Alexander Technique and Back Pain: What the Trials Show

What it is

The Alexander Technique is a method taught through lessons that aim to improve posture and ways of moving. [1] The Better Health Channel (Victoria, Australia) says it is not an exercise regime and is learned with a qualified teacher; that page was last reviewed in 2014. [2] It is named for Frederick Matthias Alexander (1869 to 1955), an actor whose career, according to Wikipedia, was hampered by recurrent laryngitis. [3] In the main back pain trial, lessons involved paying attention to release of unwanted head, neck and spinal muscle tension, guided by verbal instruction and hand contact, plus practice between lessons. [4] The general overview is on the Alexander Technique page.

The ATEAM trial

The best evidence on back pain is ATEAM, a randomized trial published in the BMJ in 2008. It was run in 64 general practices in England with 579 people who had chronic or recurrent low back pain. [5] Participants were randomized to normal care, six massage sessions, six Alexander lessons or 24 Alexander lessons, and half of each group also received a doctor's exercise prescription with nurse behavioural counselling. [5] The main measures were the Roland Morris disability score (the number of activities limited by pain) and days in pain. [5] Funding came from the UK Medical Research Council, which was independent of the trial's running and analysis. [4]

Results at one year, compared with normal care:

[5]

The authors reported that exercise and Alexander lessons, but not massage, remained effective at one year, and that six lessons followed by an exercise prescription achieved 72% of the effect of 24 lessons alone. [5] No significant harms were reported. [5] Of the 579 people, 463 (80%) returned 12-month questionnaires. [4]

Label: promising but limited. This is one large, well-known trial in UK primary care. Participants cannot be unaware of which treatment they receive, so expectation may play a part in self-reported outcomes, and the lessons were compared with normal care, not with another movement-teaching method.

Other trials

• Iran, 2022 (80 people, chronic low back pain). Alexander Technique was added to routine care in three 60-minute sessions a week for 12 weeks and compared with routine care alone; pain scores were lower in the Alexander group at the end and one month later. [6] This was a single smaller trial using self-rated pain.
• Neck pain, UK (517 people). 20 one-to-one lessons plus usual care reduced neck pain and disability a little more than usual care at 12 months (3.79 percentage points); no serious adverse events were linked to the lessons. [7] Practitioners came from the two main UK professional associations, which may limit how far results apply elsewhere. [7]
• Neck pain, Germany (72 people). Five sessions were not superior to local heat, and the authors said it could not be recommended as a routine intervention at that time. [8] Adverse events were mainly slightly increased pain and muscle soreness. [8]

So the neck pain evidence is mixed, and back pain rests mainly on ATEAM. Proper evidence not found in our search for a recent systematic review that pooled Alexander Technique trials for back pain; we searched PubMed for Alexander Technique with "back pain" and "systematic review" terms.

What guidelines say

NICE's low back pain guideline recommends considering a group exercise program, and the recommendations we read do not mention the Alexander Technique. [9] NICE's Parkinson's guideline does say to consider the Alexander Technique for people with Parkinson's disease who have balance or motor function problems. [10] The NHS likewise says it may offer lessons for people with Parkinson's who have balance or movement problems that put them at risk of a fall. [1] That is a different condition from back pain.

Teachers and training

The American Society for the Alexander Technique says its member teachers have completed at least 1,600 hours of training over three years. [12] That describes one US professional association's standard. Wikipedia states that in the UK there is no statutory regulation of who may teach, and that professional organizations offer voluntary membership. [3] The ATEAM lessons were taught by registered teachers. [5] Ask any teacher about their training and association. We do not list teachers. Compare options on Movement practices for chronic pain, and see Feldenkrais for pain and mobility, Pilates for low back pain and Yoga for low back pain.