MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

One alternative therapy that I have so far neglected on this blog is the Alexander Technique (AT). Actually, it was not really meant to become an alternative therapy when it was first discovered.

F.M. Alexander (1869-1955), an Australian actor, often experienced chronic laryngitis while performing. As his doctors could not help him, he developed a solution on his own. He found that excess muscular tension in his neck and body were causing his problems, and began to experiment on new ways to speak and move with greater ease. His health improved to such an extent that he decided to teach others what he had learned. Over a career span of more than fifty years, he refined his methods. After teaching for over 35 years, he began to train teachers of the ‘Alexander Technique’.

As used in alternative medicine, AT is an educational method aimed at increased sensory awareness and kinesthetic control to modify postural and movement patterns which might be associated with musculoskeletal problems. Proponents claim AT works for a range of conditions, including:

It has been suggested that AT is effective for chronic low back pain; however, so far only one recent study has determined its effects on chronic non-specific neck pain.

In this randomized controlled trial, patients were randomly allocated to either 5 weekly sessions of AT, heat pack application (HEAT) or guided imagery (GI). The primary outcome measure  was the neck pain intensity on a 100-mm visual analogue scale at week 5. Secondary outcomes included neck disability, quality of life, satisfaction and adverse effects. Analyses of covariance were applied on an intention-to-treat population testing ordered hypotheses AT vs. HEAT and AT vs. GI.

A total of 72 patients were included, and 52 of them received all 5 interventions. No significant group difference was found for neck pain intensity when AT was compared to HEAT. However, an exploratory analysis revealed superiority of AT over GI. Significant group differences were also found for physical quality of life in favor of AT vs. HEAT or GI. Adverse events mainly related to slightly increased pain and muscle soreness. AT patients reported increased body awareness and control over the body, relaxing or stimulating effects and mood changes after the sessions.

The authors conclude that 5 sessions of AT were no better than a heat pack application for relieving chronic non-specific neck pain. Therefore it cannot be recommended as routine intervention at this time. Since exploratory analysis revealed some improvements of AT further trials are warranted for conclusive judgment.

One of the most irritating things with alternative medicine research, in my view, is the phenomenon that researchers tend to be quasi-religious advocates of the treatment they investigate. This seems to compel them all too often to extrapolate beyond reason and to drawing conclusions which are way too optimistic, frequently to an extend that borders on scientific misconduct. It is therefore a real pleasure to find an article that does not fall into this trap. I commend the authors for reporting this RCT and for their wisdom of being adequately cautious when formulating their conclusions.

I only wished it would happen more often!

3 Responses to A decent trial of Alexander Technique with exceptionally cautious conclusions

  • I also commend the authors for their wisdom of being adequately cautious when formulating their conclusions. However, I have strong reservations about comparing any form of treatment for chronic non-specific neck (or other joint) pain to the application of heat packs over a five-week period. If the trial had been extended to include the application of a cold packs, for the purpose of comparison, the results might have more significance.

    Correct me if I’m totally mistaken: I was under the impression that the Alexander Technique (AT) is now usually proffered in the UK as a long (even a life-long) course of one-to-one tuition for improving one’s posture, concentration, and proficiency in dexterous tasks — such as playing a musical instrument or competing in sporting activities — rather than being a treatment for joint-specific health issues. In other words, I’m interested to learn whether the AT is being proffered primarily as a life-coaching technique or as a healthcare therapy.

    • Hello Pete 682,
      The answer to your question is that the AT is proffered both as coaching (not necessarily life long) for improvement of practical activities, and for assumed health benefits.

      I’m an Alexander Technique teacher and a musician and I try to have a practical approach when teaching the technique. I don’t like the AT being labeled as a therapy, but I must confess that I do point out possible health benefits in my marketing. The people that come to me for lessons who are not musicians are normally people who have some kind of health issue.

      The education versus therapy question is something that has been heavily debated amongst Alexander teachers over the years. It is a dilemma. On the one side we want to be seen as teachers and not therapists, on the other side we wish to make a living. Most people (even musicians) don’t come to us before they are in pain.

      Halvard Heggdal

      • Thanks for your reply, Halvard. I’ve never had any formal AT tuition, but many years ago someone kindly taught me the basics and I’ve used that knowledge ever since. I’ve found it very useful for being aware of when my posture is poor while sitting, standing, lifting, and performing various manual tasks. I’ve also found it helpful for correctly adjusting the driver’s seat in vehicles: the most comfortable setting is rarely a good postural position.

        I guess many people were reprimanded when they were young with words such as “Don’t slouch!”, but few have ever been shown how to obtain (and maintain) good posture. Sadly, the initial tuition people receive regarding good posture often comes from a physiotherapist — after the damage has been done.

        I can understand the education versus therapy dilemma. As a comparison, is diet and nutrition education or therapy? Without adequate education from an early age, diet and nutrition eventually becomes a necessary therapy/intervention for so many people.

        We can learn a plethora of best health practices from freely available pamphlets, library books, and the World Wide Web. However, it’s much easier, and much more fun, to learn from a tutor who provides practical lessons.

        Best wishes,
        Pete

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