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.
How does the Alexander Technique compare with other treatments?
Pilates is often the first port of call for people with back pain, as far as exercise is concerned. Indeed, a study from Queen’s University in Ontario, Canada, found that it was valuable in alleviating non-specific lower back pain. But Lynne Robinson, director of the Body Control Pilates association advises, proceeding with caution. «Pilates is not a treatment for back pain,» she says. «We don’t diagnose and we don’t treat – our role comes after treatment, and any good teacher will ideally work one-to-one, in conjunction with the client’s medical practitioner.»
A key element of Pilates is core stability training – exercises to work on the deep-set muscles situated in the trunk and pelvic area that have a role in protecting the spine and keeping the «core» of the body stable. A recent study from the University of Queensland found that isolation of the deep abdominal muscles could successfully improve recruitment patterns in lower back pain sufferers, reducing pain. But, contrary to popular belief about Pilates, it’s not all about the core. «Pilates is brilliant for backs because it works the spine through all its planes of movement,» says Robinson. «Extension, flexion, rotation and side flexion – as well as teaching good body awareness and use, improving breathing and posture.»
· To find a qualified Pilates teacher, visit pilatesfoundation.com.
There’s a lot more to chiropractic than crunching and clicking bones and joints, according to Tim Hutchful from the British Chiropractic Assocation. «Chiropractic is wrongly pereceived to be simply a manipulative technique – that’s just like saying dentists only do fillings,» he says. «It’s actually a complete package of care, which could involve everything from hands-on treatment to postural assessment and stretching.»
«Most back pain is accumulative.» – says Hutchful. «Symptoms are the last thing to come and the first thing to go – so we tend to blame the problem on the last action we did, rather than looking at the bigger picture.» There has been some controversy about manipulative techniques, however, Hutchful argues that the chiropractic treatment package offers the opportunity to prevent the likelihood of problems happening in the first place, by addressing everything from the pen you write with to the way you pick up your baby. «When a patient walks in, yes, I want to alleviate their pain, but I also want to look at its cause and the aggravating factors, because without addressing these, the problem will return.»
· To find a chiropractor, contact the British Chiropractic Association chiropractic-uk.co.uk.
While a Pilates or AT teacher isn’t qualified to diagnose your back pain or prescribe treatment, an osteopath is. In fact, osteopaths specialise in dealing with back pain – non-specific chronic cases as well as acute injuries and post-surgery rehabilitation. «The role of the osteopath is to help the individual manage themselves in ways that will optimise their recovery,» says Professor Eyal Lederman, who is registered with the General Osteopathic Council. «Treatment will likely involve a combination of hands-on treatment, movement re-education and exercises to practise at home, as well as the development of coping strategies.» Even while looking specifically at back pain, an osteopath will take into account the health of the entire musculoskeletal system and treat the whole body, rather than just focusing on a specific symptom or region of pain.
While many people find relief from back pain from osteopathy (expect to feel the benefits within two to six sessions) one study, published in the New England Journal of Medicine, found that it was no more effective than «standard care». That’s not to say that it is ineffective – just that both approaches work equally well (and osteopathy subjects need fewer painkillers).
· To find a registered osteopath contact the General Osteopathic Council, osteopathy.org.uk. Tel: 020-7357 6655.
Sceptics argue that the benefits of acupuncture are in the mind, or at best temporary, as the treatment addresses only the symptoms (pain) and not the underlying cause (for example, by addressing posture). It is based on the theory of energy or «chi» pathways throughout the body. Problems occur when there is an energy blockage, and acupuncture needles are said to help get energy flowing freely again. A study from the University of Maryland lends weight to this argument – researchers analysing the findings of 33 different studies concluded that it did have a positive effect on lower back pain – in the short term. But what about in the long term? One small British study found a modest reduction in back pain in patients who received 10 sessions over a three-month period – and pain levels were still lower than a control group two years later.
Acupuncture is also said to increase levels of the natural pain-killing chemicals in the brain, endorphins, as well as relaxing the muscles.
· For more information, contact the British Acupuncture Council: acupuncture.org.uk.