Tai chi has been referred to as a form of moving meditation. It is a gentle form of exercise that incorporates movement,
breathing and meditation. It has been used as a form of medical treatment for a wide range of ailments
in China for hundreds of years. It is considered a component of traditional Chinese medicine [TCM]. In recent
decades it has become increasingly popular as a supplementary form of treatment in Western medical practices.
Many prior studies have found that the use of some tai chi styles, such as the Yang and Sun styles, have been effective
in the treatment of arthritic knee pain. The Chen tai chi style differs from those styles, in that it incorporates
some high-impact movements that place additional stress on the knees. In the past few years, the use of artificial
intelligence as a tool of medical research has increased. The present study attempts to identify prior studies
that have used Chen style tai chi with the goal of determining whether the Chen style has long-term detrimental
effects on knee health. Microsoft Copilot, an artificial intelligence chatbot, was utilized to find relevant studies.
Copilot summarized three studies and one article that were not relevant for purposes of the present study. A
search of the PubMed database found two studies that were not relevant. The present study concluded that the
use of artificial intelligence in medical research can be a good first step, but that its results must be verified for
relevance and accuracy. The present study also concluded that more research is needed on the long-run effects
of the Chen style of tai chi on knee health.
Tai chi has been referred to as a form of moving meditation. It
is a gentle form of exercise that incorporates movement, breathing
and meditation. It has been used as a form of medical treatment for
a wide range of ailments in China for hundreds of years [1-8]. It is
considered a component of traditional Chinese medicine [TCM]. In recent
decades it has become increasingly popular as a supplementary
form of treatment in Western medical practices [9-65]. In the past few
years, the use of artificial intelligence as a tool of medical research
has increased [66-95]. The present study attempts to identify prior
studies that have used Chen style tai chi with the goal of determining
whether the Chen style has long-term detrimental effects on knee
health. Microsoft Copilot, an artificial intelligence chatbot, is utilized
to find relevant studies. Performing high-impact stomping moves in
tai chi has its benefits and detriments. One positive aspect of hard
stomping moves is that they can increase bone density. One possible
drawback is that such moves, if practiced over time, can cause knee
damage, or at least that is the belief held by some tai chi practitioners.
Chen style tai chi incorporates high-impact stomping moves among
its postures. The purpose of the present study is to address the issue
of whether high-impact stomping moves can cause knee damage if
practiced on a regular basis over time. We decided to ask this question
to Microsoft Copilot, an artificial intelligence chatbot, the goal being
to find medical studies that might have examined this question.
We chose to posit this question to Microsoft Copilot, a popular
chatbot (as of this writing). However, there are some caveats. Copilot
and other chatbots have sometimes been found to produce inaccurate
results [96-100]. Thus, caution and due diligence are called for in
any studies that incorporate artificial intelligence. Another potential
problem is that some studies have found chatbots to be biased [101-
109]. This finding is especially prevalent for studies that examine political
questions, although there is also a possibility that bias can exist
for medical studies, especially if the medical study includes a controversial
political issue. We gave the following instruction to Copilot.
Chen style tai chi includes stomping moves. Have any studies been
conducted to determine whether the regular practice of Chen style tai
chi over time causes knee damage? Write a two-part essay. In part 1,
summarize studies that have found that the regular practice of Chen
style tai chi can cause knee damage. In part 2, write an essay summarizing
studies that have found that the regular practice of Chen style
tai chi does not result in knee damage. Cite references.
Studies Suggesting Chen Style Tai Chi Can Cause Knee
Damage
Some studies have explored the biomechanical effects of Chen
style Tai Chi on the knee joint and have found that certain movements
can lead to increased stress on the knee [110]. For instance, a study
published in the journal Medical & Biological Engineering & Computing
analyzed the load and stress distribution on the knee joint during
typical lower limb movements of Chen style Tai Chi [110]. The study
found that movements such as “stretch down” (SD) and “part the wild
horse’s mane” (PWHM) resulted in greater knee joint forces and contact
stresses, which could potentially aggravate knee pain in individuals
with knee osteoarthritis (KOA) [110]. The researchers suggested
that practitioners should consider elevating their postures to reduce
knee flexion angles and decrease the required muscle strength and
load on the knee joint [110].
