Paul Little, professor of primary care research,1 George Lewith, reader,1 Fran Webley, overall trial coordinator and trial manager for Southampton site,1 Maggie Evans, trial manager for Bristol site,4 Angela Beattie, trial manager for Bristol site,4 Karen Middleton, trial data manager,1 Jane Barnett, research nurse,1 Kathleen Ballard, teacher of the Alexander technique,5 Frances Oxford, teacher of the Alexander technique,5 Peter Smith, professor of statistics,3 Lucy Yardley, professor of health psychology,2 Sandra Hollinghurst, health economist,4 Debbie Sharp, professor of primary care4
May 26, 2008


Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain.


One year after the trial started and following 24 Alexander Technique lessons the number of days in pain fell by 85% compared with the control group.


Objective: To determine the effectiveness of lessons in the Alexander technique, massage therapy, and advice from a doctor to take exercise (exercise prescription) along with nurse delivered behavioural counselling for patients with chronic or recurrent back pain. Supervised exercise classes—mainly strengthening and stabilising exercises—probably have moderate benefit for chronic pain. A trial of advice from a doctor to take aerobic exercise showed short term benefit for acute pain, but the evidence of longer term benefit for chronic or recurrent pain and for exercise “prescriptions” is lacking. Results: The effect of 24 lessons in the Alexander technique was greater at one year than at three months, with a 42% reduction in Roland disability score and an 86% reduction in days in pain compared with the control group (table 4). The effect of six lessons was maintained —a 17% reduction in Roland disability score and a 48% reduction in days in pain.


Lessons in the Alexander technique offer an individualised approach designed to develop lifelong skills for self care that help people recognise, understand, and avoid poor habits affecting postural tone and neuromuscular coordination. Lessons involve continuous personalised assessment of the individual patterns of habitual musculoskeletal use when stationary and in movement; paying particular attention to release of unwanted head, neck, and spinal muscle tension, guided by verbal instruction and hand contact, allowing decompression of the spine; help and feedback from hand contact and verbal instruction to improve musculoskeletal use when stationary and in movement; and spending time between lessons practising and applying the technique. The Alexander technique is thus distinct from manipulation, back schools, and conventional physiotherapy. The practice and theory of the technique, in conjunction with preliminary findings of changes in postural tone and its dynamic adaptability to changes in load and position, support the hypothesis that the technique could potentially reduce back pain by limiting muscle spasm, strengthening postural muscles, improving coordination and flexibility, and decompressing the spine.

Published Information

BMJ 2008; 337:a884 doi:10.1136/bmj.a884


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