Category Archives: Alexander Technique

Paracetamol Doesn’t Help Lower Back Pain

Millions of Days Taken Off Work for Back Pain!
According to the NHS, work-related back pain caused the loss of 7.5 million working days during just one year in 2010 – 2011 ~ and this figure is not unique, it is similar for many other years as well. That is a lot of time off work and must have a big impact on the economy, so treatments for back pain are constantly being researched.

The Lancet has just published the results of a research trial that took place in Australia, which looked at the efficacy of prescribing paracetamol for people with acute lower back pain (24 July 2014). This research was a randomised, controlled trial with over 500 subjects in each group, taken from primary care centres in Sydney and the results show that paracetamol is no more help than taking a placebo at aiding recovery from acute lower back pain! 

The findings of this research therefore ‘question the universal endorsement of paracetamol in this patient group’. This traditional way of dealing with acute back pain is shown, for instance, in the NHS Choices website which mainly advocates ‘keeping active and if necessary take over-the-counter painkillers‘.  No wonder the pain often lingers.

Causes of Back Pain

Some back pain is caused by illness or an accident but the NHS states that the majority of problems are caused by ‘bad posture while sitting or standing, bending awkwardly, or lifting incorrectly’ – what F M Alexander called ‘habits of mis-useAddressing such habits and learning to improve our body-use is a cornerstone of the Alexander Technique and it is now recommended by the NHS as a method of reducing long-term back pain. This recommendation comes as a result of the major ATEAM Research Trial in 2008 that showed lessons in the Alexander Technique were more helpful for people with chronic lower back pain than were either massage or an exercise regime prescribed by doctors.

Prevention is Surely Better than Cure.
I suggest that it would be far more helpful to use the AT sooner, in order to help reduce acute back pain before the problem becomes chronic and therefore a long-term problem. 
Even better is to learn and to use the Alexander Technique in order to let go those habits of mis-use of which we are mainly unaware, until an AT teacher can help us to recognise them, and help ourselves prevent back problems from developing in the first place.
Update

The British Medical Journal, BMJ, have published another paper by the Australian Research Team 31 March 2015. This is an overview of 15 randomised controlled research trials exploring back pain and the effectiveness of using paracetamol. 

The outcomes showed that paracetamol did not help back pain, caused liver toxicity and did not improve the quality of people’s lives! – and this is what is usually recommended as the first line of defence to help back pain!

You can read an ouotline of the findings below, as reported in the BMJ. As a result of this research, the medicines safety regulator is assessing the safety of over-the-counter drugs and the National Institute for Health and Care Excellence, NICE, is awaiting the results of the review before making any decisions about whether or not to continue recommending paracetamol for lower back pain and arthritis. It may recommend exercise instead. 

Some of this research has been in the public domain for over a year. However the ATEAM Research Trial which showed that the Alexander Technique was more helpful than exercise for lower back pain and improved the quality of people’s lives, was published back in 2008. How long will it take NICE to understand the implications of this research into the effectiveness of the Alexander Technique and to act on it by recommending AT lessons for back pain, instead of toxic drugs?


You may see the outline of the findings below:
Published March 2015 BMJ 2015;350:h1225

‘What is already known on this topic

  • Clinical guidelines recommend paracetamol as first line a
    nalgesic drug for both spinal pain (neck and low back pain) and osteoarthritis of the hip and knee

  • The evidence base supporting these recommendations has recently been called into question

What this study adds

  • High quality evidence suggests that paracetamol is ineffective in reducing pain and disability or improving quality of life in patients with low back pain

  • There is high quality evidence that paracetamol offers a small but not clinically important benefit for pain and disability reduction in patients with hip or knee osteoarthritis

  • Though high quality evidence shows that patients taking paracetamol are nearly four times more likely to have abnormal results on liver function tests compared with those taking oral placebo, the clinical relevance of this is unclear.’

 

Chilling Out in the Garden

After the Work – Enjoy your Garden

 
Now this is dedication to using the Alexander Technique Lying Down Procedure! 
 
This AT pupil kindly sent me a photo (Aug 2012) which was taken whilst he lay in semi-supine up his garden. He specifically built the little jetty over his pond, so that he can use it as a quiet place to practise the Lying Down or Constructive Rest Procedure outdoors.  
 
