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How to prevent knee injury when practicing Tai Chi ?

As Tai Chi, an outstanding martial art of Chinese Wushu, has gained recognition for its health benefits with the development of society, an increasing number of people now participate in learning and practicing Tai Chi. However, among those who practice Tai Chi, some individuals often experience varying degrees of knee joint pain and, in some cases, even long-term knee joint injuries. So, how can one avoid injuring the knee joints while practicing Tai Chi?

Throughout our extensive teaching experience, we have paid great attention to this issue and conducted specific analyses. The knee joint is formed by the connection of the tibia and fibula with the femur, with the patella in front and two crescent-shaped cartilages, known as menisci, in the middle. It is surrounded by a capsule containing multiple ligaments and muscles. The structure of the knee joint does not allow it to be a universal joint; its main function is to flex and extend backward in the direction of the tibia and femur. Sideways rotation of the knee joint is limited and mainly depends on the sliding movement of the two menisci. This structural characteristic makes the knee joint susceptible to injury when subjected to uneven or excessive forces.

After extensive practical experience, we believe that knee joint pain or injury during Tai Chi practice is primarily caused by the following four factors:

1. The first aspect is incorrect lower limb movements leading to knee joint pain or injury.

During Tai Chi practice, incorrect lower limb movements causing knee joint pain or injury are quite common and can be observed in the following situations:

– In the process of stepping forward, the supporting leg does not turn the toes outward. When changing postures in Tai Chi, it is essential to lift the foot before stepping forward. Some individuals skip this step, resulting in forced twisting of the knee joint, causing misalignment between the upper and lower legs at the knee joint and leading to knee joint pain or injury.

– Before stepping forward, the angle of the supporting leg’s foot placement is improper, without rotating the knee and coordinating the leg’s rotation with the body’s turning. This can also create a misalignment between the upper and lower legs at the knee joint, resulting in knee joint pain or injury.

– Incorrect angles when stepping or pivoting. Some practitioners emphasize moving forward or backward at 45, 30, or 60-degree angles, or stepping sideways to the left or right without considering the natural angles that the supporting and stepping legs should maintain. If the legs are not in a naturally coordinated position during stepping or pivoting, the knee joint can experience misalignment, leading to long-term knee joint pain or injury.

– While lifting the foot and stepping, failure to relax the hips and keeping the supporting leg’s knee too straight rather than slightly bent in a natural position. If the supporting leg is overly extended and the center of gravity shifts forward during the stepping process, it will increase the pressure on the knee joint, directly compressing the menisci, potentially leading to meniscus injuries.

– After stepping or pivoting, not relaxing the hips promptly. If the hips are not relaxed immediately after stepping or pivoting, the center of gravity will remain on the supporting leg for an extended period, leading to excessive and prolonged pressure on the supporting leg. Especially when there are mistakes in foot placement or stepping, the knee joint may be subjected to misalignment, resulting in injury to the supporting leg.

– During changes in body postures and shifts in the center of gravity, when the knee extends beyond the toes, there will be no room for the menisci to slide, directly subjecting the patella and ligaments in the front of the knee joint to excessive stress, which can cause pain or injury in the knee joint area.

– In changes of body postures and center of gravity shifts, insufficient relaxation of the hips and not aligning the knee joint with the direction of the toes, causing the knee joint area to be in a twisted state, leading to knee joint pain or injury.

The Second Aspect: Knee Joint Pain and Injury Due to Excessive Lower Limb Load

Compared to other physical activities, Tai Chi involves relatively significant lower limb load, placing considerable stress on the knee joints. The degree of knee joint load is relative and depends on the practitioner’s individual qualities. Generally, adolescents have stronger load-bearing capacity than adults; younger adults have stronger knee joint load-bearing capacity than older adults; individuals who exercise regularly have stronger knee joint load-bearing capacity than those who don’t. Whether beginners or professional athletes, each person has their limit for knee joint load, and exceeding this normal value can lead to knee joint pain or injury.

During the process of practicing Tai Chi, most basic leg movements require the knee joints to be in a bent state. For beginners, inadequate leg muscle strength may lead to muscle soreness and excessive stress on the knee joint, making it more prone to tension and pain. Professional athletes, on the other hand, might have a smaller probability of knee joint injuries due to their greater leg muscle strength. However, higher training intensity and errors in technical movements or prolonged training can still lead to knee joint pain and injuries.

The knee joint can sustain injuries due to excessive force, and this risk exists in various Tai Chi practitioner groups. It could be due to a single instance of localized excessive force, such as forceful stomping or sudden movements causing excessive local stress on the knee joint, leading to bone, muscle, ligament, or meniscus injuries. It could also result from the cumulative effect of prolonged excessive physical activity, such as extended periods of training with low stances or long periods of single-leg flexion and extension, causing excessive stress on the knee joint. Additionally, excessive physical activity over a prolonged period can lead to overloading the knee joint for an extended time, resulting in strain and damage, leading to knee joint pain or injury.

The Third Aspect: Knee Joint Pain and Injury Caused by Poor Movement Habits

1. Failure to perform warm-up exercises or inadequate warm-up exercises. Some people skip warm-up exercises before practicing Tai Chi or omit them altogether. Without adequate warm-up exercises, various organs and the nervous system of the body do not receive sufficient stimulation, especially the nerves and muscles around the knee joint. In such a situation, practicing Tai Chi directly without the body adapting to the movements can prevent the knee joint capsule from secreting sufficient lubrication, making it more susceptible to excessive load and causing knee joint pain or injury.

