The Great Alexander

Lower-back pain is among the most-common medical complaints. Could a decades-old technique used by dancers, actors, and musicians offer relief?

If you believe in evolution, two of the greatest advances in human history have been upright posture and opposable thumbs. Standing upright left our hands free to do other things, while opposable thumbs have made possible the culminating human achievement: text-messaging your pizza-delivery order.

Yet our upright posture has also helped make low-back pain the second most common complaint in the physician’s office. A whopping 80 percent of adults will experience at least one episode during which they feel as if their back is so tight it could shatter; or—in the case of a pinched nerve—that a bug zapper has inhabited their back and is pulsing down into their legs.

While stem-cell therapy research moves slowly forward, the promise of replacing one’s worn-out aching back with a new model (the Nimbus 2000, perhaps?) remains a long way off. For most, treatment will include patience, pain medications, anti-inflammatory drugs like ibuprofen (Advil, Motrin, etc.) or acetaminophen (Tylenol), more patience, and physical therapy. Some will find relief through chiropractic care. Some will require steroid injections, or—as a last ditch effort—surgery.

Despite the ubiquitous and agonizing nature of low-back pain, there have been no major breakthroughs in its treatment, and it rarely grabs headlines in medical journals. Which is why I was surprised to see the topic splashed across the cover of a recent edition of the highly respected British Medical Journal. The issue included the details of a study in which a group of low-back pain sufferers received normal care, massage therapy, or lessons in something called the “Alexander Technique.”

Before I describe how to locate your Alexander, and how to manipulate it, let me tell you what the study’s authors found. After one year, 24 lessons in the Alexander Technique reduced disability scores by 42 percent. The lessons also decreased the monthly number of days with low-back pain from 23 to 3. Adding an exercise regimen to those 24 lessons didn’t change things much, but adding exercise to six Alexander Technique lessons reduced disability scores by 31 percent and dropped the number of painful days in a month from 23 to 10. Okay, so it’s just one study, but those are some pretty impressive numbers.

The obvious questions for physicians like myself are: What exactly is the Alexander Technique—and how can we bill for it?

I’m kidding (sort of). According to the BMJ article, the technique was developed by an Australian actor named F. M. Alexander in the late 1800s as “an individualized approach designed to develop lifelong skills for self care that help people recognize, understand, and avoid poor habits affecting postural tone and neuromuscular coordination.” It takes three years of full-time training to become a certified Alexander Technique instructor. There are eight such practitioners in Minnesota, and I recently met with two of them.

Lauren Hill teaches the Alexander Technique in a Summit Avenue studio in St. Paul. Brian McCullough has a private studio near the University of Minnesota, where he also teaches Alexander Technique classes for music majors, actors, and dancers. A poster on the wall of McCullough’s studio shows an egg perched on a fingertip beneath the word “POISE,” and both studios have similar furnishings: several wooden chairs, a body-work table, and a ceiling-to-floor wall mirror.

Both Hill and McCullough worked through an initial session with me. Though every Alexander Technique instructor has his or her own style, there are some points that are consistent.

Typically, the instructor asks you to do some basic movements, such as walking or rising from a chair, while he or she guides and shapes the movement with his or her hands. It is definitely a hands-on experience, but not in the way going to the chiropractor is a hands-on experience. Tactile feedback from the instructor seems to help reawaken some long-forgotten kinesthetic sense in your body, and establishes new, more coordinated patterns of movement.
An Alexander Technique lesson also includes frequent verbal guidance, which reinforces the instructor’s tactile directions: “A place of lightening and ease,” “Head leading, body following,” “Sending things away from other things, a lengthening of muscle.”

The goal, Hill tells me, is not the relaxation of muscles so much as striking a balance between opposing muscle groups. She also reminds me that the Alexander Technique is not a class in posture per se, but that bad posture typically results from bad habits and the misuse of muscles. When those are addressed, a healthy posture returns. In that regard, many of us don’t know what a healthy posture looks like. When I find myself slumped over in front of a computer and say to myself “Sit up!” my “correct” posture is hyperbolic and dysfunctional, and requires far more effort than a balanced posture.

As I worked my way through my lessons with Hill and McCullough, I struggled to wrap my mind around what the technique really entails. There is a paucity of language to describe movement, which may be why there’s a wealth of literature trying to explain exactly what the Alexander Technique is. Here’s my attempt: Remember trying to walk the rails of a train tracks as a kid? Sometimes it was simple, nearly effortless: Your weight fell right down through your spine, hips, and legs; your arms sat loosely at your side, rather than flailing at the air. Balance was an afterthought.

That’s what the Alexander Technique seems to aspire to—getting to a place where your daily motions are smooth, balanced, effortless, easy. Too many of us spend too much time like we’re flailing on the rail: hunched over laptops, slouched into car seats, a bundle of conflicting muscle movements draped over contorted postures.

Two distracted lessons, where I was concentrating more on how to write about the Alexander Technique than on how to implement it, weren’t enough to transform me. But I did get glimpses of a better way of standing, of holding myself, all with a sense of ease—and those glimpses return to me still. They make me think F. M. Alexander was onto something. And that even though his technique won’t be the end of low-back pain, it could be a way out for many.

Craig Bowron is a Twin Cities internist.