Back pain is a leading cause of disability in Western societies, but we have had little success in developing long-term treatments. The Alexander technique is a personalized approach to back pain management that helps patients to develop lifelong skills for self care and to improve postural tone and muscular coordination. An article published finds that the technique, in combination with an exercise program, can offer effective long-term treatment for sufferers of chronic back pain.

The Alexander technique is not considered a form of exercise and must be taught to patients so that they can practice it on their own. It has been suggested in other studies that the Alexander technique along with massage can help alleviate some short-term back pain, but its long-term effects remain unknown. To investigate long-term outcomes, a team of researchers from the University of Southampton and the University of Bristol led by Professor Paul Little compared the one-year outcomes of massage, exercise, and the Alexander technique for the relief of back pain.

The researchers selected a sample of 579 patients with chronic or recurrent back pain from 64 general practices in the south and west of England. Randomization created four groups of patients: one group received normal care, the second received massage, the third received six Alexander technique lessons, and the fourth received 24 Alexander technique lessons. Half of the patients from each group were also told to walk briskly for 30 minutes each day five times per week; this was the prescribed exercise program.

Surveys of disability were sent to patients after three months and again at one year in order to see how back pain limited their activities. The questionnaire asked, for example, if the patients walked more slowly than usual or were able to get out of the house often.

Results of the study revealed that after one year, lessons in the Alexander technique combined with exercise were associated with significantly reduced pain and improved functioning. Massage offered little benefit after three months.

Patients who received one year of Alexander technique lessons reported fewer days with back pain over the past four weeks compared to patients receiving normal care – 18 fewer days of back pain (for the 24-lesson group) compared to the median of 21 days of back pain. Six lessons of Alexander technique were still associated with 10 fewer days of pain, and massage was associated with seven fewer days of pain.

Patients receiving Alexander technique lessons also indicated an improved quality of life. Further, six one-to-one lessons in the Alexander technique accompanied by exercise had nearly the same benefit as 24 lessons in the technique alone.

“Massage is helpful in the short term…[but] the Alexander technique retained effectiveness at one year…the results should apply to most patients with chronic or recurrent back pain,” conclude the researchers.

An accompanying editorial written by Professor Maurits van Tulder (VU University in the Netherlands) says: “Exercise therapy significantly reduces pain and improves function in adults with chronic low back pain, particularly in patients visiting primary care providers because of back pain.” Van Tulder calls for more research to compare the effects of the Alexander technique with different types of exercise.

Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain
Paul Little, George Lewith, Fran Webley, Maggie Evans, Angela Beattie, Karen Middleton, Jane Barnett, Kathleen Ballard, Frances Oxford, Peter Smith, Lucy Yardley, Sandra Hollinghurst, Debbie Sharp
BMJ (2008). 337: a884.
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Written by: Peter M Crosta