Alexander technique

 Alexander technique is an alternative medicine and educational discipline focusing on bodily coordination, including psychological principles of awareness. It is applied for purposes of recovering freedom of movement, in the mastery of performing arts, and for general self-improvement affecting poise, impulse control and attention.

The Technique takes its name from F. Matthias Alexander, who, in the 1890s,^[1] developed its principles as a personal tool to alleviate his breathing problems and hoarseness and hence enable him to pursue a career as a Shakespearean actor.

Teachers use demonstration, explanation, and repeated examination of what spontaneously occurs in the student. Light hand contact is also used to detect the student's unnecessary physical and mental stresses. Hands-on suggestions are offered in the context of everyday actions such as sitting, standing, walking, using the hands, and speaking. Assistance with sports, hobbies, or the performing arts may be requested by students as further topics of personal interest.^[2]

History

Alexander was a Shakespearean orator who developed problems which resulted in losing his voice. After doctors informed him they could find no physical cause, he carefully observed himself in multiple mirrors. His use of empirical observation revealed that he was needlessly stiffening his whole body in preparation to recite or speak.^{[citation needed]} Further, Alexander observed that many individuals experiencing breathing and voice problems commonly tightened the musculature of the upper torso, especially the neck, prior to phonation in anticipation of the act of voicing. He suggested that this habitual pattern of dropping the head backwards and downwards in relationship to the spine needlessly disrupted efficient overall body alignment. After innovating new substitution strategies that included sharpening his ability to choose that new response, he found that his old pattern of voice loss ceased entirely. His new process also allowed the discovery of additional improvements towards his original intention to become a better orator.

Alexander came to believe that his work could be applied to improve longevity and human evolution in general. He developed the quality of his "work" (termed Alexander Technique after his death) so as to make his process of experimentation and self-training repeatable. He recorded his experiences in four books. He also trained educators of his Technique while living in London from 1931 until his death in 1955. Teacher training classes were interrupted during the wartime period between 1941 and 1943, which Alexander spent teaching pupils with his brother Albert Redden Alexander (1874–1947) in Massachusetts, USA.

The Technique

Basic premises

The National Institutes of Health (NIH) National Center for Complementary and Alternative Medicine (NCCAM) defines the Alexander technique as an education/guidance practice to "improve posture and movement, and to use muscles efficiently."^[3]

The Alexander Technique is considered to be primarily an educational process to be practiced by the student, rather than a curative treatment or therapy. Generally, it does not consist of routine exercises, but is meant to be applied in any moment when quality improvements are desired during action. For this reason, F.M. Alexander preferred not to recommend exercises for his students to perform, and most Alexander teachers follow this intent. Alexander's approach was to emphasize the use of freedom to choose beyond conditioning in every action.

The exceptions are two prescriptive forms or exercises intended to be done in separate but brief practice times. A procedure recommended to all students is lying semi-supine as a means for effective rest, releasing muscular tension and as an opportunity to use the conscious mental "Directions" Alexander devised. The other procedure is termed a "Whispered Ah," used to subtract unnecessary effort from the use of the voice.

Freedom, efficiency and patience are the prescribed values. Proscribed are unnecessary effort, self-limiting habits as well as mistaken assumptions. Students are led to change their previous habitual and largely automatic routines that are interpreted by the teacher to currently or eventually be physically limiting and structurally inefficient. The Alexander teacher provides verbal coaching while monitoring, guiding and preventing unnecessary habits at their source with specialized hands-on assistance to show what is meant. This specialized assistance requires Alexander teachers to demonstrate on themselves the improved physical coordination they are communicating to the student.^[4]

Alexander developed his own terminology to talk about his methods, outlined in his four books. These terms were created to describe the sometimes paradoxical experience of learning and substituting new improvements.

"Sensory Appreciation"

F. M. Alexander insisted on the need for strategic reasoning and "Constructive Conscious Control" because kinesthetic sensory awareness is a relative sense, not a truthful indicator of fact. The current postural attitude is sensed internally as a normal state of affairs, however inefficient. Alexander's term, "debauched sensory appreciation" describes how the repetition of a circumstance encourages habit design as a person adapts to circumstances or builds skills. Once trained and forgotten, completed habits may be activated without feedback sensations that these habits are in effect, just by thinking about them.^[5] Short-sighted habits that have become harmful over time, such as restriction of breathing or other poor postural attitudes that limit freedom of movement & shorten stature, will stop after learning to perceive and prevent them.

"End-Gaining"

Another example is the term "end-gaining", which means to focus on a goal so as to lose sight of the "means-whereby" the goal could be more appropriately achieved. According to Alexander teachers, "end-gaining" increases the likelihood of selecting older or multiple conflicting coping strategies with the potential for needless cumulative, ongoing self-injury. End-gaining actions are usually carried out because a more imperative priority justifies it, which is usually impatience or frustration.

"Inhibition"

In the Alexander Technique lexicon, the principle of "inhibition" is considered by teachers to be the most prominent. F.M. Alexander's selection of this word pre-dates the modern meaning of the word originated by Sigmund Freud. Inhibition describes a moment of conscious awareness of a choice to interrupt, stop or entirely prevent an unnecessary habitual "misuse." As unnecessary habits are prevented or interrupted, a freer capacity and range of motion resumes, experienced by the student as a state of "non-doing."

