This covers research into specific beneficial effects of learning and practising the Technique. The first section contains references to the research papers; the second section contains references to reports of research papers. As not all research papers are published (or can be located) the second section contains references to papers which are not listed in the first section.
Section I: Research papers
‘Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain’ by Paul Little, et al.
A randomised controlled trial of Alexander lessons was published in the British Medical Journal 20th August 2008. Its main conclusion was that individual lessons in the Technique have long term benefits for patients with chronic back pain. 579 patients with chronic or recurrent low back pain were recruited from 64 GP practices. Patients were randomly allocated to certified teachers, and control groups included patients receiving massage, exercise, or GP normal care. Lessons in the Alexander Technique outperformed all control groups. The results showed that taking one-to-one lessons in the Technique led to long-term benefits: a reduction in the number of days in pain and significant improvement in function and quality of life.
‘Alexander Technique and supervised physiotherapy exercises in back pain: A four-group randomised feasibility trial’ by Paul Little, et al.
Out of 83 patients with recurrent back pain, 69 were randomised and 56 (81%) were followed up at 6 months. Most patients had long-standing pain (median > 300 days of pain). Three methods of recruitment were successfully piloted. At 3 months the Alexander Technique improved proprioception and exercise classes improved trunk extension strength. At 6 months the Alexander Technique improved the timing of multifidus muscle onset and the active straight leg raise test and exercise classes improved multifidus muscle thickness and the ability to contract. The combined effects of the AlexanderTechnique and exercise classes were improvements in muscle tone, elasticity and thickness and contractile ability. The study found that the trial of the Alexander Technique and supervised physiotherapy exercises in back pain was feasible and that these interventions may provide clinically important benefits in back pain.
‘The impact of Alexander Technique lessons on chronic mechanical low back pain’ by P. Vickers, F. Ledwith, A. Oppenheimer
91 outpatients with chronic mechanical low back pain were recruited from pain clinics at three local hospitals and allocated to one of three groups: Alexander Technique (AT); ‘no treatment’ control; attention control. Patients were assessed before and after treatment on a set of four outcome measures for pain intensity, disability caused by pain, and pain behaviour. Follow-up assessments were made at three, six and twelve months after the treatment period. At post-test assessment the AT group had the best, statistically significant scores for every rating; scores for pain behaviour and disability were highly statistically significant. By six-months follow-up there was no statistically significant difference among the three groups, but some individuals continued to enjoy considerable benefit from AT training well beyond that point.
‘Improvement in automatic postural coordination following Alexander Technique lessons in a person with low back pain’ by T. W. Cacciatore, et al.
This case report describes the use of the Alexander Technique with a client with a 25-year history of low back pain. After lessons, her postural responses and balance improved and her pain decreased. The introduction includes a thorough explanation of the Alexander Technique from a scientific perspective.
‘Alexander Technique Lessons or Acupuncture Sessions for Persons With Chronic Neck Pain: A Randomized Trial’ by Hugh MacPherson, et al.
The conclusion of a large randomized controlled trial with 517 patients with chronic neck pain is that lessons in the Alexander Technique led to significant reductions in neck pain and associated disability. Study evaluated clinical effectiveness of Alexander Technique lessons or acupuncture versus usual care for persons with chronic, non-specific neck pain and found that both are effective.
‘Preliminary evidence for feasibility, efficacy, and mechanisms of Alexander Technique group classes for chronic neck pain’ by Rajal G. Cohen, et al.
Ten participants who were predominately middle-aged and had experienced neck pain for at least six months, attended ten one-hour group classes in AT over five weeks. After the intervention: 1) participants reported significantly reduced neck pain; 2) fatigue of the superficial neck flexors during the cranio-cervical flexion test was substantially lower; 3) posture was marginally more upright, as compared to the second pre-intervention values. Changes in pain, self-efficacy, and neck muscle fatigue were retained at the second post-test and tended to be correlated with one another.
Pain – General
‘Taking Charge Choosing a New Direction: A Service Evaluation of Alexander Technique Lessons for Pain Clinic Patients SEAT: an Approach to Pain Management’ by S. McClean, L. Wye
A clinical trial carried out in an experimental setting demonstrating the therapeutic value and effectiveness of Alexander Technique (AT) lessons for chronic back pain. Findings suggest that lessons in the AT are feasible, acceptable and beneficial in terms of improving quality of life and patients’ management of pain as well as reducing pain related NHS costs by half. Greatest changes were found in how the patients/students managed their pain (more than half stopped or reduced their medication) and the impact that the pain had on their daily lives.
