Scientific Research on the Health Benefits of the Alexander Technique - a brief review
Neck pain study
There is strong evidence for impressive long-term benefits from Alexander Technique lessons for people with chronic neck pain in a major study published in the notable U.S Journal The Annals of Internal Medicine.
Some quotes about the A.T. by Nobel Prize winning scientists:
"We already notice, with growing amazement, very striking improvements in such diverse things as high blood pressure, breathing, depth of sleep, overall cheerfulness and mental alertness, resilience against outside pressures, and in such a refined skill as playing a musical instrument."
Professor Nicholas Tinbergen, Nobel Prize winner for medicine and physiology
"Alexander has done a service to the subject by insistently treating each act as involving the whole integrated individual, the whole psycho-physical man. To take a step is an affair not of this or that limb solely, but of the total neuromuscular activity of the moment - not the least of the head and neck."
Sir Charles Sherrington, Nobel Prize winner in medicine
"Alexander's method lays hold of the individual as a whole, as a self-vitalising agent. He reconditions and re-educates the reflex mechanisms and brings their habits into normal relation with the functioning of the organism as a whole. I regard this method as thoroughly scientific and educationally sound.”
Professor George E Coghill, Nobel Prize winning anatomist and physiologist
"The quality of our "Use of ourselves" has a profound effect on how we are, 24 hours a day. Many examples of under-performance, as well as posture-related or tension-related pain, and injuries, are unwittingly aggravated, or even caused, through habitually poor use. Conversely, learning improved use through the Alexander Technique can lead to surprising improvements; even people suffering with the most intractable conditions often report reduced pain, increased stamina and greater strength. The Alexander Technique does not treat pain and disease, it teaches greater skill in movement and reaction, which in turn enables our natural vitality to assert itself."
Professor Raymond Dart,
palaeoanthropologist and discoverer of the "missing link".
More quotes from well-known people.
Back Pain - go to this page.
On this page:
Reviews of evidence for the health benefits of the A.T.
Balance and fear of falling in older people
Skilled performance and stage fright
Other musculoskeletal conditions, including knee osteoarthritis
How does the AT work? Towards a scientific model
Improved Mobility, Better Posture and Psychological Benefits
A large, well-designed, well-conducted, randomised, controlled trial for people with chronic neck pain (of a median duration of 6 years) published in the Annals of Internal Medicine in November 2015 here (pdf of full text here) found that people who had an average of 14 Alexander Technique lessons had a 31% reduction in pain and associated disability compared with the group who received usual GP-led care alone. These benefits were sustained over the following 7 months during which participants were followed.
Although this study only examined the effectiveness of 14 lessons for people with chronic neck pain, extrapolating from the back pain trial and other studies, it seems reasonable to expect that a longer course of lessons would lead to considerably more improvement.
A second paper, published in January 2018, shows that much of the benefit of A.T. lessons in the neck pain study came from increased "self-efficacy", defined as a person's confidence that they can manage their own situation. 87% of participants who had A.T. lessons reported a significant improvement in the way they lived and cared for themselves one year after the intervention, compared with 25% of controls who received usual care. The paper concluded that "Alexander Technique lessons led to long-term improvements in the way participants lived their daily lives and managed their neck pain. Alexander lessons promote self-efficacy and self-care, with consequent reductions in chronic neck pain."
A third paper, published in May 2018, reports on the in-depth interviews that were conducted with some of the trial participants, revealing participants’ feelings of greater control over managing their neck pain through becoming more self-aware and learning how to apply Alexander Technique skills. Participants also described how they continued to use the understanding and skills they had gained, after the Alexander lessons had ceased, to sustain and in some cases further improve their reduction in neck pain.
A review of evidence for the A.T. by NHS Choices for various health conditions, found that there is evidence that the Alexander Technique can help people with:
long-term back pain – lessons in the technique may lead to reduced back pain-associated disability and reduce how often you feel pain for up to a year or more
long-term neck pain – lessons in the technique may lead to reduced neck pain and associated disability for up to a year or more
Parkinson's disease – lessons in the technique may help you carry out everyday tasks more easily and improve how you feel about your condition.
NHS Choices also states that "some research has also suggested the Alexander technique may improve general long-term pain, stammering and balance skills in elderly people to help them avoid falls."
A Systematic Review of Medical and Health-Related Studies on the
A paper published January 2012 (before the publication of the neck pain study above) in The International Journal of Clinical Practice, titled "Evidence for the effectiveness of Alexander Technique lessons in medical and health-related conditions: a systematic review" concluded that "strong evidence exists for the effectiveness of Alexander Technique lessons for chronic back pain and moderate evidence in Parkinson’s-associated disability. Preliminary evidence suggests that Alexander Technique lessons may lead to improvements in balance skills in the elderly, in general chronic pain, posture, respiratory function and stuttering."
A number of studies have found that lessons in the AT lead to sustained benefit for people with Parkinson's disease including significantly reduced disability and depression.
In 2002, a randomized control trial published in Clinical Rehabilitation assigned 98 Parkinson’s patients either to 24 individual lessons in the Alexander Technique, 24 individual massage sessions, or no intervention beyond their normal drug treatment. The study showed that Alexander lessons significantly increased the ability of patients to carry out everyday activities. No significant change was found in the massage group. The benefits remained when patients followed up 6 months after their lessons ended. The Parkinson’s patients who took Alexander Technique lessons also had less change in their Parkinson’s medication than either of the other groups (important, since medication dose usually increases with time as the disease worsens). The patients reported improvements in balance, posture, walking, increased ability to cope with the disease and reduced stress.
As a result of this research, the National Institute for Care and Excellence (NICE) states in its latest guidelines: ‘Consider the Alexander Technique for people with Parkinson’s disease who are experiencing balance or motor function problems’.