Whilst he is lying there he can see the fish and other wildlife living in the pond and garden – and he can also look up into a big tree above him, with sky and clouds as a backdrop. He has a beautiful view which is continuously moving, which helps him not to fix his eyes on just one point as he lies there. This will also help him to remain alert yet quietly ‘working on himself’.
 
Active Rest by pond.jpg
 
© Nicholas Franchini           Photo: Leonardo Franchini
What a great way to unwind after periods of work, sports or gardening – or just to return to a quiet place in oneself. You can find more info about using the lying down procedure here.
Now I wonder if I can create a special outdoor space for myself, where I can practise the lying down procedure with even more pleasure….

Mindfulness and the Alexander Technique

Mindfulness

 

Mindfulness is a topic that has been explored in the media of late. For instance, an article in the Sunday Times, ‘Breathe deep and mind how you go’ discussed the value of using mindfulness training as a way of helping school children who find it hard to cope with their various experiences of stress, including exams and “body image” pressures. Heads of high-performing schools are concerned at the ‘alarming rise in (pupils) suffering from mental health disorders’ and there is a move to build more resilience in children. This is admirable – but hopefully people are also addressing ways to reduce some of the pressures put upon these youngsters?

Some aspects of mindfulness training have similarities with aspects of the Alexander Technique. The Times article states that a number of schools use mindfulness training as a way of helping children ‘to act consciously and thoughtfully… rather than react with a kneejerk reaction’ and mindfulness ‘has proved effective in ameliorating young people’s mental and emotional difficulties’. This is something that is part and parcel of Alexander lessons, where we learn to inhibit unhelpful habitual reactions, so gaining more conscious control and more choice as to how we respond to situations. 

Mindfulness training in classrooms helps children learn to notice their thoughts and feelings as they sit quietly and breathe deeply. Anthony Seldon suggests that ‘Every school in Britain could begin this journey back to sanity and self control by introducing two minutes of stillness every day’. Whilst this is a great beginning, just two minutes a day does sound somewhat minimal.

 

Mindfulness in Movement – Including Breathing

 

One of the beauties of the Alexander Technique is that part of the work is learning to develop what could be called ‘mindfulness in movement’, so that we aim to live our lives and perform everyday activities, including breathing, with more awareness. Becoming aware of our breathing and just observing it, as in some mindfulness training and in the AT is one thing. Being asked to make ourselves ‘breathe deeply’, as some people advocate, is another. It very much depends on HOW we breathe, as to whether or not this is helpful or, possibly, even harmful.

F. M. Alexander known as F.M.) was aware of how schools and the army used to advocate deep breathing exercises and he wrote extensively about the pitfalls of following any routine which used end-gaining principles‘ to force the breath. For instance his paper ”The Dangers of Deep Breathing’ (1908) outlines how this frequently results in distortions and patterns of mis-use such as ‘lifting the chest and collapsing’ whilst trying to breathe deeply, which usually ’cause an exaggeration of the defective muscular co-ordination already present, so that even if one bad habit is eradicated, many others – often more harmful – are cultivated’ .

F.M. himself had breathing problems as a young man, which contributed to him losing his voice when he was reciting on stage. He described himself as breathing through his mouth so that he made audible ‘sucking and gasping noises’. In learning how to change these habits, F.M. began to develop the Technique as we know it today. Alexander was known by many as ‘The Breathing Man’ and he helped many people become better poised, with a coordinated use of their muscular mechanisms, so that their breathing could work smoothly and naturally. This is still a central part of Alexander lessons today.

 
Attention v Concentration
 

William James, an early and influential psychologist is quoted, as having stated that an education that taught people how to focus their attention would be “the education par excellence” – whilst he could perhaps be describing mindfulness training, this could also describe the Alexander Technique as well. F.M. was very keen to apply his methods to the general education of children, so that they could avoid developing bad habits that might stay with them all their lives. In 1924 the ‘Little School’ was started with

the help of Irene Tasker, a Montessori and AT teacher and the children were given Alexander Technique lessons alongside ordinary schoolwork, so that they were taught how to be aware of their psychophysical functioning – that is, their thinking and body use – throughout their school day. Unfortunately the second World War interrupted the work of this school and it was not able to be re-started after the war ended. Today, a number of schools incorporate the Technique into the curriculum to great effect, as do music and drama colleges. 

