The Alexander Technique is an educational method, not a health-care intervention. Alexander teachers do not diagnose medical conditions, nor do lessons typically target specific medical problems. Lessons teach cognitive and attentional strategies that help cultivate postural skill. As a result, Alexander teachers traditionally conceive of health benefits as a side-effect of effective learning, rather than the goal of instruction.
However, one of the most common reason people study the Alexander Technique is to overcome or cope with chronic pain. A 2015 survey of Alexander teachers and their students in the United Kingdom found that:
Nearly two-thirds (62%) of people began Alexander Technique lessons for musculoskeletal reasons, including back symptoms (22%), posture (10%), neck pain (10%) and shoulder pain (6%). The next largest category of reasons was ‘‘General’’ (18%), including general interest in the Alexander Technique, general well-being, tension release and generalised stiffness. Other reasons given included performance (10%), psychological (5%), and neurological problems (3%). (Eldred, J. et al. p. 456)
Since health benefits are experienced by students of the Alexander Technique, AT can be assessed like any intervention, whether educational or therapeutic. If high quality clinical trials establish that the Alexander Technique is effective for particular conditions, then the Alexander Technique may be prescribed by health-care providers.
A Systematic Review of Research on Health Benefits of the Alexander Technique
A systematic review is an article that attempts to provide a complete summary of current literature on a research question. In 2012, Woodman and Moore published a systematic review of research on the effectiveness of Alexander Technique lessons for medical conditions. Systematic reviews have rigorous inclusion criteria. Of 271 publications identified by the authors, 18 met the criteria, including three randomised, controlled trials (RCTs), two controlled non-randomised studies, eight non-controlled studies, four qualitative analyses and one health economic analysis. Woodman and Moore concluded:
Strong evidence exists for the effectiveness of Alexander Technique lessons for chronic back pain and moderate evidence in Parkinson’s-associated disability. Preliminary evidence suggests that Alexander Technique lessons may lead to improvements in balance skills in the elderly, in general chronic pain, posture, respiratory function and stuttering, but there is insufficient evidence to support recommendations in these areas.
Randomised Control Trials
Randomised Control Trials (RCTs) are often referred to as the gold standard for clinical research, and successful results on RCTs are most likely to shift medical practice. RCTs require considerable resources and are often run by experienced research teams. In traditional medicine, RCTs are often funded by the pharmaceutical industry or through government grants. (Woodman, 2015.)
Woodman and Moore’s 2012 systematic review highlights two randomized control trials.
Little, P., Lewith, G., Webley, F., et al. (2008) Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain. British Medical Journal. 337, a884-a884. doi: https://doi.org/10.1136/bmj.a884
One to one lessons in the Alexander Technique from registered teachers have long term benefits for patients with chronic back pain.
Stallibrass, C., Sissons, P., Chalmers, C. (2002). Randomized controlled trial of the Alexander Technique for idiopathic Parkinson’s disease. Clin Rehabil. 6(7), 695-708. doi:10.1191/0269215502cr544oa
There is evidence that lessons in the Alexander Technique are likely to lead to sustained benefit for people with Parkinson’s disease.
Since the publication of the systematic review, one notable clinical trial has demonstrated the effectiveness of AT on reducing both chronic neck pain and the use of painkillers for neck pain:
MacPherson, H., Tilbrook, H., Richmond, S., et al. (2015). Alexander Technique Lessons or Acupuncture Sessions for Persons With Chronic Neck Pain. Ann Intern Med. 163(9), 653. doi:10.7326/m15-0667
Basic Research with Clinical Implications
As noted above, the criteria for systematic reviews eliminates many kinds of research, including basic research. While the RCTs listed above aimed at establishing whether the Alexander Technique had a therapeutic effect for back pain, neck pain, and the symptoms of Parkinson’s Disease, the trials did not try to establish why the Alexander Technique might be effective—i.e. the underlying mechanisms. The following studies included specific measures associated with changes in symptoms for back pain, neck pain, knee pain, and Parkinson’s Disease, which may be suggestive of the underlying mechanisms involved in possible therapeutic effects:
Becker JJ, Copeland S, Botterbusch E, Cohen RG. (2018). Preliminary evidence for feasibility, efficacy, and mechanisms of Alexander technique group classes for chronic neck pain. Complement Ther Med. 39 (pp. 80-86). [PubMed]
Reductions in neck pain associated with reduction in engagement of superficial muscles of the neck after group AT classes.
Preece, SJ, Jones, RK, Brown, CA, Cacciatore, TW, & Jones, AK. (2016). Reductions in co-contraction following neuromuscular re-education in people with knee osteoarthritis. BMC Musculoskeletal Disorders, 17. https://doi.org/10.1186/s12891-016-1209-2
Reductions in knee pain associated with reduced co-contraction in leg muscles during walking after AT lessons.
Cohen RG, Gurfinkel VS, Kwak E, Warden AC, Horak FB. (2015). Specific postural instructions affect axial rigidity and step initiation in patients with Parkinson’s disease. Neurorehabilitation and Neural Repair. 29(9). (pp. 878–888. doi: 10.1177/1545968315570323
Reduced axial rigidity and smoother step initiation in patient’s with Parkinson’s disease after brief AT-like postural instruction.
Cacciatore TW, Gurfinkel VS, Horak FB, Cordo PJ, Ames KE. Increased dynamic regulation of postural tone through Alexander Technique training. Human Movement Science. 2011;30(1):74-89. doi: 10.1016/j.humov.2010.10.002
Significant reduction in trunk and hip stiffness in subjects with back pain after AT lessons.
Cacciatore T, Horak F, Henry S. Improvement in automatic postural coordination following Alexander Technique lessons in a person with low back pain. Phys Ther. 2005;85(6):565-578. [PubMed]
Reduction in back pain associated with improvements in automatic postural coordination in response to translation test and improvement in balance after AT lessons.
For a fuller discussion of these and other studies, visit “Some Experiments That Help Explain How AT Works.” Though basic research like the above is unlikely to shift clinical practice, it can influence whether research teams initiate larger and more expensive clinical trials.
Lists of Published Research
Both the clinical trials and basic research listed on this page is by no means exhaustive. A full list of published research with short summaries is also given on the STAT and AmSAT Alexander Technique sites:
Alexander Studies Online also includes research collections:
Up to date lists of clinical trials can be fairly easily found using search engines such as Google Scholar or PubMed. The two links below give the results for the keyword combination: “‘Alexander Technique’ clinical” (other keyword combinations are also possible of course):
- Google Scholar search of “alexander technique” clinical
- PubMed search of “alexander technique” clinical
Eldred, J., Hopton, A., Donnison, E., Woodman, J., & MacPherson, H. (2015). Teachers of the Alexander Technique in the UK and the people who take their lessons: A national cross-sectional survey. Complementary Therapies in Medicine. 23,3. (pp. 451–461). doi.org/10.1016/j.ctim.2015.04.006
Woodman, J.P., Moore, N.R. (2012). Evidence for the effectiveness of Alexander Technique lessons in medical and health-related conditions: a systematic review. International Journal of Clinical Practice. 66, 98-112. doi: 10.1111/j.1742-1241.2011.02817.x
Woodman, J. (2015). Alexander Technique Lessons as a Health-Care Intervention. In C. Rennie, T. Shoop, K. Thapen (Eds.) Connected Perspectives. London: Hite