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Five minute guide to ... Alexander technique

Professor Paul Little gives GPs a quick briefing on the technique and how his study found it helpful for chronic or recurrent low back pain

Professor Paul Little gives GPs a quick briefing on the technique and how his study found it helpful for chronic or recurrent low back pain

The basics

It's an individualised approach that helps people develop the skills to recognise, understand and avoid poor habits of body use that affect their postural tone and neuromuscular co-ordination. We don't fully understand the mechanism but you'd expect it to help by limiting muscle spasm, strengthening postural muscles, improving co-ordination and flexibility, and decompressing the spine.

The history

It was initially developed in the late 1800s by F Matthias Alexander, an actor who found that the way he was using his body had a dramatic effect on his ability to perform. It's widely used in drama and music schools and is increasingly finding a place in the health arena.

In August our group in Southampton published a paper in the BMJ suggesting the Alexander technique provides significant benefit over usual care for patients with chronic low back pain.

What it involves

The teacher first demonstrates to people what they are doing wrong, using hand contact to observe and interpret subtle changes in muscle tone and co-ordination and to convey non-verbal information.

This is integrated with oral and written advice to help the patient practise and maintain better body use.

The technique is an active self-help process, not a magic bullet. To make use of it, patients have to practise between lessons and also apply it in everyday activities.

Who it helps

Our study group was those with chronic or recurrent back pain. Although it might well help those with acute pain, our evidence only supports its use in chronic or recurrent pain.

The evidence

Before our trial there had been suggestive evidence from a small trial that the Alexander technique could help back pain in the short term, but there was no evidence of long-term benefit. But our trial provides robust evidence.

It involved more than 100 teachers working with patients from 64 practices, which suggests that the benefit is likely to be generalisable – not just the effect of a particularly enthusiastic teacher.

Our study followed up patients over a year. We saw lasting benefits, with similar benefit being maintained at three months and a year for 24 lessons. There was a 45% reduction in the Roland disability score compared with the control group and a reduction from 21 days in pain per month in the control group to just three days. There were also benefits for a wide range of secondary outcomes.

The trial also supported the additional effect of a GP prescription for aerobic walking exercise (a 17% reduction in Roland disability score) so that six lessons and a walking prescription resulted in 72% of the effect of 24 lessons.

Availability

As far as I am aware, the Alexander technique is not available on the NHS – which until now was appropriate as there was not good evidence for its effectiveness.

The best way for patients to find a bona fide practitioner is to use the Society of Teachers of The Alexander Technique www.stat.org.uk. Patients should be advised to find a teacher that is both good with their hands – in showing them what they're doing wrong – and can also provide clear verbal explanation and instruction.

It's probably unrealistic to expect any of the principles to be usefully employed in a 10-minute GP consultation.

Experienced teachers need to assess patients' problems individually, since the pattern of misuse will vary from individual to individual. Only a fully trained teacher will have the subtle assessment skills required and be able to provide nuanced, individual advice.

Our trial discovered some useful books – Illustrated Elements of Alexander Technique by Glynn Macdonald and Body Learning by Michael Gelb. These can support lessons but current evidence suggests the patient needs to have lessons to be helped.

Contraindications

Generally there are no contraindications – but it's important any serious underlying pathology is assessed and treated. If the problem is chronic or recurrent functional low back pain with no red flags, then the Alexander technique is suitable.

This is not to say that the technique could not help cope with and manage pain from no matter what source – it is just that we excluded cases where there was a serious underlying pathology.

Professor Paul Little is a GP in Romsey and professor of primary care research at the University of Southampton. His wife became an Alexander technique teacher after finding it helpful for chronic back pain, leading to his interest in formally studying the technique

Teachers use hand contact to detect and correct poor postural habits Teachers use hand contact to detect and correct poor postural habits

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