The Effectiveness and Safety of Tai Chi on Knee Pain: A Systematic Review and Meta-Analysis
Abstract
1. Introduction
2. Materials and Methods
2.1. Protocol and Registration
2.2. Data Sources and Searches
2.3. Inclusion/Exclusion
2.3.1. Types of Studies
2.3.2. Participants
2.3.3. Types of Interventions
2.3.4. Types of Comparisons
2.3.5. Types of Outcome Measures
2.4. Study Selection
2.5. Data Extraction
2.6. Assessment of Risk of Bias (ROB)
2.7. Safety Assessment
2.8. Data Analyses
3. Results
3.1. Study Selection and Description
3.2. Participants
3.3. Intervention
3.4. Control Interventions
3.5. Outcomes
3.5.1. Tai Chi Versus Health Education
3.5.2. Tai Chi Versus No Intervention
3.5.3. Tai Chi Versus Stretching and Health Education
3.5.4. Tai Chi Versus Physical Therapy
3.5.5. Tai Chi Versus Resistance Training
3.6. Safety of Tai Chi
3.7. Assessment for ROB
4. Discussion
4.1. Main Findings
4.2. Limitations of the Review
4.3. Implications for Future Studies
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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First Author (Year) | Patient(s), Sample Size | Experimental Group (Intervention, Regimen) | Control Group (Intervention, Regimen) | Outcome Measurements | Main Result | Adverse Events |
---|---|---|---|---|---|---|
Song R (2003) [29], South Korea | Knee pain patients with knee osteoarthritis n = 43 | Tai Chi n = 22; total of 36 sessions (three times a week for 12 weeks) | No intervention, n = 21 | 1. WOMAC score (1) Joint pain (2) Joint stiffness (3) Physical function 2. Function scale (1) Balance (2) Cardiovascular functioning 3. Muscle strength (1) Abdominal muscle strength (2) Knee muscle strength | 1. (1) p < 0.05 (2) p < 0.05 (3) p < 0.01 2. (1) p < 0.01 (2) NS 3. (1) p < 0.01 (2) NS | n.r. |
Brismée JM (2007) [30], United States | Knee pain patients with knee osteoarthritis n = 31 | Tai Chi n = 18; total of 18 sessions (three times a week for 6 weeks) | Health education n = 13; total of 18 sessions (three times a week for 6 weeks) | 1. VAS for knee pain 2. WOMAC score (1) Overall (2) Pain (3) Stiffness (4) Function 3. Function scale (knee ROM) | 1. p < 0.05 2. (1) p < 0.05 (2) p < 0.05 (3) NS (4) p < 0.05 3. NS | (E) Minor muscle soreness and foot and knee pain after first session. No AEs were observed during the remaining sessions. (C) None. |
Lee HJ (2008) [31], South Korea | Knee pain patients with knee osteoarthritis n = 41 | Tai Chi n = 28; total of 16 sessions (twice a week for 8 weeks) | No intervention n = 13 | 1. WOMAC score (1) Total (2) Pain (3) Stiffness (4) Physical function 2. Functional scale (6 min walking test) 3. Quality of life (SF-36) (1) Total (2) Physical health (3) Mental health | 1. (1) NS (2) p < 0.05 (3) NS (4) NS 2. p < 0.001 3. (1) p < 0.05 (2) p < 0.05 (3) p < 0.05 | n.r. |
Wang C (2009) [32], United States | Knee pain patients with knee osteoarthritis n = 40 | Tai Chi n = 20; total of 24 sessions (twice a week for 12 weeks) | Stretching and health education n = 20; total of 24 sessions (twice a week for 12 weeks) | 1. WOMAC score (1) Pain (2) Stiffness (3) Function 2. VAS for pain 3. Functional scale (1) 6 Minute Walk Test (2) Balance score (3) Chair stand time 4. Quality of life (SF-36) (1) Physical health (2) Mental health 5. Depressive scale (CES-D) 6. Self-Efficacy Score | 1. (1) p < 0.001 (2) p < 0.05 (3) p < 0.01 2. p < 0.01 3. (1) NS (2) NS (3) p < 0.001 4. (1) p < 0.01 (2) NS 5. p < 0.01 6. p < 0.05 | (E) One participant in the Tai Chi group reported an increase in knee pain at 2 weeks. This was resolved following the modification of that participant’s Tai Chi Technique. (C) None. |
Wortley M (2013) [33], United States | Knee Pain patients with knee osteoarthritis n = 31 | (E) Tai Chi n = 12; total of 20 sessions (two times a week for 10 weeks) | (C1) Resistance training n = 13; total of 20 sessions (two times a week for 10 weeks) (C2) No intervention n = 6 | 1. WOMAC score (1) Pain (2) Physical function (3) Stiffness 2. Functional scale (1) 6 min walking test (2) Time up and go test (3) Stair climb and descent test | 1. (1) p < 0.01 in (C1), NS in (E) and (C2) (2) p < 0.05 in (C1), NS in (E) and (C2) (3) p < 0.05 in (E), p < 0.001 in (C1) and NS in (C2) 2. (1) NS in (E), (C1) and (C2) (2) p < 0.001 in (E), p < 0.01 in (C1) and NS in (C2) (3) NS in (E), (C1) and (C2) | n.r. |
