Category Archives: Back pain

Why hands-on in Alexander teaching?

Alexander Technique hands-on teaching The Alexander Technique is essentially a self-help method for positive change that involves discovering how to think differently. So why do Alexander teachers use hands-on work to help people learn the technique?

Touch can provide a subtle yet powerful means of communication. Hands-on Alexander work uses a gentle, reassuring, instructive, non-judgemental and unique quality of touch that requires at least 3 years of training to acquire – and which then continues to be refined over a lifetime of teaching. Here are the main reasons why we use hands-on work (not mutually exclusive):

  • Helping people become calmer, more present and more alert. When the whole mind-body self quietens, the best conditions possible are created for positive change and learning
  • Aiding the development of greater self-awareness
  • Providing abundant opportunities to help people develop and practice core Alexander skills, such as giving oneself time to make conscious choices over whether and how to respond to any given stimulus (rather than just reacting automatically)
  • Enabling people to discover a clearer sense of embodiment – the sense of self as a whole, rather than as a mind linked with a body
  • Helping people to develop greater integration, coordination and stability within themselves
  • Encouraging the development of better postural support and balance
  • Guiding movement to enable people to have an experience of more fluidity and less effort than they would otherwise have been able to achieve
  • Helping people become aware of habitual tension patterns, and to let go of excessive muscle tension
  • Enabling people to better manage and reduce pain
  • Assessing what is happening within people, to provide feedback and to guide and tailor the teaching to the individual.

Hands-on Alexander work can bring about a profound sense of well-being. When someone leaves an Alexander lesson they generally feel more relaxed, yet alert, and more in control – strong motivators to continue to apply the technique in their daily life.

The majority of Alexander teachers combine their hands-on work with spoken guidance and dialogue. This synergistic combination creates the optimal learning environment for most people, equally engaging both experiential and cognitive learning.

If the spoken guidance element of teaching is lacking, it’s much harder to enable people to think differently and to ‘gain all the tools’ needed. Outside of the lesson, people are then less equipped to be able to work out for themselves how to apply and develop the Alexander Technique for themselves. As a result they may remain more dependent on the teacher than they need be.

At the other end of the spectrum, a small number of Alexander teachers claim that it is possible to predominantly, or even solely, teach without the use of hands-on work. This is sometimes now taking the form of online teaching. Perhaps remote teaching can provide useful supplementary support for people who already have a reasonable amount of Alexander experience. However, and particularly for those beginning lessons, the teacher’s guiding touch provides an invaluable help in developing the core skills, such as the ability to not just react unthinkingly but to pause to choose whether and how to respond to a stimulus. So, not using any hands-on work makes learning harder but it will also leave people short-changed of the full potential of the Alexander Technique to transform their lives. An article by Alexander teacher Joe Armstrong, eloquently discusses the importance of hands-on work in enabling the longer-term and life-transformative changes that can occur as a result of Alexander lessons.

Another important consideration is that, to date, all of the Alexander teaching in clinical research trials has consisted of hands-on combined with spoken guidance. This research provides good evidence that one-to-one Alexander lessons using hands-on work together with spoken instruction are effective in reducing pain and disability for people with chronic pain (back or neck), as well as enabling people with Parkinson’s to manage the associated disability. In contrast, there is currently no research evidence that either hands-on work alone, or spoken guidance alone are effective. It is also worth remembering that when FM Alexander began teaching his technique to others, he started out using just spoken guidance. But he then brought in hands-on work because he discovered that words alone were rarely enough to convey his meaning. This nicely reflects the practical and experiential nature of the Alexander Technique.

So I would argue that combining hands-on and spoken guidance together is essential if we want the teaching process to be as effective as it can be. In this way, people will be equipped with the necessary skills and understanding to be able to apply the Alexander Technique for themselves, as well as to continue to learn and develop it for the long term.

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.

‘Core strength and stability’?…but we’re vertebrates!

Skeleton doing plankYou won’t find many Alexander Technique teachers talking about ‘core stability’ or ‘core strength’. This is the notion that a core group of abdominal muscles exists that can be strengthened through specific exercises to provide us with better posture and a ‘strong and stable back’ 😉. The idea arose in the late 1990s and seems to have found a place in mainstream thinking. This place, however, is not deserved as researchers and health practitioners from a range of different disciplines now believe that ‘core stability’ is something of a myth (see the links at the end of this post).

For sure, so-called ‘core strength’ exercises can help you look more ‘streamlined’ if that is what you want, but there is very little evidence to support the idea that targeted ‘core strength and stability’ exercises are particularly good for back pain, or for our general health and well-being. Instead, the focus on bracing and pulling in the stomach may make things worse – encouraging us to hold even more muscular tension and placing destabilising forces on the spine.

