Category Archives: Research

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.

How does the Alexander Technique work?

Research paper movement anticipation affects posture

New research has shone light onto a possible cause of some of our unhelpful postural and movement habits. Dr Rajal Cohen and her team found that simply the anticipation of making a movement caused people to put their head out of alignment with the rest of their body [1]. The research illustrates a common tendency to over-focus on the desired end result (in this instance walking towards something in order to put an object down), without sufficient awareness or interest in what we might be doing to ourselves in the process of achieving our goal. This undesirable tendency (‘end-gaining’) is something we can learn to recognise and diminish through Alexander Technique lessons.

The Alexander Technique was developed during many months and years of dedicated and careful experimentation. It was the solution to a very personal, career-threatening problem – the loss of FM Alexander’s voice. The practical, thoughtful method that Alexander discovered, allowed him to overcome the persistent hoarseness that had plagued his life as a theatre actor.

Today people take Alexander lessons for a wide range of reasons covering areas as diverse as health, sports, music and business. Because of its fundamental nature – encompassing how we react, think, move and even breathe – the Alexander Technique can be applied in any activity, allowing greater choice, freedom and ease in everyday life.

Clinical trials have demonstrated that one-to-one Alexander lessons with STAT-registered teachers can lead to long-term reduction in persistent back and neck pain, as well as enabling people with Parkinson’s to minimise the effects of their condition on their daily lives. The Alexander Technique has been taught for many years in music and drama colleges, enabling students to improve their performance, and avoid anxiety and injury. It is now being taught in some schools to help children to ‘learn how to learn’, and Alexander lessons are also increasingly being taken up in business and in sports.

So how can one approach be applied across such diverse fields? How does the Alexander Technique actually work? FM Alexander first developed the method (the practice) and later sought to understand and explain the theory behind it. He was clearly ahead of his time, being one of the first in the Western world to recognise that mind and body are inseparable – this concept is beginning to be more widely accepted in our stubbornly dualistic world, but mostly we don’t get beyond simply acknowledging that there is some kind of link between mind and body. Alexander also recognised that the way we do everything that we do in life (our ‘use’) profoundly affects our long-term functioning – something that biomechanist, Katy Bowman eloquently writes about today. And Alexander’s method relies on our potential for fundamental change – and this potential has been borne out in more recent decades by neuroscience’s recognition of brain plasticity. Research by Tim Cacciatore and colleagues has demonstrated that training in the Alexander Technique leads to improved postural and overall muscle tone, movement coordination, flexibility and balance.

The latest research by Dr Cohen’s team is very welcome as it clearly supports Alexander’s belief that mind and body are indeed inseparable. The study found that just the thought of moving caused an anticipatory negative effect on posture. Furthermore this effect was more pronounced in those participants who were found to be least able to consciously prevent themselves from reacting to a test stimulus; and it was also worse in those who generally tended to be less ‘present’ (mindful).

Learning the Alexander Technique involves developing greater self-awareness and more conscious choice over how we respond in any situation. This skill of conscious (intentional) inhibition enables us to prevent unwanted habits, and thereby to access our inherent movement coordination, balance and posture that would otherwise tend to be hampered by such habits. Alexander work helps us remain more present and embodied. It enables us to avoid the tendency described in Dr Cohen’s research of continually ‘jumping ahead of ourselves and living in the future’.


1. Baer JL, Vasavada A, Cohen RG. Neck posture is influenced by anticipation of stepping. Human Movement Science 2019;64:108–122.

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)!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.

“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.