Tsai PF (2013) [34], United States | Knee pain patients with knee osteoarthritis n = 55 | Tai Chi n = 28; total of 60 sessions (three times a week for 20 weeks) | Health education n = 27; 60 sessions (three times a week for 20 weeks) | 1. WOMAC score (1) Pain score (2) Physical function (3) Stiffness 2. Function scale (sit to stand test) 3. MMSE score | 1. (1) p < 0.01 (2) NS (3) p < 0.05 2. NS 3. NS | No AEs occurred in (E) and (C). |
Chenchen W (2016) [35], United States | Knee pain patients with knee osteoarthritis n = 204 | Tai Chi n = 106; total of 24 sessions (two times a week for 12 weeks) | Physical therapy n = 98; total of 24-48 sessions (2-4 sessions a week for 12 weeks) | 1. WOMAC score (1) Pain (2) Physical function (3) Stiffness 2. Function scale (physical function) 3. Depression scale (BDI) 4. Medication use 5. Quality of life (SF-36) | 1. (1) NS (2) NS (3) NS 2. NS 3. p < 0.01 4. NS 5. p < 0.05 | No AEs occurred in (E) and (C). |
Zhu Q (2016) [36], China | Knee pain patients with knee osteoarthritis n = 46 | Tai Chi n = 23; total of 72 sessions (three times a week for 24 weeks) | Health education n = 23; total of 24 sessions (once a week for 24 weeks) | 1. WOMAC score (1) Pain (2) Physical function (3) Stiffness 2. Function scale (SPPB) | 1. (1) p < 0.01 (2) p < 0.01 (3) p < 0.001 2. p < 0.001 | No AEs occurred in (E) and (C). |
Buyukturan O (2019) [37], Turkey | Knee pain patients with partial anterior cruciate ligament injury n = 58 | Tai Chi n = 29; total of 24 sessions (three times a week for 8 weeks) | No intervention n = 29 | 1. VAS for pain 2. Function scale (Lysholm Knee Scale) 3. Muscle strength (Biodex System 4-Pro) (1) Extension PT 60°/sec (2) Flexion PT 60°/sec (3) Extension PT 180°/sec (4) Flexion PT 180°/sec 4. Proprioception scale | 1. p < 0.01 2. NS 3. (1) p < 0.05 (2) NS (3) p < 0.05 (4) NS 4. p < 0.001 | n.r. |
Liu J (2019) [38], China | Knee pain patients with knee osteoarthritis n = 52 | Tai Chi n = 28; total of 60 sessions (five times a week for 12 weeks) | Health education n = 24; total of 60 sessions (five times a week for 12 weeks) | 1. KOOS score (1) Pain (2) Symptoms (3) Daily living (4) Sport (5) Quality of life 2. Serum biomarker (1) BDNF (2) IFN-g (3) PD-1 (4) TIM-3 3. Functional connectivity changes in brain regions (1) PAG (2) VTA | 1. (1) p < 0.01 (2) NS (3) NS (4) p < 0.01 (5) p < 0.01 2. (1) NS (2) p < 0.01 (3) p < 0.01 (4) NS (3) p < 0.01 3. (1) Tai Chi decreased right PAG rsFC with the medial orbital prefrontal cortex, and the decreased rsFC was associated with improvements in knee pain (2) There was also a significantly decreased rsFC between the left VTA and the medial orbital prefrontal cortex in the Tai Chi group | No AEs occurred in (E) and (C). |
Hu X (2020) [39], China | Knee pain patients with knee osteoarthritis n = 92 | Tai Chi n = 52; total of 72 sessions (three times a week for 24 weeks) | Health education n = 40; total of 24 sessions (once a week for 24 weeks) | 1. VAS for pain 2. WOMAC score (1) Pain (2) Physical function (3) Stiffness 3. Proprioception scale (1) Plantarflexion of ankle (2) Dorsiflexion of ankle (3) Varus of ankle (4) Valgus of ankle (5) Flexion of knee (6) Extension of knee | 1. NS 2. (1) NS (2) p < 0.05 (3) NS 3. (1) p < 0.05 (2) p < 0.05 (3) p < 0.05 (4) NS (5) p < 0.05 (6) NS | n.r. |
Program Name | Details of Program | |
---|---|---|
Song R (2003) [29] | 12-form Tai Chi from Sun-style Tai Chi | 20 min; 12-form Tai Chi from Sun-style Tai Chi (1) Warm-up exercise (2) Tai chi movement (3) Cool-down exercise |
