The Alexander Technique and Back Pain
Notes for a workshop on the Alexander Technique presented to the 5th Interdisciplinary World Congress on Low Back and Pelvic Pain, Melbourne November 14, 2004, by David Moore, director of the School for F.M. Alexander Studies, Melbourne.
The Alexander Technique is an educative process, which provides a means of changing ingrained patterns of coordination and stress reactions which may be underlying causes of back pain and a wide range of other dysfunctions.
The Alexander technique was developed from the work of F. Matthias Alexander (1869 – 1955), an Australian actor who lost his voice on the stage. Through a long process of observation and experimentation he discovered that the loss of his voice was due to an overall pattern of contraction (misuse) and that in order to regain the healthy functioning of his voice he had to change this overall pattern of misuse. He then began to work with others first as an elocution teacher, but increasingly with a range of people with diverse medical problems, as it became clear that altering overall patterns of miscoordination had a profound effect on many pathological conditions.
The 1973 Nobel Prize winner in Physiology or Medicine, Nicholas Tinbergen, devoted half of his Nobel oration to Alexander’s discoveries. He said "This story of perceptiveness, of intelligence and of persistence, shown by a man without medical training, is one of the true epics of medical research and practice."
He moved to London in 1904 and developed a busy practice working, amongst others, with many leading actors, doctors, intellectuals and politicians of his day. One of his major supporters was the philosopher and educationalist John Dewey who wrote introductions for Alexander’s four books, and in whose work the influence of Alexander can be discerned. (His influence can also be discerned in Alexander’s books, some of which he assisted in editing).
Alexander set up a training school for teachers of the technique in London in 1931 running a three year full time training, and since his death training schools have been set up in many countries throughout the world, including the School for F.M. Alexander Studies in Melbourne.
Basic principles of the Alexander Technique
during this workshop I will be using a number of technical terms. Defining these terms will also help explain the technique in more detail.
USE: is a technical term we use in this work to denote an overall pattern of posture and tension and the manner in which we respond to stimuli (in Alexander's case, the stimulus to project his voice.) Use refers to neither mind nor body exclusively - an act as simple as moving an arm depends on thought, intention and motivation as well as the physical action of the muscles involved. What we are dealing with in this work is a global pattern of movement and reaction.
None of the following describes the meaning of "use", but if we combine all these into a present moment observation in an individual we can be said to be observing how he is using himself.
All the variables listed above tend to from an underlying constant state (which may vary in intensity but not in overall quality). From an Alexander point of view, none of the above can be adequately understood much less dealt with in isolation from the others.
When we look at something like lower back pain what we are observing is a result of a habitual and ongoing dysfunctional pattern of use.
These dysfunctional patterns of use are so much part of us that we are largely unconscious of them, or pick out only isolated aspects which we then try to change by such expedients as standing and sitting "straight’ pulling our shoulders back, "deep breathing" or "relaxing". Such patterns can however only be dealt with as a whole.
USE AFFECTS FUNCTIONING
This work is based on the premise that they way we use ourselves affects the way we function. The proposition that "use affects functioning" was named "The Alexander Principle" by Dr Wifred Barlow, in his influential book of the same name. Change the way in which we use ourselves and we indirectly alter our functioning.
In the drawing above we see how the "use" affects and is affected by both structure and functioning. Any effective intervention in terms of back pain will be aiming to turn what has become a vicious cycle into a virtuous cycle in relation to these three variables. For any intervention to have the possibility of having long term benefit all three variable will need to change.
In relation to back pain different modalities tend to focus more on one point in this cycle. Surgery, orthotics, and certain forms of manipulative therapy focus on structure. Acupuncture, massage therapy and medication focus on functioning. Movement education focuses more on the aspect of use.
From the Alexander point of view, the emphasis in many forms of remedial exercise however can tend to focus too narrowly on structural aspects, neglecting the wider aspects of the problem. Overemphasis on the role of individual muscles or groups of muscles as key stabilizers looses sight of the overall coordination in which these muscles operate.
When you make a movement, any movement, you use
Muscles stabilizing the part of the body which is moving
Muscles responsible for maintaining the balance of the whole body in the changing situation created by the movement
Muscles responsible for maintaining the shape of the body, the integrity of the structure
You also need to inhibit, consciously or unconsciously muscular activity, which will interfere with the movement you are making.
PHYSICAL COORDINATION AND PRIMARY CONTROL
One aspect of Alexander technique training is that teachers develop a highly sophisticated understanding of the physical coordination of the body as a whole. Coordination can only take place if the various parts of the body are in proper relationship to each other – starting from the balance of the head on top of the body. Alexander referred to the relationship of the head, neck and back as creating a primary control over the coordination of the whole body.
The attempt to change the coordination of a particular part of the body – (eg increasing or decreasing the lumbar curve, or strengthening or stretching particular muscles or groups of muscles) should therefore only be undertaken in the context of awareness of the whole body from head to feet. Indeed Alexander claimed that many interventions, whist "successful" in alleviating particular symptoms, contained the danger of giving rise to unintended consequences due to the lack of attention to their affect on the overall pattern of coordination. (Common examples of this are lower back damage due to incorrect stretching of hamstrings (forward bends) and tightened neck muscles from the process of activating "core postural muscles".)
