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Alexander technique-
Category: Bodywork-mind integrated technique
Description: "Mind-body awareness". Re-education of postures, alignment of the spine and body relative to the axis of the spine and to gravity in order to reduce muscle tension, and move mindfully through life. The technique is a simple one that may be mastered in only 6 lessons for most people although many trainers will use 24 lessons. The integration of the body and mind are explored, and the examples given when lifting weights, the mind is definitely involved as an active component and conversely, when sitting at a desk working on the computer, the muscles of the body adopt certain postures and stresses.
History: A technique developed by Frederick Alexander (1869-1955) in 1895 over a century ago. Alexander was a non-medically trained Shakespearian actor who had developed vocal loss due to un-amplified performances. After viewing in a mirror his habit of tightening up other muscles and changing his posture in preparation for singing, he worked on reducing these issues, and subsequently regained his voice. He applied this knowledge to educating others to relax musculature, and arrange their relationship to gravity. Subsequently he taught his technique around the country and published four books on the subject. He trained others to teach his work for 25 years until his death in 1955. It is a systemic integration technique. This is a technique that effectively is a postural alignment technique, used to retrain the body to be more anatomically correct.
Touted Uses: Relief of muscle stress and pain, improvement of coordination and balance, and changes our way of moving every day. The technique is frequently employed in musicians and performers to enhance their performance and to reduce injury propensity.
Protocol: The patient remains fully clothed and the trainer first asks some probing questions about stress points, job, movements, etc. The trainer by placing hands on the structures, assesses muscle tension, posture, and alignment, and through a series of lessons that involve reassessment. It involves “thinking” of balance points. Trainers in the Alexander technique do not diagnose anything- they note the postures and stresses, and educate the patient to notice these. The cost of the sessions are usually 70-100 dollars per hour for individual lessons, but less for group lessons. Packages of individual lessons may be obtained at a discount if purchased all at once in advance.
Training: There are several thousand teachers of Alexander worldwide. To become a teacher of Alexander (trainer), there are no set course requirements but some professional societies require successful completion of a 3 year full-time study program at an accredited teacher training course with 1500-1600 hours of instruction. However many have trained informally on an apprenticeship basis to allow the teachers to become certified based on a peer-review process. There are many training workshops and courses throughout the US. The largest professional society in the US is the American Society for the Alexander Technique and to be certified requires a minimum of 3 years training at an approved training course.
LEVEL OF EVIDENCE:
ALPHA LEVEL- Strong evidence exists for the effectiveness of the Alexander Technique lessons for chronic back pain and moderate evidence for Parkinsons's disease (Int J Clin Prac 2012 Jan;66(1): 98-112).
BETA LEVEL- After 600 hours of training in the Alexander technique, patients with chronic neck pain demonstrated significant improvement in their ability to deal with pain, exercise, relaxation and learned to improve the way they lived and cared for themselves compared to usual care alone. There was a pain reduction of 31% from beginning to 1 year later in the Alexander patients but the usual care group also had significant (approx 27%) reduction in pain suggesting the alexander technique provides a small improvement over conventional care. There was no improvement in perceived stress nor diet nor ability to rest. (Eur J Integr Med 2018 Jan;17:64-71 and Ann Intern Med 2015 Nov 3;163(9):653-662))
A study of the Alexander technique vs usual care on well being in older adults with visual impairment demonstrated no differences, therefore the technique is ineffective in this population (Clin Exp Optom 2017 Nov;100(6):633-41).
A RCT of Alexander technique vs local heat application found no difference in pain intensity (Clin Rehabil 2016 Mar;30(3):247-58)
In a study of 579 patients randomized to Alexander, massage or normal care, the 24 lesson Alexander group had the largest decrease in number of days of back pain in the past 4 weeks (-18) while 6 lessons reduced back pain by 10 days and massage by 7 days. The Alexander technique continued to be effective one year later (BMJ 2008 Aug 19;337:884
GAMMA LEVEL- After 20 lessons in the Alexander technique, 21 patients with knee osteoarthritis demonstrated a mean WOMAC pain score reduction of 56% that was maintained at 15 months followup (BMC Musculoskelet Disord 2016 Aug 27;17(1):372).
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