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PATIENT-CENTER-CARE-COMMENTARY 

32 
   Clinical Practice in Athletic Training 
  Volume 1 – Issue 2 – October 2018 

Expanding Clinical Practice with Complementary and Integrative 
Health, such as Tai Chi, as Therapeutic Interventions 
Connor A. Burton, LAT, ATC 
Indiana State University, Terre Haute, IN 

Key Phrases 
Therapeutic exercise, emotional wellness, mental health, tai 
chi 

Correspondence 
Connor Burton, Indiana State University, 567 N. 5th Street, 
Terre Haute, IN 47809. 
E-mail: cburton24@sycamores.indstate.edu
Twitter: @cburt105

Full Citation 
Burton CA. Expanding Clinical Practice with Complementary 
and Integrative Health, such as Tai Chi, as Therapeutic 
Interventions. Clin Pract Athl Train. 2018;1(2):32-36. 
https://doi.org/10.31622/2018/0002.5.1  

Submitted: September 1, 2018 Accepted: October 23, 2018 

COMMENTARY 

The National Institutes of Health (NIH) define

complementary and integrative health (CIH) as 
“those health care practices not currently 
considered an integral part of conventional 
medicine.”1 When an intervention is used in 
addition to conventional care, it is deemed as 
complementary medicine. Integrative medicine 
are those interventions that are used in place of 
conventional care.1 Across the general public, the 
utilization of CIH in Western society is growing. A 
2012 study of nearly 89,000 Americans indicated 
that 33.2% were utilizing CIH.2 Within this study, 
various reasons for utilizing CIH included 
health/wellness improvement, treatment for 
symptoms related to disease, or to improve side 
effects from modern medicine.2 Some Western 
health care providers have brought CIH into their 
practice, whether it be direct incorporation or 
referral to another qualified provider. Some of 
these interventions include chiropractic services, 
massage therapy, relaxation techniques, yoga 
and tai chi.1 Although CIH continues to grow in 
Western society as a whole, the utilization of CIH 

Copyright © by Indiana State University      
All rights reserved. ISSN Online 2577-8188 

in modern health care does not follow a similar 
trend. In order to provide patients with optimal 
care and satisfactory outcomes, it is crucial to 
consider all potential interventions when 
developing a patient-centered plan of care. 
Acting as the first point of care for the majority of 
our patient populations, athletic trainers can talk 
with patients about these unique interventions. In 
so doing, we play an integral role in starting a 
movement of holistic health care which provides 
patients which more options to meet their goals 
and needs. 

What is Tai Chi and how is it implemented into 
practice? 

There is a strong body of literature supporting the 
use of tai chi as an intervention for the mental 
health of young, physically active individuals.3-5 
Tai chi is a form of martial art and mind-body 
exercise which originated in China.5 This technique 
is commonly described as combining slow-paced, 
precise, and constant functional movements with 
controlled breathing.3-5 Tai chi can be 
implemented into clinical practice through one-on-
one patient care with goals of addressing specific 
conditions. Due to the uniqueness of athletic 
training as a health care profession, tai chi can 
also be implemented into clinical practice in group 
intervention sessions. Two examples of this 
implementation could be facilitation of proper 
breathing during movement for endurance 
athletes or promotion of positive mental health. 
The literature supports the use of tai chi for both 
orthopedic (balance, agility, postural control, 
lower extremity strength,3 cardiovascular and 
respiratory function,7 and pain reduction5) and 
mental health (anxiety,4,5 depression,4,5 self-
esteem,5 and mood.5). Across the literature, 
improvement of outcomes were found regardless 
of the duration (15 to 60 minute sessions), 

https://doi.org/10.31622/2018/0002.5


Using Tai Chi as a Therapeutic Intervention to Expand Complementary 
and Integrative Health in Clinical Practice  

 

 

33 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                         Volume 1 – Issue 2 – October 2018  

frequency of sessions (once per week to daily) 
and length of patient enrollment in the program 
(3 to 12 week intervention).  

