Research

People study the Alexander Technique to overcome problems with chronic musculoskeletal pain, improve posture, general well-being, or skilled performance (Eldred et al. 2015). Some National Health Service (UK) insurance trusts offer Alexander Technique lessons as part of their outpatient pain clinics. According to the NHS, “Supporters of the Alexander technique often claim it can help people with a wide range of health conditions. Some of these claims are supported by scientific evidence, but some have not yet been properly tested.” A 2011 systematic review of clinical trials concluded that “Strong evidence exists for the effectiveness of AT lessons for chronic back pain and moderate evidence in Parkinson’s-associated disability” adding “Preliminary evidence suggests that AT lessons may lead to improvements in balance skills in the elderly, in general chronic pain, posture, respiratory function and stuttering” (Woodman & Moore 2011).

A 2014 systematic review of trials concluded that AT sessions may improve performance anxiety in musicians (Klein et al. 2014). A recent study found that purpose-designed AT classes for music students may beneficially influence performance related pain and the associated risk factors of poor posture, excess muscle tension, stress and performance anxiety; there were also reports of improvements to instrumental technique, performance level and practice effectiveness indicating the relevance of AT training to musical skill development (Davies 2020). The AT was as effective as beta-blocker medications in controlling the stress response during an orchestra performance in one study (Nielsen 1994), and in another study application of the AT to music performance showed improvement relative to controls in overall music and technical quality as judged by independent experts blind to subjects’ condition assignment; there were also improvements in heart rate variance, self-rated anxiety and positive attitude to performance (Valentine et al. 1995).

AT lessons are commonly used as an effective intervention for reducing chronic lower back pain (Hafezi et al. 2022). A large scale clinical trial published in the British Medical Journal showed one on one lessons in the AT from registered teachers have long term benefits for patients with chronic back pain (Little et al. 2008) and AT was viewed as effective by most participants (Yardley et al. 2010). Using EMG to record muscle activity, one study found AT lessons decreased axial stiffness by 29% on average in subjects with low back pain while resisting rotation suggesting that dynamic modulation of postural tone can be enhanced through long-term training in the AT (Cacciatore et al. 2011). Participants in another study reported significantly reduced neck pain and fatigue of the superficial neck flexors during a cranio-cervical flexion test in a study that concluded group AT classes may provide a cost-effective approach to reducing neck pain (Becker 2018). 

AT lessons resulted in trends towards fewer falls and injurious falls along with improved mobility among past multiple-fallers (Gleeson 2015) and improved functional reach in older women (Dennis 1999). The AT has also been applied in cases of joint hypermobility (Bull 2015). Clearly the AT has implications for movement coordination (Cacciatore et al. 2014). A pilot study published in The Journal of Urology showed that an AT training program designed for laparoscopic surgeons resulted in significant improvement in posture, improved surgical ergonomics and endurance as well as decreases in surgical fatigue and the incidence of repetitive strain injury (Reddy et al. 2011). 

AT lessons may provide a useful approach to improve mental wellbeing by increasing one’s sense of control, confidence and agency in a range of settings (Kinsey et al 2021). A study of people with chronic lower back pain found significant differences before and after AT lessons in their constructs of intention, perceived risk, direct attitude and behavioral beliefs (Kamalikhah et al. 2016). Perhaps not coincidentally, the AT was influential in the creation of some forms of psychotherapy, including Gestalt therapy (Tengwall 1981).

There is good evidence that AT lessons lead to sustained benefit for people with Parkinson’s disease (Stallibrass, et al. 2002). After having lessons, Parkinson’s patients had significantly less difficulty in performing daily activities, were significantly less depressed, had a significantly more positive body concept and significantly less difficulty on the fine movement and gross movement subscales of the activities (Stallibrass 1997).

There was a significant reduction in knee pain, stiffness and co-contraction recorded in a study following AT instruction in people with knee osteoarthritis; there was also an improvement in function which appeared to be maintained at 15 months post-baseline (Preece et al. 2016). A strong association was found between a course of AT instruction and increases in measures of respiratory muscular strength and endurance in healthy young and middle-aged adults (Austin, Ausubel 1992).

