Carol Circled a Tai Chi Flyer and Left It on My Desk

THE 30-SECOND VERSION

Tai chi is one of the few approaches strongly recommended for hip osteoarthritis, the wear-and-tear arthritis that stiffens joints with age, and a recent trial found people can learn it at home with no teacher.

METHOD OF THE WEEK

Tai chi earned a rare top grade for hip arthritis

A recent trial found people can learn it at home with no instructor.

Carol left a folded flyer on my desk last spring. It came from the rec center down the road. Someone had circled a line in red: "Beginner Tai Chi, 10 a.m." I knew it was Carol. She circles things the way an accountant flags an error.

Tai chi is a Chinese practice of slow, flowing movements done while standing, with steady breathing. I had seen people doing it in a park once. It looked like slow arm waving, and I was not sold. But Carol does not circle things for no reason.

I did what I always do. I looked up the research. The American College of Rheumatology, or ACR for short, sets the main treatment guidelines for arthritis in the United States. I expected to find tai chi filed next to yoga, a polite footnote. Instead the ACR gave it a "strong" recommendation for hip and knee osteoarthritis, the wear-and-tear kind where joint cushioning breaks down over time. "Strong" is their highest positive grade. Few treatments earn it.

Then I found the RETREAT trial, published in JAMA Internal Medicine in 2025. Researchers asked a plain question: can people learn tai chi on their own, at home, with no teacher? They gave 178 adults with OA an online tai chi program, with no class and no instructor to guide them. Just a screen and a living room. So what happened?

QUICK QUIZ · TAP TO ANSWER

In the RETREAT trial, what share of the home tai chi group saw a meaningful drop in pain?

Tap your guess and a ready-to-send reply opens. Just press send. The answer is below, under The why.

About 25 percent

About 50 percent

About 73 percent

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THE WHY

Why slow movement does real work on a stiff hip

Quiz answer: About 73 percent. In the group that got only written advice, 47 percent reached that mark.

The RETREAT trial was run by Zhu and colleagues and published in JAMA Internal Medicine in 2025. They enrolled 178 adults with knee OA. Half were assigned by chance to an online tai chi program at home. The other half got written advice only. After 12 weeks, about 73 percent of the tai chi group hit a pain drop big enough to matter. No serious side effects were reported.

That one trial is not alone. In 2025, Zhao and colleagues published an updated review in Osteoarthritis and Cartilage. The review pooled 28 trials, each one randomized, meaning people were sorted into groups by chance so the results would be fair. Across 1,676 adults with OA, tai chi cut pain by what researchers call a medium-sized effect. This is measured with a score called Cohen's d, where 0.2 is small, 0.5 is medium, and 0.8 is large. Tai chi scored 0.64 and also improved stiffness and self-reported function.

It matched physical therapy and the gains lasted

In 2016, Wang and colleagues published a head-to-head trial in Annals of Internal Medicine. They enrolled 204 adults with knee OA and split them into 12 weeks of tai chi, twice a week, or 12 weeks of standard physical therapy. Both groups improved by similar amounts on a standard pain and function score called the WOMAC, which rates pain, stiffness, and daily function from 0 to 2,400. The tai chi group improved by 167 points, the physical therapy group by 143. The gap was not large enough to count as a real difference. And the gains held for a full year. In other words, slow movements in a gym matched hands-on treatment from a trained therapist.

One honest note. Most of the large trials focused on knee OA, not hip OA. But the ACR's strong recommendation covers both joints. Both are weight-bearing and move through a wide range of motion. The slow shifts of tai chi ask the hip to rotate, load, and stretch at a gentle pace. Yang style, the most common form, is the version used in most OA research.

I tried a beginner video at home the week after Carol left that flyer. The movements were slow enough that my hips did not fight me. I felt foolish in the living room, shifting my weight from foot to foot like a slow pendulum. Carol watched from the kitchen doorway and said nothing. In our house, that means she approves.

⚠ WHEN TO STOP

When to stop and call your doctor

These are uncommon, but they’re signals to get checked promptly rather than move through:

● Pain that shoots down a leg

● Numbness between your legs or around your groin

● New trouble controlling your bladder or bowels

● A hip that will not bear weight after a fall

● Sudden inability to move the leg or hip

When in doubt, get it checked. PainFree is not medical advice. It complements your doctor’s care and never replaces it.

THIS WEEK’S QUICK WINS

Three ways to try tai chi this week

🎯 Search for a beginner Yang tai chi video

Look for one that runs 10 to 15 minutes and is labeled "senior" or "chair-supported." Follow along once in the living room near a counter for balance.

15 minutes • A first feel for the pace

🦶 Try the basic weight shift

Stand behind a chair, hands on the back, and shift your weight slowly to one foot for 3 seconds, then the other. This is the core motion of tai chi, and it loads each hip gently.

2 minutes • Gentle hip loading

📋 Check your local rec center

Many YMCAs and town rec centers run tai chi classes for older adults, often free or low cost. Look for "Yang style," "gentle," or "beginner" in the class title.

5 minutes • Finding a class nearby

RESEARCH BRIEF

Twenty-eight trials found tai chi eased arthritis pain by a medium-sized effect

Zhao and colleagues pooled 28 trials in a review published in Osteoarthritis and Cartilage in 2025. In each trial, people were sorted into groups by chance so the comparison would be fair. The trials covered 1,676 adults with osteoarthritis. Compared to groups doing no structured exercise, tai chi reduced pain by a medium-sized effect, scored at 0.64 on a scale where 0.2 is small, 0.5 is medium, and 0.8 is large. It also improved mobility, stiffness, and self-reported function.

trials pooled

1,676

adults with OA studied

0.64

Cohen's d pain effect size

Tai chi's pain benefit held up across 28 separate trials, making it one of the more tested gentle approaches for OA.

WHAT THE EVIDENCE SAYS

TENS, acupuncture, and capsaicin cream for hip pain

TENS

TENS is a small battery device that sends mild electrical pulses through pads stuck to the skin. The 2019 ACR guideline strongly recommends against it for hip and knee OA, citing small studies and low-quality evidence.

Acupuncture

Manheimer and colleagues published a 2018 Cochrane review of 6 studies and 413 people. They found acupuncture probably makes little or no difference in hip pain compared to sham, a fake version where needles go in the wrong spots. The ACR gives it a conditional, or weaker, recommendation. Low risk, but keep your hopes modest.

Topical capsaicin cream

Capsaicin is the compound that makes chili peppers hot, used in skin creams to calm pain nerves over time. A 2024 review of 8 trials and 498 patients, published in Phytotherapy Research, found it may reduce OA pain, but the evidence was weak and burning at the site was common. The ACR conditionally recommends it for knee OA. Hip evidence is thinner because the joint sits deeper under muscle and fat.

Always check with your doctor or pharmacist before starting a new treatment.

WORTH KNOWING

52 weeks

In the largest head-to-head trial of tai chi for OA, pain and function gains from just 12 weeks of twice-weekly classes lasted a full year, as long as people kept up some practice at home.

Wang et al., Annals of Internal Medicine, 2016, tracking 204 adults with knee OA.

Here's to giving slow a fair shot,
Walt

QUICK POLL · TAP TO ANSWER

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