On this blog, we have discussed the Alexander Technique before; it is an educational method promoted for all sorts of conditions, including neck pain. The very first website I found when googling it stated the following: “Back and neck pain can be caused by poor posture. Alexander Technique lessons help you to understand how to improve your posture throughout your daily activities. Many people, even those with herniated disc or pinched nerve, experience relief after one lesson, often permanent relief after five or ten lessons.”

Sounds too good to be true? Is there any good evidence?

The aim of this study, a randomized controlled trial with 3 parallel groups, was to test the efficacy of the Alexander Technique, local heat and guided imagery on pain and quality of life in patients with chronic non-specific neck pain. A total of 72 patients (65 females, 40.7±7.9 years) with chronic, non-specific neck pain were recruited. They received 5 sessions of the Alexander Technique, while the control groups were treated with local heat application or guided imagery. All interventions were conducted once a week for 45 minutes each.

The primary outcome measure at week 5 was neck pain intensity quantified on a 100-mm visual analogue scale; secondary outcomes included neck disability, quality of life, satisfaction and safety. The results show no group differences for pain intensity for the Alexander Technique compared to local heat. An exploratory analysis revealed the superiority of the Alexander Technique over guided imagery. Significant group differences in favor of the Alexander Technique were also found for physical quality of life. Adverse events were mild and mainly included slightly increased pain and muscle soreness.

The authors concluded that Alexander Technique was not superior to local heat application in treating chronic non-specific neck pain. It cannot be recommended as routine intervention at this time. Further trials are warranted for conclusive judgment.

I am impressed with these conclusions: this is how results should be interpreted. The primary outcome measure failed to yield a significant effect, and therefore such a negative conclusion is the only one that can be justified. Yet such clear words are an extreme rarity in the realm of alternative medicine. Most researchers in this area would, in my experience, have highlighted the little glimpses of the possibility of a positive effect and concluded that this therapeutic approach may be well worth a try.

In my view, this article is a fine example for demonstrating the difference between true scientists (who aim at testing the effectiveness of interventions) and pseudo-scientists (who aim at promoting their pet therapy). I applaud the authors of this paper!

14 Responses to A sound study of the Alexander Technique as a treatment for neck pain.

  • The study shows that Alexander Technique is helpful but limited. I assume that the lack of recommendation would have to do with the time and expense not being justified. What level of effect would be required to justify an intervention?

  • My comment would be that since the primary purpose of Alexander technique is to educate the individual to impact long term benefits through self-management, the study appears to be incomplete as an accurate measurement of its efficacy if it does not include follow up outcome measurements as to perceived improvements in neck pain a month later, 6 months later, etc. relative to the other two controls. This outcome measurement potential seems to be indicated in the study’s result: “Significant group differences in favor of the Alexander Technique were also found for physical quality of life.”

    • @Monika,
      In the interests of transparency, and in order to for vested interests to be known, I’ve taken the liberty of posting links to your website;
      Your website says “MONIKA GROSS has been a certified instructor of the Alexander Technique since 1985”, so you have a very clear financial and emotional commitment to this method. It also says “She is a member of the International Somatic Movement Education and Therapy Association (ISMETA), as a Registered Somatic Movement Educator (RSME) and Registered Somatic Movement Therapist (RSMT).”
      Somatics; , which says,
      “Alternative medicine[edit]
      Several forms of alternative medicine consider sensory experience of the body important to the therapeutic process.
      The Alexander technique, an early example of such a practice, was developed by Frederick Matthias Alexander, an actor, in the 1890s.[4] It is an educational somatic technique intended to undo students’ habits of using unnecessary tension in movement.[5][6]”

      • I appreciate your comment, Frank. I apologize for your confusion about whether I was trying to make a comment here without full disclosure. I participated once before in a prior discussion about Alexander Technique on Dr. Ernst’s site earlier this year in February, and I identified myself fully at that time. In my comment on this current thread, my name still has that identifying link to my website, so it was my assumption that that serves as a continual disclosure. If there is any curiosity about my lengthy comment for the earlier study discussion, you can read it here:

        I see that you made a similar comment about someone on that thread as well:
        Would you have a background that you would wish to share here as well?

