British Journal of Therapy and Rehabilitation, November 1997, Vol 2, No 11, p. 621-626
by Stevens CH
The Alexander Technique has become increasingly recognised as a self-help method for various health and performance problems. It enjoys some scientific support and is widely available on a private basis. What does it do more precisely and what physiological principles may underlie it? This article looks briefly at its development and some of the evidence for its effects.
The Alexander Technique is named after FM Alexander who developed it in the last two decades of the 19th century (Alexander, 1985; Stevens, 1995a). Alexander was attempting to deal with problems he had with his voice but found that it could be used to help many other types of difficulties. The list of conditions for which it is reported to be useful include stress-related problems such as ulcers and other digestive disorders, some forms of heart disease and high blood pressure, asthma and chronic bronchitis, tension-related sexual disorders, epilepsy and migraine (Barlow, 1973). Barlow found it of particular use in the rehabilitation phase of many illnesses, and a range of rheumatic problems from disc lesions, low back pain and arthritis, to tennis elbow and frozen shoulders have also responded well. Barlow also reports that the technique has had considerable success in helping people suffering from anxiety and depression. What could account for such reported improvements in so many different conditions? Either some mechanism is activated which has widespread effects on the body, the reports are a result of some sort of suggestion like positive thinking, or some as yet undiscovered mechanism is at work. To evaluate these possibilities, the author will first look at what Alexander himself reported.
Alexander's experience
FM, as he was called, became an actor but developed voice problems which forced him to stop performing. Determined to find out what was the reason for his voice loss, he observed himself in a mirror when reciting and when talking normally to see if he could observe any behavioural reasons for his problems. After a long period of observation he noticed that when he recited:
1 He was breathing in with an audible gasp;
2 He was adversely affecting the balance of the head on the neck;
3 He was exaggerating the curves of his spine and there was undue muscle tension throughout the body;
4 This undue muscle tension was particularly noticeable in the legs and feet.
He found that 1 could be prevented by preventing 2 and 3 but that these in turn could only be prevented by inhibiting 4 first. He found also that he needed the objective information from the mirror to correct his incorrect proprioceptive sensations which he could see were not giving him accurate information about his body state. By using this objective information he could then consciously inhibit the behaviours which were causing his loss of voice.
Thus the Alexander Technique rests on careful observation and the conscious inhibition of faults discovered by observation with the use of objective instruments to augment the unaided senses. For these reasons, it is unlikely that the results reported are due to suggestion. When Alexander found how to put this method into practice he found that his voice problems were cured, and that problems with his health were also helped.
What lessons in the Alexander Technique entail
Problems are usually assessed by observing the student in everyday situations and helping them to understand and sense what they are doing to their body which may be a factor in the symptoms they are suffering. They are then taught how to improve their way of using the body's support system and applying this to their movements.
Most teachers use touch to augment vision and speech for the assessment and teaching of the fine coordination of posture and movement. This touch is a gentle sensing and guiding, not a manipulation or treatment. As the technique is an education and not a therapy, the thrust is in helping a student to understand and sense what they are doing and for them to learn what they can do for themselves to make improvements.
Depending on the type of training teachers have received, they will use different approaches to assessing a student's problems and the way in which they propose to treat these difficulties.
What mechanisms may explain the improvements?
By 1894 FM had developed his methods to the point where others asked him to help them with their problems. His discovery was, as far as we can tell, entirely empirical: lots of trials and lots of errors led to it. It was not until the 1920s that knowledge of the various postural reflexes became widely available because of the work of Magnus and his collaborators (Magnus, 1925). He showed that posture is the result of a number of local, segmental and whole body reflexes whose activities are integrated in the spinal cord, brain stem and midbrain. Later investigators showed the influences of the cerebellum and other brain structures, including the cortex.