FM Alexander wrote of the problems of ‘mind-wandering’ and old habits which result in ‘thought-grooves’ but suggested that while we need to gain control of our thought processes we should ‘beware of so-called concentration‘ as it denotes conflict and leads to physical tension. 

Instead, Alexander says:

We must cultivate… the deliberate habit of taking up every occupation with the whole mind… which necessitates bringing into play every faculty of the attention’. (The Alexander Technique  – Essential Writings of F M Alexander selected by Edward Maisel 1974)

Now this, surely, is mindfulness in action and it enriches our lives.

NHS Overview of Alexander Technique

NHS Choices

It is encouraging that the NHS website includes an overview of the Alexander Technique in the ‘Choices’ section of the site. This gives a description of the AT and also includes details of some research studies which have investigated aspects and outcomes of having Alexander Technique lessons. 

NHS Choices states that there is evidence the Alexander Technique may help to relieve long term back pain and acknowledges that there is preliminary evidence to suggest it may help with Parkinson’s Disease, depression, avoidance of falling, improving respiratory function and stuttering. 

Anecdotal Evidence and Support from the Scientific Community.
There has always been support for the Alexander Technique from members of the medical profession and the scientific community. When F M Alexander was developing the Technique in the 1920’s, he had the support of eminent scientists such as the psychologist and educational reformer Prof John Dewey, the anatomist Prof Raymond Dart and the neurophysiologist Sir Charles Sherrington. When F M was establishing his first teacher training course in 1930, he was also supported by a large number of doctors who respected and valued his work. Still later in 1973 when Nikolaas Tinbergen became Nobel Laureate for Physiology and Medicine, he devoted a section of his acceptance speech to describing the benefits of the Alexander Technique.  

There is by now a wealth of anecdotal evidence re the benefits of learning the Technique, such as can be seen from the Testimonials section of my website. Conditions which people mention as having improved with learning the AT include:

  • Back Pain
  • Headaches
  • Mood swings
  • Posture
  • Repetitive Strain Injuries
  • Stress
  • Whiplash

Students also found AT lessons aided: recuperation; reduction in the use of pain relief medication; pregnancy and childbirth; general wellbeing; confidence; musical performance; running marathons! These are just some of the ways in which people have found the AT has helped them and an exploration of the literature available about the Alexander Technique will reveal many other conditions, activities and lifestyles that have benefited from the application of AT work.

Research based Evidence 

As yet, only some aspects of the Technique have been researched and only a few large scale clinical trials have taken place but an increasing amount of research is being undertaken to investigate the effectiveness of the Alexander Technique.  The NHS considers some of these studies robust enough to scientifically support the claims that both Alexander teachers and their pupils have made about the Technique and includes references to these in their article, including the ATEAM Trial  in which the AT came out as the most effective treatment for patients with chronic and recurrent back pain.

If you would like to find out more about more research that has been done, The Society of Teachers of the Alexander Technique website lists a much wider range of studies than does the NHS site, including the major studies and some of the small scale preliminary ones which have begun evaluating the Technique. These studies indicate a wider range of possible benefits to be gained from taking AT lessons and further research into these topics would be advantageous. Of course funding is an issue as large scale clinical trials are costly but STAT’s Research Group is keen to support and promote further AT research within academic institutions.

Sitting Can Damage Your Health

The Health Hazards of Sitting


This is the title of an article in the Washington Post which aims to address some of the health problems associated with sitting, particularly for long periods of time. Whilst many of these problems were familiar to me as an Alexander teacher, I was rather surprised when I saw that over-sitting increases your risk of mortality. 

A research study of people watching TV over a period of 8.5 years, showed that those who watched for 1-2 hours a day had a 4% risk of dying, whereas people who watched 5-6 hours had a 31% risk – and over 7 hours a day resulted in a massive 61% risk of dying. Of course many office workers also sit at their desks for over 7 hours a day – so beware.

Some of the health hazards listed that are associated with too sedentary a lifestyle are organ damage, poor circulation and brain function, muscle degeneration, soft bones, strained necks and bad backs. Quite a list!

What Can We Do to Avoid Problems?

So what does the article suggest people can do about this if they have to sit or use desks for long periods of time? Some gentle exercises are mentioned and these may well help, depending on how they are performed.

