Maintaining equilibrium during a global pandemic

By Seth Freeman

With the world knocked off its axis by a virulent plague, it is unsurprising if we find ourselves feeling a little off balance. A helpful way of maintaining equilibrium during this unsettling period, at least for me, has been the daily practice and regular attendance at classes of Tai Chi, an ancient, gentle and subtly healing martial art.

I signed up for Tai Chi lessons in the spring of last year as part of a class exercise in a Public Health graduate school course focused on “Complementary and Alternative Medicine” (CAM). The plan was to try it out for a few weeks, write the requisite course paper and move on. But, as Sifu (master) Ryan Scott of the School of Martial Arts, West Los Angeles, explains, Tai Chi is not something you learn, finish and then go on to the next thing. Like Music or any of the arts, it can be, if you choose to accept the challenge, a fascinating, continuous and always evolving study.

Even in non-epidemic times people fall. Sometimes, especially with older adults, falls result in injuries which can be extremely serious, even fatal. According to the Personal Health column in the Science section of the New York Times, “An older American dies from an injury related to a tumble every 19 minutes.” Estimates of Emergency Department visits attributable to falls are usually in the millions, sometimes tens of millions. According to the CDC, “In 2015, total medical costs for falls totaled more than $50 billion.”

Somewhere along the evolutionary journey, probably on the savannahs of Africa, primates, then apes, and finally human beings more completely committed to bipedalism, giving up both front legs and a balance-enabling tail. While this change presumably better empowered early humans to survive, it left modern humans vulnerable to tripping, slipping and falling down in their mostly hard-edged, solid-floored, obstacle-course-like homes, offices, stores and city streets. The Center for Disease Control’s recommendation for this modern aspect of the human condition: “Do exercises that make your legs stronger and improve your balance.” The CDC specifically notes that, “Tai Chi is a good example of this kind of exercise.

If Tai Chi (Tai Chi Chuan, more formally), can, in fact, improve balance and therefore reduce the likelihood of falling all while helping people cope with a life-altering pandemic, how does it work? There are some tantalizing clues to possible answers to this question. Low bone mass density — or porous bones (osteopenia or osteoporosis) — is linked to fall risk and to injuries from falling. Although the common wisdom has long held that bone density can only be improved through various forms of resistance training, Tai Chi’s gentle, smooth flowing movements do nevertheless appear to confer greater bone density on participants. Tai Chi is clearly a low impact exercise, but nevertheless, again in contrast to widely held assumptions about strength-training, it has been shown to add muscle strength. Additionally, there are numerous hints that Tai Chi nourishes the connective tissue in participants, and the pivotal role of connective tissue in health is increasingly becoming more appreciated.

Tai Chi class in West Los Angeles

So what actually is Tai Chi Chuan, a practice in which 3.79 million people in the United States participated in 2017 and in which nearly 250 million people are engaged worldwide? The Harvard Medical School Guide to Tai Chi offers a reasonable description: “Tai Chi is a mind-body exercise rooted in multiple Asian traditions, including martial arts, traditional Chinese medicine and philosophy. Tai Chi training integrates slow, intentional movements with breathing and cognitive skills.”

In actually doing the practice, the cognitive aspect of Tai Chi looms larger than a casual observer might initially realize. The prescribed sets of precise movements and body positions known as “forms” demand intense focus and memory, with the paradoxical goal of eventually being able to perform a twenty-minute-long form almost automatically, although still mindfully. Simply put, the challenge to the brain is equal to or greater than the challenge to the body. This aspect of Tai Chi actually makes intuitive sense and comports with our Western view of physiology, especially regarding balance. In the ability to maintain proper balance the neurological component is of at least or greater importance than muscle strength and flexibility.

Sifu Scott (pictured below with students) has been practicing Tai Chi and numerous other forms of martial arts for over twenty years, making pilgrimages to China, to meet the Shaolin monks, and to Japan to deepen his understanding.

These days, in the time of the coronavirus, the classes are conducted in the optimum way for people to gather during an epidemic — outdoors in a verdant park, everyone wearing masks and keeping at least ten feet apart. Just being outdoors under the trees on a mild summer day in Southern California, among friends, at a safe social distance and wearing masks, is palliative even before the class officially begins.

