This post summarizes research by Rajal Cohen, et al, “Lighten Up: Specific Postural Instructions Affect Axial Rigidity and Step Initiation in Patients with Parkinson’s Disease,” published in Neurorehabilitation and Neural Repair in 2015. It was originally published at Alexander &.
Word came last week [Editor’s Note: February, 2015] about a new study published in the journal Neurorehabilitation and Neural Repair about the Alexander Technique and patients with Parkinson’s Disease.
Parkinson’s Disease is a progressive neurological condition affecting movement. Progressive in this sense means that symptoms worsens over time. The condition often begins with slight tremors and reduced facial expressions and may eventually lead to a stiffening and slowing of all movement. Parkinson’s is largely treated with medication, though Parkinson’s patients and their doctors often explore methods that can improve a patient’s quality of life while coping with the disease.
The Alexander Technique and Parkinson’s has been studied before. In 2002, a randomized control trial published in Clinical Rehabilitation assigned 98 Parkinson’s patients either to 24 individual Alexander Technique lessons, 24 individual massage sessions, or no intervention beyond their normal drug treatment. The study showed that Alexander lessons significantly increased the ability of patients to carry out everyday activities (there was no significant change in the massage group). The benefits remained when patients followed up 6 months after their lessons ended. The Parkinson’s patients who took Alexander Technique lessons also had less change in their Parkinson’s medication than either of the other groups (this is notable since medication dose usually increases with time as the disease worsens). The patients themselves reported improvements in balance, posture, walking, and increased coping with the disease and reduced stress.
One of the challenges in a randomized control trial like the 2002 study is to explain why a particular intervention is effective. In the 2002 study, massage was used to control for the effects of touch. Though massage and the Alexander Technique use touch quite differently, they use an equivalent amount of touch in a session. Since the Alexander Technique had a beneficial effect but massage did not, the researchers could conclude that touch alone wasn’t enough to benefit the Parkinson’s patients. The patients who took Alexander Technique lessons clearly learned something, but what?
Enter the most recent study: “Lighten Up: Specific Postural Instructions Affect Axial Rigidity and Step Initiation in Patients with Parkinson’s Disease,” by lead author, Dr Rajal Cohen.
This was a smaller study and deceptively simple: 20 patients with mild to moderate Parkinson’s Disease practiced two contrasting postural instructions for all of ten minutes each. One set of instructions, called “Pull Up,” was based on effortful conceptions of posture. The other set of instructions, “Lighten Up,” were based on the Alexander Technique of releasing into length.
The research team then measured axial rigidity (increased axial rigidity interferes with movement), postural sway (sway can increase the risk of falling in Parkinson’s patients), and the smoothness and efficiency of initiating movement.
The study is fascinating to anyone who is interested in movement and posture because it shows that how we think about posture can make a measurable difference in the quality of our posture and movement.
During the study, the Parkinson’s patients read contrasting explanations for the two separate set of instructions. The “Pull Up” instructions were based on familiar conceptions of posture:
Parkinson’s makes you weaker, so it is important to activate your core muscles to pull yourself up to your full height. For the next few minutes I would like you to focus on feeling your neck and trunk muscles work strongly to pull you up.
The patients then practiced these specific “Pull Up” instructions (which might be familiar to anyone who has worked with either a personal trainer or a drill sergeant):
Use your core muscles to pull yourself up to your fullest height; engage the muscles in your abdomen and lower back; feel your neck and trunk muscles working to pull you up; pull your stomach in, your head and chest up, and your shoulders back.
“Lighten Up” instructions were based on the Alexander Technique. The researchers had the subjects read this explanation:
Whatever our condition, we make matters worse by pulling ourselves down, and especially by tightening the neck and pulling the head down. For the next few minutes I would like you to focus on allowing an upward direction.
Then the patients practiced the following instruction:
Notice that you are pulling yourself down and give yourself permission to stop doing it; let your head balance easily at the top of your spine; allow your spine to be uncompressed and your torso to open effortlessly; let your shoulders and chest be open and light.
As a control, the researchers had the patients practice a “relaxed” condition:
Imagine that it is the end of a long day and you feel tired and lazy; allow your head to feel heavy and sink slightly forward and down; relax your shoulders and allow them to hang heavily.
The researchers varied the order in which the patients practiced “Pull Up,” “Lighten Up,” and “Relaxed,” to control for possible carryover effects from the different instructions. What did they find? When patients practiced “Lighten Up,” they showed less axial rigidity, less postural sway, and increased smoothness of initiating movement than when they practiced “Pull Up” or “Relaxed.”
There are a couple of surprising things about these results. The authors note that since Parkinson’s Disease has such a detrimental effect on motor control, they did not expect the patients to show a measurable difference when practicing something so subtle as differing postural intentions. Most remarkable to me is that such brief instructions, given without the hands-on guidance found in a traditional Alexander lesson, would have a beneficial result. The study gives some inkling of why a course of lessons—like the 24 lessons in the 2002 study of Parkinson’s patients—might be so positive.
One of the things that excites me about this study is the way in which it clearly articulates the difference between how Alexander Technique teachers approach posture—lightening up to make things easier—versus more familiar approaches to posture—pulling up to make you stronger. We Alexander teachers often feel like we are in danger of getting swept away in the great wave of “core conditioning,” struggling to prove the benefits of a gentler approach to movement than “power through” and “no pain no gain.” If this study can help convince people that lightening into length has proven benefits, it might help not only Parkinson’s patients, but anyone who wants to move more easily and effectively.