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Recent medical research shows that Alexander Technique lessons can help people with chronic neck pain

The Society of Teachers of the Alexander Technique (STAT)

The Alexander Technique: What it is and how lessons can help people with chronic neck pain

What is the Alexander Technique?

The Alexander Technique is a self-care method that helps people improve the way they carry out their daily activities, move, stand, sit, work and play. Although the lesson experience itself is enjoyable, often leaving one feeling lighter, taller and less stressed, lessons should be viewed as a form of personal re-education, rather than as therapy. To gain lasting benefit, people need to incorporate what is being taught in lessons into their daily lives. In this way it becomes possible to reduce or manage pain that is related to negative reactions to life or to poor postural and movement habits that are often the underlying cause of problems.

Learning and applying the Alexander Technique can lead to improvements in balance, mobility, postural muscle tone, coordination, and general functioning − changes that can all contribute to a reduction in chronic or recurrent neck or back pain. Learning the Technique enables people to be more in control of their health and wellbeing and reveals how much the mind and body work together intimately as one.

Alexander Technique lessons

Teachers use skilled, sensitive hand contact together with spoken guidance to help people become calmer, improve overall postural muscle tone, let go of unwanted effort and allow free head poise. This enables subtle spinal lengthening, observable as a gradual reduction in undue spinal curvature, probably through changes in related muscle activity. The resulting more comfortable carriage of the head, neck and back is associated with improved postural tone and coordination that often bring relief from neck and back pain. People are shown how to continue looking after themselves while walking, using a computer, sitting etc. Lessons are individually tailored to meet needs and capabilities, and applied to the performance of daily activities. The aim is for people to develop sufficient skill and understanding to use the Alexander Technique in daily life on their own, so reducing their neck pain, and ultimately preventing it.

Lying in semi-supine with the head supported and the spine free to lengthen, provides an ideal situation for practising the fundamental Alexander thinking skills and observing the beneficial effects

The evidence

A randomised, controlled clinical trial (the ATLAS trial) at York University, funded by Arthritis Research UK, has shown that Alexander Technique lessons can result in long-term benefit for people with chronic neck pain. The trial involved people with neck pain lasting 3 months or more, with an average (median) of 6 years. Participants were randomised to one of three groups and offered 20 one-to-one Alexander lessons provided by STAT-registered teachers along with continued usual GP-led care; or acupuncture along with usual GP-led care1; or usual GP-led care alone.

1 In this trial, acupuncture led to benefits similar to those obtained from attending Alexander Technique lessons.

The trial showed the following long-term benefits for people who attended Alexander lessons:

• They experienced nearly a third less pain and associated disability (a 31% reduction) at the end of the trial, 1 year later.

• This reduction was significantly greater than that experienced by the group who received usual GP-led care alone, and was large enough to be considered clinically relevant.

• The extent to which people were able to manage their pain (‘self-efficacy’) increased more in the Alexander group than in the usual care alone group, and this increase in self-efficacy was associated with a greater reduction in pain and associated disability at 1 year.

• Following Alexander lessons, improvement was also seen in people’s mental health at 1 year, as revealed by a self-report quality-of-life questionnaire.

• No safety issues related to Alexander lessons were identified.

Other benefits of Alexander Technique lessons

Since Alexander lessons help people change the way they stand, sit, and move in everyday life, the benefits for chronic neck pain patients might also apply to sufferers of other chronic conditions when the way that someone performs these activities causes problems or makes existing ones worse. The Alexander Technique provides a means for addressing poor coordination generally. There is good evidence that taking lessons can lead to significant long-term reductions in chronic back pain. A large randomised trial showed an 86% reduction in back pain and a 42% increase in the number of everyday activities that could be carried out without being limited by back pain, one year after Alexander lessons began. There is also evidence that learning the Technique helps those with Parkinson’s to manage their condition better and reduce their level of disability. Preliminary evidence exists for benefits of Alexander lessons in several other areas, in addition to improvement in overall wellbeing.

References

MacPherson H, Tilbrook H, Richmond S, Woodman J, Ballard K, et al. Alexander Technique lessons or acupuncture sessions for persons with chronic neck pain: A randomized trial. Annals of Internal Medicine 2015;163 (In Press).

Cacciatore TW, Gurfinkel VS, Horak FB, Cordo PJ, Ames KE. Increased dynamic regulation of postural tone through Alexander Technique training. Human Movement Science 2011;30:74–89.

Little P, Lewith G, Webley F, Evans M, Beattie A, et al. Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain. British Medical Journal 2008;337:a884.

Woodman JP, Moore NR. Evidence for the effectiveness of Alexander Technique lessons in medical and health-related conditions: a systematic review. International Journal of Clinical Practice 2012;66:98–112.

Stallibrass C, Sissons P, Chalmers C. Randomised controlled trial of the Alexander Technique for idiopathic Parkinson’s Disease. Clinical Rehabilitation 2002;16:705−718.

 

Alexander Technique and Parkinson’s

I have given an hour’s presentation ( including working with some volunteers) about the Alexander Technique and Parkinson’s to 30 Physiotherapists and Occupational therapists from the Durham and Darlington NHS Trust at Bishop Auckland Hospital. Research has been done and the Alexander Technique is recommended by NICE ( National Institute of health and Clinical Research) to help people with Parkinson’s. It was well received with many people asking questions at the end. The Senior Occupational therapist, Emma Carr wants to set up 6 week courses for people with Parkinson’s and this would include an Alexander workshop.