One suggestion is to sit on something wobbly (intentionally wobbly, that is).  I understand Google has supplied them for their staff to use, which is great. I must say I do love sitting on my exercise ball whilst computing and I am doing so right now.

I agree that using a ball in this way can help us stop fixing our bodies which in turn helps to keep our musculature active and flexible – and it’s hard to slump when sitting on a ball. But some people start locking their hip and leg muscles when on the ball, perhaps because of fearing falling off, so it can help them to learn how to avoid that tension reaction and allow themselves to sit freely, despite the constant movements. Balls can also be used for gentle exercises and for having a good stress-busting bounce occasionally (like a grown-up Space Hopper). 

Another good suggestion the article made is to use desks that enable people to alternate sitting and standing. One of my pupils had an adjustable desk at work and it did help her manage her back pain – but of course she also had to learn new ways of sitting, standing and moving around in order to make best use of this facility because previously, using the desk on its own had not get rid of her back pain. That’s where learning the AT can be so very useful, because applying the AT whilst working and living her life, my pupil gradually got rid of her debilitating back problems and then joined a dance class for fun – she could not have done that before!

The article also illustrates some of the impacts of slumping at a desk and makes it very clear how unhelpful this can be, showing a woman sitting in a collapsed position. However, the text here is somewhat misleading as it seems to suggest that we avoid using our sitting bones:

People who sit more are at greater risk for herniated lumbar discs. A muscle called the psoas travels through the abdominal cavity and, when
it tightens, pulls the upper lumbar spine forward. Upper-body weight rests
entirely on the
ischeal tuberosity (sitting bones) instead of being distributed
along the arch of the spine. 

But we do need to sit on our sitting bones! The main illustration in the article, of the slumped woman, does show too much weight going through the rear part of the sitting bones, which is not helpful and would be likely to cause lumbar back pain. However, if the pelvis were realigned to be more upright, the weight could be distributed through the spine, then transferred through the pelvis and into the central part of the sitting bones, or into the legs if standing.  

Strangely, the illustrations showing people the ‘correct’ way to sit and stand, omit showing the pelvis and sitting bones altogether, so the person appears to be finely balanced on thin air and the tiny coccyx. 

“There’s No Such Thing As A Right Position” FM Alexander

It is so easy to fall into wanting a quick fix and assume that standing or sitting up straight for sensible amounts of time and then taking exercise, will solve all problems. Well, while this strategy may help a bit, it’s quite possible to sit and stand in a rigid manner, for instance, which can build up tensions, restrict our breathing and may lead to other problems in the future. Stiffening like this is tiring and people usually can’t keep it up for long.

As Alexander himself put it when teaching:

I am putting into gear the muscles that hold you up, and you are putting them out of gear and then making a tremendous effort to hold yourself up, with the result that, when you cease that effort, you slump down worse than ever”. (FM Alexander Aphorisms) 

So it is not just about the positions we sit and stand in, but the manner in which we use our bodies during our activities that makes the biggest difference of all. We can learn to be aware of our body use, gradually putting our muscles ‘into gear’ so we find an easier and more balanced way of sitting and moving around that enhances, not damages, our health.

Applications of the Alexander Technique: Luggage

Everyday Activities:- Pulling a Case or Trolley

 
One of the activities that people sometimes ask to explore as part of their Alexander lesson is “How is the best way to pull luggage around and avoid getting backache?”
 
These days we are fortunate to have roller luggage and laptop cases that dramatically redce the weight that we have to deal with when travelling and commuting. Despite this, many people still end up with back ache or sore shoulders after pulling bags around, so it is really helpful to think about how to apply the AT to this and other everyday activities. 
 
As usual, it is important not to assume that good equipment will solve the problem on its own – we still need to think about the way we use ourselves as we manoeuvre heavy cases through crowds of people…..
 
We can learn a lot from the way this little girl is moving. She is alert, poised and aligned; her head is balanced as it leads her into movement; her upper chest widens out comfortably as her right arm reaches back and pulls the handle of her trolley. This child is not consciously aware of how she is using her body. However, as we get older we can learn to develop mindfulness and be aware, so we can give ourselves more choice as to how we move and act in the world.
 
