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RSI and the Alexander Technique

November 19, 2002

"Last March I was diagnosed by a GP as [having] tendonitis. I am an amateur musician and my day job puts me in front of a computer all day long so, I am in a couple high risk groups. A musician friend told me about the Alexander Technique, I got on the web ... and in three weeks I was at the five day course. I am at this point playing music as much as I like and am virtually free of symptoms. The Alexander Technique helps you to understand how you were misusing your self to cause the condition in the first place. This awareness will probably be different for each individual. Specifically it allows me to use a lot less tension while playing music, washing dishes, typing at the computer, and almost everywhere else. Because my arms are relaxed while I play I can play much better then before I got tendinitis. I can type faster. If I notice tension building in my arms, it is also building in my neck[1]

 

The Alexander Technique was formulated in Melbourne in the 1890s by a young Tasmanian actor named Frederick Matthias Alexander, to alleviate the chronic hoarseness that he had developed as a result of projecting his voice on stage. Having had medical tests that revealed no underlying pathology and advice and exercises from voice experts that had failed to help him, Alexander reasoned that he must be misusing himself in some way that created the irritation of his vocal folds. He thought that if he could discover what it was that he was doing wrong, and stop doing it, he would be able to correct his problem.

 

With the aid of mirrors Alexander soon discovered what he believed to be the cause. He saw that when he projected his voice, he also contracted his neck and pulled his head back, while at the same time jutting his chin forwards and thereby putting pressure on his larynx. Furthermore this tightening in the head and neck was echoed by contractions throughout his body, along with disordered breathing. He found that this pattern of use was so intensely associated with the projection of his voice that breaking this association was initially almost impossible. However, with time and persistence he was able to successfully change his posture and breathing, and subsequently his voice returned.

 

Alexander then went on to use the Techniques he had developed to work with other actors and professional voice users. Over time he became extremely skillful in guiding people away from their negative postural patterns, and the health benefits of his technique were quickly recognised, not just for vocal and breathing problems, but for all kinds of physical difficulties. Before long a number of doctors in Melbourne, and then Sydney when he moved there, were sending him patients.

 

A doctor friend advised that Alexander needed to establish himself at the "centre of the world" in order for his technique to be well known, so Alexander moved to London in 1904 where he built up a teaching practice, and his students included a number of leading actors, politicians, scientists, writers and doctors. In 1931 he set up the first school to train Alexander Technique teachers. Since his death in 1955 a large number of training courses have been established in many countries through out the world, and national societies have been set up affiliated to the original British society, The Society of Teachers of the Alexander Technique.

 

Today Alexander Technique is well known in sports and performing arts circles as an effective way, not only to treat pain and injury, but to enhance performance. For most people it has a reputation as a form of "posture training", as well as being an efficacious treatment for back and neck problems and - perhaps most particularly - RSI.

 

Repetitive Strain Injury (RSI)

 

The widespread use of computer keyboards has led to a growing awareness of a set of muscular-skeletal problems known generically as repetitive strain injury (RSI). This term is often used to cover a wide variety of syndromes including carpal tunnel syndrome, tendinitis, bursitis, tenosynovitis, tendonitis, De Quervain's syndrome, thoracic outlet syndrome, myofascial pain syndrome, trigger finger/thumb and intersection syndrome. Symptoms include pain in the arms, wrists, elbows, hands neck or shoulders; heaviness, tingling, swelling or weakness in the arms hands or fingers; lack of coordination in the use of hands and fingers; bluish colour in the fingers and fluctuation of temperature in the hands. The onset of debilitating symptoms is frequently sudden, occurring after a period of intense work combined with stress; although, for most people, underlying discomfort would have been present for some time prior to this.

 

RSI is not a recent phenomenon. Historically people whose work involves repetitive movements, such as fish filleters, weavers and factory workers, have long been vulnerable. Musicians in particular tend to suffer from a wide range of symptoms and have done so for many centuries. In the past the The careers of many talented musicians have been aborted by injury.

 

However, as knowledge of RSI has become more prevalent, many people are aware that seeking treatment earlier, or ceasing certain aggravating activities, will avert total incapacitation. If people can learn to change their patterns when they experience mild discomfort, then they can normally manage to continue their work. However for those who reach the chronic stage, continuation of normal activity becomes impossible and the process of healing can take one to two years.

 

Using the Alexander Technique for RSI

 

Let's look at "Bill". He was both a guitarist and a web designer and when I first saw him he was suffering from almost all the symptoms I mentioned before. From past experience I knew that, having reached this stage, we would be looking at a period of about two years to overcome the problem. Initially the process was complicated by the conflicting advice Bill had received from his physiotherapist, as well as his own "common-sense" beliefs about what was required - that he needed to sit and stand "straight". He achieved this by pulling his shoulders back which effectively pulled his head back and narrowed his back, particularly between his shoulder blades.

