Alexander Technique effective for back pain

The Alexander Technique isn't a therapy, but a taught way of using the mind and body.  It's practitioners are teachers.  The Society of Teachers of the Alexander Technique (STAT) says 'it enables people to improve their general functioning  and well-being. Teachers show people how to re-establish good body use, natural balance and co-ordination, and to recognise and avoid poor movement habits that cause or aggravate their pain'.

Design of the trial and the findings

 579 patients from 64 GP practices and 59 Alexander Technique teachers took part in the trial.  It showed that 24 Alexander Technique lessons were the most effective for reducing back pain, but that six lessons followed by exercise were 70% as good.  The randomised controlled trial compared four groups (6 Alexander Technique lessons, 24 Alexander Technique lessons, massage and a control group).  Half the patients in each group also received a GP prescription for aerobic exercise with nurse behavioural counselling.

The best results were seen in the 24 lesson group.  One year after the trial started the number of activities limited by low back pain had fallen by 42%.  The average number of days in pain were 3 per month, compared with 21 days in pain for the control group.  The exercise group had improved function with a disability score better at 1 year than 3 months, but days in pain were not significantly better than the control group. The massage group had 14 days in pain compared with 21 for the control group, but the three month improvement in disability score was not maintained.

Since the effect of massage on the disability score was no longer significant by one year, but the effect of 6 Alexander Technique lessons was maintained, the authors concluded that the long term benefits were not the result of a placebo effect related to attention and touch, but due to patients having learned the technique.

Getting funding and support

Kathleen Ballard is an Alexander Technique teacher who was involved in the trial alongside her colleague Frances Oxford, both members of STAT. Kathleen explained the huge amount of work that went into making the trial viable.

'It requires dedication and perseverance to set up and complete a trial: in our case it took ten years from initiation to publication.  We depended on having strong advocates in the research community who wanted to conduct the trial.  We also had the advantage that there was already preliminary research evidence which enabled grant reviewers to be supportive and recommend funding. 

'The trial was initiated by Professor Paul Little after observing anecdotal evidence that people with back pain gained substantial benefit from Alexander Technique lessons. He had already established a reputation as a clinical scientist with experience in running clinical trials.  He's an MRC research fellow in primary care.  Hence he could attract other senior staff into the research team including a statistician and a health psychologist as well as a trial manager.  The MRC agreed funding after ten reviewers submitted reports on the proposal.'

Clearly the huge amount of organisation needed for trials like these will be a barrier for many complementary therapies.  But the rewards are considerable too - Alexander Technique teachers now have a credible body of evidence to point to.  It may also lead to the Alexander Technique being added to the NICE guidelines for backpain and a greater rate of referral and recommendation by NHS GPs.