As noted, tai chi can serve as an intervention to 
address causative factors related to mental 
health, as well as functional limitations. As a 
clinician, it is important to understand how a 
technique can be an effective option in patient 
care. Moreover, when aiming to provide patient 
centered care, it is equally important to educate 
the patient regarding how each available 
technique can be an effective component of the 
patient plan of care. For tai chi, the emphasis of 
the intervention is placed on incorporating 
relaxation and deep breathing into functional 
movements.3-5 A visual aid of what a tai chi 
intervention could look like is detailed in Table 1. 

This table details notes for the clinician developing 
and implementing the intervention (left column) in 
addition to patient education and queues for 
appropriate integration of breathing with 
functional movement (right column). 

Indications and Considerations for 
Implementing Tai Chi 

Similar to each therapeutic intervention a clinician 
uses in clinical practice, it is important to 
understand the indications, contraindications, and 
considerations for a technique prior to 
implementing the technique into a plan of care. 
Like general physical activity there is an adherent 
risk of injury which must be acknowledged when 
performing tai chi. Individuals who have health 
conditions which require consultation with a 

Table 1: Phase progression of diaphragmatic breathing with basic and advanced movements. 
Phase Concepts for Clinician Examples of Cueing 
Diaphragmatic 
Breathing  

Hand placement above/below umbilicus 
Patient should begin diaphragmatic 
breathing. Time spent practicing 
dependent on dysfunction 
Correct any shoulder elevation and rib 
expansion during breathing 
Progress patient appropriately  
supine  sitting  standing 
 

“Please find a position that is comfortable for 
you.” (standing, seated, or supine) 
“Please place one hand on your stomach and 
one hand on your stomach below your belly 
button.” 
“Breathe in through your nose so that you feel 
your stomach expand under your hand. 
Breathe out through your nose so that you feel 
your stomach shrink under your hands.” 

Functional 
Movement 
with Breathing 

Patient continues diaphragmatic with 
basic movements (Single leg squat, arm 
elevation) 
Maintain proper breathing from phase 
one with movement. Ensure abdomen is 
moving with inhalations 
Progress patient to advanced functional 
movement when breathing is controlled 
and routine 
 

“Starting in a standing position with feet 
shoulder width apart, breathe in as you raise 
your arms straight out in front of you.”  
“Breathe out as you squat down and lower 
your arms to your side at the same time.” 
“Breathe in as you rise up out of the squat 
and raise your hands straight in front of you.” 
“Continue to focus on breathing through your 
belly and not raising your shoulders up or 
expanding your chest when breathing.” 
 

Advanced 
Functional 
Movement 

Introduce occupational/sport specific 
movement with breathing  
Adjust movement speed and intensity 
according to patient progress and 
occupational/sport demands (Lifting an 
object repetitively, throwing a pitch, 
rebounding with contact) 

“Breathe in as you properly squat down to 
pick up this weighted object and breathe out 
as you pick the object up.”  
“Breathe in as you enter your wind-up phase 
and breathe out as you progress through your 
early cocking and follow-through phases of 
throwing.”  



Using Tai Chi as a Therapeutic Intervention to Expand Complementary 
and Integrative Health in Clinical Practice  

 

 

34 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                         Volume 1 – Issue 2 – October 2018  

physician prior to partaking in physical activity 
(e.g. heart condition, severe osteoporosis) should 
take precaution. Additionally, individuals with an 
orthopedic injury that requires modifications to 
activities of daily living or physical activity should 
take precaution and consult with their health care 
provider.  

To obtain the greatest results, the difficulty of the 
tai chi exercises should be tailored to the patient’s 
experience level with the intervention and fitness.6 
Tai chi can be utilized for any patient who is 
physically active. For patients who only complete 
walking and activities of daily living, a clinician 
can develop a program which revolves around 
foundational movements, such as mini squats with 
synchronous arm swings or controlled lunges. For 
patients who partake in a high level of physical 
activity, a clinician can develop a program which 
progresses through foundational movements into 
advanced movements which resemble free 
flowing dance movements, or tailor the program 
to introduce breathing with occupational/sport 
specific activities. In the realm of athletic training, 
patients may present with breathing dysfunction 
caused by a variety of factors such as 
compensatory movements in the kinetic chain, 
diaphragmatic dysfunction, thoracic sprain or 

strain, rib dysfunction, heightened levels of 
anxiety or stress, or faulty breathing mechanics. 
Inherently, breathing dysfunction can result in a 
negative impact on health-related quality of life 
for patients.  

