Back pain is one of the most frequent disabling conditions in Western societies. The management of patients varies considerably within and between countries, and not many treatments work in the long term.
The Alexander Technique developed in the late 1800s by a Shakespearean actor who lost his voice and discovered the cause to be a tightening of his upper torso also can benefit those with chronic back pain, according to researchers.
The Alexander Technique aims to help each user develop lifelong skills that will aid their posture and coordination. Individual lessons involve assessing the patient’s musculoskeletal habits and focusing on the release of tension in the neck, head and spine. Teachers give verbal instructions and use hand contact to improve the student’s musculoskeletal use. The techniques are repeated at home between sessions.
British researchers recruited 579 patients with chronic or recurrent low back pain from 64 general practices in the south and west of England. The patients received either standard care, massage therapy, six Alexander Technique lessons, or 24 Alexander Technique lessons. A physician also told half of each group’s members to do specific exercises, and a nurse provided structured behavioral counseling.
The counseling was based on Ajzen’s theory of planned behavior, which says that a person’s attitude toward an action (in this case, exercise) and their perceived control are the most significant determinants of behavior.
After three months, and again at 12 months, the participants filled in disability questionnaires to record which activities were limited by their back pain. Limited activities could include having to walk more slowly than usual, or not leaving the house as often as usual.
The results showed that Alexander Technique lessons combined with the exercise program significantly reduced pain and improved functioning.
“Exercise and lessons in the Alexander Technique, but not massage, remained effective at one year, compared with standard care,” the researchers reported. The group that received six technique lessons achieved 72 percent of the effect of 24 lessons, and the researchers believe the results should apply to most patients with chronic or recurrent back pain.
Patients receiving Alexander Technique lessons also reported improved quality of life. The behavioral counseling provided only modest benefits.
However, Professor Maurits van Tulder from VU University in the Netherlands raises doubts. In an accompanying editorial, he warns that the study may not be generalizable to clinical practice because participants in this study were a random selection of patients who had attended primary care practices with chronic back pain in the past five years. “These people were not seeking care [at the time of the study] and may not be comparable to those who visit their primary care doctor for treatment of lower back pain,” he writes.
Professor van Tulder said that the evidence already strongly supports exercise therapy. For example, a large review found that exercise therapy “significantly reduces pain and improves function in adults with chronic low back pain.” But he warns that simply telling patients to exercise at home is ineffective; instead, the patients need expert supervision and guidance.
Van Tulder does not dismiss the Alexander Technique completely, but calls for further research to compare it with different types of exercise. He also wants to see further investigation into the effectiveness of cognitive behavioral therapy, acupuncture, yoga, and progressive relaxation for chronic back pain. “Patients’ preferences and expectations should also be considered,” he adds, “because these factors seem to influence outcomes.”
Cognitive behavioral therapy and supervised exercise therapy both are recommended, among other approaches, in the current medical guidelines in the US and in Europe for chronic low back pain.
References and other resources
Little, P. et al. Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain. The British Medical Journal, 2008;337:a884.
van Tulder, M. Conservative non-pharmacological treatment for chronic low back pain. The British Medical Journal, 2008,337:a974.
Godin, G. and Kok, G. The theory of planned behavior: a review of its applications to health-related behaviors. The American Journal of Health Promotion, Vol. 11, Nov/Dec 1996, pp. 87-98.