‘Early Experiences of a Multidisciplinary Pain Management Programme’ by K. Fisher.
Chronic pain sufferers participated in a multiple-intervention study. During the study, after three months, and one year later, the subjects rated the Alexander Technique as the most helpful method for relieving chronic pain.
Diseases: Knee osteoarthritis
‘Reductions in co-contraction following neuromuscular re-education in people with knee osteoarthritis’ by Stephen J. Preece, Timothy W. Cacciatore, et al.
22 subjects between the age 40 and 70 with knee osteoarthritis received 20 Alexander Technique lessons over a 12 week period. Following the lessons there was a significant reduction in knee pain and stiffness and an improvement in function which appeared to be maintained at 15 months post-baseline. This study demonstrates the potential efficacy of interventions, such as the AT, which can successfully modify muscle activation patterns in patients with knee OA.
‘Does Alexander Technique: A role in dementia care?’ by Charlotte Woods
A pilot study where two residents and two care workers were recruited from a care home. They attended between 11 and 14 Alexander Technique lessons over a 4–6 week period. Each lesson lasted 10–40 minutes and consisted of combined hands-on and verbal guidance from the author. The study illustrates the types of changes observed in both carers and residents after Alexander Technique lessons, in particular, positive changes were reported in pain, mobility, mood and motivation, and social interaction.
Diseases: Parkinson’s disease
‘An evaluation of the Alexander Technique for the management of disability in Parkinson’s disease – a preliminary study’ by C. Stallibrass.
The initial findings of 7 volunteers with PD who each received a median of 12 lessons, and concluded that ‘the Alexander Technique reduces depression and improves the management of disability’.
‘Randomized Controlled Trial of the Alexander Technique for Ideopathic Parkinsons Disease’ by C. Stallibrass, P. Sissons, C. Chalmers.
This study assigned 93 subjects to receive Alexander Technique lessons, massage, or no treatment. AT lessons (but not massage) led to significant improvement in self-assessed disability, both immediately after the lessons and six months later.
‘Retention of skills learnt in Alexander Technique: 28 people with idiopathic Parkinson's disease’ by Chloe Stallibrass, et al.
This follow up study describes the responses to a questionnaire completed by a sample of 28 people with idiopathic Parkinson's disease six months after receiving a course of lessons as participants in a controlled trial. The responses show that every participant retained some degree of skill.
‘Lighten up: Specific postural instructions affect axial rigidity and step initiation in patients with Parkinson’s disease’ by Rajal Cohen, et al.
Instructions based on the Alexander Technique given to people with Parkinson’s Disease led to reduced postural sway, reduced axial postural tone, greater modifiability of tone, and a smoother center of pressure trajectory during step initiation, possibly indicating greater movement efficiency.
‘Statistical evidence that the beneficial effect of learning and applying the Alexander Technique is generic’ by Chloe Stallibrass
This article presents an analysis (not previously reported) of data collected in a study “Randomized controlled trial of the Alexander technique for idiopathic Parkinson’s disease” published in 2002. In this trial the performance of 25 activities by the Alexander Technique group was compared to two control groups. In this article the 25 activities are analysed by two subgroups: the first group comprising activities regularly used in lessons, and the second, activities never or very rarely used. The analysis of the questionnaires from patients showed that both types of activity improved. The results demonstrate that learning the Alexander Technique has generic beneficial impact on the performance of activities of different kinds, regardless of whether they are performed in lessons. This is in contrast to therapies involving repetitive physical exercises focused on particular problems.
‘Long term effects of Alexander Technique in managing motor symptoms of young onset Parkinson’s disease’ by Candace Cox
A summary of a case study. The subject was diagnosed with PD in 2003 and had AT lessons from 2007 to 2013. The subject developed and then maintained a high standard of physical functioning; her posture and balance through sitting, standing and reaching are measurably better than they were 10 years ago.
‘Observations on the use of respiratory muscles in posture’ by David Garlick, et al.