        Perhaps Dr Ernst could clarify the identification guidelines: Is it proper protocol to identify what our interest or background is each time we make a comment, within the same thread or in any future threads, or is our original identification attached to all our comments all that is needed? Thank you for you assistance in how to continue to participate fully and professionally in these important discussions!

  • In the Alexander Technique community anecdotes about immediate relief from neck or back pain from a single lesson are common. Now we can conclude that this is not what prospective pupils should expect.
    If anybody with neck pain comes for lessons and expect to be much better after only five lessons and five weeks they could probably do just as well by trying some heat packs.

    I have commented on this trial previously on my blog:

    • NHS Choices has this to say:

      How it may help

      Teachers of the Alexander technique say it can potentially benefit people of all ages and levels of physical fitness.

      There’s some evidence that the Alexander technique is effective in helping to relieve long-term back pain.

      There’s also preliminary evidence to suggest that it may help elderly people improve their balance skills and avoid falls, and that it may be beneficial for people with Parkinson’s disease.

      The National Institute for Health and Care Excellence (NICE) state in its guidance that for people with Parkinson’s disease, the technique may help them to make lifestyle changes that have both positive physical and mental outcomes.
      For people with Parkinson’s disease, studies have suggested that it may be able to:

      * help the person perform everyday tasks more easily

      * reduce depression

      * increase self-confidence

      * slow down the worsening of symptoms

      * delay the need for increased medication

      However, these studies are few and small. If you have Parkinson’s disease, you should speak to your GP before trying the Alexander technique.

      The Alexander technique may also help reduce general long-term pain and improve respiratory function and stuttering. However, the evidence in these areas is even more limited and more studies are needed before firm recommendations can be made.

      There’s currently a lack of evidence to support the use of the Alexander technique for any other health condition including:

      long-term asthma

      I’d call that a partial endorsement. For more details of clinical trials see:

    • Disclosure: I’m an Alexander Technique teacher. I have vested interests. I’m trying to be objective, but you have reason to be sceptical. I do hope, however, to be believed when I claim to know more about the Alexander Technique than wikipedia.

  • and I’d call that over-optimistic because it partially is not based on compelling evidence.

  • I am not a doctor or an Alexander teacher but just an interested observer who has had a lot of Alexander lessons. I would love to learn things about AT from this website. However studies like this don’t prove or disprove anything in my view. The study was comparing different kinds of things as if they were similar things. As Doctor Barlow, a NHS medical doctor and consultant said in his book the Alexander principle . “ You don’t do anything to people with AT.” You apply a principle to encourage people to relieve tension and misuse and achieve balance and poise. This can’t be compared to other kinds of activities under controlled conditions as if it doesn’t matter what AT is. He was a great believer in testing and measuring the effectiveness of AT. The question is how can it be done to get to the truth of the matter?

    • comparing a treatment of unknown effectiveness to something else [e.g. placebo, no treatment at all, or a therapy of known effectiveness] is the ONLY way to learn anout the effectiveness of that treatment. neither you nor Barlow [if you quoted him correctly] make the slightest sense.

    • Philip Corless wrote: “As Doctor Barlow, a NHS medical doctor and consultant said in his book the Alexander principle . ‘You don’t do anything to people with AT’.”

      He forgot to mention the main thing that is done to people:

      Alexander technique, NHS

      The Alexander technique is taught by a qualified teacher in 1-to-1 lessons.

      Lessons often take place in a studio, clinic or the teacher’s house and usually last 30 to 45 minutes.

      You’ll need to attend a number of lessons to learn the basic concepts of the Alexander technique. Often, around 20 or more weekly lessons are recommended.

      Alexander technique lessons are mostly available privately. Each lesson usually costs around £35 to £50.

      There aren’t currently any laws or regulations stating what training someone must have to teach the Alexander technique.

      It’s important to remember that most teachers of the Alexander technique aren’t medical professionals. They should not diagnose, offer advice on or treat conditions that should be managed by a suitably qualified mainstream healthcare professional.

      An AT practitioner, who is neither regulated nor medically competent, is (for some unfathomable reason) allowed to wring £700 to £1000 from each victim customer, over a period of 20 weeks, in return for a minimum of 10 hours spent teaching only the basic concepts of the technique.

      Marvellous !

      Philip Corless appears to be conflating three distinct categories of things:
      • the intervention per se;
      • learning the technique;
      • the claimed beneficial effects of the intervention, which can be tested in the conventional manner.

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