Research on How the Alexander Technique Works

Here we provide an annotated, chronological list of published peer-reviewed studies, including experiments about how AT works and studies that measure physiological or movement changes associated with AT or AT-like interventions. This list is not exhaustive, but rather gives a general overview of the state of current basic research on AT.

2020

Cohen, R.G., Baer, J.L., Ravichandra, R., Kral, D., McGowan, C., Cacciatore, T.W. (2020). Lighten up! Postural instructions affect static and dynamic balance in healthy older adults. Innovation in Aginghttps://doi.org/10.1093/geroni/igz056

A sequel study to Cohen et al’s 2015 study. Researchers studied the effects of contrasting posture instructions on balance in older adults. Healthy, older subjects were given contrasting postural cues: “Effortful” cues to “pull up” into length based on common conceptions of posture; “Light” cues to “lighten up” into length based on the Alexander Technique; and “Relaxed” as a control. Researchers assessed balance during simple standing and 3-second foot lift (balancing on one leg). Though there was little difference in postural alignment across the three conditions, the “Light” condition led to the least postural sway in standing and longest duration foot lift with considerably less muscular effort. The study suggests that common “effort” based posture cues may degrade balance, especially in older adults.

Read Andrew McCann’s summary of the research: Lighten Up! Trying Hard to “Stand Up Straight” May Interfere with Balance

2019

Baer J., Vasavada A, Cohen RG. (2019). Neck posture is influenced by anticipation of stepping. Hum Mov Sci. 64 (pp. 108-122). [PubMed

Research on posture and inhibitory control. The study found that forward head posture (FHP) increased in anticipation of movement, especially more challenging movement. Higher FHP was associated with worse performance on Stroop, a test of inhibitory control, and with lower self-reported mindfulness (MAAS). Poor performance on Go/No-Go task was associated with an extended (backward tilted) head relative to the neck and shortening the neck in anticipation of movement.

Read Andrew McCann’s summary of this study: What We Do Before the Thing We’re Doing—Research on Anticipation, Inhibition, and Posture.

2018

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]

A study to determine if group Alexander Technique classes were feasible and promising for chronic neck pain. Participants took 10 AT classes, twice a week for five weeks. After the class, participants reported significantly reduced neck pain. In addition, recording from neck muscles during a neck flexion task indicated a reduction in neck muscle fatigue. Posture was marginally more upright. Participants retained benefits at five weeks post-test. There was no control group, but validity was improved by the inclusion of two baseline measurements, 5 weeks apart, showing no spontaneous remission before the classes began. 

2017

Loram ID, Bate B, Harding P, Cunningham R, Loram A. (2017). Proactive selective inhibition targeted at the neck muscles: this proximal constraint facilitates learning and regulates global control. IEEE Trans Neural Syst Rehabil Eng. 25(4). (pp. 357–369). doi: 10.1109/tnsre.2016.2641024

Violinists used real-time ultrasound feedback of their neck muscles to minimize unnecessary neck muscle movement while performing skilled and unskilled tasks. Reduction in neck muscle activity led to cascading, uninstructed effects across the body, including reduced pressure on the violin chin rest, reduced forward movement of the shoulders, reduced leg muscle activity, improved balance, and lower galvanic skin response, suggesting that the violinists were also more calm.

2016

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

Participants with a diagnosis of knee osteoarthritis were given 20 one-on-one Alexander Technique lessons. After lessons, co-contraction in the leg muscles during walking was significantly reduced. The participants reported a substantial reduction in pain and benefits were retained at 15-month follow up.

Read Andrew McCann’s summary of this study: Alexander Technique Lessons Reduced Knee Pain and Co-Contraction in Subjects with Knee Osteoarthritis.

Hamel KA, Ross C, Schultz B, O’Neill M, Anderson DI. Older adult Alexander Technique practitioners walk differently than healthy age-matched controls. Journal of Bodywork and Movement Therapies. 2016;20(4):751-760. doi: 10.1016/j.jbmt.2016.04.009

This study compared how older (61–76) Alexander Technique teachers walked compared to age-matched, healthy control subjects. During the stance phase of walking, the AT teachers had greater ankle range of motion, plantar flexion at toe-off, and lower range of motion in the trunk and head compared to the controls. During the swing phase of walking, they had increased hip and knee flexion and somewhat increased dorsiflexion compared to the controls. In other words, older Alexander Technique teachers walked like younger adults.

2015

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 

This study contrasted the effects of verbal, AT-type “lighten up” posture instruction against effort-based “pull up” posture instruction in subjects with Parkinson’s Disease. Subjects practiced the contrasting instructions for 10-minutes each before applying them to standing and step initiation. In the “lighten up” condition, subjects showed reduced postural sway, reduced axial stiffness, greater adaptability of tone, and a smoother center of pressure trajectory during step initiation than in the “pull up” instruction or a control “relax” condition.

Read Andrew McCann’s summary of this study, “Lighten Up” or “Pull Up?” Alexander Technique-type Instruction and Parkinson’s Disease.

O’Neill MM, Anderson DI, Allen DD, Ross C, Hamel KA. (2015). Effects of Alexander Technique training experience on gait behavior in older adults. Journal of Bodywork and Movement Therapies. 19(3). (pp. 473–481). doi: 10.1016/j.jbmt.2014.12.006

This study compared the amount of sideways sway (mediolateral mass displacement) between older (70–75) Alexander Technique teachers and healthy, age-matched controls during comfortably-paced and fast walking. The AT teachers showed less sideways sway during fast walking than comfortably-paced walking—a difference not present in the control group. The AT teachers also had a smaller stride width. The results suggest that AT teachers have greater dynamic stability in walking and as a result, potentially less fall risk.