 

This advice fitted in with his own faulty sensory perception and sense of what was right, whereas where I was guiding him felt completely wrong. As Alexander said in another situation "He gets what he feels is the right position, but that only means that he is getting the position which fits in with his defective coordination." The fact is that a pose of ease and balance is exactly what an RSI sufferer is unable to attain. They can either slump or "sit up straight", both of which will incoordinate discoordinate the body and aggravate the pain. What is required is a re-education of the sensory and motor cortex to establish the pathways for a healthy coordination of the body.

 

We began with lessons two or three times a week. Initially I did a fair amount of work with Bill, getting him to lie on the table to help undo the overall contraction. At this point I have to say that Alexander Technique work is quite unlike either massage or manipulation. It involves the teacher very gently helping the student to gain length and expansion throughout the body, beginning with an opening, lengthening and releasing of the neck and back. This needs to be done with care because, for people with severe RSI symptoms, opening too fast can easily aggravate symptoms. We also looked at coordinating the body when standing, sitting and walking. Eventually we moved on to include handling and playing a guitar, and sitting at a computer.

 

Concepts of Alexander Technique

 

In this article I will talk a lot about use, which in Alexander terms refers to the totality of our functioning, that is: the way we think, the way we move, our posture and our reactions. The way we use ourselves affects the way we function - in Alexander's case, the way he used his body, caused his loss of voice. If we misuse ourselves we create discomfort, pressure, pain or disease. Undoing faulty patterns of use allows the natural healing processes to work.

 

If a person's use of their body is faulty their breathing will also inevitably be faulty. In my experience people suffering from RSI almost always have habitual abdominal tension which restricts their breathing. This then promotes a pattern of shallow chest breathing punctuated by the occasional conscious deep breath. In Alexander work, the teacher is always aware of the student's breathing, but does not necessarily address this directly - if the abdominal tension and the associated pattern of misuse can be altered then the breathing will also change, without recourse to breathing exercises.

 

In Bill's case for example, his pattern of breathing was also seriously disturbed, as is always the case with faulty use. The breathing was mostly shallow chest breathing, but Bill frequently used conscious breathing to "relax", a breathing style that was just as problematical as his attempt to have a "straight" back.

 

One of the beliefs of Buteyko - whose breathing exercises have proved to be efficacious in the control of asthma - is that asthmatics "over breathe" and in doing so over-oxygenate the blood, and create an acidic system. This creates a predisposition, not only to the inflammation of the airways associated with asthma, but also to a large range of other disorders.

 

It is my hypothesis that the inflammatory condition that Bill was suffering from was aggravated by this faulty breathing. Certainly 95 per cent of the RSI sufferers I have worked with have had distinct abdominal contractions, preventing the full range of movement of the diaphragm and predisposing them to shallow chest breathing. The Alexander Technique differs from the Buteyko method in that faulty breathing is recognised as a symptom of faulty use, to be dealt with indirectly rather than by the practice of exercises.

 

One of the aims of the Alexander Technique is psychophysical unity. Alexander's initial belief when he treated himself was that he was suffering from a "physical" problem. However, his investigations soon led him to the conclusion that there was no such thing as a purely physical or purely mental problem. Even the simplest action of raising an arm relies on the interaction of the nervous system and muscles. Particular muscular or physical restrictions in the movement of the arm will be related to dysfunctional messages from the nervous system, related to faulty sensory perception.

 

Alexander was also interested in stimulus and response. He said, "You are not here to do exercises or to learn to do something right, but to be able to meet a stimulus that always puts you wrong and to learn to deal with it."[3] When he experienced voice problems, his response was to contract his whole body in a way that put the maximum amount of restriction in his vocal folds. Similarly, a writer faced with a deadline may respond by creating the maximum amount of psychological and physiological tension conducive to the creation of or aggravation of RSI. The way Alexander overcame this problem was to change the ingrained response to the stimulus. For example, it has been observed that in people with quite severe RSI, just the act of sitting down in front of a computer - without doing anything else - may be enough to set off their symptoms.

 

One of the primary features of the Alexander Technique is its emphasis on undoing, or inhibition. The gap between the stimulus and response is the critical moment of potential freedom from our habits; therefore learning to inhibit response is critical. Whilst most methods of dealing with voice problems, back pain or RSI depend on the practice of exercises to "strengthen or relax the muscles, the vocal mechanism or breathing, the Alexander Technique focuses on undoing the set of mind and muscles in response to a stimulus to act.