The Society of Teachers of the Alexander Technique (STAT) Randomised controlled trial of Alexander Technique lessons (AT), for management of disability by people with Parkinson’s

Evidence for the efficacy of Alexander Technique lessons for patients with Parkinson’s

A randomised, controlled clinical trial was funded by the Foundation for Integrated Medicine, the Parkinson’s Disease Society, REMEDI and the University of Westminster. It showed that the skills learnt in Alexander Technique (AT) lessons, when applied in daily life, lead to sustained benefit for people with Parkinson’s.1,2 The trial was designed and led by Dr Chloe Stallibrass.

Clinical trial details in brief

All contact with the trial participants, apart from the AT lessons and the massage sessions, was with the Research Manager, Peta Sissons. The two AT teachers were both members of STAT.

A total of 93 people with clinically diagnosed idiopathic Parkinson’s were recruited into the trial, mainly through publicity in the national press. They were randomly allocated to three groups:

  • a control group (no intervention)
  • a group who received 24 lessons in the AT (two lessons a week for 12 weeks)
  • a group who received 24 sessions of therapeutic massage (two sessions a week for 12 weeks) to control for the likely effects of touch and personal attention in AT lessons.

The groups were balanced for age, gender, and duration and severity of illness using a randomising computer program. All participants continued their pharmacological treatment for Parkinson’s throughout the trial and received usual care.

Outcome measures

The main outcome measure was the Self-rated Parkinson’s Disease Disability Scale. Participants rated their performance of everyday activities both at best and at worst times of day: the ‘worst’ times excluded periods of freezing. There were five secondary outcome measures, including one for depression.

Results: One-to-one Alexander Technique lessons provide significant and sustained benefits for people with Parkinson’s

The results of the main measure clearly showed:

 Of the approaches tested, lessons in the AT provided the most benefit. Following 24 AT lessons, participants performed everyday activities with less difficulty than the control group, at both best (p=0.04) and at worst times of day (p=0.0004).

 At 6-months’ follow-up the comparative improvement was maintained both at best times (p=0.03 and worst times of day (p=0.01).

 The improvement in the massage group was not statistically significant. This indicated that the benefits from the AT lessons were due to learning and applying skills over and above any improvement due to touch and personal attention.

 Post-intervention, ie during the follow-up period, the AT group was significantly less likely to have adjusted their Parkinson’s medication to cope with worsening symptoms during the trial than were the other two groups (p=0.001). This intriguing finding merits further research.

 At 6-months’ follow-up, of the participants who had not changed their medication for whatever reason, a smaller proportion of the AT group than the other two groups, reported worsening symptoms, (p=0.045).

The secondary measures showed the AT group to be less depressed after 24 lessons compared with the control group (p=0.03) on the pre-determined questions in the Beck Depression Inventory.

In an open-ended questionnaire, 41% of the AT group said that they felt more positive/hopeful as a result of the AT lessons; 35% said they felt less stress/panic, and 28% said they had improved self-confidence. When asked to list activities that had improved for them personally, 59% mentioned improved balance/posture, 48% mentioned improved walking, 38% improved speech and 28% reduced tremor. These answers were provided spontaneously rather than being elicited via specific questions

What is the Alexander Technique?

The AT is a thoughtful self-help method for the life-long enhancement of an individual’s way of functioning and wellbeing. Learning and applying the AT leads to improvements in balance and mobility, postural tonus3, coordination and functioning. This is because one-to-one AT lessons enable an individual to recognise, understand and avoid poor postural habits and ways of moving that can interfere with the working of movement control systems.

Alexander Technique lessons

Teachers use sensitive hands-on contact and spoken explanation to help people attend to head poise and lengthening of the spine in a way that facilitates improvements in postural tone, coordination and control of movement. Lessons are tailored to individual needs and capabilities and applied to daily activities. The aim is that people develop sufficient skill and understanding to begin applying the AT in daily life on their own, in order to manage their disability better and benefit their health and wellbeing.

Other applications

The benefits demonstrated in regard to Parkinson’s might also apply in other chronic conditions where a person’s manner of standing, sitting, moving and speaking is thought to contribute to their problems. Learning and applying the AT is a means for improving general mal-coordination and has been shown to help patients with non-specific low back pain (ATEAM trial, BMJ, 20084).

References

  1. Stallibrass C, Sissons P, Chalmers C Randomised Controlled Trial of the Alexander Technique for Idiopathic Parkinson’s Disease. Clinical Rehabilitation 2002 Vol. 16: 705-718
  2. Stallibrass C, Frank C, Wentworth K Retention of skills learnt in Alexander Technique lessons: 28 people with idiopathic Parkinson’s disease. Journal of Bodywork and Movement Therapies 20005 Vol. 9; no. 2: 68-75
  3. Cacciatore, TW, Gurfinkel, VS, Horak, FB, Cordo, PJ and Ames, K (2007). Alteration of muscle tone through conscious intervention: increased adaptability of axial and proximal tone through the Alexander Technique. Proceedings of the International Society for Posture and Gait Research, 18.
  4. Little P, Lewith G, Webley F, et al. Randomised controlled trial of Alexander Technique lessons, exercise and massage (ATEAM) for chronic and recurrent back pain. British Medical Journal 2008;337:a884. http://www.bmj.com/cgi/content/full/337/aug19_2/a884

Contacts for further information

Questions about the Parkinson’s clinical trial: Dr C Stallibrass,10A Greencroft Gdns, London NW6 3LS. Tel: 0207 2093625 Email: chloestallibrass@gmail.com

For further information about the Alexander Technique: Website: www.stat.org.uk

STAT, Grove Business Centre, Unit W48, 560-568 High Road, London, N17 9TA, Tel.: 020 8885 6524