It is now well accepted that it’s actually exercise in general and everyday activity that helps people recover from and prevent back pain. Of course, Pilates or yoga can be a great help here; just be aware that in a well-taught class you are unlikely to find a focus on ‘core’ or other specific muscles. There is also good evidence that Alexander Technique lessons are an effective approach for long-term resolution of back pain.

From an Alexander Technique perspective, we are intricate, finely tuned beings that work best when we allow ourselves to function as an integrated mind-body whole. We are also a lot stronger when we use ourselves as an interconnected whole rather than as if we consist of ‘separate parts’, which is a common concept of ourselves. So here’s one example – if I want to push open a heavy door and my underlying, largely subconscious, concept of strength is that it’s my arms that do all the pushing, then I’m going to find it harder work than if I simply put my arms out and use my body weight to send the door out of the way as I walk through it. In an Alexander lesson, we become aware of the countless ways in which we tend to make life harder for ourselves through our habitual ways of doing things. We also discover how everything is a lot less effort when we are shown how we can allow ourselves to work in a more integrated, coordinated and balanced way.

Humans are vertebrates, just like dogs and horses, and so at the physical core of our whole being you’ll find our spine and skull. Alexander teachers are interested in how well a person is working as a whole, and the head / neck / back dynamic relationship is a good indicator of this. Our head and spine constitute our central coordinating axis – and it was FM Alexander who discovered that, in this respect, we’re just like other vertebrates. Think of a deer or cheetah running and you’ll see a beautifully poised head leading the movement and the body seems to just flow along behind. Even though we are on two feet rather than four, the same principle applies. Most of us start out with pretty efficient, well-coordinated movement (think of the free, easy movement and balance of most 2–3 year-olds). However, we tend to lose some of this coordination and balance as we gradually adapt ourselves to our environment, which is usually a largely sedentary world of chairs, tables and computers. We tend to get stuck in habitual ways of doing things, including over-use of our arms and legs, which compromises the natural length and springiness of the spine.

The ideal situation is that all our muscles are doing the appropriate amount of work required for any given task at any given time, so we need to be able to continually adapt according to what we’re doing. In general, however, our muscles tend to be doing too much work, as holding tension is a very common habit. In contrast, the system of deep muscles associated mostly with the spine and head that provide us with postural support is usually in need of a bit of waking up. It’s all a matter of balance and, with such a complex system, there’s no way we can directly bring that balance about through any specific exercises. Alexander lessons provide a practical and effective approach to this problem. Through learning greater self-awareness and from direct experience of guided movement we can re-discover the central coordinating role of our ‘true core’, the healthy dynamic relationship between our head and spine. When this is working better, we’re more able to let go of unwanted muscular tension and discover easier, freer movement.

So, if you’re a vertebrate and would like to discover how you can access your ‘true core strength and stability’, find yourself a registered Alexander Technique teacher – feel free to get in touch if you’re in the Edinburgh / East Lothian area or search find your local teacher here.

Read more about the myth of core stability:

Eyal Lederman: http://www.cpdo.net/Lederman_The_myth_of_core_stability.pdf

Peter O’Sullivan: https://www.youtube.com/watch?v=YezBG_NdLgs&feature=player_embedded

Emma Wightman: http://www.stockbridgeosteopathicpractice.com/the-myth-of-core-stability-part-1.html

https://trustme-ed.com/blog/the-problem-with-core-stability

The Alexander Technique keeps me safe

Stay safe with the Alexander TechniqueThis past month I’ve spent a lot of time driving up and down between Edinburgh and Bristol due to family illness. During this time I often found myself thinking ‘thank goodness for the Alexander Technique, I’m so lucky to have this skill!” – I was able to stay calm, aware and focused throughout, even when I’d had very little sleep and the road conditions were awful.

There have been countless times in my everyday life – for example, picking up something heavy, climbing a ladder, walking on uneven ground – when I’ve used the Alexander Technique to help me stay safe. How does this work? – by becoming more aware of oneself and what is happening moment by moment, and being able to give oneself a little bit of space and time in which to consider how best to respond in any given situation. So, for example, if I’m climbing up a ladder to wash the windows I’m very aware of my changing balance with each step – not trying to control or micro-manage, just staying present and paying attention to what I’m doing with myself rather than solely focusing on cleaning the windows. So if, for example, a rung is slippery I’m more likely to be able to adapt and stay in balance and so stay safe.