One misconception of Magnus' work is the idea that in human adults such reflexes were pathological. It now appears that this is not so, unless they are overt, as with stroke patients. Such reflexes, however, underlie normal postures and movements (for a literature survey see Stevens, 1995b). From the above it would appear that Alexander found a method for consciously inhibiting interferences with normal postural reflexes (when these interferences are not due to damage to the reflexes themselves). Such interferences can be seen particularly when people are sitting at unsuitable furniture or in difficult emotional situations of conflict or failure. In the first example of ergonomically unsuitable furniture, only part of the answer seems to lie in better design. Equally important is leaning to inhibit interferences with the reflex support system. It is well accepted that the various postural reflexes modify the stretch reflex and affect the body in general (Roberts, 1978). This provides an economical explanation for the diversity of results reported. However, it should be noted that the author is open to other explanations for the effects of the Alexander Technique.
Let us look more carefully at the claims and tests that have been made to assess their validity.
Scientific opinion
Sir Charles Sherrington, who had trained Magnus, knew of and supported Alexander's work. He wrote:
Alexander has done a service to the subject (the physiology of posture and movement) by insistently treating each act as involving the whole psychophysical man. To take a step is an affair, not of this or that limb solely, but of the total neuromuscular activity of the moment, not least of the head and neck. (Sherrington, 1946)
The number of physicians and surgeons seeing the importance of Alexander's work reached the point where Bruce and 18 colleagues wrote to the British Medical Journal urging that his technique be included in the medical curriculum (Bruce et al, 1937)
Shortly afterwards Alexander worked with the biologist Coghill, who wrote:
Mr Alexander's method lays hold of the individual as a whole, as a self vitalising agent. He reconditions and re-educates the reflex mechanisms and brings their habits into normal relation with the function of the organism as a whole. I regard his method as thoroughly scientific and educationally sound. (Coghill, 1941)
Later Dart, discoverer of Australopithecus africanus, took lessons and reported (1970):
The electronic facilities of electromyography and electroencephalography have confirmed Mr Alexander's insights and authenticated the technique he discovered ... of teaching both average and skilled individuals to become aware of their wrong body use, how to eliminate handicaps and thus how to achieve better use of themselves both physically and mentally.
More recently, Tinbergen (1974) devoted half of his Nobel Prize acceptance speech to the Alexander Technique. In it he said:
We already notice, with growing amazement, very striking improvements in such diverse things as high blood pressure, breathing, depth of sleep, overall cheerfulness and mental alertness, resilience against outside pressures, and in such a refined skill as playing a musical instrument.
So much for opinions; what published experimental evidence is available? In this account I will initially describe the literature, making some critical comments at the end. For a more exhaustive critical survey see Stevens (1995b).
Dr Wilfred Barlow
Barlow (1956) had subjects adopt a standard standing position and photographed them from the front, side and back. Analysing these photographs he was able to score their posture by using a grid system. He compared two groups of individuals before and after receiving training; one group received Alexander lessons and the other exercises aimed at improving posture. In the Alexander group there was a significant reduction in the number of postural faults following the lessons in both men and women, while in the other group there was no significant change. The Alexander group were students at the Royal College of Music. In an attempt to determine whether fit young individuals have postural problems, Barlow measured 112 female physical education students who also showed a large number of postural defects.
Effects on performance
Barlow's study with music students suggested a correlation between objective postural changes and performance. Their teachers reported the following on the students' progress: all the students improved physically both in their singing and acting abilities. They were easier to teach and had become more psychologically balanced. In addition, the success of the students in an important singing competition was far greater than could have been expected. In their opinion the Alexander Technique was the best method they had experienced of aiding singing performance and should form the basis of a singer's training.
Jones (1972) also showed that not only did the singer and others listening feel that the voice and breathing were improved, but that there were measurable changes in the sound indicated by spectral analysis. More recently Doyle (1984) also observed objective improvements in violin players after Alexander training.
