Research backs technique


The Alexander Technique has improved matters for many back pain sufferers. Sylvia Thompson reports on the treatment

THE ALEXANDER Technique has been found to be a valuable treatment approach for sufferers of back pain. A new study, reported in the British Medical Journal, has shown that patients with chronic non-specific low back pain report fewer days of pain and more flexibility, following up to 24 lessons in the Alexander Technique.

The technique, which has been popular with musicians and actors for decades, teaches people how to unlearn poor posture and incorrect movement, and then re-learn the body's natural and correct postures and movements.

Back pain is one of the most common health problems in the Western world and recent figures suggest one in four workers suffers from back pain. Other figures suggest that one in 10 adults will develop chronic low back pain.

The study, which was carried out with about 600 patients in GP practices in the south and west of England, has been heralded as one of the first major studies to show long-term benefits for patients with non-specific low back pain.

"We have received a massive response to the study partly because there are not many good treatments for people who suffer from chronic back pain," says Prof Paul Little, professor of primary care research at the University of Southampton, who was the lead researcher on the randomised controlled trial.

The trial compared how patients fared in terms of pain relief and improved mobility three months, and one year, after the trial. More specifically, it looked at what improvement was shown following 24 lessons in the Alexander Technique, six lessons in the Alexander Technique, six sessions of massage therapy or normal GP care.

Half of the patients in each of the groups were also given a GP prescription for exercise together with structured behavioural counselling by a practice nurse.

Results of the trial showed that the patients improved best following the 24 lessons of Alexander Technique. For instance, three months after the trial started, the group who were randomly allocated 24 Alexander Technique lessons said they had experienced eight days of pain per month compared with 13 days of pain in the group which had received six lessons in the Alexander Technique and 24 days in pain for those who had received normal GP care.

Interestingly, the effects of 24 lessons of the Alexander Technique was greater at one year than at three months, and the effects of six lessons of the Alexander Technique was maintained after one year. Exercise was found to reduce disability over time but not pain, whereas massage therapy had the opposite effect - a reduction in pain but no long-term improvement in flexibility.

The study also found that six lessons in the Alexander Technique followed by exercise prescription were 70 per cent as effective as 24 lessons of the Alexander Technique. Little says that this may be due to how patients applied what they learned from the Alexander Technique to their exercise routine. The prescribed exercise was 30 minutes of brisk walking five times a week.

He says that one of the key aspects of the Alexander Technique is that it is an active learning experience. "It's different from osteopathy, chiropractic or physiotherapy which are therapies that are done to the patient. With the Alexander Technique, the patients have to be committed to learning and practising what they are taught," he explains.

In terms of this specific effect on back pain, Little says the Alexander Technique "helps people release harmful patterns of muscle tension which allows the spine to decompress and therefore take pressure off the nerve roots which cause the pain".

He adds: "They learn to release tensions that have been built up habitually and learn to do things in a more co-ordinated way."

Little says there has been evidence that yoga can help reduce back pain. "There is some evidence that strengthening exercises, supervised by a physiotherapist, can help, and some studies have found acupressure and acupuncture might help, but the trials were smaller."

Since the effects of massage therapy on flexibility were no longer significant after one year, the trial authors concluded that the long-term benefits of taking Alexander Technique lessons are unlikely to be due to placebo effects of attention and touch, and more likely to be due to active learning of the Alexander Technique.

Little says the chief benefit of the trial is to inform GPs and patients about the Alexander Technique: "Not many people know about it, and although I can't see GPs prescribing the Alexander Technique, they can advise patients who can afford it to go for lessons. The fact that six lessons followed by an exercise prescription offered 70 per cent of the benefit offers people that option."

Richard Brennan, an Alexander Technique teacher based in Galway city, says: "I think the trial proves to the medical community for the first time that the Alexander Technique really does help people with chronic back problems.

"This means that doctors and health insurance providers will now feel assured that the technique not only helps people with back pain, but that it is preferable to surgery or drugs with all their possible side effects."

Alexander: the facts

What is it?The Alexander Technique is not a therapy as such. It is a process of re-education, during which the individual unlearns poor posture and movements that have led to tension and pain in the body.

By becoming consciously aware of the strain and unnecessary effort of such postures and movements, the individual goes on to relearn the body's correct posture and movement.

What does it treat?The Alexander Technique does not treat specific conditions. However, by unlearning postural errors and learning better posture and movement, people find relief from back, neck and shoulder pain, tension headaches and repetitive strain injury.

Other conditions influenced by body stress and strain, such as irritable bowel syndrome and some breathing problems, can also be relieved by lessons in the Alexander Technique.

How does it work?Alexander Technique teachers focus on teaching people how to release unnecessary tension while doing everyday activities such as brushing their teeth, sitting at a table or desk, standing in a queue, driving a car or walking. Usually between 20 and 30 half-hour one-to-one lessons are recommended.

How can I contact a practitioner?Alexander Technique teachers in Ireland belong to either the UK-based Society of Teachers of the Alexander Technique (Stat) or the Irish Society of Alexander Technique Teachers (Isatt).