Neck pain trial

Clinical trial results have demonstrated that people with chronic neck pain who attended one-to-one Alexander Technique lessons gained significant long-term benefit, with clinically relevant and statistically significant reductions in neck pain and associated disability maintained 1 year after lessons began. 1

About the trial2

  • The ATLAS (Alexander Technique Lessons or Acupuncture Sessions for people with chronic neck pain) study was a large, well-designed, well-conducted, randomised, controlled trial.
  • The trial involved 517 people who had neck pain lasting 3 months or more − in fact the average (median) turned out to be 6 years, so for many their neck pain was quite intractable.
  • Study participants were randomly allocated to one of the following three groups, offering:
    • 20 one-to-one Alexander Technique lessons (along with continued usual care led by their GP)
    • 12 acupuncture sessions, with equivalent overall length of time to the 20 Alexander lessons (along with continued usual care led by their GP)
    • usual care alone, led by their GP.


  • All Alexander lessons were delivered by trained teachers registered with STAT.
  • The trial was not a comparison of Alexander lessons and acupuncture (it was not designed for this); it evaluated the effectiveness of Alexander lessons compared with usual care alone, and of acupuncture compared with usual care alone.
  • At the beginning of the study, all participants completed standard questionnaires to describe their current level of neck pain and how this affected their ability to carry out daily tasks. Quality of life and self efficacy (the belief in one’s ability to manage and reduce pain and prevent it from interfering with daily life) were also assessed. The evaluations were repeated at 3, 6 and 12 months after the beginning of the study.
  • The trial was managed by a large research team based at the University of York and was funded by Arthritis Research UK.

Trial results1

  • The participants who attended Alexander lessons gained significant long-term benefit, with average reductions in neck pain and its associated disability large enough to be considered clinically relevant.
  • At the end of the trial, 1 year after the study began, they were experiencing nearly a third less pain and associated disability (a 31% reduction).

ATLAS results

  • The reduction in pain and associated disability for the Alexander group was significantly greater than that experienced by the group who received usual GP-led care alone.
  • The benefit continued to the end of the study; this was about 7 months after the allocated Alexander lessons had finished and 1 year after they had begun.
  • This benefit was observed despite the long-established nature of the neck pain − on average, people had suffered it for 6 years.
  • The extent to which people felt able to manage their pain (‘self-efficacy’) increased more in the Alexander group than in the usual care alone group, and this increase in self-efficacy was associated with a greater reduction in pain and associated disability at 1 year.
  • Following Alexander lessons, improvement was also seen in people’s mental health at 1 year, as revealed by a self-report quality-of-life questionnaire.
  • No safety issues related to Alexander lessons were identified.
  • In this trial, acupuncture led to benefits similar to those obtained from attending Alexander lessons.


  • Offering people with chronic neck pain, 20 one-to-one lessons in the Alexander Technique can lead to long-term improvement in their pain and associated disability. 1
  • The findings are particularly encouraging given the long-standing nature of people’s neck pain – on average they had 6 years of neck pain prior to beginning the study.
  • The observed improvement in self-efficacy gained from Alexander lessons illustrates the self-care nature of this method and helps to explain the sustained benefit which continued to the end of the study, more than 6 months after the lessons had finished. 1
  • Alexander Technique lessons are an appropriate option to offer people with chronic neck pain. 1
  • There are now two large randomised controlled trials published that demonstrate the effectiveness of one-to-one Alexander lessons for people with chronic musculoskeletal conditions: ATEAM for chronic back pain and ATLAS for chronic neck pain. 1,3


  1. MacPherson H, Tilbrook H, Richmond S, Woodman J, Ballard K, Atkin K, Bland M, Eldred J, Essex H, Hewitt C, Hopton A, Keding A, Lansdown H, Parrott S, Torgerson D, Wenham A, Watt I. Alexander Technique lessons or acupuncture sessions for persons with chronic neck pain: A randomized trial. Annals of Internal Medicine 2015;163:653-62.
  2. MacPherson H, Tilbrook HE, Richmond SJ, Atkin K, Ballard K, Bland M, Eldred J, Essex HN, Hopton A, Lansdown H, Muhammad U, Parrott S, Torgerson D, Wenham A, Woodman J, Watt I. Alexander Technique Lessons, Acupuncture Sessions or usual care for patients with chronic neck pain (ATLAS): study protocol for a randomised controlled trial. Trials 2013 Jul 10;14:209.
  3. Little P, Lewith G, Webley F, Evans M, Beattie A, Middleton K, Barnett J, Ballard K et al. Randomised controlled trial of Alexander Technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain. British Medical Journal 2008;337:a884.