The British Medical Journal (BMJ), in August 2008 published the findings of a research study into the effects on the back pain of back pain patients having lessons in the Alexander Technique. Here are some questions and answers about the trial and its findings
The Alexander Technique and the Back Pain trial: Questions and Answers
Randomized controlled trial of Alexander Technique lessons, Exercise And Massage (ATEAM) for chronic and recurrent back pain
Core Messages
• 24 AT lessons proved to be most beneficial
• 6 lessons followed by exercise were about 70% as effective as 24 lessons
• Long-term benefits unlikely to be due to placebo effect
• Lessons were one-to-one, provided by experienced STAT teachers
• This was a scientific randomised controlled trial
The trial
This research trial compared the long-term benefits of:
- 6 lessons in the Alexander Technique (AT)
- 24 lessons in the AT
- 6 sessions of a classical massage
- GP- prescribed aerobic exercise
with GP normal care (control group) for NHS patients with significant chronic or recurrent non-specific low back pain.
Half the patients in four groups (6 AT lessons, 24 AT lessons, massage and control) were provided with a GP prescription for taking general aerobic exercise (mainly 30 minutes of brisk walking or the equivalent each day) with practice nurse behavioural counselling. The prescription was given six weeks after patients entered the trial so that exercise followed the 6 massage sessions and 6 AT lessons, but often overlapped with most lessons for the 24 AT lesson group.
579 patients were recruited from 64 GP practices and 59 Alexander Technique teachers participated in the trial.
How were the results/outcomes measured?
Two main outcome measures were used, the principal one being the Roland Morris disability scale. This consists of 28 statements representing the ways that back pain affects a patient's life - the number of statements agreed with is the score. The lower the score, the better is the patient's condition. Functional improvement was assessed by using this scale. The other main outcome measure was of days in pain in the past four weeks and the number was recorded. Ten secondary outcome measures were also used.
What were the main results of the trial?
1. The best results were seen in the 24 AT lesson group, with important
improvements in function, quality of life and reduction in days in pain.
One year after the trial started, the average number of activities limited by low back pain (the RM disability score) had fallen by 42%, and the number of days in pain was only three per month, compared with 21 days in pain in the control group.
2 At three months after the trial started all the intervention groups – 6 and 24 AT lessons, exercise and massage – showed some significant benefit compared with the normal GP care control group.
3. One year results for Exercise and Massage The exercise groups had improved function, with the disability score better at one year than at three months; days in pain were not significantly different
from the control group (21 days).
The massage group’s three month improvement in the disability score was not maintained; days in pain (14) were still less than the control group (21 days).
4. Since the effect of massage on the disability score was no longer significant by one year, but the three month beneficial effect of 6 AT lessons was maintained, the authors concluded that the long-term benefits of taking Alexander Technique lessons are unlikely to be due to placebo effects of attention and touch and more likely to be due to active learning of the technique.
5. At one year, a series of 6 AT lessons followed by GP prescribed aerobic exercise (mainly walking) was about 70% as beneficial as a series 24 AT lessons alone.
The results show that taking AT lessons can have a long-term beneficial effect, significantly decreasing days in pain and improving the functioning and quality of life of patients.
Funding of the trial
The Medical Research Council (MRC) funded the trial (£585,000). The NHS Research and Development Fund contributed an additional £186,000.
The trial was run from Southampton and Bristol University Departments of Primary Care. The trial management team was led by Professor Paul Little (Southampton) and Professor Debbie Sharp (Bristol).
The Alexander Technique component of the trial was taught by STAT
teachers. STAT and the interests of the Alexander Technique were represented on the trial management team by Kathleen Ballard and Frances Oxford.
References
For ATEAM paper and the BMJ, visit:
http://www.bmj.com/cgi/content/full/337/aug19_2/a884
For research papers on the AT, visit:
http://www.stat.org.uk/pages/research1.htm
Note on lessons in the trial
All AT lessons were provided individually on a one-to-one basis. Teachers had to agree to use both hands-on teaching and adequate verbal explanation. Trial participants were taught and helped to make use of the Alexander Technique to improve muscle tone, co-ordination, balance, and movement skills, - and to recognise and avoid habits that caused or aggravated their pain.
All the AT teachers had been teaching for at least three years and were members of STAT, the Society of Teachers of the Alexander Technique.
****************
The Alexander Technique
The AT is a taught life-long self-help method that can enable patients with chronic or recurrent non-specific low back pain to reduce number of days in pain and overcome associated incapacity. Experience shows it can also help patients avoid recurrence.
AT Lessons provide an individualized approach to learning this technique for general self-improvement, through the practical teaching of self-care skills that help people recognize, understand and avoid poor habits adversely affecting their postural muscle tone and neuromuscular coordination.
Are good results guaranteed?
Both learning and applying the Alexander Technique demand the active
participation of patients/pupils. Learning to change long established habits can be a gradual and challenging process. Good results depend on the interest and ability of individuals to follow the advice received and on their resolve to apply what they have learnt to their daily activities. Although teachers do not aim to, nor offer a ‘cure’, people usually experience valuable benefits.
What makes people come for lessons?
Back pain is one of the most common reasons. Even though people often contact us after they have tried everything else, they can still gain significant benefit. However, if they make the AT teaching profession an early point of call, following a medical diagnosis of non-specific low back pain, they might save themselves a lot of pain and money.
Is it safe to take AT lessons?
Participants in the ATEAM back pain trial were asked to report any adverse events that occurred during AT lessons that were part of the trial. 288 people had Alexander Technique lessons -making a total of more than 2,400 lessons and no reports of adverse events were received.
Are teachers regulated and insured?
Members of STAT (The Society of Teachers of the Alexander Technique) have successfully completed a three-year training on a course recognized by the Society, have professional indemnity insurance, and are subject to a Code of Professional Conduct. There is an established Complaints procedure.
Do all teachers teach the same way?
All STAT teachers teach the same principles and other core material but the approach will vary according to their training, experience, personality and interests – and according to the needs of a pupil.
How much do AT lessons cost?
The cost of lessons varies according to locality and a teacher’s overhead expenses and experience. Currently, the cost of a lesson is similar to the cost of an osteopathy or physiotherapy session.
Are AT lessons funded through the NHS or private insurance companies?
NHS departments in different areas and various insurance companies seem to follow different policies. On occasion, the NHS may pay for AT lessons. The research results clearly show that AT lessons can be effective for back pain patients and as a result we look forward to AT lessons being more widely available on the NHS. There are some private medical insurance companies that already agree to reimburse AT lessons, a list we hope will expand.
How many AT teachers are there?
In the UK there are about 900 teachers who are registered members of STAT. Only STAT teachers took part in the trial. STAT and its overseas affiliated societies represent in total nearly 3,000 teachers.
How do I find a teacher?
You can contact the Society of Teachers of the Alexander Technique on: Tel: 0845 230 7828 - email: enquiries@stat.org.uk
Visit the website: www.stat.org.uk which includes a teacher search facility, or write to:
STAT, 1st Floor - Linton House, 39-51 Highgate Rd, London NW5 1RS.
If you would like any further information please do not hesitate to contact me by email at philip.tucker1@ntlworld.com or by telephone on 01865 433151
Philip Tucker MSTAT