Alexander Technique vs. Targeted Exercise for Neck Pain—A Preliminary Comparison

Abstract

Background: Alexander technique private lessons have been shown to reduce chronic neck pain and are thought to work by different mechanisms than exercise. Group classes may also be effective and would be cost-effective. Design: A two-group pre-test/post-test design. Participants were assigned to either a general Alexander technique class or an exercise class designed to target neck pain. Both groups met over 5 weeks for two 60 min sessions/week. Participants: A total of 16 participants with chronic neck pain (aged 50+/−16 years) completed this study. Interventions: The Alexander class used awareness-building methods to teach participants to reduce habitual tension during everyday activities. The exercise class was based on physical therapy standard of care to strengthen neck and back muscles thought to be important for posture. Measures: We assessed neck pain/disability, pain self-efficacy, activation of the sternocleidomastoid muscles during the cranio-cervical flexion test, and posture while participants played a video game. Results: Both groups reported decreased neck pain/disability after the interventions. Sternocleidomastoid activation decreased only in the Alexander group. Conclusion: In this small preliminary study, Alexander classes were at least as effective as exercise classes in reducing neck pain and seemed to work via a different mechanism. Larger, multi-site studies are justified.

Altered coordination strategies during upright stance and gait in teachers of the Alexander Technique

“…Alexander Technique teachers had similar BMIs and walking speeds compared to the control group. In addition, results of a recent intervention study indicated that reductions in neck pain following Alexander Technique classes were due to different mechanisms than reductions in pain following exercise classes ( Becker et al, 2021 ). Potentially different mechanisms for reducing pain may support additive effects of Alexander Technique lessons and exercise, as was found in a clinical trial for people with low back pain ( Little et al, 2008 ).…”

“…No special equipment is needed, so the Alexander Technique can be delivered in any setting. Although often taught privately, research supports the effectiveness of group lessons, making the work both accessible and scalable ( Becker et al, 2021 ).…”

“…Alexander Technique instruction uses three main principles: 1) improved awareness of the whole body in three-dimensional space; 2) purposeful inhibition of habitual excess muscular activity in the planning, initiating, and carrying out of movement; and 3) the use of mental commands or imagery to establish a more poised and dynamic use of the head, torso, and limbs ( Cacciatore et al, 2005 ). A growing body of research suggests that the Alexander Technique may provide long-term improvements after taking a series of lessons and also immediate improvements using Alexander-based cues, across many posture and movement domains ( Dennis, 1999 ; Stallibrass et al, 2002 ; Batson & Barker, 2008 ; Little et al, 2008 ; Cohen et al, 2015 ; MacPherson et al, 2015 ; O’Neill et al, 2015 ; Hamel et al, 2016 ; Preece et al, 2016 ; Loram et al, 2017 ; Becker et al, 2018 ; Cohen et al, 2020 ; Becker et al, 2021 ). Additionally, research suggests that improvements may translate to other domains and tasks that are not directly addressed by Alexander Technique lessons or classes, such as balance improving without ever having performed balance tasks during lessons ( Cacciatore et al, 2020 ).…”

“…Support for the applications to pain and wellbeing is shown by randomized controlled trials demonstrating the effectiveness of the Alexander Technique in reducing back pain and reducing disability in Parkinson’s Disease ( Stallibrass et al, 2002 ; Little et al, 2008 ). Additionally, research has shown benefits for people with knee osteoarthritis and neck pain ( MacPherson et al, 2015 ; Preece et al, 2016 ; Becker et al, 2018 ; Becker et al, 2021 ). Support for the application to posture and balance is demonstrated by research on quiet upright stance and single-leg stance showing reduced postural sway in older adults and individuals with Parkinson’s Disease when given Alexander Technique-based instructions to think of their upright posture effortlessly compared with conditions where they relaxed or thought of upright posture more effortfully ( Cohen et al, 2015 ; Cohen et al, 2020 ).…”

The effects of the Alexander Technique on Chronic Non-specific Neck Pain: A Systematic Review and Meta-analysis

“…Forty-nine studies were selected as the potentially eligible studies after screening repeatedly. After reviewing the full text, three studies were included in this meta-analysis eventually and two of which were RCTs [20,21] while another one was quasi-randomized trial [22] . The total number of patients from three studies that included were 407, with 204 patients in Alexander Technique group and 203 patients in usual care group, respectively.…”