This post originally appeared on Wisconsin Tai Chi Academy’s blog and is reproduced with permission.
Have you ever heard of “Tai Chi Knee”? I first heard about it years ago when I saw a promotion for a book claiming to explain why Tai Chi knee is a ‘normal’ part of Tai Chi practice, along with tips on how to ‘minimise’ the risk of developing Tai Chi Knee. The basic premise was that the positions that some Tai Chi stances require students to put their lower limbs in put a significant amount of strain on the knee joint, and this in turn will cause pain and eventually joint problems. While it is suggested that appropriate strength and conditioning of the knee can minimise these effects, it is accepted that “some” degree of pain is to be expected through learning and performing Tai Chi – a ‘sacrifice for the art’ if you will.
I’m here to tell you that is a complete fallacy. Tai Chi Knee is nothing more than poor understanding and instruction of Tai Chi. It is not something that should exist.
Before becoming a Tai Chi Instructor I was (still am) a Physical Therapist. Throughout my experience with Tai Chi it has always amazed me the level of understanding the old masters had of biomechanics and kinesiology. Every stance, or ‘form’, in Tai Chi is a carefully considered combination of structure and position which results in strength, balance and effective distribution of external forces (eg: gravity) acting on the body. There is no form in any style of Tai Chi that allows or accepts pain or dysfunction as a result of adopting that position. The very notion that such a thing would exist is absurd as it goes against the very principle of using Tai Chi as a way of moving energy (Qi) around the body as part of developing optimal health.
How does “Tai Chi Knee” happen?
In theory, Tai Chi Knee often occurs as the result of either poor alignment of the knee relative to the rest of the body, or applying torsion through the knee while bearing weight through it. I say “in theory” because with correct Tai Chi practice, neither of these things should occur.
The knee is often referred to as a hinge joint as it’s primary movements are to bend (flex) and straighten (extend). However, because of its anatomy, the knee can also be rotated very slightly. Rotation usually occurs in a ‘closed-chain position’, that is, with the feet in contact with the ground or some other surface. In this position the femur can turn slightly over the tibia, creating a torque (rotational force) through the knee. Depending on the alignment of the knee in relation to rest of the leg, it can also flex on one side or the other (lateral flexion). This results in one side of the knee being stretched, while the other is compressed. This movements are often minimal, however they do create strain and wear on the knee.
Excessive and/or repetitive torsion and/or lateral forces can lead to wear and tear on knee structures, especially the ligaments and cartilage. Tai Chi practitioners are at risk of experiencing these forces if:
- the alignment of the knee is incorrect relative the rest of the leg, especially in relation to the foot (often causes lateral forces);
- body-weight is applied through the knee while attempting to change position, for example, when turning to change direction (often causes torsion); and/or
- the joint is being overstressed, as may occur if the student is attempting to move through a range, or at a depth, that their musculoskeletal system has not been conditioned to (often occurs when attempting to perform movements that are too deep or too long).
How to avoid “Tai Chi Knee”
The good news is that with correct instruction and careful practice you never have to experience Tai Chi Knee. While it’s beyond the scope of this article to suggest the correct practice for every Tai Chi form in every set across all styles, here are some general considerations:
- work to your current ability: particularly important if you are new to Tai Chi, or new to exercising in general. Your body needs to adapt and make changes in order to perform at its best. No movements or positions should be forced. A good instructor will not expect you to over strain or stretch your body in order to make things look “correct”; rather, they will help you work within your capacity while showing you how to challenge yourself to make improvements over time;
- align your knees with your feet and your hip joints: generally speaking, your knee should not fall inside or outside of your foot or hip joint as this causes excessive lateral forces. If you are unsure, have your instructor check your alignment while performing your form;
- anytime the foot needs to turn, the weight should be coming off that foot: a position change is generally associated with a weight shift; this is important as it allows the foot to be able to turn freely and avoid torsion through the knee. If it isn’t easy to move the foot, chances are you have your weight distributed incorrectly – have your instructor check and correct;
- some movements may cause strain, but none should cause pain: some forms in Tai Chi can be challenging, and this challenge is what encourages our bodies to adapt and improve. No forms should cause pain. I differentiate between pain and strain as follows: strain should be mildly uncomfortable, however relieves immediately upon cessation. Pain is anything strong that a mild discomfort, and/or persists after cessation. It is important to clarify what you’re feeling with your Tai Chi practice with your instructor.
Of all the things that can result in knee pain, Tai Chi should not be one of them. In fact, Tai Chi is well supported through clinical research as a means of reducing knee pain. Tai Chi Knee should not ever be a thing. If any Tai Chi instructor tells you to expect to develop Tai Chi Knee, my advice would be: run! While your knees are still healthy!