While considering improvements in performance the following experiences of two athletes are noteworthy. Paul Collins, Canadian National Marathon Champion 1949-52 and veterans world record holder in 10 events from 200 kilometers to 6 days (ie the distance run in 6 days) has said:
Through the Alexander Technique I was able to rehabilitate my running after 25 years of being unable to run through injuries, to the extent that I was able to set ten world records for veterans in 1982. (Stevens, 1987)
Howard Payne, Commonwealth record hammer thrower, improved his throw by 5.64 metres at the age of 37. Commenting on this, which he believed to be due primarily to taking Alexander lessons, he says:
Balance is a vital aspect of good hammer throwing and getting the head, neck, spine and pelvis in the correct relationship enables the balance of the throw to come so much more easily. Once the balance is settled there is an enormous improvement in turning speed. (Payne, 1968)
Breathing
Lung capacity and peak expiratory flow rate shows a significant improvement after a course of Alexander lessons (Austin and Ausubel, 1992), while breathing is deeper and slower (Robinson and Garlick, 1985).
Pain
A study was made of the use of the Alexander Technique in a pain management clinic (Fisher, 1988). Patients rated it the best of 13 activities used on a course on pain management. Questionnaires measuring this were administered at the end of the course, 3 months later and 1 year later.
Professor FP Jones
Jones used a different approach to Barlow, preferring to measure muscle activity and movement patterns for unguided and guided movements. Only a few of his studies are considered here.
Straightening up from a slumped sitting position is usually associated with a sense of effort. When muscle activity is measured there is a high level of activity in the main neck muscles. However, when the habitual stiffening is prevented, the movement feels easier and the neck muscles show less activity. Jones (1965) suggested that this was due to the facilitation of appropriate head-neck reflexes.
Jones and Gilley (1960) used radiographs to confirm that the Alexander movements produced an increase in the length of the sternomastoid muscles, these being key muscles in the control of head position and movement. Further examination of the radiographs showed that there was an increase in the height of the cervical discs in Alexander subjects and that there was also a forward movement of the centre of gravity of the head.
Jones (1965) also used interrupted light photography to study the sit-to-stand movement. The photographs show a quicker and more direct movement following Alexander training.
Some criticisms of these studies
Barlow's studies can be criticised for the artificial nature of the test situation but give consistent, if subjective criteria for assessing static posture.
The breathing studies demonstrate significant changes using standard procedures, in Austin's case with a control group.
The pain study was of course based on subjective reports and could usefully have been extended to include some objective studies. However, it was controlled and involved follow-ups.
Jones' work often did not include controls, although it could be argued that each subject acted as their own control. As the methods used in the first two studies reported are standard ones and were carried out by qualified personnel, it is assumed that the measures are reliable. In the interrupted light study the sampling rate was low, putting some doubt on the validity of the derived velocity and acceleration calculations.
To deal with problems such as these, together with others, an experimental programme of research was undertaken.
The author's experimental programme
1. We began with an examination of the influence of leg position on the sit-to-stand movement. This enabled criteria for determining the quality of a movement to be developed, without requiring subjects to assume unusual positions (Stevens et al, 1989).
2. We then performed an analysis of habitual and guided (using the Alexander Technique) sit-to-stand movements. Force plate, electromyographic and displacement data confirmed that guided movements required less muscle activity and less force to perform the movement and were also quicker. In addition the centre of balance was more to the rear; with the subject being taller at the end of the Alexander movement. A higher sampling rate that that used by Jones (50 Hz vs 10 Hz) was used to measure displacement data (Stevens et al, 1989).
3. A comparison of unguided movement patterns in an experienced practitioner of the Alexander Technique when using the Technique in the movement or when not was then undertaken. Using the criteria developed previously the Alexander movements were found to be more efficient than the non-Alexander movements, using less force and taking less time. Here we used higher sampling rates of 300 Hz to allow more reliable calculations of velocity and acceleration. The study suffers, however, from being restricted to one subject and only six sets of measurements (Stevens, 1995b).
4. The effect of neck and back splinting on postural stability was examined in untrained subjects to explore the relative importance of the neck, back and other postural reflexes. No significant effects were found (Stevens, 1995b).