Child with trolly .jpgAwareness and Choice
 
Some frequent but unhelpful habits to notice and to ask yourself about:
  • Do I hold the luggage handle at the right height for me?
  • Do I twist my torso as I drag the luggage behind me?
  • Do I pull down on one side of my body?
  • Do I rush through stations and airports tensely, carelessly, or with awareness?
  • Do I grab the luggage, or thoughtfully take hold of it – and how do I lift it?
  • Do I remember to stop and think before pulling or lifting something heavy – am I evenly balanced with a lengthened spine when I move or lift?
When you develop this type of Alexander Technique self-awareness, you can begin to answer some of these questions, so that you can have more choice about how to perform any activity. By  taking a moment to think about your body use and applying the AT to something like pulling your cases, you can help yourself avoid over-tiring, straining or even damaging your neck / back / hands / arms as you travel around. This process of noticing unhelpful habits can be easier with your AT teacher and some fruitful work can be done with this sort of topic in Alexander lessons

Improve Your Sleep

How Much Sleep do We Need?

An episode of the TV programme ‘Trust Me I’m a Doctor’ discussed the issue of sleep and an experiment that researched the question of how much sleep people need. It has been shown that people who have six hours sleep were sleep deprived and did not function as well when performing mental tasks, as those who had seven hours sleep. Also, that tests revealed a number of genes related to illnesses such as heart disease, were found in greater numbers in those research subjects that had less sleep. So it is obviously a good idea to aim to have at least seven hours sleep, in order to remain in good health.

It wasn’t just the length but also the quality of sleep that was discussed. High levels of alcohol can disturb our sleep and using computers which produce a blueish light from the screen late in the evening tends to over-stimulate our brains, resulting in poor sleep. Apparently you can download an App that changes the temperature of the screen to a more yellowish glow, which is less stimulating, so computer users might like to try that to see if it helps.

Improve the Quality of Your Sleep with the AT

There were not many suggestions on the programme as to how we can go about improving the quality of our sleep. However, there was a moment of synchronicity for me, as so often happens, when an AT pupil of mine came in the next day talking about the same issue (not having seen the programme). He said that since he started having Alexander lessons, ‘The quality of my sleep is much better and I’m less stiff in the mornings’.

You may ask, why is this? The fact that he is thinking more and more about the AT during his working day and that he regularly uses the lying down procedure, means that he is less tense and stressed at the time of going to sleep than he used to be. Using the lying down procedure just before going to bed can help us let of of the day’s tensions and can set us up for sleep. This allows us to enjoy a deeper and more refreshing sleep without the help of any drugs, which is great.

Unwinding

Many people ask me ‘what’s the best way to sleep?’ and I think this is a difficult question to answer as many people find they can only fall asleep in one particular position. Sometimes these positions may be very tightly curled up and actually cause discomfort by the morning.

How do you sleep? If you curl up tightly, the first thing you can begin to change, is to allow your body to soften and lengthen out within the position you are used to then, over time, you can learn to adapt how you go to sleep. Lying on the back allows your body to unwind and lengthen out without putting pressure on shoulders, your neck or your lower back – but don’t lie in semi supine to sleep, as bent knees will restrict the circulation in your legs if you stay like this for too long.

As you begin to drop off to sleep, you can think of your body becoming softer, freeing up your muscles and allowing yourself to unwind and lengthen out, taking a lovely gentle quietness with you as you drift off – you will probably sleep a lot better as a result.

Alexander Technique Helps Accidents and Shock

Using the Alexander Technique Helps with Accidents and Shock


Two of my pupils have. unfortunately, had accidents recently in which they fell and experienced shock as a result.  Sensibly, both of them used the Alexander Technique to help them handle the situation and found that it was very beneficial and reassuring to use.

Concussion and Shock

The first to fall was a woman in her 60s, who who fell in the Paris metro and the doors struck her head, giving her concussion and she experienced a shock reaction. However, whilst she was receiving first aid and then whilst waiting in A & E, she began to use the AT in order to help herself return to a calmer state and to avoid tension building up. The AT helped when she was left alone for some long time, as she waited for a consultant to examine her and she was wondering just how bad her injury was. 

