as you move. 

Using tai chi and qigong to address pain and nerve sensitization is not so different from regular practice. If you're dealing with pain, it will serve as a reminder to always be soft and relax, and as a guideline for how well you're using correct technique. 

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