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At the heart of general practice since 1960

Posture therapies

Dr Tanvir Jamil looks at the evidence base for Alexander and Feldenkrais techniques

There are two main forms of posture therapy. Alexander technique focuses on improving awareness of movement to improve ease of movement, while Feldenkrais technique is a synthesis of Alexander technique, yoga,

stretching and Eastern martial arts.

nHow can it work?

Tension patterns develop after the age of three or four that interfere with the natural easiness, balance, support and freedom of movement people enjoy as children. Tension patterns of slumping and then assuming 'good posture' become so habituated they feel normal. Postural techniques offer a way to let go of destructive tensions by learning to monitor the way people co-ordinate themselves in any activity. They can then carry out that activity with the minimum of strain. Pupils are taught how to use their body correctly and inhibit old habits of incorrect movement and posture. Each natural movement (walking, crawling, turning of the head, bending) is broken down into its constituent parts.

These are incorporated into simple exercises taught in groups. Pupils receive lessons from Alexander teachers who give constant direction and feedback. The teacher may hold the head and the upper back of the pupil simply to allow them to stand up correctly. The pupil will stand and sit using the correct techniques, using the legs for power and rather than leading with the head.

Breath control and breathing movement are also taught to aid easier and more efficient movement. Teachers claim that with even partial success problems often begin to resolve themselves simply because the pupil is no longer subconsciously causing them by unnecessary effort.

nResearch

 · Stallibrass C. An evaluation of the Alexander technique

for the management of disability in Parkinson's disease.

Clin Rehabil. 1997;11:8-12

Seven patients were given questionnaires before and after lessons in the Alexander technique. After lessons the subjects were significantly less depressed, had less difficulty in performing daily activities and with fine and gross movements. The results are encouraging but larger samples and inclusion of control groups are needed to verify these findings.

 · Elkayam O et al. Multidisciplinary approach to chronic back pain: prognostic elements of the outcome. Clin Exp Rheumatol. 199614;3:281-8

Sixty-seven patients with back pain of more than three months' duration were given a four-week programme of back schooling, psychological intervention, acupuncture, chiropractic and the Alexander technique. Patients benefited significantly in the treatment groups with improvement maintained for six months. But outcome was clearly related to psychosocial factors.

 · Ruth S, Kegerreis S. Facilitating cervical flexion using a Feldenkrais method: awareness through movement.

J Orthop Sports Phys Ther.1992 1:25-9

Normal subjects who performed a Feldenkrais exercise attained more neck flexibility than those who sat and chose their own activity. This study would have been more useful if it had compared Feldenkrais with physiotherapy or other techniques.

What is it good for?

 · Poor posture

 · Pain relief neck and back pain, sciatica, whiplash, repetitive strain injury, sports injuries

 · Pregnancy back pain

 · Psychological stress, tension, anxiety, depression, insomnia

 · Chronic conditions multiple sclerosis, polio, rheumatoid arthritis, Parkinson's disease

 · Help in breathing and voice control in singers, dancers, public speakers, actors, sportsmen

Pros

nSafe.

nAlexander courses often organised by local authorities in day or evening classes. Some sports centres, fitness clubs and health farms also offer courses.

nBooks and videos are readily available that list numerous self-help exercises.

Cons

nCost: a full course takes two or three months to learn. Can work out expensive.

nTime: needs regular daily commitment for practice.

nCan be difficult to learn the correct techniques without a suitably-qualified teacher.

nFeldenkrais technique popular in the US but difficult to find a teacher in the UK.

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