There is a growing evidence base for the effectiveness of Alexander lessons for people with a variety of health-related conditions, including back pain and neck pain. Other research is beginning to explain some of the fundamental changes – including to movement coordination and balance – that occur in people taking lessons and contribute to the observed health benefits.
Please note that this section includes links to PDF documents that require Adobe Acrobat Reader.
Back pain trial
A major clinical study has shown that one-to-one lessons in the Alexander Technique lead to significant long-term benefit for people with chronic low back pain. After one year, compared with people who received usual GP care, those who had taken 24 Alexander lessons had significantly:
- less back pain (3 days of pain per month versus 21 days)
- less incapacity
- and improved quality of life.1
Watch a video about the back pain trial
These findings are supported by several smaller studies which also showed that people with chronic back pain were able to reduce their pain following Alexander lessons.2,3,4
Neck pain trial
A large randomised, controlled clinical trial run by the University of York and funded by Arthritis Research UK, has shown that one-to-one Alexander Technique lessons lead to long-term benefit for people with chronic neck pain, with reduction in pain and associated disability maintained 1 year after lessons began.5
The trial also demonstrated that people were able to improve the way they lived their daily lives and managed their pain following the Alexander lessons. Learning the Alexander Technique led to increased self-efficacy (confidence in being able to bring about the desired outcome through own behaviour) and ability for self-care. Furthermore, these improvements were found to be linked with the observed long-term reduction in chronic neck pain and associated disability.6
Experience in pain clinics
Two reports have highlighted how valuable Alexander Technique lessons can be for people with chronic pain. The first was a pilot study involving 43 people attending an NHS pain clinic and offered six one-to-one Alexander Technique lessons. The findings suggest that an Alexander teaching service in a pain clinic can help people reduce their pain and to better manage their condition. The study reported that after 3 months (following lessons) half the participants were able to stop or reduce their use of pain medications.7
Read more about this study: poster summary (PDF format 620K).
The second study was an audit of an Alexander Technique teaching service in an NHS Community Pain clinic. More than 70% of the 158 patients with persistent pain reported that their Alexander lessons helped them ‘quite a lot’ or ‘very much’ to move more easily, improve their wellbeing and be empowered to be able to manage their condition better.8
A randomised, controlled trial has shown significant benefits of Alexander Technique lessons for people with Parkinson’s disease in reducing associated disability.9,10,11 Participants also reported subjective improvements in balance, posture and walking, as well as increased coping ability and reduced stress9. As a result of this research, the National Institute for Care and Excellence (NICE) states in its latest guidelines: ‘Consider the Alexander Technique for people with Parkinson’s disease who are experiencing balance or motor function problems’.12
A separate small study has suggested significant benefits in balance and mobility for people with Parkinson’s when they practised instructions based on Alexander Technique principles.13
Balance and movement studies
Training in the Alexander Technique is known to improve balance (see ‘How the Alexander Technique works’, below). There is evidence from several studies to suggest that instruction in the Alexander Technique may be a valuable intervention to help older people with their balance, particularly for those who have a fear of falling, or who have experienced a fall.14,15,16,17 In addition to improvements in clinical measures of balance,15 better movement, mood and confidence to go about daily activities have also been reported.17
Watch a video from one of the balance studies.16
Research has also shown that older Alexander Technique teachers (60–75 years) not only show greater dynamic stability during walking than people of similar age who have no Alexander training, but also that they have gait (walking) patterns that are similar to those of younger adults.18,19 Earlier studies have shown a more poised state of head balance, with reduced muscular tension in the neck, as well as significantly less force required following lessons to perform everyday actions, such as standing up from a seated position.20,21,22,23
The value of the Alexander Technique in the performing arts has long been recognised, and it is an integral part of teaching at several leading music and drama institutes (e.g. RADA and the Royal College of Music). A systematic review has analysed all available research on the effect of Alexander instruction for musicians. The analysis concluded there is evidence for Alexander lessons leading to reduced performance-related anxiety in musicians, and that further research is warranted to explore effects on other performance-related outcomes.24
A pilot study has reported reduced pain and disability following one-to-one Alexander lessons for people with knee osteoarthritis.25 Read more here.