A separate small study published in Neurorehabilitation and Neural Repair suggests significant benefits in balance and mobility for people with Parkinson’s when they practised instructions based on Alexander Technique principles.
Balance and fear of falling in older people
Several small studies in older people have shown AT instruction to be effective in this group for improving balance, reducing the fear of falling and improving functional reach.
A new pilot study shows that participating in AT group classes can be helpful for older people with a fear of falling. The findings show that the AT can help this group to do things they did not think they could do, empowering them to make different choices about what they do and don’t do, and how they do it.
Skilled Performance and stage fright
The Alexander Technique is taught in almost all of the major schools of music, drama and dance in the UK and abroad to improve skilled performance, because the benefits are self-evident. Research has looked at the role of the AT in music training and performance. A 2014 sytematic review found good evidence from two randomised and two non-randomised controlled trials that the A.T. reduced performance stress (stage fright) in musicians.
One recent study demonstrated improved musical technique in the form of greater evenness of touch in pianists after having a lesson in the Alexander Technique.
Another study demonstrated a reduction in performance-related anxiety and improved performance quality in musicians following Alexander Technique lessons.
In a small study surgeons who undertook a course of Alexander Technique lessons reported significant improvements in posture, endurance and surgical ergonomics, and this was accompanied by a reduction in perceived discomfort when performing basic laparoscopic ('keyhole surgery') skills.
A research overview of the evidence for the effectiveness of the A.T. in musculoskeletal conditions:
A slide summarizing the evidence to date, with references, produced for a presentation given to The Society for Back Pain Research Annual Meeting, November 2016.
Although at the moment there are only large, randomised studies for back and neck pain, a few smaller studies (such as the Knee Osteoarthritis study below,) and anecdotal evidence suggests that the A.T. may be similarly effective for several other musculoskeletal conditions, especially for shoulder pain.
A pilot study with 21 patients, conducted by the University of Salford and funded by the BUPA Foundation, has demonstrated the effectiveness of lessons in the AT for knee osteoarthritis. After a course of 20 lessons there was a 56% decrease in pain and an overall 54% decrease in a comprehensive measure that included pain, disability and the psychological consequences of knee osteoarthritis after 20 lessons. This improvement was maintained at a 15 month follow-up.
The "dose response curve" (the amount of improvement in pain scores as measured at 5, 10, 15 and 20 lesson intervals) strongly suggests that further lessons would lead to still further reductions in pain and disability.
Interestingly, changes in the use of certain muscles in the legs in the direction of that seen in people without knee osteoarthritis correlated closely with improvements in pain scores, demonstrating a possible mechanism for the effectiveness of the AT in these patients.
Applications are currently being made for funding for a large randomised controlled trial.
A subjective sense of greater ease of breathing has often been reported by pupils taking lessons in the AT. This has been tested in a study published in Chest, that showed a significantly enhanced respiratory function in adults following a course of 20 weekly lessons.
How does the AT work? Towards a scientific model
A YouTube video (2 minute animation) explaining the paper ''Potential Mechanisms of the Alexander Technique: Toward a Comprehensive Neurophysiological Model’ by Timothy W. Cacciatore, Patrick M. Johnson, and Rajal G. Cohen published in Kinesiology Review 9 (2020).' You can find the full paper here and a lay summary here.
Psychological Benefits of the A.T.
Alexander Technique students consistently report psychological improvements as an important consequence of lessons (see 'What clients say' and 'Quotes'), including more confidence and a reduction in stress. This has been supported by the findings of the additional publications from the major RCT back pain and neck pain studies and in several studies on the benefits of the A.T. for stage fright in musicians.
Here is an interesting video explaining that 93% of people who have lessons in AT report positive psychosocial changes as a result of lessons. There are several possible mechanisms for these benefits, including better balance and freer breathing (see above) and improvements in mobility and posture.
A recent paper published in ScienceDirect reviewed all publications on the AT to ask the question; "How does the Alexander Technique lead to psychological and non-physical outcomes?" It concludes that "A variety of non-physical outcomes of the AT were found, including improved general wellbeing and increased confidence to address present and future challenges, as well as identifying that difficult emotions can arise in lessons. Two main causal pathways were identified – 1) improvements in physical wellbeing leading directly to psychological wellbeing; and 2) an experience of mind-body integration leading people to apply AT skills to non-physical situations."
In one study, published in Human Movement Science, that employed various measures of mobility, training in the Alexander Technique was shown to reduce stiffness by as much as 50%. Another study found improved mobility in people with Parkinson's disease as a result of AT lessons.
Apart from the many health benefits of mobility, studies have shown a correlation between mobility and perceived attractiveness and health. An interesting example of this is a study published in Biology Letters and widely reported in the media, in which the variability and amplitude of dance moves was found to be positively associated with perceptions of attractiveness.
Posture and Self-Confidence
Lessons in the Alexander Technique are known to lead to a marked improvement in posture, and this is supported by several small studies.
Many studies have shown a strong connection between good posture and measures of the respect accorded to a person, as well as their own self-confidence and sense of personal power, and this is a benefit frequently reported by AT pupils. An interesting example of research into this connection is to be found in a study published in The Journal of Psychological Science in which good posture was found to have an even greater positive impact on confidence than real experiences of positions of power. Another study published in the European Journal of Social Psychology showed that good posture was positively associated with confidence in one's own thoughts and sense of oneself.
A new (2022) meta-analysis of 73 studies found, when comparing open poses to closed, robust effects for changes in both behaviour and mood. Crucially, they found "that it is the absence of contractive displays rather than the presence of expansive displays that alters affective (emotional) and behavioral responding." This is exactly the principle on which the Alexander Technique is based.
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