 

"The belief is very generally held that if only we are told what to do in order to correct the wrong way of doing something, we can do it, and that if we feel we are doing it all is well. All my experience, however, goes to show this belief is a delusion"[4] Faulty use is invariably associated with compromised functioning and faulty sensory perception - the inability to sense accurately what one is doing with oneself. It is the universal experience of Alexander teachers that when they manually guide many of their students into what is a more coordinated posture or movement that the students feel completely wrong - quite out of alignment. This has important consequences if such students undergo a series of "corrective" exercises to try to overcome their problems. If these exercises are carried out in correlation with their faulty sensory perception they are just as likely to reinforce the faulty patterns of movement that have caused the problem in the first place. Even if they do relieve the problem to some extent, they may well set the exerciser up for other problems.

 

Alexander Technique teachers work indirectly with their students. Their primary aim is not to cure particular symptoms, but rather to restore accurate sensory perception. Accurate sensory perception is essential for good coordination and good coordination is essential for overall functioning. In Alexander's case the restoration of good coordination not only resulted in the cessation of his voice problems but also of his long-standing respiratory ailments which he had suffered from since childhood.

 

"There is no such thing as a right position, but there is such a thing as a right direction."[5] Faulty sensory perception, and the consequent dysfunctional messages sent by the nervous system to the muscles can impact negatively on the functioning of the voice, breathing and musculo-skeletal system. These unconscious "directions" also relate to our overall stress pattern. In fact the bodies of people with musculo-skeletal problems are held in a chronic pattern of tension. Alexander often referred to this chronic pattern of tension as being a manifestation of "unduly excited fear reflexes." By observing himself in a mirror to see what might be affecting his voice, Alexander developed a series of conscious "directions" which would move his body out of its habitual pattern of contraction. These involved moving his head "forwards and up" rather than back and down, in a way that allowed his whole back to lengthen and widen whilst undoing any downwards pressure through the legs or shortening and narrowing the shoulders. It is impossible to satisfactorily explain these directions in writing. As Alexander said "I think them inadequate, but with a teacher present to demonstrate in person what he means by them they serve their purpose."[6]

 

In the process of regaining his voice Alexander found that the very thought of projecting his voice created the habitual tightening reaction. The more he tried to project his voice, the more he tightened. What he had to do instead was to take the focus off the end (projecting his voice) and instead attend to the means he was using. This involved inhibiting the habitual reaction and sending his conscious directions to the whole body to create the conditions for his voice to be free. The same principle is applied in all activities using the Alexander Technique.

 

 

Stefan

 

I applied these concepts to my work with "Stefan", a student of guitar, who had to give up the performance part of his course due to debilitating shoulder pain whilst playing. Unlike Bill, Stefan had not progressed to the point where the pain affected every other aspect of his life, but obviously the inability to continue with his course was a severe blow. In working with him we looked at guitar playing almost from the start. He exhibited considerable extra tension whilst playing, manifested by a collapsed torso, tight jaw and shoulders and restricted breathing. By the application of the Alexander directions first of all guided by a teacher, and then applying the directions himself not only did this extra tension dissipate, but a clearly audible improvement in the tone of the playing resulted.

 

Now, six months later and back at school, Stefan says: "Not only has the application of the technique dealt with my RSI, but my overall playing and technique is much improved. In particular the ability to express musically has much improved. I believe that the Alexander Technique should be an essential part of any musical training."

 

 

Alexander Technique Lessons: Treatment or Education?

 

The Alexander Technique rather uneasily straddles two different paradigms. Is it therapeutic or educational? Alexander refers to his area of expertise as being "therapeutics".[7] More frequently, however, he refers to his work as educational. Alexander explains the conditions necessary for the work to be successful. "There must be a clear realisation by the pupil that he suffers from a defect, or defects, needing eradication. In the second place, the teacher must make a lucid diagnosis of such defects and decide upon a means of dealing with them. In the third place there must be a satisfactory understanding between the teacher and pupil of the present conditions and the means proposed to remedy them."[8]

 

An Alexander teacher will guide the pupil with both verbal instruction and manual guidance, into a more effective manner of use. Often the movements will be common everyday ones like sitting, standing, bending and walking. The teacher will also look at activities the pupil may be having problems with, or wishes to refine and develop - whether they be vocalising, working at a computer, playing an instrument or swinging a golf club. Very frequently the way in which the pupil needs to move will seem to him or her completely wrong, due to the influence of faulty sensory perception. Gradually neural pathways will be developed to perform movements in a manner that was previously impossible and the pupil will develop the ability to take this learning into his or her everyday activities.

 

The Alexander Technique has no set of exercises to give people. In the beginning it is a matter of working out what people are doing that is interfering with optimal functioning and asking them to not do that. As such it poses a particular challenge to our normal way of approaching problems where we look to do something to make a change. The concept of non-doing for many people requires a major conceptual and behavioural shift.

