Alexander Technique: A Balm For Back Pain?

Our Review Summary

A feature on the National Public Radio (NPR) website proclaimed an alternative therapy known as “The Alexander Technique” to be “highly effective” in the treatment of chronic back pain. But what does “highly effective” mean in real world terms—for a condition considered resistant to effective treatment?

Does the Alexander Technique—which educates patients on posture, movement and neuromuscular coordination—find strong support in multiple clinical trials? Is the therapy more effective than common evidence-based treatments for chronic back pain? Is it cost-effective? Unfortunately, the NPR story never provided answers to any of these questions.

Instead, it examined the value of this therapy through the prism of two individuals heavily invested in its success: (1) a jazz trumpeter attempting to use the Alexander Technique to work through his chronic back symptoms; and (2) a therapist who makes a living teaching these methods.

The article included brief comments from the British researcher who led a clinical trial showing the Alexander Technique to be superior to six sessions of massage and an uNPRoven exercise program. But the journalist highlighted only the most positive results from this study, and none of its potential limitations—of which there are several. (See BackLetter, 2008). And the writer didn’t seek out dispassionate commentary from any independent experts, much to the article’s detriment.

So what might those experts have said about the Alexander Technique? They might have pointed out that the Alexander approach to chronic low back pain has been examined in only a single randomized clinical trial.  To be persuasive, these results would need to be confirmed in other clinical settings. Though they are promising and warrant further investigation, it isn’t clear if these findings represent a breakthrough, a further option for individuals with low back pain, or a false hope. 

At present there is no evidence that the Alexander Technique is more effective than other common evidence-based treatments for chronic low back pain—from manual therapies to structured exercise programs to multidisciplinary rehabilitation.  A recent systematic review performed for the British National Health Service concluded that all of these may be viable options for chronic back pain—but that none stood out as superior. (See NICE, 2009). So calling the Alexander Technique “highly effective” may be a bit of a reach.

In addition, the cost-effectiveness of this approach remains very much up in the air. In the clinical trial cited above, the Alexander Technique (which involved either six or 24 visits with a therapist) proved less cost-effective than a simple exercise program. (See NICE, 2009)

So should individuals with chronic or recurrent back pain consider the Alexander Technique as a treatment option? That would be a reasonable response. However, they should opt for this treatment approach only after taking a balanced look at both its potential strengths and its weaknesses—a process this article didn’t facilitate.

References:

BackLetter, The Alexander Technique for low back pain: the hazards of over-interpreting a single clinical trial, 2008; 23(9): 97-106.

NICE (National Institute for Health and Clinical Excellence), Early management of persistent, nonspecific low back pain, May, 2009; see http://www.nice.org.uk/nicemedia/live/11887/44334/44334.pdf

 

 

Why This Matters

Back pain is a common human symptom that affects approximately half of the general population of the United States every year. Roughly 5-10% of those who experience back pain go on to develop chronic symptoms lasting more than three to six months. (See Lawrence RC, 2008).  These individuals exact a huge toll in terms of medical costs, work loss, and long-term disability claims.

There are more than 200 hundred treatments for chronic back pain in the clinical marketplace. However, few if any have been proven to improve the long-term natural history of this condition. While some therapies show promise over the short to medium term, they generally have a modest impact on pain and function.

So the identification of more effective treatment approaches for chronic back pain remains a major public health priority.

Reference: 

Lawrence RC, Estimates of the prevalence of arthritis and other rheumatic conditions in the United States, part II, Arthritis & Rheumatism, 2008; 58(1): 26-35.