Another small study has suggested that Alexander lessons can lead to improved breathing capacity.26 Preliminary, data suggest benefits of lessons for those who stutter27 and in improving posture.20,28
How does the Alexander Technique work?
Research suggests that some of the benefit from learning the Alexander Technique results from improving postural and overall muscle tone, coordination, flexibility and balance. These improvements in overall functioning may explain some of the health benefits that have been observed.
Thus, studies have shown that individuals who have undergone Alexander Technique training have an increased adaptability of postural muscle tone with reduced stiffness, and improved movement coordination and balance.4,29,30,31 The more dynamic postural muscle tone is thought to play a key role in bringing about the changes in movement and balance.31
More fundamentally, the Alexander Technique operates through increased awareness, intentional inhibition of unwanted reaction and unnecessary action, and with more effective direction of thought; all of which lead to improved overall muscle tone and postural support with less stiffness.6,32
Other research has shown that unwanted postural habits can result from our tendency to focus on what we’re about to do, rather than what we are doing this moment.33 Applying Alexander thinking enables us to stay more present and embodied, and this can prevent or reduce negative effects of anticipation on our posture and movement.
Review of evidence
The evidence for the effectiveness of Alexander Technique lessons across different health-related conditions was evaluated and published in the International Journal of Clinical Practice in 2012.34 This systematic review found strong evidence for the effectiveness of Alexander lessons for people with chronic back pain and moderate evidence in helping alleviate disability associated with Parkinson’s. Preliminary evidence was found across a diverse range of other health-related conditions.
Since then the neck pain trial has been conducted and published, and an updated review ‘Effectiveness of Alexander Technique lessons for people with musculoskeletal conditions’ has been presented.35
You can read the submitted version (i.e. the pre-peer-reviewed version) of the earlier full review, or link to the published final form (note there may be a journal fee to access the final article but the submitted version, which is free, is very similar to the final one). The journal also invited us to produce a short video presentation summarising the main findings of the review. Both the video and the review are aimed mainly at health professionals but may also be of interest to some members of the public.
- 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.
- Little P, Stuart B, Stokes M, Nicholls C, Roberts M, et al. Alexander Technique and supervised physiotherapy exercises in back pain (ASPEN): a four-group randomised feasibility trial. Efficacy Mech Eval 2014;1(2).
- Vickers AP; Ledwith F; Gibbens AO. The impact of the Alexander Technique on chronic mechanical low back pain (unpublished report). 2000.
- Cacciatore TW. Improvement in automatic postural coordination following Alexander Technique lessons in a person with low back pain. Physical Therapy 2005;85:565–78.
- 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.
- 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;17:64–71. doi: 10.1016/j.eujim.2017.11.006.
- McClean S, Brilleman S, Wye L. What is the perceived impact of Alexander Technique lessons on health status, costs and pain management in the real life setting of an English hospital? The results of a mixed methods evaluation of an Alexander Technique service for those with chronic back pain. BMC Health Services Research 2015;15:293.
- Hawksley H, French K, Benson C, Hemphrey L. Alexander Technique in the management of chronic pain: an audit cycle in a community pain service. British Pain Society Annual Conference. Liverpool, UK 2012.
- Stallibrass C; Sissons P; Chalmers C. Randomized; controlled trial of the Alexander Technique for idopathic Parkinson’s disease. Clinical Rehabilitation 2002;16:695–708.
- Stallibrass C. An evaluation of the Alexander Technique for the management of disability in Parkinson’s disease – a preliminary study. Clinical Rehabilitation 1997;11: 8–12.
- Stallibrass C; Frank C; Wentworth K. Retention of skills learnt in Alexander Technique lessons: 28 people with idiopathic Parkinson’s disease. Journal of Bodywork and Movement Therapies 2005;9:150–7.
- National Institute of Care and Excellence. Parkinson’s disease in adults. July 2017. https://www.nice.org.uk/guidance/ng71.
- Cohen RG, Gurfinkel VS, Kwak E, Warden AC, Horak FB. Lighten up: Specific postural instructions affect axial rigidity and step initiation in patients with Parkinson’s disease. Neurorehabilitation and Neural Repair 2015;29:878–88.
- Gleeson M, Sherrington C, Lo S, Keay L. Can the Alexander Technique improve balance and mobility in older adults with visual impairments? A randomized controlled trial. Clinical Rehabilitation 2015;29:244–60.
