Category Archives: Neck pain

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.

“Really uplifted by it, really empowered by it…”

Embodiment and self efficacyThis description of an experience of learning the Alexander Technique comes from one of the participants in a large randomised controlled clinical trial for people with chronic neck pain. It is from a series of in-depth interviews that were carried out with some of the trial participants and which form the basis of a new publication by myself and other members of the ATLAS study team [1]. Our analysis explores the participants’ experiences of learning the Alexander Technique (or of having acupuncture, the second intervention evaluated in the trial) and contrasts these experiences with their previous medical care. The participants’ accounts of their experiences help to explain the basis for the observed clinical benefits in the trial of long-term reduction in neck pain and associated disability following Alexander lessons or acupuncture [2]. They also complement the trial findings of participants developing greater self-efficacy [3].

Here I look at the experiences of the participants who attended Alexander lessons. They reported that learning the Alexander Technique led to greater self-awareness, and they explained how applying the Alexander thinking skills led to a sense of more control over managing and overcoming their neck pain. Participants’ reflections include:

“Really uplifted by it, really empowered by it and really surprised at, at what I had experienced.” (Female)

“…you don’t really have to physically do anything, you’ve just got to think it… So you can be walking down the street and you can put it into practice, I can be at work…I had made my muscles go soft that for ten years hadn’t been, and that was just from my teacher just explaining what to do and just very lightly touching my shoulders and just…talking me through it.” (Female)

“You’re in control, you know.” (Male)

For many participants the increased self-awareness and a sense of interconnectedness and embodiment were integral to the transformative process they experienced. The perception of ‘neck pain’ could no longer be reducible to a ‘body part’.

“She looked at me as [a] whole rather than as a shoulder and a neck … And I’m not just learning to relax certain muscles that were the problem, it was everything, which, I suppose in some respects, just balanced, balanced me a lot better.” (Female, Interview 2)

“I’m a much calmer person, it’s taught me how to take a step back and assess a situation rather than jump straight in … because I’ve learnt how to do it, I’ve learnt how to take a step back, I’ve learnt how to relax my body.” (Female, Interview 1)

Participants described how they continued to use the understanding and skills they had gained, after the Alexander lessons had finished, to sustain and in some cases further improve their reduction in neck pain. For example, one participant said:

”The positive thing about [the Alexander Technique] is you can carry on doing the things that the teacher’s taught yah to help yah, and I do. And gradually it’s just got better and better, you know. And as for life changing, probably the Alexander’s changed me because I never used to realise it, but with being in pain you used to tend to be a bit short tempered and…. grumpy.” (Male, Interview 2)

Find out more

Our article is published in Complementary Therapies in Clinical Practice, read it here.

More on the ATLAS trial

ATLAS was a randomised, controlled trial that recruited 517 patients with chronic neck pain and evaluated one-to-one Alexander Technique lessons with a STAT-registered teacher, or acupuncture, each plus usual care, compared with usual care alone. The main clinical findings of this trial are published in the prestigious Annals of Internal Medicine [2]. The trial demonstrated statistically significant and clinically meaningful reductions in neck pain and associated disability for both interventions compared with usual care alone. Read more about the study here.

  1. Aniela Wenham, Karl Atkin, Julia Woodman, Kathleen Ballard and Hugh MacPherson. Self-efficacy and embodiment associated with Alexander Technique lessons or with acupuncture sessions: A longitudinal qualitative sub-study within the ATLAS trial. Complementary Therapies in Clinical Practice 2018;31:308–14.
  2. Hugh MacPherson, Helen Tilbrook, Stewart Richmond, Julia Woodman, Kathleen Ballard, 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.
  3. Julia Woodman, Kathleen Ballard, Catherine Hewitt, Hugh MacPherson. Self-efficacy and self-care-related outcomes following Alexander Technique lessons for people with chronic neck pain in the ATLAS randomised, controlled trial. European Journal of Integrative Medicine 2018;17:64–71. 

 

Is ‘text neck’ real?

Text neckI saw a recent newspaper article claiming that there is no such thing as ‘text neck’, saying that research has dismissed any link between use of mobile phones and neck pain. As is often the case with mainstream media, the journalist was basing this rather bold statement on the findings of just one small study [1].

The problem with this type of journalism is that large claims are based on small amounts of evidence, without taking into account the bigger picture. Had the journalist taken the trouble to look further, they would have discovered that quite a lot of research has already been done in this area. While the jury is still out, the weight of evidence is pointing towards the likelihood that there is a link between mobile technology use and neck and shoulder pain. For example, research published in 2017 reviewed all the studies to date that had examined a possible relationship between mobile touch screen technology use and musculoskeletal problems such as neck pain [2]. The researchers’ analysis of the 45 studies identified led to their conclusion that there is some (albeit limited) evidence of musculoskeletal problems, particularly neck and shoulder symptoms, associated with mobile technology use. They stressed that the evidence is limited, largely due to the lack of controlled and long-term studies, but they were sufficiently concerned to issue guidance, including reducing excessive time using mobiles [2].