Less obvious perhaps but equally as important, is how learning the Alexander Technique is helpful for safety in its broader sense, particularly over the long term. So it’s not just about in-the-moment avoidance of accidents or strain – I’ve also protected my long-term health and well-being through the Technique. I’m convinced that without it I’d be a bit of a wreck now with neck pain and RSI – I was beginning to get signs of these developing before I started Alexander lessons. Through the lessons and my subsequent training to be an Alexander teacher, I’ve integrated the Technique into my daily life for better balance, movement coordination and mindful calm.

Driving home for Christmas

Sitting slumpedIf you usually have to drive to work, you may be looking forward to having a break from your daily commute (even if you’re facing a long drive home for Christmas first). For all too many of us, driving contributes to, or even causes, back, neck or shoulder pain, as well as stress. How can the Alexander Technique make the daily commute a bit easier? Here are some things to think about and try out at home over the festive break.

 

 

Sitting in balance, supportedHow are you sitting?

Car seat design has a lot to answer for but even with the best seat in the world, it’s still easy to end up with aches and pains. The most important factor is not the seat but yourself and your ‘human ergonomics’. This is where the Alexander Technique can be so helpful. An Alexander teacher can enable you to discover how to drive with less effort and stress, sitting easily in balance, holding the steering wheel with less tension, and ‘rising above’ the antics of fellow road users.

If you’re trying to sit up straight or hold yourself upright then you’re not on the right track. Good posture − like that seen in most toddlers − is effortless. It does take time, and Alexander work, to wake up the deep postural muscles that are the hallmark of a ‘strong back’, but a good start is to develop an awareness of your sitting bones and the support coming from underneath. So, find a reasonably firm chair to sit on and slide your hands under your bottom from each side so that you’re briefly sitting on your hands. Can you feel the bony parts of yourself that you’re sitting on? These are our sitting bones, the rocker-shaped bottom of the pelvis (see photos). Now you’ve found them, take your hands away and try gently shifting yourself forwards or backwards to get a sense of how to balance on them, allowing your weight to drop straight down through the chair. Can you get a sense of the support coming up from the ground through the seat and up through your sitting bones? It’s this support that triggers our reflexes that send us upright.

 Balanced on sitting bones

Skeleton driver nicely balanced on its ‘sitting bones’

 

 

 

 

Bottom of pelvis (sitting bones) balanced on supporting surfaceClose-up of the back of the pelvis and lower spine. Note the ‘sitting bones’ in full contact with the supporting surface below and in balance

 

 

 

 

How are you seeing?

Modern lifestyles, particularly the widespread use of mobile technology, are having the effect of narrowing our attention and visual field. Our vision is becoming more like a spotlight that focuses only on the specific object that our attention is currently on. This way of seeing can become a habit, and one which is certainly not helpful when driving! A safe driver is aware of everything around the current focal point, so that while looking at the road ahead, they will still immediately see movement at the periphery of their vision, such as if the door of a parked car they’re about to pass begins to open.

If your visual field seems quite narrow or two-dimensional and you’re interested in improving it, begin by spending a few minutes each day – perhaps looking out the window, or when you’re out on a walk – allow yourself to look at an object with a soft lively gaze, and notice the shapes, colours etc of what’s around it (these won’t be in focus). Don’t experiment with this when driving in case it distracts you – wait till you’ve developed the skill. This more natural, ‘panoramic’ (more three-dimensional) vision will pay dividends in whatever you’re doing through increased awareness and better balance.

How are you thinking?

No doubt, you’ll be familiar with the stress of trying to get to an appointment in time and being delayed by traffic. And as anyone who sufferers from chronic pain knows, stress makes it worse. The Alexander Technique helps us to shift our attention onto prioritising ‘looking after ourselves’ (keeping our poise) rather than over-focussing on the goal of getting there on time.

Another unwelcome aspect of driving is other drivers behaving selfishly or aggressively. The next time another driver does something that annoys you, see if you can take a second and, rather than just reacting unthinkingly, continue to keep your awareness of the road ahead, and at the same time notice the support of the seat coming up through your sitting bones and think of the distance up to the crown of your head and beyond. Then slowly and gently exhale through your lips, as if you were blowing a small feather away. Repeat a couple of times, noticing the in-breath automatically coming in through the nose and the continuous cycle of breath with no holding between the inbreath and the outbreath. Now decide whether or how you’d like to respond.

I hope you’ll enjoy exploring these ideas and discovering a more comfortable, calmer and less effortful way of driving.

Adapted from a previous article for BackCare’s Talkback magazine: Is your daily commute driving you to despair?; read the article for tips on how to adjust your car seat so that you can sit comfortably.