- Tai Chi Productions
|By: Dr Paul Lam|
© Tai Chi Productions. All rights reserved except copying for educational, non profit purpose. For example you can copy this article for your fee paying students and conference attendees provided you do not charge a fee for it. This is an integral part of Dr Lam's book "Teaching Tai Chi Effectively", and should be interpreted in relation to the complete book.
When you are teaching tai chi, your students' safety is of paramount importance. Teaching safely makes you a more effective teacher. No matter what your students' objectives are, any injury will set them back from achieving them. It seems likely that if we don't take on this responsibility ourselves, governments might soon force us to do so. To safeguard the public, many countries are now bringing in regulations for the conduct of exercise classes. It may not have happened with tai chi classes yet in your country, but it could eventually. The benefit for us, if we take on this responsibility, is that we can probably do a better job than the government.
My colleagues and I have worked hard to make our Tai Chi for Health programs the safest possible and we teach the pre-cautions outlined below in our workshops. To be certified to teach, participants must pass the test for safe teaching. The vast majority of tai chi instructors/leaders who have attended our workshops support this measure. Many told us that they wanted to learn about safety but couldn't find out where to learn it. Gary, a tai chi instructor for 10 years, had been suffer-ing from back pain for the same length of time. He told me that after attending my workshop, he stopped doing the straight leg toe-touch exercise in his pre-tai chi warm up and his back pain has disappeared.
In 2005, Accident and Compensation Corporation (ACC), a government body in New Zealand, paid for 10,000 older adults to attend tai chi classes to improve their health and prevent injury. The ACC recognises the importance of safe tai chi teaching and invited me to help them design safety measures and set up training courses for class teachers, to be used throughout the country. I have used essentially the same guides as I do in my workshops. These are easy to learn and most of them are such common sense that you may be doing them already.
There are significant differences in different tai chi styles and schools, therefore the safety requirements for them are different. My guide here is based on commonly accepted varia-tions of the 'soft' tai chi styles such as Yang and Sun. If you have any doubts about the forms you teach, I recommend you check with appropriate health professionals. All my Tai Chi for Health programs are designed in consultation with medical ex-perts in their respective fields, with safety as the top priority. For example, the Tai Chi for Arthritis program has had input from arthritis specialists (rheumatologists and physiothera-pists).
The notion that 'my teacher taught me this, so it must be safe' is just as faulty thinking as saying that my teacher knows everything there is to know about medicine now and into the future. There is a well-known saying in China that if you keep stamping on a stone (performing the Chen-style movement Golden Guard Stamping on the Ground) until you've bored a hole in the stone, you are then good enough to graduate from the Chen-style. I often wonder how many people have crushed their knee cartilages by 'stamping on a stone' like this! In fact I know of many Chen stylists who have suffered from serious problems with their knees.
Once you have the intention to minimise injury, you can find ways to do so. Start by using my guide here and make sure you constantly upgrade your knowledge. Remember, medical knowledge is updated constantly. You may have already been taking many of these precautions, but safety is so important that it is always worth revising your knowledge.
There are many medical conditions that are not obvious, even to a doctor's eyes. An exercise teacher is not a health professional, so be aware of your limitations. Dr Pam Kircher, a medical doctor from the USA, says that even though she is li-censed to practise medicine, she never does so during a tai chi class. The reason why? Although she knows medicine and may be correct in the information she gives, she doesn't have the student's medical chart in front of her to review their his-tory, lab tests, etc, so it's possible to miss something. For that reason, she doesn't feel it's right to give medical advice to stu-dents. She says, 'When I teach tai chi, I wear my tai chi hat, not my medical doctor hat.' Being a medical doctor too, I don't practice medicine in my tai chi classes; I refer students back to their health professionals. One day a student reminded me that I am his doctor, so I asked him to make an appointment to see me at the clinic where I have access to his medical records and our medical equipment.
When students enrol, consider asking them to complete and sign a medical waiver form for your protection. In that form there should be a statement to the effect that students acknowledge by signing the form that it is their own responsibility to tell you if there is any medical condition that may affect them doing tai chi.
It is also the student's responsibility, if they have any medical condition, to get their health professional's approval to take your class and for them to provide you with instructions about any special precautions that must be taken. I have provided a sample waiver form in the Appendix. Be sure to check with your legal adviser to ensure this form complies with your own country's legal requirements.
Safety precautions can be classified into four categories:
1. General care.
2. Exercise care.
3. Specific precautions for tai chi.
4. Precautions for people with special medical problems.
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Avoid dangerous exercises
There are some dangerous exercises that are not part of most recognised 'soft' tai chi forms, although they could be part of your warm up exercises. Here are some of the common ones.
