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It is obvious to many medical practitioners today that a huge number of people are suffering from debilitating health problems that are linked to poor posture and malco-ordination. Doctors, Physiotherapists, Chiropractors and Osteopaths are often exasperated when patients return again and again with the same complaint despite extensive and costly treatment.
People are in effect causing themselves huge amounts of pain without realising it. The malcoordinated way people sit, stand and move often involves over-tensing the entire muscular system and this tension can increase over the months and years, directly or indirectly causing many of many the back, neck, shoulder, hip, knee and foot problems that we see today. Excessive tension can also put strain on the respiratory and digestive systems, as they both need a free muscular system to work effectively and efficiently. Tense muscles will not do the nervous and circulation systems any favours either, and it is very possible that a wide range of medical conditions may be caused or exacerbated by an over-tensing of the muscular system. What is often needed is health education rather than treatment or drugs, because there can be no lasting cure unless a person realises that their postural habits are the cause of their own problems. This is where the Alexander Technique can help.
The Alexander Technique is not a therapy or a form of treatment - it is a way of educating a person as to the root cause of postural problems; it is a method of releasing excessive and unwanted muscular tension throughout the body, often accumulated over many years of stressful living. This excess muscular tension often starts in childhood and, if left unchecked, may give rise later in life to common ailments such as back and neck pain, arthritis, hip and knee problems, shallow breathing, hypertension, sciatica, and even insomnia. Vast amounts of money are being spent on the treatment of these illnesses (to say nothing of the pain and discomfort that is felt by the patient or the huge strain on the health services), yet the number of patients presenting continues to increase. I have personally witnessed that with the education afforded by the Alexander Technique, many people can be helped to understand the causes of their problems and be taught how they can help themselves. Over the last 22 years I have seen thousands of people whose aches and pains have diminished or disappeared altogether as they have become more aware and changed detrimental habits affecting balance, posture and co-ordination while they were performing everyday actions. The Technique simply brings into consciousness tensions throughout the body that have previously gone unnoticed and, in my experience (both as an ex-back sufferer and an Alexander Teacher), are very often the root cause of many common malfunctions and ailments.
When applying the Alexander Technique a person will first learn how to be aware and release the muscles that have become unnecessarily tense while they are sitting, standing or lying on a table. This tension has often gone completely unnoticed because it often builds up very gradually over many years. The person will also learn new ways of moving while performing everyday tasks which will cause far less strain on the body, to prevent the tension from returning. They will discover different ways of sitting, standing and walking that will put less strain on the bones, joints and muscles, thus making the body work more efficiently. In fact, many people who have undergone a series of Alexander Technique lessons experience a general feeling of lightness throughout their body and some even describe the sensation as like 'walking on air'. Since our physical state directly affects our mental and emotional well-being, people often say that they feel much calmer and happier even after just a few sessions, which often results in less domestic tension and a greater ability to cope with life in general.
As children, generally our posture and ease of movement are a joy to watch, but as we start to tense our muscles in reaction to many of life's worries and concerns, our posture can deteriorate into what can border on deformity. Yet this is frequently not the case with people outside the modern western world - many of the indigenous races who still live on the land, such as the Berber people from North Africa, or from rural parts of India, retain their natural upright healthy posture throughout their lives. Have you ever wondered why many people from India or Africa can still squat easily at 80 years of age when many of us in the west find it hard to do at 35? It is simply because they are moving in a very different way than we are.
Everyone have a series of postural reflexes and muscles throughout the body that support us and naturally co-ordinate our movements, yet many people interfere with these natural reflexes by overusing the phasic muscles to such an extent that many adults often hold far more tension in their bodies than is really necessary. Permanently hunched shoulders and stiff necks have become the norm as more and more people sit in a slumped way, or hold themselves in a very rigid fashion. People become accustomed to these unhealthy ways of sitting and standing, putting strain on their bodies, yet no matter how uncoordinated these positions are they will come to feel 'right' to the people themselves.
Not until years later will people begin to suffer from aches and pains or restriction of movement. Many modern methods of combating such problems involve powerful painkilling drugs that block out the body's warning system, whose function it is to tell us that something is wrong. Often, doctors can offer little advice, as their training revolves around the treating of symptoms rather than uncovering, and rectifying, the causes of such problems. The Alexander Technique, however, does just this; it can reveal the underlying cause, so that they are then able to eliminate the tension which is responsible for so many of the ailments that we so often mistakenly put down to the ageing process.
Frederick Matthias Alexander was born in Tasmania, Australia in 1869. He was a very sickly child, suffering from recurring respiratory problems. Due to his frail health, he was taken away from school at an early age and was tutored in the evenings by the local school teacher.
Alexander decided to train to be an actor and reciter and it was not long before he gained a fine reputation as a first class reciter, and went on to form his own theatre company specialising in one man Shakespeare recitals.
