(Reproduced by kind permission
of STAT. This material appears on the STAT web-site: see
controlled trial of Alexander Technique lessons,
Exercise And Massage (ATEAM) for chronic and recurrent back
long-term benefit for low back pain has been demonstrated by
a major study published by the
British Medical Journal on 20th August 2008 at
To summarise: §
24 AT lessons proved to be most beneficial
Six lessons followed by exercise were about 70% as
effective as 24 lessons
Long-term benefits unlikely to be due to placebo
Lessons were one-to-one, provided by experienced
This was a scientific randomised controlled trial
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
1. The trial
trial compared the long-term benefits of the following
Six lessons in the Alexander Technique (AT)
24 lessons in the AT
Six sessions of a classical massage
GP-prescribed aerobic exercise
with a control group
which received normal GP care, for NHS patients with
significant chronic or recurrent non-specific low back pain.
Half the patients
in four groups (Six 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 six
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.
2. 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 in a standard
questionnaire 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 the number of days in pain in the past
four weeks. 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 -six
and 24 AT lessons, exercise and massage -showed some
significant benefit compared with the normal GP care control
3. One year
results for Exercise and Massage:
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
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 six AT lessons followed by GP prescribed aerobic
exercise (mainly walking) was about 70% as beneficial as a
series of 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.
3. Funding of the trial
Research Council (MRC) funded the trial (£585,000). The NHS
Research and Development Fund contributed an additional
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
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.
4. Note on lessons in the trial
Technique lessons were provided 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, coordination, balance, and movement skills, and
to recognise and avoid habits that caused or aggravated
All the Alexander
Technique teachers had been teaching for at least three
years and were members of STAT, the Society of Teachers of
the Alexander Technique.