The Connective Tissue Connection

Peter M. Wayne, of the Osher Center for Integrative Medicine at Brigham and Women’s Hospital and Harvard Medical School, suggests that, “there is good reason to believe that Tai Chi, with its emphasis on steady balance and dynamic, integrated movements, will substantially influence the body’s network of connective tissue and modify its structure and function.” This idea could go a long way toward explaining the health benefits of Tai Chi, but it raises a rather basic question: why is it Tai Chi which confers these benefits rather than other forms of exercise, or even just the ordinary movements of daily life? Often the inverse of the question is asked, focusing on the abnormal and impaired condition of connective tissue which can at times result from strenuous or improper physical exercise in sports, running, strength-training and other exertions as well as from the casual, unschooled and, even mindless movements most of us use throughout the day — in sitting, standing, walking, lifting, bending, getting in and out of cars. In this view, the movements of Tai Chi are palliative, ameliorating the damage we inadvertently do to our anatomy, but not a modality for improving the quality of already healthy systems.

The role of the nervous system and endocrine system as well as the musculoskeletal system in balance, energy and overall well-being are more intuitive and more immediately understood than that of connective tissue. Cartilage, blood, fat, tendons, ligaments are all types of connective tissue, but we are mainly interested here in fascia, tissue which is made up of largely two protein-based materials — collagen and elastin. The human body produces substantially less of these substances as it ages, a well-known fact which has given rise to a multi-billion dollar industry of collagen supplements, injections and other treatments — and even, weirdly, “collagen water,” to reduce the appearance of aging — wrinkles — in the skin. Most people think much less frequently about the connective tissue inside their bodies which also receives less and less collagen and elastin over time.

A great deal more research is needed to unravel the Tai Chi > Connective Tissue > health/flexibility/balance connections, but intriguingly, many observers either equate or find suggestive parallels between fascia and the meridians of traditional Chinese medicine.

Fascia in the human body

It may be that the importance of connective tissue is the key insight at the core of traditional Chinese medicine. In fact, understanding connective tissue may be a way to bridge the views of Western and Eastern medicine practices about the human body, disease and healing, leading to the intriguing notion that the healing qualities which Tai Chi apparently confers could derive in part from the influence of musculoskeletal movement on the body’s state of wellness.

It would be a reach, based on current evidence, to suggest that Tai Chi practices increase collagen or elastin within the fascia, but the proprietary movements do appear to enhance connective tissue health. Instead of healing leading to improved movement, the movement itself could be the dynamic mechanism of healing. You need to be well to move well, to be sure, but the practice of Tai Chi would seem to suggest that healing also flows in the opposite direction — moving well can lead to wellness and wellbeing.

Beyond just enhancing balance, it has been suggested that Tai Chi has benefits for those with fibromyalgia and those who have mild or moderate Parkinson’s. It can help lower blood pressure and improve aerobic capacity. And quite possibly it achieves these results through stimulating and engaging connective tissue in a salubrious movement feedback loop.

The movements of Tai Chi are cunningly calculated to challenge the nervous system. As Sifu Scott states, if it doesn’t feel awkward in the beginning, you are doing something wrong. Eventually, however, the logical flow of the movement begins to make sense, usually with tiny micro-adjustments to the shape of the motions of the hands or feet. That level of attention to detail requires a mindfulness which can be difficult in many other practices but is unavoidable and essential in Tai Chi. The brain’s remarkable plasticity is, of necessity, fully engaged. Perhaps, finally, this is Tai Chi’s ultimate secret — and its gift.

Today, during the epidemic, when we face daily uncertainty and a disequilibrating lack of control over our environment and our future, a practice like Tai Chi can be uniquely empowering, allowing us to be active — and at the same time pro-active — about our physical and mental health.

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Seth Freeman, MPH, is a multiple Emmy-winning writer/producer for television, a playwright and a journalist.

Seth Freeman, MPH, is a journalist, a playwright, and an Emmy-winning writer/producer of television, who created the series Lincoln Heights.

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