Applying A Patient-Centered Lens To Care 

An important part of effectively providing 
patient-centered care is understanding more 
about the patient than just the condition. This 
understanding must dive deeper than a physical 
wellness understanding of the individual. There 
are seven dimensions which are key to 
understanding the holistic wellbeing of a patient. 
These dimensions include: social, emotional, 
spiritual, environmental, occupational, intellectual, 
and physical.8 When providing care to a patient 
presenting with a form of breathing dysfunction, 
that can be defined as a breathing disorder in 
which respiration patterns change due to chronic 
factors resulting in dyspnea and other symptoms,9 

a holistic approach must be employed to identify 
the contributing factor(s). Examples of how a 
condition can impact the seven dimensions of 
wellness can be found in Table 2. This is not 
intended to be an exhaustive list of  

 

Table 2. Implications of Impairment on the Seven Dimensions of Wellness. 
Dimension Implications   
Social External pressure to continue occupational/sport duties; change or 

loss of social identity 
Emotional Internal pressure to continue occupational/sport duties; internal loss 

of social identity; stress and/or anxiety associated with pain during 
physical activity/breathing 

Spiritual Dependent on the patient’s spiritual beliefs tai chi can support, 
conflict, or be indifferent towards patient’s spiritual health 

Environmental Increased number of provider visits can increase the impact of on 
environmental factors (pollution, healthcare system, economic, etc.) 

Occupational Pressure to continue meeting the organizational expectations of 
occupation/sport activity during and after injury 

Intellectual Patient education and cultural understanding of impairment is vital 
for treatment and success of interventions   

Physical Patient may experience pain with activities of daily living, pain with 
occupational/sport specific functions, or decreased level of function 



Using Tai Chi as a Therapeutic Intervention to Expand Complementary 
and Integrative Health in Clinical Practice  

 

 

35 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                         Volume 1 – Issue 2 – October 2018  

holistic factors to consider, but is designed to help 
a clinician understand the frame of mind 
necessary to apply well-rounded patient care and 
extent of impairment on these domains. A patient 
who presents with thoracic, musculoskeletal pain 
with breathing during exercise and increased 
levels of stress and anxiety during physical 
activity many be a patient case worth considering 
the use of tai chi as a therapeutic intervention. 
When considering social and emotional wellness, 
a patient could be experiencing internal or 
external pressure to perform at a high level.  Of 
the examples provided in Table 2, some of these 
factors can result in heightened anxiety and stress, 
which may result in physiologic changes like 
increased heart rate and respirations. These 
changes can alter the intricate function of the 
respiratory system.  

CONCLUSION 

As a CIH technique, tai chi can be incorporated 
into a patient’s plan of care in conjunction with 
other interventions. As the current literature 
indicates,3-5 patient outcomes related to mental 
health and physical impairment significantly 
improve regardless of the programming 
parameters for tai chi intervention. Due to the fact 
that guidelines are not specific, a clinician should 
work with the patient to set a plan of care which 
best suits the patient’s availability, needs, and 
preferences. As a clinician it is viable to provide 
patients with options when establishing a plan of 
care which aims to address the goals the patient 
seeks to accomplish while receiving care. In order 
to best address patient needs and goals, a 
clinician must not only understand the clinical 
relevance of all considered interventions, but also 
recognize the impact a condition and intervention 
will have on the seven dimensions of patient 
wellness.  

REFERENCES 

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Health and Human Services – National 
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3. Bu B, Haijun H, Yong L, et al. Effects of 
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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                         Volume 1 – Issue 2 – October 2018  

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