When less is most definitely more

Skeleton brushing teethDo you get mouth ulcers? Apparently, 2–10% of the population suffer from frequent mouth ulcers with no obvious cause [1]. If you often have mouth ulcers, you may well have tried treating them with different gels or creams. If that’s the case, have you ever considered if there might be a different way of addressing the problem? Whether there might be something that you could stop doing, something to take away, rather than the usual approach of adding a treatment, or working out what you need to do?

Of course, there are many different reasons for getting mouth ulcers [2] but it now seems that one factor could be toothpaste, or rather the sodium lauryl sulphate that is an ingredient of most toothpastes. Using such toothpastes might be causing mouth ulcers in some people and/or making their ulcers last longer and be more painful [3–5]. So if you frequently have mouth ulcers it might be worth finding out if they improve if you stop putting sodium lauryl sulphate in your mouth (several brands of toothpaste are available that don’t contain this ingredient).

What a lovely commonsense solution – to stop doing the thing that might be causing or exacerbating the problem. A logical solution yes, but it does fly in the face of our usual approach. Because, in general, we try to work out what we need to do to try and solve a problem, rather than asking what we could stop doing. Wouldn’t it be great if we could use this approach of simply taking something away to tackle other problems in life?

Well the good news is that just stopping what we usually do can be a highly effective approach for a great many of the issues we face. Whenever the problem is caused by, or aggravated by, the way in which we do things – and we do most things in an habitual fashion – then reducing or stopping that habit is likely to be beneficial. This is the basis of the Alexander Technique, asking the question, what might I be doing now that could be causing or contributing to this problem? And then using the technique to prevent or reduce the habit.

One example is back pain. For the majority of people with back pain there is no underlying medical condition, so a visit to the GP is usually followed by a diagnosis of ‘simple’ or ‘non-specific back pain’. The GP’s diagnostic process is essential in order to be able to rule out any more serious underlying medical issues. But when there is no obvious medical cause, doctors can struggle to identify the root cause of the problem. However, the good news is that GPs and other healthcare professionals are increasingly realising the pivotal impact of the way in which we lead our lives on our overall health (and not just in the obvious examples of diet and ‘lifestyle’).

US biomechanist, Katy Bowman [6] has comprehensively researched and written about the huge impact on our long-term state of health and functioning, of the way in which we move about while carrying out our everyday activities. It’s something that FM Alexander worked out more than a hundred years ago when he developed his technique in order to resolve his voice problems. It’s only more recently, however, that insights from research in biomechanics, neuroscience and clinical trials validate what Alexander discovered for himself over many years of experimentation and observation.

Back pain is the most common reason that people begin Alexander lessons [7]. And what do people learn in these lessons? They learn how to become more aware of their habitual ways of standing/sitting/walking/carrying/texting etc, and how these ways of doing things tend to put unnecessary strain on their back and joints. Through gaining an experience of doing things differently in a lesson, they discover how they can reduce or stop these habitual interferences with their natural movement coordination and balance.

Of course we didn’t start out in life with these habits but we developed them as (usually) subconscious strategies in adapting ourselves to our environments and largely sedentary lifestyles. Watch most 2–3 year-old children and you’ll see fluid, effortless movement and easy balance. That’s because nearly everyone is born with the potential for good movement coordination, balance and postural support. However, this inherent capacity becomes ‘buried’ under accumulated years of habitual responses. If we can learn how to prevent or reduce the habits that are getting in the way, we’ll tend to regain some of that natural poise and ease of movement. So if our back pain is caused by, or aggravated by, an overall tendency to contract in any movement or in just sitting or standing, then as we gradually reduce the strain on our spine, muscles and other tissues, our back problem has more of a chance to resolve itself.

Two large randomised controlled trials have demonstrated that one-to-one Alexander Technique lessons from STAT-registered teachers are effective, long-term solutions for the pain and disability associated with persistent back or neck pain [8,9].

So the next time you are faced with a problem, just take a moment to consider whether ‘just doing something’ is really the most effective approach. Or whether it’s time to find yourself an Alexander teacher to discover the truly groundbreaking and challenging skill of not just reacting like we usually do!


  1. Altenburg A, et al. The treatment of chronic recurrent oral aphthous ulcers. Deutsches Arzteblatt International 2014;111:665–73. doi: 10.3238/arztebl.2014.0665.
  2. NICE recommends that if you keep getting mouth ulcers, do mention it next time you see your GP, and to be aware that you should see your doctor without delay if you ever have a single ulcer that lasts for more than 3 weeks (just in case it’s malignant) https://cks.nice.org.uk/aphthous-ulcer#!topicsummary.
  3. Herlofson BB and Barkvoll P. The effect of two toothpaste detergents on the frequency of recurrent aphthous ulcers. Acta Odontol Scand1996;54:150–3.
  4. Chahine L, et al. The effect of sodium lauryl sulfate on recurrent aphthous ulcers: a clinical study. Compend Contin Educ Dent 1997;18:1238–40.
  5. Shim Y, et al. Effect of sodium lauryl sulfate on recurrent aphthous stomatitis: a randomized controlled clinical trial. Oral Diseases 2012;18:655–660.
  6. Bowman K. Move your DNA. 2017. Propriometrics Press.
  7. Eldred J, Hopton A, Donnison E, Woodman J, MacPherson H. Teachers of the Alexander Technique in the UK and the people who take their lessons: A national cross-sectional survey. Complementary Therapies in Medicine 2015;23:451–461.
  8. Little P, Lewith G, Webley F, 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.
  9. MacPherson H, Tilbrook H, Richmond S, Woodman J, Ballard K, et al. Alexander Technique lessons or acupuncture sessions for persons with chronic neck pain: A randomized trial. Annals of Internal Medicine 2015;163:653–62.