What is the Alexander Technique (AT)?
The Alexander Technique was originally developed in order to bring about the best conditions for skilled performance. It is a practical method for changing the way people use themselves in everyday activities, both in terms of patterns of movement and in terms of how people think about movement. The AT is not a therapy: it is a sophisticated method of re-education with therapeutic consequences. It does not aim to treat a particular symptom, but instead addresses a person’s entire way of approaching movement in a course of practical lessons.
How does it work?
The Alexander Technique works by helping people to identify and prevent the harmful postural and movement habits that can aggravate, or may be the cause of, stress, pain and under-performance. Working to its principles enables students to become aware of disadvantageous responses to stimuli, particularly with regard to physical movements, and then to learn to complete an action without those aspects that are inefficient. These include any unnecessary stiffening or shortening in stature.
What do students learn?
Students learn how to release tension and rediscover better balance, both mentally and physically. With increased awareness they can learn how to be poised without stiffness in a way that can be commonly seen in small children, gifted athletes, dancers, etc, but in a way that is not commonly seen in adults. Students learn to move gracefully and powerfully with less effort, to be alert and focused with less strain, to breathe and speak more easily and freely and to be calmer and more confident.
How is it taught?
Lessons in the Alexander Technique are usually given on a one-to-one basis. The teacher uses their hands together with verbal explanation in order to guide the pupil through everyday movements such as sitting, standing, walking, bending and lying down. Early in his teaching career F.M. Alexander, the originator of the AT, discovered that assisting a pupil to experience moving in a more refined way, relatively free from habitual interferences was, rather as “a picture is worth a thousand words”, a faster and clearer way of learning a skill than almost any amount of verbal explanation. The method of hands-on work that he developed is remarkable in that the teacher does not actually do something to the pupil, but instead uses his or her hands for gentle guidance in movement. Almost anyone who has experienced the hands-on method of the AT is struck by the power and effectiveness of this way of learning.
The Alexander Technique involves no specific exercises or equipment and can be applied to any activity. Everyday clothes are suitable for lessons.
What are the benefits of the Alexander Technique?
The AT may help relieve back pain, neck pain, joint pain and stiffness, stress, tension, breathing difficulties, performance anxiety and more. It promotes improved posture, mobility, balance, agility, confidence, poise and vocal performance.
What is the evidence for the effectiveness of the Alexander Technique?
The AT has long been accepted as a powerful tool for skilled performance and it is an important part of the curriculum at the most prestigious music conservatoires and acting academies. It is gradually becoming better known by doctors as a way to help patients with relevant health conditions.
The results of a large, randomised clinical trial, recently published in the British Medical Journal (1) evaluating the effectiveness of the Alexander Technique compared with other health interventions for chronic low back pain, found that one year after lessons, individuals with back pain who had undertaken 24 Alexander lessons had only 3 days of pain per month compared with 21 days for similar patients who were receiving the usual standard-of-care from their family doctor, as well as reporting much less incapacity and a striking number of other ‘quality of life’ benefits. Even participants who had only 6 lessons had less than half the number of days of pain. No adverse effects were reported.
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 (9), 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.
Smaller but well-designed studies have shown the Technique to be of benefit in Parkinson’s disease (2-4), balance in elderly people (5,6), breathing disorders (7), knee osteoarthritis (10) and in a number of other conditions where the way that a person uses themselves in activity has an effect of how well they function. The evidence for the effectiveness of AT lessons across different health-related conditions has recently been evaluated and the findings published in the International Journal of Clinical Practice (8). The review found strong evidence for the effectiveness of AT lessons for people with chronic back pain and moderate evidence in helping to alleviate the disability associated with Parkinson’s. Preliminary evidence was found across a diverse range of other health-related conditions. There are several ongoing studies.*
*There is a much more comprehensive (and clearly presented) summary of the current evidence for the effectiveness of the AT here.
How many lessons do students need?
Alexander Technique teachers generally recommend that students aim to have an introductory course of about 20-30 lessons. This is the number of lessons needed by the average student to resolve the most common presenting symptoms, and to have a sufficient grounding in the principles in order to continue to progress without assistance. It is generally an advantage, but not essential, for students to have lessons twice or even three times weekly for the first few weeks, after which weekly lessons are usual. Benefits from a course of lessons have been shown to persist and even increase over the long term(1). In the UK and several other countries many health insurance companies will cover the cost of lessons for patients with relevant health problems.
Who can be helped by the Alexander Technique?
The Alexander Technique can benefit people of any age, at almost any level of physical fitness, and from all backgrounds. For the more common types of neck, back and other muscle and joint pain, the AT is likely to help where the problem is either caused or exacerbated by errors in coordination, including posture and balance. Even in conditions with systemic causes, or as a result of injury, better posture, balance and regulation of forces in movement may go some way towards alleviating symptoms.
As with all educational processes, AT lessons are essentially a partnership between teacher and student and therefore require an interest in participating and in learning something new. Most people find a course of AT lessons an interesting and enjoyable experience (1).
Finding a teacher
Most teachers in the UK are members of the Society of Teachers of the Alexander Technique (STAT), which is affiliated with most of the major international representative bodies. Membership requires the successful completion of a comprehensive three year full time training at an approved course, continuing education, adherence to a code of conduct, professional indemnity insurance and possession of an enhanced disclosure DBS (previously CRB) certificate.
1. Little P; Lewith G; Webley F; et al. Randomised controlled trial of Alexander Technique lessons; exercise and massage (ATEAM) for chronic and recurrent back pain. British Medical Journal 2008;337:a884.
2. Stallibrass C; Frank C; Wentworth K. Retention of skills learnt in Alexander Technique lessons: 28 people with idiopathic Parkinson's disease. Journal of Bodywork and Movement Therapies 2005;9:150-7.
3. Stallibrass C; Sissons P; Chalmers C. Randomized; controlled trial of the Alexander Technique for idiopathic Parkinson's disease. Clinical Rehabilitation 2002;16:695-708.
4. Stallibrass C. An evaluation of the Alexander Technique for the management of disability in Parkinson's disease - a preliminary study. Clinical Rehabilitation 1997;11: 8-12.
5. Dennis RJ. Functional reach improvement in normal older women after Alexander Technique instruction. Journals of Gerontology Series A: Biological Sciences and Medical Sciences 1999;54:M8-M11.
6. Batson G, Barker S. Feasibility of group delivery of the Alexander Technique on balance in the community-dwelling elderly: preliminary findings. Activities Adaptation and Aging 2008;32:103-119.
7. Austin JHM and Ausubel P. Enhanced respiratory muscular function in normal adults after lessons in proprioceptive musculoskeletal education without exercises. Chest 1992;102:486-90.
8. Woodman JP and Moore NR. Evidence for the effectiveness of Alexander Technique lessons in medical and health-related conditions: a systematic review. International Journal of Clinical Practice 2012;66:98–112.
9. MacPherson H, Tilbrook H, Richmond S, Woodman J, Ballard K, Atkin K, Bland M, Eldred J, Essex H, Hewitt C, Hopton A, Keding A, Lansdown H, Parrott S, Torgerson D, Wenham A, Watt I. Alexander Technique lessons or acupuncture sessions for persons with chronic neck pain: A randomized trial. Annals of Internal Medicine 2015;163:653-62.
10. Preece, SJ, Jones RK, Brown C, et al. Reductions in co-contraction following neuromuscular re-education in people with knee osteoarthritis. BMC Musculoskeletal Disorders 2016; 17:372.
© Peter Bloch, 2013 (revised 2017)