Qualitative Study (2025)

Overview

Our 2024 randomized controlled trial showed that a virtually delivered tai chi, qigong, and meditation program improved pain, disability, sleep, and quality of life. It could not show how those changes happened, or what the experience was like for the people in it. This companion study asked them.

Written feedback was gathered from 96 program participants, and 20 took part in interviews of 30 to 45 minutes. The interviewers had no prior relationship with the participants. A draft account of the findings was sent back to all 20 for comment, and every one who replied said it reflected their experience.

Study Aim

To understand how participants experienced the Heal and Strengthen the Spine with Tai Chi and Qigong program, and how they perceived its effect on their physical, emotional, and mental well-being.

Participants

Twenty participants were interviewed, 15 women and 5 men, aged 44 to 82, with an average age of 66.5. Most had been in the waitlist group, so their memory of the program was recent. Their diagnoses included spinal stenosis, spondylolisthesis, osteoporosis, compressed discs, and Parkinson’s disease. Before joining, they had tried exercise, physical therapy, pain medications, injections, and surgery.

What We Found

1. Participants learned skills that changed their relationship to pain

   All but one of the twenty described learning practices that changed how they related to pain. Rather than pushing through it, they learned to read it as a signal to pause, relax, and adjust. Several described finding tension they had not known was there, and learning to release it. The program’s guiding phrase, no pain, more gain, was named by half the participants as having changed how they approached movement. One put it simply: “I understand pain as a signal from my body to stop.”

2. The benefits reached beyond pain relief

   Every participant reported at least one benefit beyond pain. Of the seventeen who had pain when they started, thirteen said it lessened. Of the thirteen who reported sleep difficulties, eleven said their sleep improved. Others described better balance, a stronger core, wider range of motion, improved posture, more energy, and less anxiety. Four whose pain did not decrease still found the program worthwhile, citing endurance, gratitude, and hope. One described standing differently: “Now I stand up straight and I’m standing taller.”

3. Hope and the teacher kept people practicing

   Seventeen of the twenty named the instructor’s enthusiasm, the class recordings, or both as what kept them going. Twelve said the ability to rewatch classes between sessions was what made continued practice possible. Many mentioned that the instructor had recovered from severe back pain himself, and that this made recovery feel possible for them too. As one participant said: “Realizing that I could get better made a big difference in my mind.”

What This Adds

Randomized trials establish whether a treatment works. They rarely explain why, or what it asks of the person receiving it. Read alongside the 2024 trial, this study suggests the program works partly by changing what people believe about their pain and what they do in response to it. That has a practical implication for anyone running a similar program: the hardest belief to shift was the idea that progress requires pushing through pain.

Citation

Yang Y, Caldwell K, Schlagal RC, DeCelle S, Simmons S III, Yang L, Abduljawad S, Ayar J, Singh JR, Sheeler R, Flynn PR, Knapp KA, Hartl R. “No Pain, More Gain”: Subjective Responses to a T’ai Chi and Qigong Program for Back Pain. Global Advances in Integrative Medicine and Health. 2025;14:1-10. doi:10.1177/27536130251384679
Read the full article

The 2024 Trial

The quantitative trial this study accompanies, a randomized controlled trial of 350 adults, was published in the North American Spine Society Journal in December 2024. It measured what changed: less pain-related disability, less pain, better sleep, and better quality of life. This study asked the people in it what the experience was like.
Read the 2024 study