Brismée JM (2007) [30] | 24-form Tai Chi from Yang-style Tai Chi | 40 min; 24-form Tai Chi from Yang-style Tai Chi (1) Warm-up exercise for 5 min (2) Tai Chi movement for 30 min (3) Cool-down exercise for 5 min |
Lee HJ (2008) [31] | 18-form Tai Chi | 60 min; 18-form Tai Chi (1) Warm-up exercise for 10 min (2) Tai Chi movement for 50 min - Raising the arms; - Opening the chest; - Painting a rainbow; - Separating the clouds; - Rolling the arms in a horse-riding stance; - Rowing the boat; - Carry ball in front of the shoulders; - Looking at the moon; - Pushing palms; - Cloud hands in a horse-riding stance; - Scooping the sea and searching the sky; - Pushing waves; - Flying dove spreads its wings; - Punching in horse stance; - Flying like wild geese; - Rotating wheel; - Stepping whilst bouncing a ball; - Balancing chi. |
Wang C (2009) [32] | 10-form Tai Chi from Yang-style Tai Chi | 60 min; 10-form Tai Chi from Yang-style Tai Chi (1) Self-massage and a review of Tai Chi principles for 10 min (2) Tai Chi movement for 30 min (3) Breathing technique for 10 min (4) Relaxation for 10 min |
Wortley M (2013) [33] | 12-form Tai Chi from Yang-style Tai Chi | 60 min; 12-form Tai Chi from Yang-style Tai Chi (1) The program began by learning the first two movements during the first session and then adding a new movement during each session for the first 5 weeks. (2) In each training session of the first few weeks, sufficient time was provided for practicing the new and previously learned movements. (3) During the last 5 weeks, participants also practiced the movements in the opposite direction to the original direction in order to similarly “load” both lower limbs. |
Tsai PF (2013) [34] | 12-form Tai Chi from Sun-style Tai Chi | Tai Chi started at 20 min per session and gradually increased to 40 min per session; 12-form Tai Chi from Sun-style Tai Chi (1) Stage 1 (30 sessions in the first 10 weeks) enabled them to learn the forms (2) Stage 2 (30 sessions in the second 10 weeks) enabled them to rehearse the forms |
Chenchen W (2016) [35] | Developed classical Yang-style Tai Chi | 60 min; developed classical Yang-style Tai Chi (1) Warm-up exercise (2) Review of Tai Chi principles (3) Tai Chi movement (4) Breathing techniques (5) Relaxation methods |
Zhu Q (2016) [36] | 8-form Tai Chi | 60 min; 8-form Tai Chi (1) Withdraw and push (2) Fan through the back (3) Wave hands like clouds (4) Lift hand (5) Brush knee and twist steps (6) Step back to repulse monkey (7) Fair lady works at shuttles (8) Golden pheasant stands with one leg (right and left) |
Buyukturan O (2019) [37] | 10-form Tai Chi from Yang-style Tai Chi | 60 min; 10-form Tai Chi from Yang-style Tai Chi (1) Warm-up exercise and a review of Tai Chi principles and techniques (2) Tai Chi movement (3) Breathing techniques (4) Various relaxation methods |
Liu J (2019) [38] | 24-form Tai Chi from Yang-Style Tai Chi | 60 min; 24-form Tai Chi from Yang-style Tai Chi (1) Warm-up exercise for 10 min (2) Tai Chi movement for 30 min (3) Breathing techniques for 10 min (4) Relaxation for 10 min |
Hu X (2020) [39] | Tai Chi | 60 min; Tai Chi (1) Warm-up exercise for 5 min (2) Tai Chi movement for 50 min (3) Cool-down for 5 min |
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Lee, H.; Sung, S.-H.; Lee, S. The Effectiveness and Safety of Tai Chi on Knee Pain: A Systematic Review and Meta-Analysis. Healthcare 2025, 13, 1615. https://doi.org/10.3390/healthcare13131615
Lee H, Sung S-H, Lee S. The Effectiveness and Safety of Tai Chi on Knee Pain: A Systematic Review and Meta-Analysis. Healthcare. 2025; 13(13):1615. https://doi.org/10.3390/healthcare13131615
Chicago/Turabian StyleLee, Hyunggon, Soo-Hyun Sung, and Sangnam Lee. 2025. "The Effectiveness and Safety of Tai Chi on Knee Pain: A Systematic Review and Meta-Analysis" Healthcare 13, no. 13: 1615. https://doi.org/10.3390/healthcare13131615
APA StyleLee, H., Sung, S.-H., & Lee, S. (2025). The Effectiveness and Safety of Tai Chi on Knee Pain: A Systematic Review and Meta-Analysis. Healthcare, 13(13), 1615. https://doi.org/10.3390/healthcare13131615