The high prevalence of musculoskeletal issues in the general population suggests that AT lessons could be useful as an early referral option in primary healthcare (Eldred et al. 2015), however, despite the promise of the AT, the philosophical system of mind-body unity embedded within it has lead to resistance in its incorporation by biomedicine (Tarr 2011). While the AT has yet to gain full mainstream medical adoption there has been strong support from members of the medical community who see the benefits of the work for their patients, particularly among physical therapists (Stern 2021). 

References (alphabetical by author):

Austin, John H.M., and Pearl Ausubel. “Enhanced respiratory muscular function in normal adults after lessons in proprioceptive musculoskeletal education without exercises.” Chest, vol. 102, no. 2, Aug. 1992, pp. 486+

Becker, J. J., Copeland, S. L., Botterbusch, E. L., & Cohen, R. G. (2018). Preliminary evidence for feasibility, efficacy, and mechanisms of Alexander technique group classes for chronic neck pain. Complementary Therapies in Medicine, 39, 80–86. https://doi.org/10.1016/j.ctim.2018.05.012

Bull, Philip The Alexander Technique Hypermobility Syndromes Association Journal Volume 3 Spring 2015 

Cacciatore T.W., Gurfinkel V.S., Horak F.B., Cordo P.J., Ames K.E., Increased dynamic regulation of postural tone through Alexander Technique training, Human Movement Science, Volume 30, Issue 1, 2011, Pages 74-89, ISSN 0167-9457, https://doi.org/10.1016/j.humov.2010.10.002.

Cacciatore T.W., Gurfinkel V.S., Horak F.B. Prolonged weight-shift and altered spinal coordination during sit-to-stand in practitioners of the Alexander Technique. Gait & Posture (2011), doi:10.1016/j.gaitpost.2011.06.026

Cacciatore Timothy W., Mian Omar S., Peters Amy, and Day Brian L. Neuromechanical interference of posture on movement: evidence from Alexander technique teachers rising from a chair Journal of Neurophysiology 2014 112:3, 719-729

Davies, J Alexander Technique classes improve pain and performance factors in tertiary music students Journal of Bodywork and Movement Therapies Vol. 24 Issue 1 p.1-7 Jan 1, 2020 https://doi.org/10.1016/j.jbmt.2019.04.006

Dennis Ronald J, Functional Reach Improvement in Normal Older Women After Alexander Technique Instruction, The Journals of Gerontology: Series A, Volume 54, Issue 1, January 1999, Pages M8-M11 https://doi.org/10.1093/gerona/54.1.M8

Eldred, J., Hopton, A., Donnison, E., Woodman, J., & MacPherson, H. (2015). Teachers of the alexander technique in the UK and the people who take their lessons: A national cross-sectional survey. Complementary Therapies in Medicine, 23(3), 451-461. doi:https://doi.org/10.1016/j.ctim.2015.04.006

Gleeson, M., Sherrington, C., Lo, S., & Keay, L. (2015). Can the alexander technique improve balance and mobility in older adults with visual impairments? A randomized controlled trial. Clinical Rehabilitation, 29(3), 244-260. https://doi.org/10.1177/0269215514542636

Hafezi M., Rahemi Z., Ajorpaz N.M., Izadi F.S., The effect of the Alexander Technique on pain intensity in patients with chronic low back pain: A randomized controlled trial, Journal of Bodywork and Movement Therapies, Volume 29, 2022, Pages 54-59, ISSN 1360-8592, https://doi.org/10.1016/j.jbmt.2021.09.025.

Kamalikhah T., Morowatisharifabad M. Rezaei-Moghaddam F., Ghasemi M. Gholami-Fesharaki M. Goklani S. Alexander Technique Training Coupled With an Integrative Model of Behavioral Prediction in Teachers With Low Back Pain Iran Red Crescent Medical Journal 2016 Sep; 18(9): e31218. Published online 2016 Aug 9. doi: 10.5812/ircmj.31218

Klein, SD; Bayard, C; Wolf, U (24 October 2014). “The Alexander Technique and musicians: a systematic review of controlled trials”. BMC Complementary and Alternative Medicine. 14: 414. doi:10.1186/1472-6882-14-414. PMC 4287507. PMID 25344325.