As he became increasingly successful, Alexander accepted more and more engagements, which put more and more strain on his vocal cords. After a while the stress began to show, as his voice regularly became hoarse in the middle of his performances. He approached various doctors and voice trainers who gave him medication and exercises, but nothing seemed to make any real difference. In fact, the situation deteriorated still further, until on one occasion Alexander could barely finish his recital. He became more and more anxious as he realised that his entire career was in jeopardy. As no one was able to help him, he decided to solve the problem himself. This took him on a journey of self-discovery that not only in the end gave him the answer to his question, but in the process led to huge discoveries about posture, balance and movement, and revealed to him how many of us interfere with our postural reflexes, contributing to much of modern humankind's suffering. Alexander's findings were greatly underestimated, yet it could be claimed that his discovery was one of the greatest of the twentieth century.
Alexander had only two clues to follow up when he started his investigations: that the act of reciting on stage brought about the hoarseness which caused him to lose his voice, yet during normal speaking, this hoarseness disappeared.
Following simple, logical steps, Alexander deduced that if ordinary speaking did not cause him to lose his voice, while reciting did, then there must be something different in what he did when speaking normally, and what he did when reciting. If he could find out what that difference was, her reasoned that he might be able to change the way in which he was using his voice when reciting, solving his problem. He used a mirror to observe himself both when speaking in his normal voice and again when reciting, in the hope that he could discern some differences between the two. He watched carefully, but could see nothing wrong or unnatural while speaking normally. It was when he began to recite that he noticed several actions that were different:
Up until this point in time Alexander had been completely unaware of these habits, and when he returned to his normal speaking voice he realised that the same tendencies were also present but to a lesser extent, which was why they had previously gone undetected.
He returned to the mirror greatly encouraged, and recited over and over again to see if he could find any more clues. He soon noticed that these three tendencies became accentuated when he was reading passages in which unusual demands were made on his voice. This confirmed his earlier suspicion that there was definitely a connection between the way in which he recited and the loss of his voice. He realised for the first time that he was unconsciously causing his own problem.
Optimistic that he was at last getting to the crux of the matter, Alexander experimented still further to see if he could achieve even more improvement in the state of his vocal cords. He did this by deliberately putting his head forward, but was surprised to find that this also had the effect of depressing the larynx. To have a closer look at how he was moving, he added two further mirrors on either side of the original one. When he observed himself again in the mirrors, he could see clearly that he was in fact still pulling his head down onto his spine, as before. Alexander was very surprised at these findings, because for the first time he realised that he was doing the exact opposite of what he thought he was doing. He was suffering from what he came to call 'faulty sensory awareness'.
At first he thought that this problem was his own personal idiosyncrasy, but later, when he started to teach his technique, he was to realise that faulty sensory awareness was very common. Alexander continued with his personal experiments in front of the mirror and began to notice that his habit of pulling his head back was not only causing the depression of his larynx, but also various tensions and stresses throughout his entire body. He started to realise that he was also lifting his chest, arching his back, throwing his pelvis forward, over-tightening his leg muscles and even gripping the floor with his feet. This was affecting his entire posture and balance. Alexander realised that the body does not function as separate entities, but as a whole unit with every part affecting every other part.
Like many other people, Alexander had never given any thought to how he moved, but simply moved in a way that was habitual because this felt 'right' to him. When trying to change his habit of pulling the head back onto his spine, he often caused more tension elsewhere and at that point nearly gave up in exasperation, but with further experimentation he eventually realised that he merely had to inhibit the habitual tense movement that was causing the problem, and then think of the new direction of movement needed, in order to bring about a favourable change. He described this process as: thinking in activity.
Over many years Alexander devised and perfected a method which primarily consists of awareness, eradication of harmful habits and free choice, and was able not only to free himself from the habit which had jeopardised his career, but also to cure himself of the recurring breathing problems that had afflicted him from birth.
When Alexander returned to the stage, many of his fellow actors suffering from similar problems sought his help, and he began teaching his Technique to others. News spread like wildfire about the actor who had cured himself of his vocal and respiratory difficulties and doctors began referring some of their patients to Alexander, who had enormous success in treating a variety of different ailments when no-one else had been able to help. He used the gentle guidance of his hands, as well as verbal instructions, to convey his Technique. He helped many people release the harmful habits which were at the root of their illnesses.
Nobel Prize winner Nikolaas Tinbergen had this to say in his acceptance speech:
This story, of perceptiveness, of intelligence, and of persistence, shown by a man without medical training, is one of the true epics of medical research and practice.
During the 1930s more and more doctors were becoming convinced that Alexander's work was indeed effective, either from their own experience or from 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 many 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 that was published in the British Medical Journal. It was signed by 19 prominent doctors requesting that the Alexander Technique be included in the medical curriculum.