 

"Beth" experienced a whiplash injury a year ago, and had suffered constant neck and shoulder pain since then, which was now associated with pain radiating down one arm when she worked on the computer, which she did for several hours a day with her job. She had undergone a considerable amount of physiotherapy and had begun a Pilates exercise program.

 

In the first lesson we looked at what Beth did with herself especially in sitting at a computer. We used a mirror so that she could compare what she felt she was doing with herself with what she was actually doing. Her attempt to sit correctly which she felt would be good for her was especially tense. When I guided her with my hands to let go of this tension she felt completely round-shouldered. However she could see in the mirror that she was not round-shouldered, and also she could feel that this "round shouldered" feeling was associated with a considerable lessening of the pain.

 

I saw Beth two weeks later. She had let go of much of the holding she was doing and had gone a little too far in the other direction, but her neck and shoulder pain was considerably less and there had been no further pain in her arm. We are now continuing with weekly lessons so that she can gradually develop a balanced way of using herself in all activities

 

 

Conclusion

 

The cases I have mentioned refer to people who have had good results from the Alexander Technique. This does not mean that I have been able to help every person who has come to me with RSI. The Alexander Technique is primarily aimed at re-education and, as these cases demonstrate, each student took an active part in their process of recovery. In severe cases I have worked with people for two or more years with gradual improvement, along with the odd relapse, before the problem has been overcome. What the technique can offer is a missing link which gives people the tools to work on themselves. In particular if people cannot sense accurately what they are doing with themselves then they cannot change what they are doing with themselves.

 

As in the case of many illnesses a case of RSI forces a person to confront what they are doing with themselves on many different levels. The use of oneself relates not only to the physical movement and postural sets but also to the accompanying psychological and emotional patterns. People who are not happy at the work they are doing are less likely to improve. Musicians who have put many years into honing their skills, and those doing work which they enjoy, are frequently highly motivated to be able to continue the work they love. In the case of people doing work they are unhappy with, a change of occupation may be the largest single factor in overcoming RSI (not to mention a whole range of other disorders.) Mental attitude is a crucial variable and in some cases psychotherapy may be a useful or even essential adjunct along with the Alexander work.

 

People coming to Alexander Technique to recover from RSI or other conditions will often find a whole new universe opening up to them. As the two musicians above have indicated, not only was their RSI dealt with, but their playing also improved. Learning Alexander technique allows people to gain a whole new area of awareness, and gives them more scope and flexibility in every area of their lives.

 

For Information on research and scientific aspects of the Alexander Technique Scientific Research: this is a far from complete overview of scientific research on the Alexander Technique

 

Mouritz Archives of articles and papers on the Alexander technique between 1923 and 1960 contains many letters and some articles for the British Medical Journal and many other medical publications.

 

The Lost Sixth Sense: A medical scientist looks at the Alexander technique. Dr David Garlick. 1990 Dr Garlick at the University of NSW has done a good deal of research on the physiological aspects of the Alexander Technique. He has also published a series of articles in Direction, an international magazine of the Alexander Technique.

 

 

Recommended Reading
 

Alexander, FM Use of the Self, Orion, London, 1932.

De Alcantara, P Indirect Procedures: A Musician's Guide to the Alexander Technique Oxford University Press, Oxford 1997

Barlow, W Alexander Principle Orion, London 1973

Garlick, D Lost Sixth Sense Laboratory for Musculoskeletal and Muscloskeletal and Postural Research, School for Physiology and Pharmacology, University of NSW, Sydney 1990

Gelb, M Body Learning, Aurum Press, London 1981

Pierce Jones, F Freedom to Change, Mouritz, London, 1976.

Westfeldt, L  F. Matthias Alexander: The Man and his Work Mouritz, London 1998

 

[1] Quoted from alextech-list@alextech.net. First Person experience: Alan

This is an email posted on an Alexander technique email list in September 2001 in answer to a question about tendinitis, which gives a very good picture of the development of and different approaches to RSI along with the place of the Alexander technique in an intelligent approach to dealing with the problem. Alan's experience of his musicianship actually improving as a result of Alexander lessons is a very common one

 

[2] Alexander, FM, Articles and Lectures, Mouritz, 1995, p. 101.

[3] ibid., p. 203.

[4] Alexander, FM, The Use of the Self, Orion, London, 1932, p. 33.

[5] ibid., p. 194.

[6] Alexander, FM, Constructive Conscious Control of the Individual, Gollancz. London 1987 p. 108.

[7] Alexander, FM, Man's Supreme Inheritance, Mouritz, London 1957 p. 53.

[8] ibid., p. 55.

 

 

 

 

 

 

 

 

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