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Press release: July 2008
Relief for Chronic Back Pain Sufferers
Clinical Trial shows Alexander Technique lessons are effective
Clinical trial results published in the BMJ show that Alexander Technique lessons provide long-term benefit
The trial results clearly show that 24 one-to-one lessons in the Alexander Technique led to important improvements in function, quality of life and reduction of days in pain for the patients. Following 24 Alexander Technique lessons the average number of activities limited by back pain had fallen by 42%. The number of days in pain was only three per month compared with 21 days in pain in the control group, one year after the trial started.
At three months after the trial started, the group randomly allocated 24 Alexander Technique lessons reported eight days in pain, and the group allocated six lessons reported 13 days in pain in the past month, compared to the control group which reported 24 days in pain. Both Alexander Technique groups showed an improvement in function at three months.
This trial is one of the few major studies to show significant long-term benefits for patients with chronic non-specific low-back pain. 579 patients were involved in a multicentre clinical trial lead by GP researcher Professor Paul Little, University of Southampton, and GP Professor Debbie Sharp, Bristol University, and funded by the Medical Research Council and the NHS Research and Development Fund.2 The trial assessed benefits provided by Alexander Technique lessons, classical massage and normal GP care. Half the patients allocated to each intervention also received a GP prescription for general aerobic exercise (30 minutes of brisk walking or the equivalent each day).
Of all the approaches tested, 24 Alexander Technique lessons, at least half taken within the first three months of the trial, proved to be the most beneficial.
Significantly, a series of six Alexander Technique lessons followed by GP-prescribed exercise was about 70% as beneficial as 24 Alexander Technique lessons alone.
There were no adverse events recorded by any of the participants allocated to the series of six or 24 Alexander Technique lessons.Since the effect of massage on activities was no longer significant by one year, whereas the effect of Alexander Technique lessons was maintained, the trial authors concluded that the long-term benefits of taking Alexander Technique lessons are unlikely to be due to placebo effects of attention and touch and more likely to be due to active learning of the Technique.
Kamal Thapen, chair of The Society of Teacher of the Alexander Technique (STAT) says: “For over 100 years people from all walks of life have learned the Alexander Technique to overcome back pain. We are delighted that this major clinical study now demonstrates that Alexander Technique lessons are effective. One-to-one lessons, provided by STAT teachers, taught trial participants to improve body use, natural balance, co-ordination and movement skills, and to recognise and avoid poor movement habits that cause or aggravate their pain.”
The price of back pain
Non-specific back pain accounts for up to five million lost working days per year3, its overall cost on the NHS, business and the economy being £5 billion a year.4 It is one of the most common conditions managed in primary care, a common cause of disability and affects general well-being and quality of life.
Benefits of Alexander Technique lessons
The Alexander Technique is a taught self-help method that helps people recognise, understand, and avoid poor habits affecting postural tone and neuromuscular coordination. Lessons involve an individualised approach designed to provide lifelong skills for self care that can lead to a wide variety of benefits.
“I would not be living an independent life now as my back would have prevented this. I wish I had discovered the Alexander Technique sooner. I was told that my back was not bad enough to operate on yet. That was at least 15 years ago!”
Retired female, 65, STAT Pupil Survey 2006
2 The Medical Research Council funded the trial with £585,000 and the NHS Research and Development Fund contributed an additional £186,000.
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1. The Society of Teachers of the Alexander Technique (STAT) was founded in the UK in 1958. It is the world’s oldest and largest professional body of Alexander Technique teachers. www.stat.org.uk
STAT Teaching members (MSTAT):
Are certified to teach the Technique after successfully completing a three-year, full-time training course approved by the Society or an affiliated society.
Adhere to the Society’s published Code of Professional Conduct and hold professional indemnity insurance.
The MRC ATEAM trial of Alexander technique, exercise and massage for chronic and recurrent back pain: Is there hope for chronic back pain sufferers?
3 Source: HSE.
4 Source: HSE.
Little P1, Webley F1, Beattie A4, Evans M4, Middelton K1,Barnett J1, Lewith G1, Ballard K5, Oxford F5, Smith P2, Yardley L3, Hollingshurst S4, Sharp D4
1Primary Care group, CCS Division, University of Southampton, UK; 2Department of Social Statistics, University of Southampton, UK; 3School of Psychology, University of Southampton, UK; 4Primary Care group, University of Bristol, UK; 5The Society of Teachers of the Alexander Technique, UK
Context: Chronic back pain is a major problem for patients, health care providers, and society but there are very few proven interventions.
Objective: To determine the effectiveness of lessons on 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.
Design: Factorial randomised trial.
Setting: 64 general practices in England.
Participants: 579 patients with chronic or recurrent low back pain; 144 were randomised to normal care, 147 to massage, 144 to six Alexander technique lessons, and 144 to 24 Alexander technique lessons; half of each of these groups was randomised to exercise prescription.
Interventions: Normal care (control), six sessions of massage, six or 24 lessons on the Alexander technique, and prescription for exercise from a doctor with nurse delivered behavioural counselling.
Main outcome measures: Roland Morris disability score (number of activities impaired by pain) and number of days in pain.
Results: Exercise and lessons on the Alexander technique, but not massage, remained effective at one year: compared with control Roland disability score 8.1: massage 0.58 (95% confidence interval 1.94 to 0.77), six lessons 1.40 (2.77 to 0.03), 24 lessons 3.4 (4.76;2.03), and exercise 1.29 (2.25 to 0.34). Exercise after six lessons achieved 72% of the effect of 24 lessons alone (Roland disability score 2.98 and 4.14, respectively). Number of days with back pain in the past four weeks were lower after lessons (compared with control median 21 days: 24 lessons 18, six lessons 10, massage 7) and quality of life improved significantly. No significant harms were reported.
Conclusions: One-to-one lessons on the Alexander technique from registered teachers have long term benefits for patients with chronic back pain. Six lessons followed by exercise prescription were nearly as effective as 24 lessons.
3. A GP’s view:
“From a discal neck injury in 1990 I developed progressive spinal problems. By 2002 I had suffered mechanical neck and back pain, several episodes of nerve root pain at different levels with loss of power and reflexes in my arms. I saw 4 neurosurgeons who all recommended (different) neck operations. I then developed complex regional pain syndrome and could barely use my right arm. I was in unbearable pain and virtually unable to move my neck. I started taking Alexander Technique lessons and began to experience improvement and lessening of pain after some 12-15 lessons. I did regular Alexander Technique for about 4 years. Progressive improvement since 2003 such that I now have no neck or arm pain. Alexander Technique lessons from a good teacher are an effective technique and were instrumental in my recovery. Based on simple applied principles it can afford sustained relief from pain of spinal origin. It teaches the body to undo neuromuscular tensions and reduce strain in normal motor function; probably cost effective were it taught in primary health care. Welcome positive trial evidence.”
Dr. Nick Mann, GP