The other morning while driving to the office I heard the tail-end of an NPR story on the Alexander Technique. I immediately wondered if there had been some new research on that technique for the alleviation of back pain that had found its way into the mainstream media, as had occurred in 2008 after a study appeared in the British Medical Journal which concluded that Alexander Technique lessons provided benefit for those suffering chronic and recurrent back pain.

A little research on my part found that there is no new completed research of note on this so-called alternative approach to back pain; however, there is research in the planning stages that aspires to understand exactly why the Alexander Technique works, when it works. And it is therefore a good time to review its place in the treatment of the chronic back pain population.

Back and neck problems account for a huge percentage of visits to health care providers, according to a 2008 study published in the "Journal of the American Medical Association"; this in turn results in over $100 billion spent on treatment and evaluation, and billions more in lost workplace productivity. The Alexander Technique has been viewed as a cost-saving alternative.

This technique was developed in the late 1800s by an actor, Frederick Alexander, as a cure for pain and hoarseness. After years of self-reflection, Alexander concluded that excessive tension originated from the head and neck, yet caused muscle strain throughout the entire body.

The technique involves learning to move more efficiently, certified instructors providing the coaching and teaching of exercises: these teachers utilize gentle hand contact and verbal instruction to aid patients in attaining awareness (and avoidance) of negative habits of muscle use which may cause and maintain pain. It is hypothesized that the Alexander Technique works through the release of tension, more balanced muscle activity and improved flexibility. Advocates thus emphasize it is more than simply changing postural habits; the technique is more about moving. Ideally, this reduction in tension will minimize its corrosive effect on muscles and other structures of the spine.

Interestingly, the technique is widely taught in music conservatories and drama departments as a method of enhancing performance and avoiding injury. One would expect this patient population to be the ideal practitioners of an approach that focuses on learning mind-body awareness; as an actor, for example, must always be aware of his presentation on stage. Self-reflection becomes a protean tool, with the potential for relieving pain, and garnering good reviews from the local drama critic.

Teachers of the Alexander Technique generally see patients individually, and a typical program will tackle such issues as:
• Comfortably sitting upright
• Reducing the overuse of superficial musculature during certain postures
• Increasing proprioceptive awareness
• Appreciating the body's warning signs of tension and compression.

Unfortunately, seekers of the benefits of the Alexander Technique will likely have to pay out of pocket for these lessons, as insurance carriers view this as an "experimental" treatment, not well supported by clinical trials. However, the 2008 study published in the British Medical Journal did find that after 24 Alexander sessions, subjects improved the ability to move freely by up to 45%. In the final month of the trial, these same subjects reported only three days of pain, whereas the group without the sessions reported 21 days. This study, however, lasted one year; and thus no conclusions about longer lasting benefits can be made.

If you suffer from chronic and refractory back pain, at least a year of relief still sounds good; talk to your doctor, and in the meantime find out more about Alexander Technique therapists at www.alexandertechnique.org.

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