2014

Cacciatore TW, Mian OS, Peters A, Day BL. (2014). Neuromechanical interference of posture on movement: evidence from Alexander Technique teachers rising from a chair. Journal of Neurophysiology. 112(3). (pp. 719–729). doi: 10.1152/jn.00617.2013

This study contrasted Alexander Technique teachers with untrained, healthy subjects in standing up from sitting. The movement was unusually slow—sit-to-stand in 8 seconds—and smooth. Healthy subjects were unable to rise smoothly, even with practice, while the AT teachers shifted weight much more evenly, and rose from the chair smoothly. Analysis of the findings suggest that the difference is in the ability of AT teachers to dynamically stabilize the spine without preventing hip flexion during weight shift, while allowing eccentric contraction in hip and leg extensors to stand. In this way, slow sit-to-stand reveals how lack of dynamic postural control in healthy, untrained subjects can interfere with movement.

Read Tim Cacciatore’s summary of the study: How Posture Interferes with Movement—Evidence from Standing Up Slowly from a Chair.

Little P, Stuart B, Stokes M, et al. (2014). Alexander Technique and supervised physiotherapy exercises in back pain (ASPEN): a four-group randomised feasibility trial. [PubMed]

2011

Cacciatore TW, Gurfinkel VS, Horak FB, Cordo PJ, Ames KE. (2011). Increased dynamic regulation of postural tone through Alexander Technique training. Human Movement Science. 30(1):74-89. doi: 10.1016/j.humov.2010.10.002

This study used a innovative device, called the “twister,” to measure the adaptability of postural tone in Alexander Technique teachers and matched, healthy controls. Alexander teachers had much more adaptable postural tone than matched controls. In addition, subjects with low back pain were given 20 one-on-one Alexander Technique lessons, twice a week, for 10 weeks. They experienced a significant reduction in trunk and hip stiffness compared to healthy controls after lessons.

Read Tim Cacciatore’s summary of the study: Twister—Measuring How Alexander Technique Lessons Affect Postural Tone.

Cacciatore TW, Gurfinkel VS, Horak FB, Day BL. Prolonged weight-shift and altered spinal coordination during sit-to-stand in practitioners of the Alexander Technique. Gait & Posture. 2011;34(4):496-501. doi: 10.1016/j.gaitpost.2011.06.026

This study documented differences between Alexander Technique teachers and healthy, matched controls in sit-to-stand. While the overall speed of the movement was the same between the groups, Alexander Technique teachers spent a significantly greater percentage of time shifting weight forward to stand, and experienced less “momentum transfer” during standing—i.e. less lurching out of the chair. Alexander teachers also maintained foot contact on the floor—unlike the controls, who unweighted the feet just prior to leaving the chair. Alexander teachers also had significantly reduced “spinal bending” during the task.

Read Tim Cacciatore’s summary of the study within the context of research on sit-to-stand: From Jones to Stevens to Cacciatore—What Can We Learn about AT from Sit-to-Stand?

2005

Cacciatore T, Horak F, Henry S. (2005). Improvement in automatic postural coordination following Alexander Technique lessons in a person with low back pain. Phys Ther. 85(6):565-578. [PubMed]

In this case study, researchers assessed a 49-year-old woman with 25-year history of idiopathic back pain before and after Alexander Technique lessons. Before lessons, she experienced back pain daily, especially in activities of daily life. After lessons, her back pain reduced to 1 to 2 days per month, and activities of daily life were unimpeded by pain. The researchers also studied her automatic postural coordination. Asymmetry in her postural response to tests improved and as did her balance standing on one leg.

1999

Dennis R. (1999). Functional reach improvement in normal older women after Alexander Technique instruction. J Gerontol A Biol Sci Med Sci. 54(1):M8-11. [PubMed]

A pilot group and experimental group comprised of women older than 65 were given eight 1-hour, twice a week, lessons in the Alexander Technique. Functional reach, a clinical measure of balance, was tested before and after lessons. The two groups experienced a significant improvement in functional reach after AT instruction compared to a control group. Benefits declined slightly at 1 month follow up. Self-report questionnaire indicated overall positive experience with lessons.

Historic Studies

These studies by Chris Stevens and Frank Pierce Jone are of historic interest in the science of the Alexander Technique. For an assessment of their research, read Tim Cacciatore’s, From Jones to Stevens to Cacciatore—What Can We Learn about AT from Sit-to-Stand?, and note Rajal Cohen’s discussion of Frank Pierce Jones in her talk, Science Catches Up.

Wilfred Barlow, M.D., also did some early research on the Alexander Technique. His papers have been published in the collection, Postural Homeostasis, and are reviewed by Rajal Cohen here.

Stevens C, Bojsen-Møller F, Soames R. (1989). The influence of initial posture on the sit-to-stand movement. Eur J Appl Physiol Occup Physiol. 58(7). (pp. 687–692). [PubMed]

Jones FP. (1965). Method for changing stereotyped response patterns by the inhibition of certain postural sets. Psychological Review. 72(3). (pp. 196–214). doi: 10.1037/h0021752

Jones FP. (1963). The influence of postural set on pattern of movement in man. International Journal of Neurology. 4. (pp. 60–71).

Jones FP, Gray FE, Hanson JA, O’connell DN. (1959). An Experimental Study of the Effect of Head Balance on Patterns of Posture and Movement in Man. The Journal of Psychology. 47(2). (pp. 247–258). doi: 10.1080/00223980.1959.9916326

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