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Alexander Technique in London Blog

Alexander technique - A five Minute Guide

by Professor Paul Little
15th October 2008

Professor Paul Little gives GPs a quick briefing on the technique and how his study found it helpful for chronic or recurrent low back pain.

The basics
It’s an individualised approach that helps people develop the skills to recognise, understand and avoid poor habits of body use that affect their postural tone and neuromuscular co-ordination. We don’t fully understand the mechanism but you’d expect it to help by limiting muscle spasm, strengthening postural muscles, improving co-ordination and flexibility, and decompressing the spine.

The history
It was initially developed in the late 1800s by F Matthias Alexander, an actor who found that the way he was using his body had a dramatic effect on his ability to perform. It’s widely used in drama and music schools and is increasingly finding a place in the health arena.

In August (2008) our group in Southampton published a paper in the BMJ suggesting the Alexander technique provides significant benefit over usual care for patients with chronic low back pain.

What it involves
The teacher first demonstrates to people what they are doing wrong, using hand contact to observe and interpret subtle changes in muscle tone and co-ordination and to convey non-verbal information. This is integrated with oral and written advice to help the patient practise and maintain better body use.

The technique is an active self-help process, not a magic bullet. To make use of it, patients have to practise between lessons and also apply it in everyday activities.

Who it helps
Our study group was those with chronic or recurrent back pain. Although it might well help those with acute pain, our evidence only supports its use in chronic or recurrent pain.

The evidence
Before our trial there had been suggestive evidence from a small trial that the Alexander technique could help back pain in the short term, but there was no evidence of long-term benefit. But our trial provides robust evidence.

It involved more than 100 teachers working with patients from 64 practices, which suggests that the benefit is likely to be generalisable – not just the effect of a particularly enthusiastic teacher.

Our study followed up patients over a year. We saw lasting benefits, with similar benefit being maintained at three months and a year for 24 lessons. There was a 45% reduction in the Roland disability score compared with the control group and a reduction from 21 days in pain per month in the control group to just three days. There were also benefits for a wide range of secondary outcomes.

The trial also supported the additional effect of a GP prescription for aerobic walking exercise (a 17% reduction in Roland disability score) so that six lessons and a walking prescription resulted in 72% of the effect of 24 lessons.

As far as I am aware, the Alexander technique is not available on the NHS – which until now was appropriate as there was not good evidence for its effectiveness.

The best way for patients to find a bona fide practitioner is to use the Society of Teachers of The Alexander Technique Patients should be advised to find a teacher that is both good with their hands – in showing them what they’re doing wrong – and can also provide clear verbal explanation and instruction.

It’s probably unrealistic to expect any of the principles to be usefully employed in a 10-minute GP consultation.

Experienced teachers need to assess patients’ problems individually, since the pattern of misuse will vary from individual to individual. Only a fully trained teacher will have the subtle assessment skills required and be able to provide nuanced, individual advice.

Our trial discovered some useful books – Illustrated Elements of Alexander Technique by Glynn Macdonald and Body Learning by Michael Gelb. These can support lessons but current evidence suggests the patient needs to have lessons to be helped.

Generally there are no contraindications – but it’s important any serious underlying pathology is assessed and treated. If the problem is chronic or recurrent functional low back pain with no red flags, then the Alexander technique is suitable. This is not to say that the technique could not help cope with and manage pain from no matter what source – it is just that we excluded cases where there was a serious underlying pathology.

Professor Paul Little is a GP in Romsey and professor of primary care research at the University of Southampton. His wife became an Alexander technique teacher after finding it helpful for chronic back pain, leading to his interest in formally studying the technique

My story: The story of my lower, middle and upper back pain. Part 1.
I started visiting my excellent teacher Briar Maxwell once a week for lessons. With hindsight I now realise that if I had visited her 3 times a week to begin with I would have made speedier progress, but once a week it was.
In my first lesson I remember the most extraordinary expansion and release in my back. It happened whilst I was on the table and it felt as if the central section of my back moved and spread out to the sides of the table, which undoubtedly it did. A sensation never felt before accompanied by a deep sense of relaxation and a pain-free back. I also remember Briar asking me to look out of the window and listen to the sounds - of builders and birds, cars and buses. I thought this was a strange thing to be asked to do, but slowly I came to realise its importance as part of an active non-doing process, getting me away from my end-gaining habits and allowing my system to operate freely.
Incidentally and importantly I discovered some time later that my first lesson with Briar was also the first lesson she had ever given after graduating as a teacher. The amazing effect it had on me was a result of her excellent training by Jean Clarke, I believe, among others, and the powerful fundamental qualities of the Alexander Technique.
At some time in my early lessons she lent me a book by FM Alexander, his third to be published and the most approachable, called The Use of the Self. I was captivated by his account of the experiment he performed on himself over many years. Here at last was a pure scientific experiment, with no known or pre-conceived outcome, being described and the subject was his whole being, his whole self. The absurdity of my metaphysical grounding struck me, and I was hooked…

My story: The story of my lower, middle and upper back pain. Part 1.

I have always been passionate about wood.

So much so that in 1984 I set up as a furniture maker and in 1990 I had the good fortune to find a wonderful workshop in Kennington- an old stable yard- and thought that my future was mapped out, and the only twists and turns would be in the grain of the wood I worked.

However during my early 20’s I had a series of crises with my back (which were straightened out by an osteopath) . This lead to a search for a cure and a way to keep my back strong and able to carry out my physically demanding job.

I attended years of yoga classes, then later many tears of Tai Chi. I swam, had massages, cranial osteopathy, acupuncture and continued to suffer back pain..

I enjoyed the classes and the treatments very much, but I always remember, as I was walking home, thinking: “But what do I do now?” I experienced a hollow sense of not knowing something important, but I had no idea what it was.

Then one day I was talking to my neighbour from my balcony. After a while she said her neck hurt and could I come downstairs to continue the conversation. Then she told me of a profound experience she had had with an Alexander Technique teacher friend who had simply moved her head and arms and legs very gently, as if doing nothing very much, and she had felt the most enormous relief from her pains.

So I had a lesson and experienced my own immense relief from pain. As I walked home after the lesson I suddenly realised that the pain was completely gone and I knew, at last, what to do: Go back for another lesson and discover what this Alexander Technique was all about…

Good posture is nothing more than keeping your body in balanced alignment, in relation to the activity of the moment. So if you happen to have a violin under your chin, then the weight of the violin needs to be supported and balanced by your whole system, right down to the soles of your feet.
You may well ask: How on earth do I do that? How can I monitor my body, my whole system, so that I can stay in a state of balanced alignment when I am engaged in an activity, or indeed in the ever-changing activities that occupy every day - let alone the specialised activity of my chosen career?
Well the Alexander Technique starts with learning to identify and improve where we are in space. Where is the true (vertical) up? Is my sense of "up" slightly tilted forward or back or to one side?
If it is, then you will undoubtedly be using a little too much muscular tension to keep you there, and when this is released in the course of your first Alexander lesson and you approach a better "up" you will start to feel the release and lightness that keeps us all coming back for more.