Studies Suggesting Chen Style Tai Chi Does Not Result in
Knee Damage
Conversely, other studies have highlighted the potential benefits
of Chen style Tai Chi for knee health, particularly for individuals with
knee osteoarthritis [111]. A randomized controlled trial published in
BMC Complementary Medicine and Therapies evaluated the efficacy
and safety of Tai Chi on knee pain and muscle strength in middle-aged
and older adults with KOA [111]. The study found that regular Tai
Chi practice significantly reduced knee pain and improved muscle
strength, suggesting that it could be a safe and effective intervention
for managing knee osteoarthritis [111]. Additionally, a narrative overview
published in the Journal of Ageing Research and Healthcare synthesized
data from various studies and concluded that Tai Chi could
enhance mobility, reduce pain, and improve overall quality of life for
older adults with knee osteoarthritis [112]. The review emphasized
that Tai Chi’s gentle, low-impact movements help maintain joint flexibility
and strength without causing strain [113].
Perhaps the most obvious flaw in the Copilot part 2 essay is the
fact that nowhere does it refer to studies that have found that the regular
practice of Chen style tai chi does not result in knee damage. Numerous
studies have found that the practice of tai chi in general can
improve knee health [114-130]. However, the other main styles of tai
chi (Yang and Sun styles, for example) do not include strong stomping
actions, whereas Chen style tai chi does include some strong stomps.
Thus, part 2 of the essay seemingly does not analyze the effect of the
practice of Chen style tai chi on long-term knee health. To investigate
this issue further, we decided to read the sources cited by Copilot to
determine whether the summaries given by Copilot omitted any relevant
information. The Haino et al. study [110] focused on the Chen
style, but did not address the strong stomps that exist in some Chen
style tai chi forms. It discussed lower limb movements such as the
deep squat, single whip, brush knee and parts of the wild horse’s
mane postures, which exhibit greater lower limb force than other
tai chi styles. The authors of that study did suggest that these lower
stances might aggravate pain in patients with osteoporosis, and
that this additional stress and pain could be mitigated by performing
these moves with a higher stance. Thus, it appears that the practice
of Chen style tai chi, if practiced in the traditional way using lower
stances than those used in other tai chi styles, can result in additional
knee pain, and even long-term damage, compared to the practice of
other tai chi styles such as the Yang and Sun styles.
Or maybe not. Low stances can also strengthen the leg muscles
that support the knees. The Hongyu Yue et al. study [111] was not
really a study at all. In that publication, the authors merely discussed
a study they were going to conduct in the near future that would incorporate
the Yang-8 tai chi style. Thus, this prospective study would
not use the Chen style of tai chi, which makes this prospective study
irrelevant for purposes of the present study. The Marks study [112]
was a review of existing literature on the effect of tai chi in general
to the alleviation of arthritic knee pain. The finding was that many
studies concluded that the practice of tai chi had a significant effect
on relieving knee pain of those suffering from osteoarthritis of the
knee. The study did not focus on the effect of Chen style tai chi in particular
on the alleviation (or worsening) of knee pain. Thus, the Marks
study is irrelevant for purposes of the present study, since it did not
examine the issue of whether the practice of Chen style tai chi, which
includes high impact foot stomps, can have an adverse effect on longrun
knee health. The Knowridge article [113] discussed tai chi in general.
It did not discuss the Chen style in particular. Thus, this article
is irrelevant for purposes of the present study, the purpose of which
was to find studies that examined the effect of Chen style tai chi on
long-term knee health. The Copilot search cited three studies and one
article that were not quite on point.
The next step was to search the PubMed database to see if any
relevant studies could be found. A search for Chen style tai chi and
knee found two studies, neither of which were relevant. One of those
studies found that the practice of Chen style tai chi was safe and effective
for individuals over age 50 who suffered from functional disability
[114]. However, that study was conducted over 12 weeks, and thus
did not study the long-term effects of practicing Chen style tai chi on
knee health. Also, it did not compare the relative effects of Chen style
tai chi to other tai chi styles that include only low-impact movements.
If anything is to be learned from the present study, it is that the
use of artificial intelligence such as Microsoft Copilot can be useful
as an initial step in medical research in that it is able to identify potentially
relevant medical studies, but that the use of AI should only
constitute a preliminary step in medical research, since the AI findings
may be irrelevant or misleading. Thus, due diligence is called for.
The AI findings must be verified by actually reading the articles cited
by AI. One must not simply rely on the AI findings without conducting
further investigation. Numerous studies have found that the practice
of tai chi can increase knee health [115-131] and can be effective
in battling knee osteoarthritis and osteoporosis. However, certain
tai chi styles, such as the Yang Style and the Sun style, involve only
low-impact moves, and thus do not cause excessive stress on the knee
joints. Chen style is different in this regard, since it incorporates higher-
stress foot stomps, which may or may not result in knee damage if
practiced over a long period of time. The present study was unable to
find any definitive studies that prove or disprove the belief that the
practice of Chen style tai chi can, over time, result in knee damage.
That does not mean that such studies do not exist. It only means that
such studies were not found in the present study. More research is
needed on this point.
ISSN: 2574 -1241
Abstract
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