The breathing measured using a bellows pneumograph system for measuring the frequency and size of respiratory movements and the relative contributions of the rib cage, abdominal-diaphragm to tidal breathing. 51 subjects participated, of which 9 were involved in Alexander Technique, and 11 in the Feldenkrais method. Preliminary findings include that respiratory muscles, in their role of raising intra-abdominal pressure, are used to assist in maintaining upright posture.
‘Enhanced respiratory muscular function in normal adults after lessons in proprioceptive musculo-skeletal education without exercises’ by John Austin, et al.
This study examined respiratory function in adults. 10 subjects received 20 Alexander Technique lessons at weekly intervals. Spirometry tests demonstrated that AT lessons led to improvement of respiratory muscular function against a control group which received no instructions.
‘Postural analysis of standing human subjects’ by David Garlick, et al.
117 subjects were examined, divided into a ‘trained’ group (which included some people trained in postural re-education, i.e. Alexander Technique) and an ‘untrained’ group. The postural analysis included photography against a background grid, measuring lumbar lordosis with a pantograph, and using a pelvic inclinometer. Results generally showed some degree of asymmetry. Weight lifters and ballet dancers had greater shoulder slopes. The line of gravity was less anterior to the ankle for ballet dancers and for males and females with postural re-education. Females trained in postural re-education had significant smaller measure of lumbar curve.
For Dr Wilfred Barlow’s 1950s’ research into using the Alexander Technique for the correction of postural faults, see Wilfred Barlow’s research.
‘Can the Alexander Technique improve balance and mobility in older adults with visual impairments?’ by Michael Gleeson, et al.
A total of 120 community-dwellers aged 50+ with visual impairments of which 60 received twelve weeks of Alexander lessons and 60 usual care (the control group). There were no significant improvements in the Short Physical Performance Battery, but there were significant improvements in the number of steps in the 4-metre walk and postural sway in quiet standing. In addition there was a non-significant reduction in falls rate and and improved mobility among past multiple-fallers in the intervention group compared to the control group.
‘Functional reach improvement in normal older women after Alexander Technique instruction’ by Ron Dennis
Women aged 65–88 who received eight Alexander Technique lessons showed a 36% improvement in forward-reaching distance (a common measure of balance control), while control subjects of the same age showed a 6% decrease over the same time-period.
‘Effects of Alexander Technique training experience on gait behavior in older adults’ by M. M. O’Neill, et al.
Six licensed Alexander Technique (AT) teachers and seven controls between the ages of 60 and 75 years of age participated in the study. AT teachers exhibited a reduction in medio-lateral center of mass displacement during fast paced walking compared to comfortably paced walking that was not present in controls. Due to this difference AT teachers displayed a smaller medio-lateral Center of Mass displacement compared to controls during fast paced walking. AT teachers also demonstrated significantly smaller stride width and lower gait timing variability compared to controls. These findings suggest superior control of dynamic stability during gait and potentially reduced fall risk in AT teachers.
‘Older adult Alexander Technique practitioners walk differently than healthy age-matched controls’ by Kate A. Hamel, et al.
The study compared the comfortable pace gait kinematics of six older AT practitioners with those of healthy, age-matched controls (between the ages of 61 and 76). During the stance phase, AT participants exhibited significantly greater ankle stance range of motion (ROM) and plantar flexion at toe off, as well as lower ROM of the trunk and head compared to controls. During the swing phase, the AT practitioners had significantly increased hip and knee flexion and a trend toward significantly increased dorsiflexion. The findings suggest that the older AT practitioners walked with gait patterns more similar to those found in younger adults.
For research into benefits for singers and musicians, see Music.
‘The impact of the alexander technique in improving posture and surgical ergonomics during minimally invasive surgery: Pilot study’ by P. Reddy, et al.
This pilot study found that surgeons who underwent instruction in the Alexander Technique experienced a significant improvement in posture and surgical ergonomics as well as decreased surgical fatigue.
‘A study of stress amongst professional musicians’ by M. Nielsen
This study examined performance stress in musicians, and found that the Alexander Technique was as effective as beta-blocker medications in controlling the stress response during an orchestra performance.
