At last, the cure for back pain?

At last, the cure for back pain?

Reported 21 August, 2008

A new study has shown that the Alexander Technique may be more effective than other common methods of treating back pain. But what is it, and how does it compare with other techniques? Sam Murphy looks at the evidence

Back pain. If you haven't got it now, the chances are you've either had it in the past or will get it in the future. Statistics show that seven in 10 of us suffer from it at some time in our lives. And it is one of the most common causes of sickness absence and disability in the western world. In fact, research from the British Chiropractic Association earlier this year found that in the UK, back pain is on the increase, rising from 47% of people "currently suffering" in 2007, to 52% in 2008.

Although the days when bed rest was the standard treatment for chronic back pain are long gone, the medical profession has yet to find a single effective solution that it can uniformly prescribe, thanks to a dearth of scientific evidence and, where studies have taken place, conflicting findings. But one back-pain treatment option for which there has been little funded research in the past (and therefore, scant evidence to support its use) is now making news in the medical community - the Alexander Technique (AT).

A study published this week in the British Medical Journal reports the results of a large-scale trial on the effects of AT on back pain. The study, which took place at GP practices in Southampton and Bristol, hypothesised that AT could alleviate back pain by limiting muscle spasm, strengthening postural muscles, improving coordination and flexibility, and decompressing the spine. One year on, the results bear this out: subjects who received 24 AT lessons reported an average of three days of back pain per month, compared with 21 days per month in the control group. The AT group also reported better function and quality of life.

So what is AT? I've asked many an Alexander teacher this over the years, and it's a question that even they find difficult to answer. "What AT isn't is a series of gentle exercises," says Elizabeth Dodgson, an AT teacher in west London, and a trustee of the charity BackCare. "It's not about being taught fixed positions (postures) in which to hold the body and it isn't manipulation, like, say, physiotherapy or massage."

Dodgson is happier talking about what AT does, than what it is. "The goal of AT is to set up the right circumstances under which the body can function as it was meant to," she explains. "You're learning the tools you need to use your body more effectively and efficiently and getting to know your patterns and habits, so you can let go of the bad ones. The hands-on element is important because it helps you feel how a movement can be different. That's difficult to do from a book.'

It's no coincidence that AT talks of pupils and teachers, rather than therapists and patients: there is a strong educational element involved. AT sessions are usually one on one, and the onus is on exploration and awareness rather than on forcing and fixing things.

Many common therapies involve lying down while someone "does" something to you but AT is a practice that you "do" yourself. Does Dodgson think that this "taking part" in your own treatment is an important factor? "Definitely. By the time people walk through the door, they are usually willing to change something," she says. "They've been through the 'my back's not working - can you fix it?' mindset and tried a lot of other things so by the time they come to me they are more open to change."

The difficulty in pinning down what AT is, or doing it yourself at home, is probably one of the reasons why it hasn't been embraced by the medical profession, thus far. "With physiotherapy, you can receive some treatment and be shown all the exercises you need to do in, say, six sessions," says Dodgson. "With AT there's no clear timescale or end point. It's a bit like learning a musical instrment. At what point have you 'learned it?'" Lessons cost around £30 each, and Dodgson says that after 20-30 lessons you should have learned enough about your body to continue working on your own.