We evolved in an environment very different from that of today. We were, no doubt, well adapted to that environment, moving through it with our heads beautifully ‘supported and suspended’ as part of our whole springy and dynamic upright structure. In this scenario, the considerable weight of our head (4.5kg or so!) did not cause us any undue strain, passing ‘straight down the plumb line’ into the ground rather than pulling the rest of our body down.

However, since the Industrial Revolution our environment has changed beyond recognition. The current world of seats, tables, cars, computers and mobile technology has changed how we spend our time, fundamentally restricting and constraining our everyday (moment-by-moment) movement into an uncomfortable mix of stasis and repetitive actions. We have developed an array of subconscious habits to try and adapt ourselves to this environment, and these are interfering with our natural movement coordination, postural support and balance. If you watch most people using a mobile, reading a book, or just looking down, you’ll see their head hanging forwards from the spine rather than pivoting at the joint at the top (see my article in TalkBack magazine for more on this [3]). With 4.5kg of weight pulling downwards for large parts of the day, it seems foolish to dismiss the possibility that neck and shoulder pain may result over the years.

While there is now a lot of attention paid to the amount of time spent on our mobiles, it may be more important to focus on how we use it – what do we do to ourselves while we are ‘lost’ in our virtual world? Why not conduct a little experiment – pick up your mobile and start reading a text or looking at social media. Ask yourself what gradually happens to your neck and shoulders, to your breathing, and to your awareness of the world around you? My belief is that – without an ability to avoid the usual habits around mobile phone use – it is likely to predispose to neck and shoulder pain over the long term. But it’s not just about biomechanics. Losing awareness of what’s around us and instead focusing our attention narrowly on our mobiles, we tend to become tense and rigid, affecting our breathing, balance and our sense of being ‘grounded’. So paradoxically, even while we are rushing about our busy days, on the move and on our mobiles, we can actually become quite frozen and fixed.

As an Alexander Technique teacher, I help people recognise what’s happening to themselves as they use their mobile, or indeed as they carry out any activity (sitting, lifting, walking etc). I then show them how they can reduce unhelpful habits so that they can lead their daily lives with more poise and freedom, and less effort. Using a mobile well

Consider finding out more about the Alexander Technique if you’d like to be able to look after yourself better and stay grounded in the real world – and not just when you’re using your mobile.

 

  1. Gerson Moreira Damasceno GM, et al. Text neck and neck pain in 18–21-year-old young adults. European Spine Journal, January 2018;1–6.
  2. Toh SH, et al. The associations of mobile touch screen device use with musculoskeletal symptoms and exposures: A systematic review. PLoS One, August 2017;12(8):e0181220.
  3. How the Alexander Technique can help you avoid ‘text neck’, Julia Woodman. TalkBackquarterly magazine of BackCare. Summer 2016 Issue; 20–21 (or click here for PDF; reproduced with kind permission).

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.

New research: Learn the Alexander Technique to improve how you live and care for yourself, and so reduce pain

Neck pain self efficacy pulicationMy colleagues and I have just published new research from the ATLAS clinical trial of Alexander lessons or acupuncture sessions for people with chronic neck pain [1]. The research concludes that Alexander lessons lead to long-term improvements in the way people live their daily lives and manage their pain. It reports the positive effect of learning the Alexander Technique on people’s self-efficacy and ability for self-care, and the way in which this is linked with long-term reduction in chronic neck pain. These findings illustrate nicely one of my favourite descriptions of the Alexander Technique – a way of looking after yourself better in daily life and for the long term.

 What were the detailed findings?

Compared with the control group (usual care alone), trial participants who had attended Alexander lessons reported significantly greater improvements across eight self-efficacy/self-care measures, including the ability to reduce pain in daily life – and this improvement was maintained at 12 months, several months after the lessons had ended. At 6 months, 81% of the participants who had attended Alexander lessons reported significant improvement in the way they lived and cared for themselves (compared with only 23% of the control group) and this increased to 87% at 12 months (compared with 25% for control). These improvements in self-efficacy and the ability to reduce pain during daily life were found to be related to the long-term clinical outcome of reduced neck pain and associated disability [1].

More on the ATLAS trial

ATLAS was a randomised, controlled trial that recruited 517 patients with chronic neck pain and evaluated one-to-one Alexander Technique lessons with a STAT-registered teacher, or acupuncture, each plus usual care, compared with usual care alone. The main clinical findings of this trial are published in the prestigious Annals of Internal Medicine [2]. The trial demonstrated statistically significant and clinically meaningful reductions in neck pain and associated disability for both interventions compared with usual care alone. Read more about the study here.

What do people say about these new findings?

Professor Hugh MacPherson from the University of York, who was the principal investigator of the ATLAS trial and one of my co-authors on the current publication, says it ‘really does set out the role of self-care and self-efficacy as key components related to the benefits of the Alexander Technique’; and describes it as a ‘landmark study for many years to come’.

 Find out more

Our article is published in the European Journal of Integrative Medicine, read it here.

 

  1. Woodman J, Ballard K, Hewitt C, MacPherson H. Self-efficacy and self-care-related outcomes following Alexander Technique lessons for people with chronic neck pain in the ATLAS randomised, controlled trial. European Journal of Integrative Medicine 2018; doi: 10.1016/j.eujim.2017.11.006
  2. 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.