Category Archives: Research

“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. 

 

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.

New study on knee osteoarthritis suggests Alexander Technique lessons can help reduce pain and disability

My involvement in research on the Alexander Technique means that I’m a keen follower of what other researchers are doing. Here I describe the findings of an interesting and promising study that has just been published. The study suggests that Alexander Technique lessons can help people with knee osteoarthritis reduce their pain and disability, and that restoring the normal pattern of leg muscle function may play a role.

Background: Knee osteoarthritis is a common condition affecting more than one in ten people in the UK, and causing considerable pain and disability. It has become clear that people with this condition have an abnormal pattern of leg muscle function when walking and moving in general. Instead of the normal pattern in which one set of leg muscles relaxes as another set contracts, in people with knee osteoarthritis, opposing sets of muscles contract at the same time and this puts a lot of stress on the joint.

What the study set out to investigate: The aims of the study were to find out whether learning the Alexander Technique could help reduce the pain and disability associated with knee osteoarthritis, and whether a more normal pattern of leg muscle function could be restored.

What the study did: 21 people with diagnosed osteoarthritis in their knees were recruited to the study and attended 20 one-to-one Alexander lessons with a STAT-registered teacher. Knee pain, as well as stiffness and functioning, were assessed by the well-established self-report measure called WOMAC. The researchers also studied the pattern of leg muscle activation in these 21 individuals and compared this with a control group of healthy individuals of similar age and weight.

What the study showed: On average, knee pain decreased by half (56% reduction) following the lessons, and this benefit was maintained longer term, as shown at the 15 month follow-up. A similar reduction was observed in the overall score of pain, stiffness and functioning. An interesting additional observation was that most people who were taking painkillers at the beginning of the study, were able to stop or reduce this following the Alexander lessons (10 out of the 15 taking painkillers at the start). The study also showed an abnormal pattern of leg muscle function, in which both sets of muscles contracted at the same time when these individuals began to walk. This abnormal pattern improved following the Alexander lessons, and became more similar to the pattern seen in the healthy control group. Furthermore, greater improvements in the pattern of muscle function were found to be associated with larger reductions in pain. Interestingly, leg muscle strength did not change as a result of the lessons, instead the improvement was associated with a reduction in excessive muscle activation.

What the results mean: The study demonstrates the potential of Alexander lessons to enable people with knee osteoarthritis to reduce inappropriate muscle activation and therefore reduce their pain and disability. These results need to be followed up with a larger, controlled clinical trial but suggest that Alexander lessons may be an appropriate alternative approach for knee osteoarthritis to the usual one of muscle strengthening exercises.

Reference: Preece SJ, et al. Reductions in co-contraction following neuromuscular re-education in people with knee osteoarthritis. BMC Musculoskeletal Disorders 2016;17:372.

Read the full paper here.