FAULTY SENSORY PERCEPTION
A major conundrum that confronts anyone trying to alter patterns of posture or movement or to learn a skill, is the little recognised fact that most people’s proprioceptive and kinaesthetic senses are not being interpreted accurately. Faulty coordination and faulty sensory perception go hand in hand. Any attempt to alter postural and movement patterns must therefore take this variable into account, and find some way of dealing with it. Indeed Alexander described the aim of his training as the restoration of kinaesthetic accuracy, which is the prerequisite of adequate coordination.
In order to overcome this apparently insuperable obstacle to improved use, Alexander teachers are trained in the use of very subtle manual guidance to work with their students in everyday activities till they can gradually develop more accurate kinaesthetic awareness, which will allow them to guide themselves in efficient movement.
(If anyone doubts that faulty kinaesthetic perception is a common phenomenon it will be amply demonstrated at this workshop.)
INHIBITION (as a good word)
One of the discoveries of Alexander in his own case was that the very stimulus to project his voice, resulted in a response of interfering with his breathing and tightening his whole body. Before he could do anything different he had to stop (inhibit) this reaction.
One of the distinctive aspects of retraining with the Alexander technique is the wrong thing has first of all to be abandoned before a change for the better can be made. In other words if we attempt to do something different without inhibiting the old habit the new way of doing things will be superimposed on a pre-existing faulty way.
In working with dancers with back pain who have consciously trained their bodies in particular ways we often come across multiple layers of correction overlaid on pre-existing faulty patterns.
This emphasis on breaking the stimulus/response pattern is central and crucial to the Alexander work. Often if the response can be inhibited the right thing will do itself.
The other distinctive aspect of working with the Alexander technique is in the use of conscious directions to begin to ease the body out of habitual contractive patterns. The directions provide a conceptual framework to provide guidance on what to think, instead of repeating the habit. In Alexander lessons these directions are given verbally in association with gentle manual guidance, and as the students sensory awareness begins to improve they are asked to apply the directions in daily activities.
These directions relate to the improvement of the primary control – allowing the neck to be free & the head to move up as the back lengthens and widens. The words in themselves are quite inadequate without the initial manual guidance.
Alexander teachers are highly skilled diagnosticians, not of pathology but of the patterns of use that may underlie pathology.
Alexander teachers consider their role as primarily educative – symptoms such as low back pain are approached in an indirect manner, by altering the overall pattern of use.
IS THE ALEXANDER TECHNIQUE LIKE YOGA, FELDENKRAIS ETC?
The late Patrick Macdonald, one of the first generation of Alexander teachers listed the items which he believed were central to the Alexander technique.
Recognition of the force of habit
Inhibition and non-doing
Recognition of faulty sensory awareness
The primary control
I am not aware of any discipline in which all these five central points are present.
I am indeed unaware of any approach to learning, change and rehabilitation, which recognises the existence of faulty sensory perception (a phenomenon which can be easily demonstrated).
Certainly any approach to rehabilitation of back pain through educative means, or any treatment whose result depends on a change in the overall use of an individual, must take into account the insights of the Alexander technique.
Accreditation and Training of Alexander Technique Teachers
Most teachers in the world have been trained at schools approved by national societies affiliated with the original English society – The Society of Teachers of the Alexander Technique. All teachers trained at these schools have undergone a minimum 1600 three-year training course over a minimum of three years with a maximum teacher to trainee ratio of 1:5 for the practical work which takes up the bulk of the course time. A major focus of this training is on how trainees use themselves, for the ability of teachers to help others change their patterns of use is from their personal experience.
List of books and resources:
F.M. Alexander’s own books are essential reading for a in depth understanding of the technique. "The Use of the Self" is the most accessible of his books.
Alexander F.M Man's Supreme Inheritance Mouritz, London, 1996
Alexander F.M Universal Constant in Living Mouritz, London, 2000
Alexander F.M Constructive Conscious Control Victor Gollancz, London, 1987
Alexander F.M Use of the Self Orion, London, 2001
Barlow W Alexander Principle Orion, London, 2001 – (Barlow was an Alexander teacher and rheumatologist and this book looks at the technique from a reasonably medical viewpoint.)
Elizabeth Langford Mind and Muscles: An Owner's Handbook Garant Uitgevers, Belguim, 1998
Conable B How to Use the Alexander Technique Andover Road Press, Columbus, OH, 1995
Garlick Dr. D Lost Sixth Sense University of NSW, Sydney, 1990 – based on his research into the Alexander technique
Gelb M Body Learning Aurum Press, London, 1981
de Alcantara P Indirect Procedures OUP, Oxford, UK, 1997 – (an excellent look at the technique for musicians
de Alcantara P Alexander Technique: A Skill for Life Crowood Press 1999
Pierce Jones F Freedom to Change Mouritz, London, 1997
Westfeldt L F. Matthias Alexander: The Man and His Work Mouritz, London, 1998
There are a considerable number of good resources on the internet. The School for F.M. Alexander Studies web-site has links to many sites.
Contact details for David Moore: School for F.M. Alexander Studies, PO Box 2233, North Fitzroy, VIC 3068, Australia