- Dennis RJ. Functional reach improvement in normal older women after Alexander Technique instruction. Journals of Gerontology Series A: Biological Sciences and Medical Sciences 1999;54:M8–M11.
- Batson G, Barker S. Feasibility of group delivery of the Alexander Technique on balance in the community-dwelling elderly: preliminary findings. Activities Adaptation and Aging 2008;32:103–119.
- Glover L, Kinsey D, Clappison DJ, Jomeen J. “I never thought I could do that…”: Outcomes from an Alexander Technique pilot group for older people with a fear of falling. European Journal of Integrative Medicine 2018;17:79–85.
- O’Neill MM, Anderson DI, Allen DD, et al. Effects of Alexander Technique training experience on gait behavior in older adults. Journal of Bodywork and Movement Therapies 2015;19:473–81.
- Hamel KA, Ross C, Schultz B, et al. Older adult Alexander Technique practitioners walk differently than healthy age-matched controls. Journal of Bodywork and Movement Therapies 2016;20:751–60.
- Barlow, W. Psychosomatic problems in postural re-education. Lancet 1955;24 Sep:659-64.
- Jones FP and Gilley FM. Head balance and sitting posture: an x-ray analysis. J Psychology 1960;49:289-93.
- Jones FP, Gray FE, Hanson JA and O’Connell DN. An experimental study of the effect of head balance on patterns of posture and movement in man. J Psychology 1959;47:247–258.
- Stevens C, Bojsen-Moller F, Soames RW. (1989) The influence of initial posture on the sit-to-stand movement. European Journal of Applied Physiology & Occupational Physiology. 58 (7): 687–92.
- Klein SD, Bayard C, Wolf The Alexander Technique and musicians: a systematic review of controlled trials. BMC Complementary and Alternative Medicine 2014;14:414. doi: 10.1186/1472-6882-14-414.
- Preece, SJ, Jones RK, Brown C, et al. Reductions in co-contraction following neuromuscular re-education in people with knee osteoarthritis. BMC Musculoskeletal Disorders 2016; 17:372.
- Austin JHM and Ausubel P. Enhanced respiratory muscular function in normal adults after lessons in proprioceptive musculoskeletal education without exercises. Chest 1992;102:486–90.
- Schulte D, Walach H. F.M. Alexander technique in the treatment of stuttering- a randomized single-case intervention study with ambulatory monitoring. Psychother Psychosom. 2006;75(3):190-1.
- Reddy PP, Reddy TP, Roig-Francoli J et al. The impact of the Alexander Technique on improving posture and surgical ergonomics during minimally invasive surgery: pilot study. Journal of Urology 2011;186:1658–62.
- Cacciatore TW, Gurfinkel VS, Horak FB, Cordo PJ, Ames KE. Increased dynamic regulation of postural tone through Alexander Technique training. Human Movement Science 2011;30:74–89.
- Cacciatore TW, Gurfinkel VS, Horak FB, Day BL. Prolonged weight-shift and altered spinal coordination during sit-to-stand in practitioners of the Alexander Technique. Gait Posture 2011;34:496–501.
- Cacciatore TW, Mian OS, Peters A, Day BL. Neuromechanical interference of posture on movement: evidence from Alexander Technique teachers rising from a chair. Journal of Neurophysiology 2014;112:719–29.
- Ballard K. Ideomotor principle – was Alexander correct? In: Rennie C, Shoop T, Thapen K (Eds.), Connected Perspectives – The Alexander Technique in context. Hite Books and Publishing, London, 2015, pp.49−71.
- Baer JL, Vasavada A, Cohen RG. Neck posture is influenced by anticipation of stepping. Human Movement Science 2019;64:108–122.
- Woodman JP and Moore NR. Evidence for the effectiveness of Alexander Technique lessons in medical and health-related conditions: a systematic review. International Journal of Clinical Practice 2012;66:98–112.
- Woodman J, Ballard K, Glover L. Effectiveness of Alexander Technique lessons for people with musculoskeletal conditions. Poster presentation at the Society for Back Pain Research annual conference, 3–4 November 2016, Preston, UK. Published in: Bone & Joint Journal Orthopaedic Proceedings 2017; 99-B (Suppl 10):7.