Randomised controlled trial of Alexander Technique lessons, exercise, and massage (ATEAM) for patients with chronic low back pain

• 24 Alexander Technique lessons proved to be most beneficial - after 1 year those who had Alexander Technique lessons had an average 3 days of pain per month compared with 21 days per month with usual GP care

• Alexander Technique lessons led to less incapacity people were able to carry out significantly more types of daily tasks without being limited by back pain 

• The study also looked at the additional effect of general regular aerobic exercise (such as walking) and found that 6 Alexander lessons followed by exercise were about 70% as effective as 24 lessons (with or without exercise) in terms of improvement in incapacity and 65% as effective in terms of reduction in number of days in pain

• Long-term benefits unlikely to be due to placebo effect

Setting 64 general practices in England.

Participants 579 patients with chronic or recurrent low back pain; 144 were randomised to normal care, 147 to massage, 144 to six Alexander technique lessons, and 144 to 24 Alexander technique lessons; half of each of these groups were randomised to exercise prescription.

Interventions Normal care (control), six sessions of massage, six or 24 lessons on the Alexander technique, and prescription for exercise from a doctor with nurse delivered behavioural counselling.

Main outcome measures Roland Morris disability score (number of activities impaired by pain) and number of days in pain.

Results Exercise and lessons in the Alexander technique, but not massage, remained effective at one year (compared with control Roland disability score 8.1: massage −0.58, 95% confidence interval −1.94 to 0.77, six lessons −1.40, −2.77 to −0.03, 24 lessons −3.4, −4.76 to −2.03, and exercise −1.29, −2.25 to −0.34). Exercise after six lessons achieved 72% of the effect of 24 lessons alone (Roland disability score −2.98 and −4.14, respectively). Number of days with back pain in the past four weeks was lower after lessons (compared with control median 21 days: 24 lessons −18, six lessons −10, massage −7) and quality of life improved significantly. No significant harms were reported.

Conclusions 

One to one lessons in the Alexander technique from registered teachers have long term benefits for patients with chronic low back pain. Six lessons followed by exercise prescription were nearly as effective as 24 lessons.

There were two qualitative research studies following on from the ATEAM trial:

1. Participating in and delivering the ATEAM trial (Alexander technique lessons, exercise, and massage) interventions for chronic back pain: A qualitative study of professional perspectives