I myself was a chronic back pain sufferer which was primarily due to my previous profession as a driving instructor. I worked long hours sitting in a car, and after several years developed lower back pain. My occasionally aching back soon turned into a very painful back with shooting sciatic pains all down my left leg.
The first port of call was my father, a medical doctor, who although obviously very concerned, could offer me little help apart from painkillers and the usual medical advice of rest. This only brought temporary relief and as time went by even the powerful painkilling drugs I was taking became less and less effective. It was not long before I needed to get back to work due to financial pressures, but sitting in the car for any length of time very quickly made the problem worse. I saw various physiotherapists, neurologists and orthopaedic surgeons but no-one could find what was causing the problem. Eventually after a number of X-rays and other tests it was revealed that I had 3 prolapsed lumbar discs, but still no clue as to the cause. I was told that I would have to get used to the fact that I would never be able to live a normal life ever again and on no account would I be allowed to lift or carry anything heavy. I was advised to undergo surgery to remove the three intervertebral discs to reduce the pain levels. Initially I agreed to the operation, but subsequently my father persuaded me not to go ahead with it, because some of his patients had had the same operation, and they were in more pain than they had been before. So instead of going ahead with the operation, I underwent an intensive course of physiotherapy treatment as an inpatient at a large residential physiotherapy hospital near London in the UK. Although the staff were very caring and obviously doing their very best to help, the treatment and the prescribed exercises, which I performed diligently, gave me no lasting benefit, so when I was discharged from the hospital my back pain was as bad as ever.
At this stage I started to investigate alternative medicine. I tried the more established therapies such as chiropractic, osteopathy, homeopathy and acupuncture, but then, in desperation I started other treatments such as reflexology, aromatherapy, reiki and spiritual healing. In fact, I was so desperate to be free from the constant agony that I would have tried practically anything, and while some of these treatments helped to some extent, generally I was only able to obtain short-term relief - the severe pain always returned within a day or so of any treatment. I finally gave up after many years of searching and resigned myself to a life of pain. At this point no one, including myself, had even been interested as to why the discs were prolapsed in the first place.
By chance I met an Alexander teacher who explained that the Alexander Technique was very effective in helping back sufferers like myself, many of whom had tried every other remedy without success. Although I was very sceptical, I decided to have a couple of sessions to see what it was about. At this point I was quite desperate as the pain was present all the time, day and night, and I felt that I had nothing to lose. I had no idea what learning the Alexander Technique meant, as I had always come across it in the context of music and acting. Within a few minutes into my first lesson my teacher asked me whether I always sat in the way that I was now sitting. I said that I did not understand what he was talking about, so he put a mirror in front of me, and then I saw straight away that I was twisting to the right while leaning to the left at about 20 degrees. This surprised me greatly, as I felt as if I were perfectly straight. He set about making suggestions, and then very gently with his hands made a few minute adjustments to the way I was sitting, and I felt two things – firstly, completely twisted to the left and leaning way off to the right; secondly my back pain started to abate. In the mirror he showed me how I was now sitting, and to my amazement I saw with my own eyes that I was sitting perfectly straight.
After a few lessons the changes felt less strange and the back pain started to ease more and more until I was no longer in pain. I then had the realisation that while I teaching people to drive I had been sitting leaning to the left while twisting to the right in order to see the road ahead to check whether the learner driver was looking in the mirrors; over the years this had become my habit wherever I was sitting, and this was probably the initial cause of my back problem. As the tensions released during a series of lessons, I also noticed that it was not only my back that was improving; I started to sleep better, my self esteem and confidence also grew and to my surprise I was gradually becoming happier as well. Within three months I was leading a normal life again and was lifting and bending without any problem at all.
When reflecting on my experience I was astounded that all the people (my father included) who had tried to help me over the years had missed the obvious. They were all trying to fix the problem without finding out why it had come in the first place, because they had not been trained to do so.
When I was suffering with back pain the Alexander Technique was little known and there was minimal research into the effects of the Technique on relieving back pain, and the medics were understandably wary at referring patients to practitioners of unproven methods. Fortunately that has radically changed due to the recent ATEAM research.
The randomised controlled trial comparing the effects of Alexander Technique lessons, exercise, and massage (ATEAM) is the most significant and extensive research ever carried out in connection with the Alexander Technique. 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. 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 undertaken 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.
It is important to realize that Alexander Technique teachers and medical practitioners are working to the same goal: to free a person from pain. They just have very different methods and it is not a case of one or the other. It can often be very advantageous for a patient to have some Alexander lessons while they are undergoing medical treatment.
For further information about the Alexander Technique please visit various pages at www.alexander.ie, or Society of Teachers of the Alexander Technique (STAT) or telephone STAT on 0044 207 482 5135 (UK number, office hours).
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.
Dr Miriam Wohl MB, ChB, ECFMG, JCC Cert, MSTAT
Julia Woodman BSc, PhD, MSTAT