Neck pain trial

Clinical trial results have demonstrated that people with chronic neck pain who attended one-to-one Alexander Technique lessons gained significant long-term benefit, with clinically relevant and statistically significant reductions in neck pain and associated disability maintained 1 year after lessons began [1].

About the trial

  • The ATLAS (Alexander Technique Lessons or Acupuncture Sessions for people with chronic neck pain) study was a large, well-designed, well-conducted, randomised, controlled trial [2].
  • The trial involved 517 people who had neck pain lasting 3 months or more − in fact the average (median) turned out to be 6 years, so for many their neck pain was quite intractable.
  • Study participants were randomly allocated to one of the following three groups, offering:
    • 20 one-to-one Alexander Technique lessons (along with continued usual care led by their GP)
    • 12 acupuncture sessions, with equivalent overall length of time to the 20 Alexander lessons (along with continued usual care led by their GP)
    • usual care alone, led by their GP (control group).

Flow chart - 517 neck pain patients randomly receiving 3 types of care over 12 months

  • All Alexander lessons were delivered by trained teachers registered with STAT.
  • The trial was not a comparison of Alexander lessons and acupuncture (it was not designed for this); it evaluated the effectiveness of Alexander lessons compared with usual care alone, and of acupuncture compared with usual care alone.
  • At the beginning of the study, all participants completed standard questionnaires to describe their current level of neck pain and how this affected their ability to carry out daily tasks. The evaluation was repeated at 3, 6 and 12 months after the study began.
  • A range of other outcomes were also assessed including quality of life and self efficacy (the confidence in one’s ability to change behaviour in order to reduce pain).
  • A qualitative sub-study within the trial used in-depth interviews with a sample of the trial participants to explore their experiences of learning the Alexander Technique, or having acupuncture, or of continuing with usual GP-led care [3].
  • The trial was managed by a large research team based at the University of York and was funded by Arthritis Research UK.

Trial results

  • The participants who attended Alexander lessons gained significant long-term benefit, with clinically relevant reductions in neck pain and associated disability [1].
  • At the end of the trial, 1 year after the study began, they were experiencing nearly a third less pain and associated disability (a 31% reduction) [1].

Bar chart - Pain reduction grouped by treatment type after 1 year. 25% or greater reduction defined as clinically significant

  • The reduction in pain and associated disability for the Alexander group was significantly greater than that experienced by the control group who received usual GP-led care alone [1].
  • The benefit continued to the end of the study; this was about 7 months after the Alexander lessons had finished and 1 year after they had begun [1].
  • This benefit was observed despite the long-established nature of the neck pain − on average, people had suffered it for 6 years [1].
  • Compared with the control group (usual care alone), those in the Alexander group reported significantly greater long-term improvements across eight self-efficacy/self-care measures, including self-efficacy and the ability to reduce pain in daily life [4].
  • 87% of Alexander participants reported that they had learnt to improve the way they they lived and cared for themselves, compared with only 25% for control group participants [4].
  • The improvements in self-efficacy and the ability to reduce pain during daily life were associated with the long-term clinical outcome of reduced neck pain and associated disability [4].
  • In-depth interviews with the trial participants revealed a rich array of experiences, including developing a greater sense of control over their neck pain following Alexander lessons. 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 [3].
  • Following Alexander lessons, improvement was also seen in people’s mental health at 1 year, as revealed by a self-report quality-of-life questionnaire [1].
  • No safety issues related to Alexander lessons were identified [1].
  • In this trial, acupuncture led to benefits similar to those obtained from attending Alexander lessons [1].

Conclusions

  • Offering people with chronic neck pain, 20 one-to-one lessons in the Alexander Technique can lead to long-term improvement in their pain and associated disability [1].
  • The findings are particularly encouraging given the long-standing nature of people’s neck pain – on average they had 6 years of neck pain prior to beginning the study.
  • Alexander lessons promote self-efficacy and self-care by imparting knowledge and skills that help people improve the way they live and care for themselves, leading to long-term reduction in chronic neck pain [4].
  • The increase in self-efficacy and self-care ability gained from Alexander lessons helps to explain the sustained benefit which continued to the end of the study, more than 6 months after the lessons had finished [4].
  • The analysis of the experiences and perspectives of the participants, complements and helps to explain the observed clinical benefits and increased self-efficacy that followed Alexander lessons [3].
  • Alexander Technique lessons are an appropriate option to offer people with chronic neck pain [4].
  • There are now two large randomised controlled trials published that demonstrate the effectiveness of one-to-one Alexander lessons for people with chronic musculoskeletal conditions: ATEAM for chronic back pain and ATLAS for chronic neck pain [1,5].

References

  1. 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.
  2. MacPherson H, Tilbrook HE, Richmond SJ, Atkin K, Ballard K, Bland M, Eldred J, Essex HN, Hopton A, Lansdown H, Muhammad U, Parrott S, Torgerson D, Wenham A, Woodman J, Watt I. Alexander Technique Lessons, Acupuncture Sessions or usual care for patients with chronic neck pain (ATLAS): study protocol for a randomised controlled trial. Trials 2013 Jul 10;14:209.
  3. Wenham A, Atkin K, Woodman J, Ballard K, MacPherson H. 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. 
  4. 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.
  5. Little P, Lewith G, Webley F, Evans M, Beattie A, Middleton K, Barnett J, Ballard K 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.