‘F. M. Alexander Technique in the Treatment of Stuttering – A Randomized Single-Case Intervention Study with Ambulatory Monitoring’ by Dorothea Schulte, Harald Walach
Two subjects with a long history of stuttering received 30 lessons each in the Alexander Technique and stuttering rates were measured before and after. In addition a number of other variables were included. Eight variables showed significant results in the randomization test with a significance level of 5%.
‘Evidence for the effectiveness of Alexander Technique lessons in medical and health-related conditions: A systematic review’ by J. P. Woodman, et al.
Of 271 publications identified, 18 were selected: three randomised, controlled trials (RCTs), two controlled non-randomised studies, eight non-controlled studies, four qualitative analyses and one health economic analysis. The 15 non-RCT studies are also reviewed. Strong evidence exists for the effectiveness of Alexander Technique lessons for chronic back pain and moderate evidence in Parkinson's-associated disability. Preliminary evidence suggests that Alexander Technique lessons may lead to improvements in balance skills in the elderly, in general chronic pain, posture, respiratory function and stuttering, but there is insufficient evidence to support recommendations in these areas.
‘Effects of the Alexander Technique on muscle activation during a computer mouse task’ by Elyse Shafarman, et al.
A summary of a research project involving 32 adults of whom 16 had years of experience of the Technique; participants with Alexander Technique experience showed significantly lower levels of muscle activation in the forearm.
Section II: Reports on research papers
Reports of the healthcare systematic review
- ‘Alexander Technique lessons as a healthcare intervention’ by Julia Woodman brings together the research that has been conducted to date (2015) on the effectiveness of AT instruction in health-related areas.
Reports of the ATEAM back pain trial
- ‘ATEAM back pain trial hits the press – worldwide!’ by Kamal Thapen.
- ‘The ATEAM back pain trial: A success story’ by Kathleen Ballard and Frances Oxford.
- ‘Hope for chronic back pain sufferers - The MRC ATEAM trial’ by Paul Little; on the origins, the methods, the recruitment, and other details of the setting up and running of a large trial, as well as an overview of the results.
Reports of the ATLAS neck trial
- ‘Understanding the new findings from the ATLAS trial and what they mean for our profession’ by Julia Woodman and Kathleen Ballard reports on two new publications from the ATLAS trial. The first is an analysis demonstrating that one-to-one lessons in the Alexander Technique promote self-efficacy and self-care ability; the second is an economic evaluation, calculating the cost-effectiveness of the series of lessons in the Alexander Technique.
- ‘ATLAS and what the trial findings mean for us’ by Julia Woodman and Kathleen Ballard; an introduction to the ATLAS research results and their implications for Alexander Technique teachers.
Report of the knee osteoarthritis study
- ‘A pilot study on the effectiveness of the AT for the treatment of knee osteoarthritis (KOAT)’ by Peter Bloch; on the first findings from a study involving 21 patients (with established knee osteoarthritis, under 70 years of age and an absence of systemic rheumatic diseases) receiving 20 lessons each in the Technique.
Report of a study of respiratory function in wind instrumentalists
- ‘Musical performance and respiratory function in wind instrumentalists – Effects of the Alexander Technique of musculoskeletal education’ by Ronald J. Dennis; on a pilot research project with 13 participants (7 experimental and 6 in the control group), testing a number of factors, main respiratory function and musical performance, pre- and post 20 lessons in the Alexander Technique.
Report of a study involving balance training in the elderly
- ‘Research in using the Alexander Technique for balance training in the elderly’ by Glenna Batson and Sarah Barker reports on a pilot project involving 18 subjects age 65–85, receiving 10 group classes, 1.5 hours each, over two weeks, and measuring a variety of movements, balancing and walking before and after.
Report of a study measuring changes in balance after five AT lessons
- ‘Report on studies using the AccuSway force plate to measure changes in balance control after five lessons in the Alexander Technique’ by Sarah Barker reports on a study using a force plate to measure changes in balance control and postural sway as a result of Alexander Technique intervention, with eight volunteers each receiving five 30 minute lessons.
Report of AT’s influence on breathing efficiency and vocal production in singers
- ‘A spectral analysis of breathing efficiency and vocal production in singers before and after Alexander Technique lessons’ by Phyllis Richmond describes a pilot project with 25 singers recording a set of three different vocal activities before and after lessons in the Technique, using a spectrogram to create a voiceprint.