5. A comparison of postural stability between subjects who had undergone Alexander training and those who had not was made. The Alexander group were no more stable with their eyes open or when their feet were in the normal position than the non-Alexander group; however, their sway was up to 26% less when standing with the eyes closed and the feet together. 15 male and 15 female untrained subjects were compared with six male Alexander subjects; studies with more subjects are required (Stevens, 1995b).
6. The influence of Alexander lessons on static posture was studied. Significant increases in both height and shoulder width were observed in musicians and office workers following Alexander training. Here 20 subjects were measured using standard anthropometric methods (Stevens, 1995b).
7. An investigation into the effects of the Alexander Technique on raised blood pressure in professional musicians under the stress of performance. The Alexander Technique produced similar reductions in stress-induced raised blood pressure to Beta-blockers but without the adverse effects on quality or performance associated with the use of the latter. There has been anecdotal evidence that practising the Alexander Technique can reduce high blood pressure. In this study of 39 subjects an attempt was made to control for stress-induced effects. The changes found were small but reached statistical significance (Nielson, 1994).
Conclusions
The Alexander Technique is a well established method for dealing with an individual's health and performance problems. Its probable underlying physiology is becoming clearer but more research is needed in particular, both in the laboratory and in the treatment of clinical conditions. All the studies listed require confirmation and extending to look at more specific conditions. This requires greater financial support than has been forthcoming in the past.
References
Alexander FM (1985) The Use of the Self. Gollancz, London
Austin JH, Ausubel P (1992) Enhanced respiratory muscular function in normal adults after lessons in proprioceptive education without exercises. Chest 102: 486-90
Barlow W (1956) Postural deformity. Proc Roy Soc Med 49: 670-4
Barlow W (1973) The Alexander Principle. Gollancz, London
Bruce BP, Caldwell JR, Dick JH et al (1937) Constructive conscious control (letter). Br Med J 1: 1137
Coghill JE (1941) Appreciation: the educational methods of FM Alexander. In: Alexander FM, ed. The Universal Constant in Living (reprinted 1987) Centerline Press, Downey, California: xxi-xxxiii
Dart RA (1970) An Anatomist's Tribute to FM Alexander. Sheildrake Press, London
Doyle J (1984) The Task of the Violinist: Skill, Stress and the Alexander Technique. PhD thesis, University of Lancaster, England
Fisher K (1988) Early experiences of a multidisciplinary pain management programme. Holistic Med 3: 47-56
Jones FP (1965) Method for changing stereotyped response patterns by the inhibition of certain postural sets. Psychol Rev 72: 196-214
Jones FP (1972) Voice production as a function of head balance in singers. J Pyschol 82: 209-15
Jones FP, Gilley PFM (1960) Head balance and sitting posture: an X-ray analysis. J Psychol 49: 289-93
Magnus R (1925) Animal posture. Proc Roy Soc Lond 98B: 339-53
Nielsen M (1994) A study of stress amongst professional musicians. In: Stevens CH, ed The Alexander Technique: Medical and Physiological Aspects. Stat Books, London : 8-9
Payne H (1968) How I improved this year. Athletics Weekly Nov 30th 18-20
Roberts TDM (1978) The Neurophysiology of Postural Mechanisms. Butterworth, London
Robinson L, Garlick D (1985) Comparison of respiratory movements and frequencies in normal and trained subjects. Proc Aus Physiol Pharm Soc 16: 256
Sherrington CS (1946) The Endeavour of Jean Fernel. Cambridge University Press, Cambridge
Stevens CH (1987, 1993, 1995a in press) Alexander Technique. Vermilion, London
Stevens CH (1995b, in press) Towards a Physiology of the Alexander Technique. Stat Books, London
Stevens CH, Bojsen-Moller F, Soames RW (1989) Influence of initial posture on the sit-to-stand movement. Eur J Appl Physiol 58: 687-92
Tinbergen N (1974) Ethology and stress diseases. Science 185: 2027
Copyright © British Journal of Therapy and Rehabilitation.
Reprinted by permission of the publisher.