| "T'ai Chi is a whole body approach to ease of movement . . . [it] has applications all the way from early weight shifting and balance activities up to sports activities." - Judy Smith, PT |
Judy Smith is a physical therapist and clinical specialist in chronic musculoskeletal pain. Her experience includes both traditional P.T. training and 15 years of yoga with an emphasis on rehab yoga. She has been a PT at Meriter Hospital, Madison, WI for 14 years and teaches stress reduction, mind/body skills and mindfulness meditation.
UCP: What is your approach to working with chronic pain patients?
JS: First, I try to teach them how to take care of themselves including learning how to calm themselves down. I spend a great deal of time using exercises to help them move functionally and with ease - meaning that they move with as little tension and effort as possible while using correct motor patterns. Often, I also have to work with their fear that movement will increase the pain.
UCP: You have used a number of wellness techniques in your PT practice. What were these and how do they contribute to your approach?
JS: I have explored yoga, mindfulness meditation, aikido, and various forms of T'ai Chi for myself and for my patients. I began studying yoga 15 years ago and found that it really helped my patients' stability and range of motion. When I started practicing Aikido and T'ai Chi, I realized that both of these arts added the component of ease of movement and flow of the movement. Because they have dynamic movement that is both relaxed and functional, I started incorporating them into my practice. In November of 1999, I took the T'ai Chi Fundamentals training. Although I had already been using some T'ai Chi principles in my practice, I found that the workshop gave me a much better understanding of T'ai Chi's potential as a therapy. The program provided me with a more complete package. It puts together a system of movement that has applications all the way from early weight shifting and balance activities up to sports activities. I appreciate that it includes simple and specific movements. The "Movement Patterns" opened up more possibilities for me in working with individual clients as well as teaching groups. I now combine these with mindfulness and relaxation exercises for my stress reduction classes.
UCP: Please describe how you use T'ai Chi with chronic pain patients.
JS: T'ai Chi is a whole-body approach to "ease of movement." Even if the patient's pain is in the back or neck, I start working with them to get their feet rooted into the ground. This contributes to better trunk and overall stability. The end result is that the extremities have more mobility with less effort. Getting rooted in the feet and improving trunk stability has helped my patients relax their shoulders while moving their hands and arms. Also, their lower backs stay as relaxed as possible while lifting their legs. For example, I had a female patient in her 30's who had low back and neck pain. I began by teaching her to relax the shoulders using the T'ai Chi arm movements. We then worked on the one-legged T'ai Chi Fundamentals Movement Patterns. These were effective in teaching her to relax her lower extremities. This not only helped her neck pain, but she also noticed great improvement in her horse back riding. Another patient who was in her 40's was unable to rotate her spine after having back surgery. I used the "T'ai Chi Fold" Movement Pattern with her to teach her how to shift her weight and rotate at the hips which allowed her to turn without shuffling her feet or rotating her spine. For another patient who had chronic neck pain, I used the "Horse Stance" posture. We were able to apply the principles of this posture to her walk and she was delighted that she had learned how to relax her body anytime she walked somewhere. This greatly decreased her neck pain.
UCP: How has the T'ai Chi Fundamentals Program worked with your fibromyalgia patients?
JS: Some of the research has shown that in fibromyalgia cases the muscles keep firing more than they should after they have been used. Thus, I focus on techniques to help patients learn to shut the muscles off. The focus isn't on stretching or strengthening the muscle, but moving in a relaxed and functional way. I have had good results starting with the first Movement Pattern "Horse Stance" and then using "Arm Swinging." I have them swing progressively higher as they learn to keep the arms and shoulders relaxed. Once they can quiet the muscles, it is possible to work on strength exercises with less irritation to the muscles. For Fibromyalgia patients it is also imperative to slow down the mind. I remind them of some of the principles of T'ai Chi such as keeping focused on what the body is doing. Bringing the attention back to the body is so important because these people are used to avoiding this.
UCP: Any other effects of the program?
JS: Yes, another thing I really appreciate about the T'ai Chi Fundamentals is that many of the movements are open and expressive and thus help elevate the mood. So many chronic pain patients are depressed because of their pain and the positive nature of the exercises makes a big difference.
Judy Smith and Tricia Yu will teach the T'ai Chi Fundamentals: Application for Therapeutic Exercise and Functional Activities workshop on February 24-25 in Madison, WI. Judy can be reached at Meriter PT Dept. 608-287-2350 or email aikiyogama@aol.com.