2. Failure to avoid wind and cold after sweating during practice, leading to invasion of pathogenic wind and causing rheumatic pain in the knee joint.

The Fourth Aspect: Aggravation of Pre-existing Lower Limb Injuries Due to Unscientific Exercise

Some Tai Chi enthusiasts already suffer from ailments like synovitis, rheumatoid arthritis, or other knee joint-related conditions. Correct and moderate practice of Tai Chi can help alleviate pain and inflammation symptoms and act as an adjunct therapy for related diseases. However, if the practice method and techniques are not correct, or if the exercise intensity is too high, it can worsen the condition.

In response to the various situations mentioned above, how can we prevent knee joint pain and injury during Tai Chi practice?

First, we must have the correct understanding of Tai Chi for fitness.

Some people simplify Tai Chi practice as a means of fitness and health without realizing that it is a sports activity. Poor exercise habits and incorrect practice methods can lead to physical harm. The fitness and health benefits of Tai Chi are scientifically proven over a long period of practice, which is beyond doubt. However, these benefits can only be achieved with proper technique and moderate exercise. On the contrary, incorrect technique, excessive exercise intensity, and poor exercise habits can lead to harm. Therefore, we must strengthen our awareness of the importance of correct technique and cultivate good exercise habits to avoid harming the knee joints, particularly by focusing on preventing knee joint injuries.

Second, we must emphasize the correctness of technique.

Whether as a coach or an athlete, whether in the early stages of learning movements or during advanced training, we must pay attention to the correctness of technique. Only by doing so can we eliminate the fundamental factors that can harm the knee joint. For example, when stepping forward, it is crucial to lift the foot first; when performing the horse stance or side horse stance, the hips should be relaxed and the knees should not extend beyond the toes; during body rotation and posture changes, one must pay attention to naturally relaxing the hips and coordinating the rotation of the knees. These key points in technique should be clearly understood from the beginning of learning so that the correctness of the movements can be ensured during practice. Even during advanced training, we must remain vigilant. Failure to pay attention to these fundamental technical aspects sooner or later leads to knee joint injuries.

Third, we must consider individual differences.

Whether professional Tai Chi athletes or general Tai Chi enthusiasts, whether coaches or practitioners, we must consider individual differences and not require that everyone’s movements be exactly the same or conform to a single standard. In training, we need to emphasize correct postures, but the range of motion, specifications of movements, exercise intensity, etc., must consider individual differences and meet the practitioners’ physiological requirements. For instance, the step size and angle of stepping or pivoting, the height of stances, etc., are related to the practitioner’s physical qualities, basic skills, length of practice, training intensity, and lower limb bearing capacity. Therefore, coaches should treat each student differently based on their circumstances, and there should not be a uniform requirement. The exercise intensity of new and experienced practitioners should not be the same to prevent excessive exercise from causing knee joint injuries. Practitioners themselves should also pay attention to the appropriateness of technique, the range of motion, and exercise intensity according to their own conditions. Only in this way can knee joint injuries be avoided.

Finally, preventive measures for knee joint injuries must be implemented.

To effectively implement preventive measures for knee joint injuries during Tai Chi practice, we should start with the following:

1. Emphasize the importance of technical guidelines at all times and in all circumstances. We must continually emphasize correct technical guidelines throughout the entire training process and apply them to every practitioner and every technical movement.

2. Arrange exercise intensity and training methods based on individual differences. For community fitness groups, collective practice is common. Therefore, the posture for beginners can be higher, and the number of repetitions in group practice can be reduced, and the exercise intensity can be relatively lower. For those experiencing knee joint pain or discomfort, special attention should be given. Injured individuals should receive proactive treatment. Those with mild pain or soreness should determine whether it is due to excessive exercise or an existing injury, and the training should be adjusted accordingly. In our experience, beginners or those who suffer from knee joint pain due to relatively high exercise intensity can adopt a method that imitates the relatively unconscious and freely playful movements of children. As we all know, when children play, their movements are the most coordinated and least fatiguing. Knee joint pain or injury in beginners is often closely related to the lack of coordination in body movements. If body movements are not coordinated, the knee joint is more prone to fatigue and pain. Therefore, practitioners can use free, unstructured movements and practice at a relatively relaxed speed to improve body coordination and reduce tension in the knee joint area, thereby reducing knee joint pain and avoiding knee joint injuries.

3. Cultivate good exercise habits. The principle of prevention first, followed by fitness should be established. As a sports activity, the Tai Chi training process must follow

 a general training program. Warm-up exercises or light practice to review routines as a warm-up should be conducted before formal training to ensure the body adapts to the movements. Whether in formal training or free practice for warm-up, attention must be paid to technical guidelines and not disregard the correctness of movements due to free practice. Develop a serious attitude towards technique, which is essential to ensure the accuracy of movements and the gradual improvement of technical proficiency. Additionally, after sweating during practice, timely protection against wind and cold should be provided to prevent illness.

Practicing Tai Chi for fitness and health is a long-term process of practical experience. We must prioritize preventing injuries, give due importance to the correctness of techniques, the scientific nature of training programs, and the rationality of training content. Moreover, we must cultivate good exercise habits. Only then can we avoid sports injuries and truly achieve fitness and health goals through Tai Chi practice. Otherwise, although the purpose of Tai Chi practice is good, the results may be counterproductive, leading to more harm than benefit. Therefore, during Tai Chi practice, we must advocate scientific fitness and stay away from sports injuries!

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