You can find more comprehensive technical information from sports medicine resources1. A good reference book, Ex-ercise Danger2, has a comprehensive list of these.
Take general exercise precautions
1. Do not practise when you are very hungry, immediately after a full meal, or when you are very upset.
2. Begin your session with warm-up exercises and end with cooling-down exercises. These help prevent injury, pain and stiffness. The length and extent of the warm-up depends on the intensity of the exercise program. My Tai Chi for Health programs include a set of warm-up exercises that you can use. These are included in Chapter 8.
3. Avoid practising in a place that is too hot, too cold or is windy.
4. Continue your session only for as long as you feel comfortable. Listen to your body and rest when you start feeling tired, are in pain, or lose concentration.
5. Don't continue doing any movement that is painful or causes you discomfort. If you experience chest pain, shortness of breath or dizziness, or if additional pain in your joints persists, contact your doctor.
6. Move well within your comfort range. The first time you do a movement, stretch to only 70 percent of your normal range of motion and increase that range gradually.
Specific precautions for Tai Chi
Many of the force-delivering movements in Chen-style tai chi have a higher risk of injury, so if you practise Chen-style, please take extra care and consult a health professional if you have any doubts.
Do all movements slowly and gently, as consistent with tai chi principles, avoid using excessive force, be focused and aware of your body's limits. If you follow the essential tai chi principles they will help you to minimise the risk of injury.
There are several common precautions that should be taken by people with special medical problems such as arthritis or diabetes. Check with your student's health professionals to confirm what precautions are appropriate for that student.
Many people have arthritis in the knee joints. Tai Chi requires the knee to bend and stay at that bent level throughout the set of forms. Students with arthritis should stand up between movements to avoid excessive stress to their knees, until they develop strong muscles and ligaments.
In classical Yang-style tai chi, many people turn their foot while their knee is bent and their weight is on their foot. People with arthritis should transfer their weight or straighten up before turning to avoid injury.
People who have had a hip replacement operation should avoid crossing the foot on the affected side of their body over to the other side of their body. During the replacement operation, the nerves responsible for feeling in the opposite side of their body may be cut, so people who've had this operation may not be able to balance well if their foot crosses the midline of their body.
Standing qigong (zhan zhuang)
Doing standing qigong can have risk of injury because standing on one spot puts extra stress on the body, especially the knee and hip joints. You can use a safer qigong like those described in my Tai Chi for Back Pain program. Older people and people with arthritis can injure their knees by standing for a long time in a stationary position.
Holding a position
If you want to correct a student's position do not hold them in the same position for long. Holding a position can be especially stressful for older people or people with arthritis and they have an increased chance of injury from doing this.
The shoulder is a very mobile joint that can be prone to injury. Many older people have arthritis and rotation cuff or other problems with their shoulders. Movements involving the shoulder should be done slowly, and moving the hands above the head should be done with care. Warn students to stop when there is any pain.
The most significant danger for people with diabetes is hypoglycaemia. 'Hypo' means low and 'glycaemia' means blood glucose (blood sugar). So hypoglycaemia is having low blood glucose. When a person's blood glucose gets too low, loss of consciousness and even brain damage can result. Hypoglycaemia affects diabetics who are being treated with medication or injections.
Exercise causes a high consumption of energy and there-fore blood glucose can be depleted rapidly. The body has an efficient system to regulate blood glucose so that it stays in the right range. However, as medication or injectable insulin aims to lower blood glucose, they may interfere with the body's regulatory system and cause hypoglycaemia. This is why peo-ple with diabetes should let their doctor know what kind of ex-ercise they are doing.
Most people with diabetes are well prepared by their health professionals to recognise signs and symptoms of hypogly-caemia. They are taught what to do. Most people with diabetes who are likely to get hypoglycaemia bring with them some food, drink or candies (such as jelly beans) just in case. En-courage them to feel comfortable with sitting down and eating whenever they feel the need. Some might bring a medication set with needle, syringe and testing kits. Don't be alarmed if they use it. In case your students forget to bring their own, you might find it useful to bring with you a small package of jelly beans or a special package of glucose from a pharmacy, designed for averting a hypoglycaemic attack. Keep in mind that it requires four to six jelly beans to avert a hypoglycaemic attack. If you do bring a package, be sure it is well sealed and clean.
It is important not to assume the role of a health profes-sional in a class. The teacher has responsibilities similar to those of an exercise leader and you should use your first aid training to do what is appropriate. However, beyond that, seek medical help.
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Three fundamental rules for safety
Encourage your students to listen to their bodies and to work within their comfort zone. Create a relaxed atmosphere in your classes so that your students feel comfortable about stopping and resting anytime they need to.