She was diagnosed with a sub dural haematoma, which is a serious condition as it is a bleed between the brain and the surrounding membrane, so she was kept under observation in the intensive care unit for a couple of days.  During this time she was propped up in a sitting position in her bed and was unable to move around. However she often reminded herself to allow her neck and body to freely release and lengthen out again and she used the AT to help her to be more comfortable.    

Once out of hospital, my pupil experienced a number of headaches and was unable to lie down or bend over for some time, but she could keep working on herself with AT whilst sitting up and she found she could comfortably and safely use monkey position instead of bending right down, which would have put pressure on her healing wound.  I am glad to say that she has made a full recovery and has been given the ‘all clear’.

Falling from a Bike

My second pupil had a fall from her bike – on the way to her AT lesson with me! Her face was bleeding, her head had been knocked and she felt shocked and ‘shaken up’.  Unfortunately she had to miss her lesson as she needed to go home and possibly the doctor. I encouraged her to use the lying down procedure when she got home, in order to both calm her nervous system and to help her re-align herself.  I was glad to hear later that lying down in ‘semi supine worked wonders’ and she was later able to take herself into work.

Using the AT in this way, immediately after an accident, can be really valuable. I remember one of my AT teachers telling me how he had been thrown from a horse and he was very worried about the impact the fall had had on him. As soon as he got home he lay down and worked on himself in semi supine for an extra-long time and when he got up, he found he actually felt OK once again.  

Alexander Technique as part of Your First Aid Kit

As Alexander teachers, we are used to working with people who are recovering from accidents, injuries and illnesses and we know that AT lessons can help people a great deal. It is also important to remember that we can use the AT as part of our first aid kit and that using the lying down procedure, or simply using the AT in whatever circumstances we find ourselves in, can immediately begin to calm the nervous system and we can use AT to help our body to re-align itself  – and in so doing, we can aid our recovery. 

It is also reassuring to know that we have a tool that we can use to help ourselves with, both in emergencies and in the long term – and this can help to empower us in crisis.

Elisabeth Walker

Elisabeth Walker ~ December 1914 – 17 September 2013

 
It is with great sadness that I heard of the death of Elisabeth Walker, an inspiring teacher and the last of the first generation of AT teachers who trained with F M Alexander himself.
 
Elisabeth ran an AT Teacher Training course in Oxford for many years with her husband Dick Walker and she was a guest teacher and speaker at many international Alexander Conferences and events. Her fascinating memoir ‘Forward and Away’ shows us just how important her family and her life as an Alexander Teacher were to her. Thankfully we can still watch a valuable record of her teaching on various videos on YouTube.
 
In 2004 an extremely youthful Elisabeth Walker attended the 7th Alexander Technique Conference in Oxford and was seen cycling to and from the Conference each day – at the age of 90!
 
Elisabeth Walker.jpg
 
Elisabeth will be missed by many people and I would like to offer my condolences to her family, particularly to Lucia Walker and Julia Cowper, who are both Alexander teachers. There will be a memorial and celebration of her life, some time next year.
 
Elisabeth
will be buried at Westmill Woodland Burial Ground on Friday 5th October.  

Alexander Technique Videos

YouTube as an AT Resource


I have just been watching ‘A Conversation With Marjorie Barlow’ on YouTube and it was good for me to be reminded of the wonderful AT lessons I had with this ‘first generation’ teacher. I also realized yet again just what a valuable resource YouTube can be for people interested in the Alexander Technique. There are videos suitable for complete beginners, right through to videos that are a useful resource for teacher trainees and experienced AT teachers.

Marjorie Barlow was F M Alexander’s niece and she trained as an AT teacher with FM himself. Later, she was one of the first people to start training AT teachers and she ran a training course for many years with her husband Dr Wilfred Barlow.  

In the video, Marjorie Barlow maintains her quiet poise throughout and her face frequently lights up with smiles and laughter as she shares some of her extensive knowledge of the Technique.  She stresses how important it is for each of us to ‘think in activity’ and that using the Technique is an attentive process. Whilst she encourages people to apply the Technique to many activities and acknowledges that each teacher will bring their own personality and experiences to the work, Marjorie Barlow encourages us to maintain the Technique in a ‘pure’ form and not to mistakenly ‘throw the baby out with the bath water’ by diluting it too much – something I very much aim to do in my own teaching.

This YouTube video is particularly valuable for teachers or anyone thinking of becoming a trainee.