Kinsey D., Glover L., Wadephul F., How does the Alexander Technique lead to psychological and non-physical outcomes? A realist review, European Journal of Integrative Medicine, Volume 46, 2021, ISSN 1876-3820, https://doi.org/10.1016/j.eujim.2021.101371

Little P, Lewith G, Webley F, Evans M, Beattie A, Middleton K et al. Randomized controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain British Medical Journal 2008; 337 :a884 doi:10.1136/bmj.a884

Nielsen M (1994). In: The Alexander Technique: Medical and Physiological Aspects, Chris Stevens (Ed.) STAT Books, London.

Pramod P. Reddy, Trisha P. Reddy, Jennifer Roig-Francoli, Lois Cone, Bezalel Sivan, W. Robert DeFoor, Krishnanath Gaitonde, Paul H. Noh, The Impact of the Alexander Technique on Improving Posture and Surgical Ergonomics During Minimally Invasive Surgery: Pilot Study, The Journal of Urology, Volume 186, Issue 4, 2011, Pages 1658-1662, ISSN 0022-5347, https://doi.org/10.1016/j.juro.2011.04.013

Preece, S.J., Jones, R.K., Brown, C.A. et al. Reductions in co-contraction following neuromuscular re-education in people with knee osteoarthritis. BMC Musculoskeletal Disorders 17, 372 (2016). https://doi.org/10.1186/s12891-016-1209-2

Schlinger, Marcy Feldenkrais Method, Alexander Technique, and Yoga—Body Awareness Therapy in the Performing Arts Physical Medicine & Rehabilitation Clinics REVIEW ARTICLE| VOLUME 17, ISSUE 4, P865-875, NOVEMBER 01, 2006

Stallibrass, C., Sissons, P., & Chalmers, C. (2002). Randomized controlled trial of the alexander technique for idiopathic parkinson’s disease. Clinical Rehabilitation, 16(7), 695-708. doi:https://doi.org/10.1191/0269215502cr544oa

Stallibrass C. An evaluation of the Alexander Technique for the management of disability in Parkinson’s disease- a preliminary study. Clinical Rehabilitation. 1997;11(1):8-12. doi:10.1177/026921559701100103

Stern J. The Alexander Technique: Mindfulness in Movement Relieves Suffering Alternative and Complementary Therapies Volume: 27 Issue 1: February 11, 2021 10-13. http://doi.org/10.1089/act.2020.29307.jcs

Tarr, Jennifer Educating with the hands: working on the body/self in Alexander Technique Sociology of Health & Illness Vol. 33 No. 2 2011 ISSN 0141–9889, pp. 252–265doi: 10.1111/j.1467-9566.2010.01283.x

Tengwall, Roger A note on the influence of F. M. Alexander on the development of gestalt therapy Journal of the History of the Behavioral Sciences volume 17 issue 1 1981 https://doi.org/10.1002/1520-6696(198101)17:1<126::AID-JHBS2300170113>3.0.CO;2-X

Valentine, E. R., Fitzgerald, D. F. P., Gorton, T. L., Hudson, J. A., & Symonds, E. R. C. (1995). The Effect of Lessons in the Alexander Technique on Music Performance in High and Low Stress Situations. Psychology of Music, 23(2), 129–141. https://doi.org/10.1177/0305735695232002

Williams, Angela The Alexander Technique, Complementary and Alternative Medicine Sourcebook, 6th Edition July 2018 978-0-7808-1632-9 pages 439-441

Woods C., Glover L., Woodman J. An Education for Life: The Process of Learning the Alexander Technique Kinesiology Review Volume 9: Issue 3 14 Aug 2020 https://doi.org/10.1123/kr.2020-0020

Woodman, J. P. Moore, N. R. Evidence for the effectiveness of Alexander Technique lessons in medical and health-related conditions: a systematic review 2011 – International Journal of Clinical Practice VL  – 66 IS  – 1 SN  – 1368-5031 UR https://doi.org/10.1111/j.1742-1241.2011.02817.x

Yardley L., Dennison L., Coker R., Webley F., Middleton K., Barnett J., Beattie A., Evans M., Smith P., Little P., Patients’ views of receiving lessons in the Alexander Technique and an exercise prescription for managing back pain in the ATEAM trial, Family Practice, Volume 27, Issue 2, April 2010, Pages 198–204, https://doi.org/10.1093/fampra/cmp093

Websites:

AmSAT bibliography of research studies

STAT bibliography of recent studies

https://www.nhs.uk/conditions/alexander-technique/

Potential Mechanisms of the Alexander Technique: Toward a Comprehensive Neurophysiological Model