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Medical Endorsements & Scientific Research supporting the Alexander Technique

Neck problems are virtually an occupational hazard for Ear, Nose and Throat surgeons. I had serious problems during my working years, but hoped for relief on early retirement. This was not the case and limitation of cervical (and thoracic) movement became quite an intrusion on my life. Physiotherapy and medication gave only short-term improvement. On being introduced to the Alexander Technique I was somewhat sceptical that anything was going to work, but can only describe the relief gained, and maintained, as quite incredible. General posture has improved and neck mobility has returned to that last experienced more than twenty years ago. What more could one ask for?
Kieran Tobin, M.B, B. Ch, BAO, FRCS(Eng), FRCS(Irl), D.L.O; Past-President of the Irish Otolaryngological, Head and Neck Society; Past-President of the E.N.T. Section of the Royal Society of Medicine of Ireland

Early Research

It could be said that it was Alexander himself who was the first person to research into the work, which has now become known as 'The Alexander Technique', as it directly originated from his experimentation on himself because of a voice problem during the late 1800s. His early findings are set out clearly in the first chapter on his book The Use of the Self.

In fact, Professor Nikolaas Tinbergen, Nobel Prize winner for Medicine and Physiology in 1973, was so impressed with the Alexander Technique himself that he devoted half of his Nobel prize acceptance speech to Alexander's work, stating:

This story of perceptiveness, of intelligence, and of persistence shown by a man without any medical training, is one of the true epics of medical research and practice.

A complete transcript of this speech is available in pdf form.

During the first half of the 20th Century, more and more doctors, first in Australia and then in the UK, became convinced that Alexander's work was indeed effective, either from their own personal experience or from seeing the effects that the Technique had on their patients. One of these doctors was Peter Macdonald, who in 1926 became Chairman of the Yorkshire branch of the British Medical Association. In his Inaugural Address he had this to say:

Alexander is a teacher pure and simple. He does not profess to treat disease at all. If the manifestations of disease disappear in the process of education, well and good; if not, the education of itself will have been worthwhile. Manifestations of disease, however, do disappear. Including myself, I know many of his pupils, some of them, like myself are medical men. I have investigated some of these cases, and I am talking about what I know.

He went on to say that although the Technique was practically unknown to doctors, it was of such importance that he thought that immediate investigation by the medical profession was imperative.

In 1937 a group of doctors led by Peter MacDonald wrote a letter which was published in British Medical Journal. It was signed by no fewer than 19 doctors and stated:

As the medical men concerned we have observed the beneficial changes in use and functioning which have been brought about by the employment of Alexander's technique in the patients we have sent to him for help - even in the case of so called 'chronic disease' - whilst those of us that have been his pupils have personally experienced equally beneficial results. We are convinced that an unsatisfactory manner of use, by interfering with general functioning, constitutes a predisposing cause of disorder and disease, and that diagnosis of a patient's troubles must remain incomplete unless the medical man when making his diagnosis takes into consideration the influence of use upon functioning.

Unfortunately, those responsible for the selection of subjects to be studied by medical students have not yet investigated the new field of knowledge and experience which has been opened up through Alexander's work, otherwise we believe that ere now the training necessary for acquiring this knowledge would have been included in the medical curriculum. To this end we beg to urge that as soon as possible steps should be taken for an investigation of Alexander's work and Technique...

Unfortunately, due to the outbreak of the Second World War, all follow-up to this letter was abandoned. However it was not until the late 1940s that the first medical research on the Alexander Technique was conducted. It was carried out by Dr. Wilfred Barlow MD, a consultant rheumatologist at Guy's Hospital in London UK and a good summary of that research can be found in his book, The Alexander Principle. reviewed here.

Late Twentieth Century Research

The next significant research was not until the 1960s and 70s; Professor Frank Pierce Jones conducted a series of studies at Tufts University USA using electromyography and EMG equipment. These studies showed that the Alexander Technique could produce a marked reduction in stress levels. His results are included in his book Freedom to Change - The Development and Science of the Alexander Technique, reviewed here.

In more recent times the number of medical and scientific studies has grown rapidly. A comprehensive series of studies of the underlying physiological mechanisms of the Technique have been conducted by Dr. David Garlick of the University of New South Wales who wrote an open letter to all doctors stating that:

The Alexander Technique can be described as a psycho-somatic, re-educative technique that does not set out to be curative but it may, in fact, have useful effects on musculoskeletal and psychological states.

The full letter can be viewed here.

Findings of his own experimentation may be found in The Lost Sixth Sense - A Medical Scientist looks at the Alexander Technique, available here.

ATEAM Research

The randomised controlled trial of Alexander Technique lessons, exercise, and massage (ATEAM) is the most significant and extensive research ever carried out in connection with the Alexander Technique. It was widely reported around the world (for a selection of Irish and UK newspaper articles please see our Recent Press Articles page). Its aim was to evaluate the effects of Alexander Technique lessons, exercise and massage on chronic and recurrent back pain. The multicentre clinical trial funded by the Medical Research Council and NHS Research and Development fund was led by GP researcher Professor Paul Little, University of Southampton UK, and GP Professor Debbie Sharp of Bristol University, UK and the results were published in the British Medical Journal in 2008.

A total of 579 patients with chronic/recurrent non-specific low back pain were recruited from 64 general practices and were randomly allocated to four interventions: 6 Alexander Technique lessons; 24 Alexander Technique lessons, 6 sessions of therapeutic massage, or control group. All patients continued to receive usual GP care during the trial. Half the participants also received a GP prescription for general exercise with behavioural counselling from a practice nurse. All participants in the Alexander Technique groups were taught by experienced STAT (Society of Teachers of the Alexander Technique) registered teachers who had all under taken a three year full time course consisting of at least 1600 hours of class work. These teachers used hand contact together with verbal explanation and advice in order to educate the participants' awareness of their postural support and movement patterns. Two main self-reported outcome measures were used: a) the Roland Morris disability score, the 'industry standard' outcome measure for back function and b) days in pain in the past four weeks. Ten other outcome measures were also used.

The trial results clearly demonstrated that taking one-to-one lessons in the Alexander Technique led to long-term benefits: following 24 lessons the number of days in pain was 3 days per month, compared with 21 days for the control group (an 86% reduction), one year after the trial started, and significant improvements occurred in function and quality of life with a 42% reduction in Roland Morris disability score compared with the control group. Of the approaches tested, Alexander lessons provided the most benefit, with the 24-lesson group achieving the best results.

Since the effect of massage on the Roland Morris score was no longer significant by one year, while the effect of Alexander lessons was maintained, the trial authors concluded that the long-term benefits of taking lessons are unlikely to be due to placebo effects of attention and touch and more likely to be due to active learning and application of the Alexander Technique in daily life. Finally, reassuringly, there were no adverse effects reported in the trial by any of the 288 participants in the Alexander Technique groups. A full account may be found at:

Randomised controlled trial of Alexander Technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain or you can Listen to an interview with Dr. Paul Little, MD, Lead Investigator for the study.

As the Alexander Technique has become better known, a growing number of doctors are confidently referring some of their patients to Alexander teachers. In the UK lessons in the Technique may be covered by the National Health Service.

Other Recent Research Programmes

There have been many other research programmes that have taken place recently and below is an up-to-date list. (If you know of any others, please contact Richard Brennan).

The Alexander Technique remains the best of the self-care strategies to prevent the sequel of poor posture and poor breathing.
Harold Wise, MD, PC, New York, NY