Potential Mechanisms of the Alexander Technique: Toward a Comprehensive Neurophysiological Model

By Timothy W. Cacciatore, Patrick M. Johnson, and Rajal G. Cohen

Editor’s note: This is an excerpt of a new scientific model of the Alexander Technique published in the Kinesiology Review. A pdf of the full paper can be read here. Read a summary of the paper here.


The Alexander Technique (AT) has been practiced for over 125 years. Despite evidence of its clinical utility, a clear explanation of how AT works is lacking, as the foundational science needed to test the underlying ideas has only recently become available. The authors propose that the core changes brought about by Alexander training are improvements in the adaptivity and distribution of postural tone, along with changes in body schema, and that these changes underlie many of the reported benefits. They suggest that AT alters tone and body schema via spatial attention and executive processes, which in turn affect low-level motor elements. To engage these pathways, AT strategically engages attention, intention, and inhibition, along with haptic communication. The uniqueness of the approach comes from the way these elements are woven together. Evidence for the contribution of these elements is discussed, drawing on direct studies of AT and other relevant modern scientific literature.

Keywords: body axis, body schema, muscle tone, musculoskeletal pain, postural tone, somatic practice


Evidence is mounting that practicing the Alexander Technique (AT) has a range of benefits. Clinical research suggests that it can help alleviate common musculoskeletal complaints such as chronic back, neck, and knee pain (Little et al., 2008; MacPherson et al., 2015; Preece, Jones, Brown, Cacciatore, & Jones, 2016). AT may improve responses to stress (Glover, Kinsey, Clappison, & Jomeen, 2018; Gross, Cohen, Ravichandra, & Basye, 2019; Gross, Ravichandra, & Cohen, 2019; Klein, Bayard, & Wolf, 2014; Valentine, Fitzgerald, Gorton, Hudson, & Symonds, 1995; Zhukov, 2019) while also improving motor performance on tasks as specialized as playing a musical instrument or as basic as standing, walking, and breathing (Austin & Ausubel, 1992; Cacciatore, Gurfinkel, Horak, & Day, 2011; Cacciatore, Mian, Peters, & Day, 2014; Cohen et al., 2020; Cohen, Gurfinkel, Kwak, Warden, & Horak, 2015; Hamel, Ross, Schultz, O’Neill, & Anderson, 2016; O’Neill, Anderson, Allen, Ross, & Hamel, 2015). See Woodman and Moore (2012) for a fairly recent clinical review. Until now, however, a comprehensive explanation for the mechanisms by which AT operates has been lacking (Woodman & Moore, 2012).

Because of its century-long history, AT suffered scientifically from being “ahead of its time.” Initial investigations into possible mechanisms of AT had to rely on sparse scientific literature (see Barlow, 1946; Jones, Hanson, Miller, & Bossom, 1963) that referenced reflex models of posture that are now known to be out of date (Davidoff, 1992). In addition, the comprehensive and multifaceted nature of AT does not lend itself to simple experimental designs, and the foundational science and technology needed to test the underlying ideas have only recently become available.

In recent decades, our collective understanding of neuroscience and psychology has progressed immensely, such that there are now solid bodies of research in which to ground our theories and research. In the last 15 years, some reports addressing possible mechanisms of AT have been published (Becker, Copeland, Botterbusch, & Cohen, 2018; Cacciatore, Gurfinkel, Horak, Cordo, & Ames, 2011; Cacciatore, Gurfinkel, Horak, & Day, 2011; Cacciatore et al., 2014; Cohen et al., 2015, 2020; Hamel et al., 2016; Loram, 2013; O’Neill et al., 2015), while other research has elaborated on concepts relevant to AT’s function.

In this paper, we propose a comprehensive model of the underlying mechanisms of AT. Based on published evidence, we posit that mental phenomena such as intention and spatial attention influence postural tone, the background muscle activity that stabilizes body configuration—and that these changes in postural tone in turn affect many aspects of the motor system. We further posit that broader research on interconnections between postural tone and body schema may help explain changes in body-based self-perception through AT training. Although AT affects pain and is likely to affect mood, our model suggests that those effects are downstream from (or at least interdependent with) changes in the motor system.

A key purpose of our model is to explain AT’s generalizability, meaning that something learned in one task carries over to other activities. By explicating the role of postural tone in motor activity, we can start to understand how AT can have such a wide range of effects.

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About the Authors

Cacciatore is with Society for Teachers of the Alexander Technique, London, United Kingdom. Johnson is with the Dutch Society for Teachers of the Alexander Technique, Amsterdam, the Netherlands. Cohen is with the University of Idaho, Moscow, ID, USA. Cohen (rcohen@uidaho.edu) is corresponding author.

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