Alexander Technique for Chronic Back Pain

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In the August 23, 2008, edition of the British Medical Journal, there is an article that created a stir in some corners of the medical world: "Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain." A translation/explanation of that: researchers in England set up a test to see what works better to relieve long-term back pain or back pain that keeps coming back. They studied the Alexander technique, exercise, and massage.

They found that among those treatment options, the Alexander technique, a little known method that teaches how to make your body move efficiently and painlessly (learn more here), was the most effective way to reduce chronic or recurrent back pain.

woman with back pain sitting on a sofa

How the Study Worked
64 general medical practices in the south and west of England took part in the study. The practices randomly selected patients they'd seen in the last year for back pain. All total, 579 patients participated.

Those 579 people were randomly put into eight groups:

  • Normal care (that'd be the control group)
  • Normal care, plus an exercise program with follow-up from a nurse
  • Six sessions of massage
  • Six sessions of massage, plus an exercise program with follow-up from a nurse
  • Six lessons in the Alexander technique
  • Six lessons in the Alexander technique, plus an exercise program with follow-up from a nurse
  • 24 lessons in the Alexander technique
  • 24 lessons in the Alexander technique, plus an exercise program with follow-up from a nurse

The study followed the patients—checked in with them—for one year. The patients were asked to fill out a questionnaire at the beginning of the study, three months in, and at the end of one year. The questionnaire helped determine which group had the best improvement in pain, according to various scales and measurements used by the medical community.

What the Study Means
Very few studies have been done that look at the effects of the Alexander technique (especially compared to the number of studies done on surgical techniques, for example). That doesn't mean, though, that the technique isn't worth consideration, as this study shows.

Patients who had 24 lessons in the Alexander technique reported just three days of pain during a four-week period. Compare that to the control group: they reported 21 days of pain during the same period. The massage group reported 14 days of pain, showing that massage therapy is somewhat beneficial, but not as beneficial as the Alexander technique.

The study found that 24 Alexander technique lessons provided the most overall benefit to patients after one year. However, the patients who had six Alexander technique lessons followed by a prescribed exercise program (with follow-up from a nurse to make sure they were doing it and doing it correctly) showed almost the same level of pain improvement as the "24 Alexander technique lessons" group.


  • The Alexander technique appears to be more effective than "normal care" for chronic back pain (normal care is medications, injections, etc.).
  • The Alexander technique appears to be more effective than massage at relieving back pain.
  • Even a short stint in the Alexander technique—if followed with a good exercise program—is beneficial for chronic back pain sufferers.

But What is the Alexander Technique?
F.M. Alexander developed the Alexander technique in the late 1800s in Australia. He was an actor, but he developed a vocal problem that kept him from the stage. Regular doctors couldn't help him, so he started to observe and pay careful attention to his body when he tried to speak. He noticed that his neck muscles were very tight, and as he worked on relaxing those, he discovered that if you think consciously about the relationship of your head, neck, and spine, your body will function better and more efficiently.

Alexander got his voice back, and he developed the Alexander technique along the way. It begins with the premise that we subconsciously develop bad movement habits that compress our spine. By learning how to rebalance the head on the neck (improving posture dramatically), the rest of the body opens up and even breathing becomes easier.

therapist adjusting a boy's head posture, balance

The Alexander technique relies on specially trained teachers who work with students one-on-one. Using gentle touch, the teacher helps the student learn how to better use their body and release muscle tension. It is a self-care technique that teaches people how to prevent and deal with pain.

Updated on: 04/24/17
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Jason M. Highsmith, MD
The Alexander technique is a hundred year old practice that has gained attention after a study by the British Medical Journal showed significant benefits from it in patients with low back pain.
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