"Primary Control"

This innate coordination that emerges is also described more specifically as "Primary Control". This is a key head, neck and spinal relationship. The body's responses are determined by the qualities of head and eye movement at the inception of head motion. What expands the qualities of further response is a very subtle nod forward to counteract backward startle pattern, coupled with an upward movement of the head away from the body that lengthens the spine. Students learn to include their whole body toward their intention of purposeful motion.

"Directions"

To continue to select and reinforce the often less dominant "good use," it is recommended to repeatedly suggest, by thinking to oneself, a tailored series of "orders" (also termed Directions.) "Giving Directions" is the term for thinking and projecting an anatomically corrected map of how one's body is designed to be used effortlessly. "Directing" is suggestively thought, rather than willfully accomplished. This is because when freedom is the objective, the appropriate responses cannot be anticipated but can be observed and chosen in the moment.

"Psycho-physical Unity"

Global concepts such as "Psycho-physical Unity" and "Use" describe how thinking strategies and attention work together during preparation for action. They connote the general sequence of how intention joins together with execution to directly affect the perception of events and the outcome of intended results. ^[6]

Disadvantages

In the United Kingdom, there is some coverage of the costs for Alexander lessons through the Complementary and Alternative Practitioners Directory. Otherwise, individuals must pay for their Alexander Technique education out of pocket. Those who are used to getting instant results may complain at a commitment of twenty to forty private lessons, which is the duration most Alexander teachers recommend that is required to gain proficiency. Private lessons usually cost in a similar range to private music lessons.

Inexpensive classes are rarely available. Workshops do exist, but usually do not last long enough to fulfill educational requirements for most students, who must then attend additional private lessons if they want to gain proficiency. Outside of the United Kingdom there is little or no insurance coverage, and the Technique's effectiveness is also not yet recognized.

Practicing the Alexander Technique cannot directly affect structural deformities once they occur (such as arthritis or other bone problems), or other diseases, (such as Parkinson's, etc.) In these cases, the Alexander Technique can only mitigate how the person copes with these difficulties.

The learning process often demands giving up "favored" ways of thinking and acting. This challenge can result in unanticipated defensiveness and resistance. If a student must halt lessons at an awkward stage, this can leave them without practical solutions for the "bad" habits they have just learned to sense.

Benefits

The Alexander Technique is used remedially to regain freedom of movement. It is used to undo the establishment of nuisance habits by performers, and it's used as a self awareness discipline and a self-help tool to change specific habits.

These first application areas include alleviating pain and weakness as a result of poor posture or repetitive physical demands, improving pain management for chronic disabilities, and rehabilitation following surgery or injury where compensatory habits that were designed to avoid former pain need to be revised after healing. The Alexander technique has been shown to be an effective treatment for chronic or recurrent back pain in a randomized study published Aug. 19, 2008.^[7]

As an example among performance art applications, the Technique is used and taught by classically trained singers and vocal coaches. Its advocates claim that it allows for the proper alignment of all aspects of the vocal cords and tract through consciously increased air flow. With this increase of breathing capacity, singers are said to be better able to exercise proper vocal technique and tone. Because the Technique has allegedly been used to improve breathing and stamina in general, advocates of the technique claim that athletes, people with asthma, tuberculosis, and panic attacks have also found benefits.

Along the application of self-help, proponents of the Technique suggest that it can help performers manage stage fright, become more spontaneous, and to increase skill repertoire. It is suggested that A.T. can be an adjunct to psychotherapy for people with disabilities, Post-traumatic Stress Disorder, panic attacks, stuttering, and chronic pain because using its principles can improve stress management abilities.^[8][9][10]

Influences since Alexander's work

The English novelist Aldous Huxley was strongly influenced by F. M. Alexander and the Technique so much so that he included him as a character in the pacifist theme novel Eyeless in Gaza published in 1936.^[11]

The American philosopher and educator John Dewey was very favorably impressed by F. M. Alexander and the Technique. In 1923, Dewey wrote the introduction to Alexander's magnum opus Constructive Conscious Control of the Individual.^[12][13] Since Alexander's work in the field came at the turn of the century, his ideas influenced many originators in the field of mind-body improvement. Fritz Perls, who originated Gestalt Therapy, credited Alexander as an inspiration for his psychological work.^[14] The Feldenkrais Method and the Mitzvah Technique were both influenced by the Alexander Technique, in the form of study previous to the originators founding their own disciplines. The Alexander Technique is one of the three healing arts that formed the foundation of Nia Technique. John Appleton, Alexander Technique teacher, has originated a variation which uses visualization techniques called Posture release imagery. David Gorman, formerly working as an Alexander Technique teacher trainer, originated a variation called LearningMethods using the systematic exploration of experience to understand the psychological root of problematic habits and change them.

Teaching

Alexander taught his technique to pupils for thirty years before creating a school to train other teachers to pass on his work. Today, the UK Society of Teachers of The Alexander Technique and its worldwide affiliates certify Alexander Technique teachers after successfully completing a three-year, 1600-hour curriculum from teaching lineage traced to Alexander.^[15][16]

The technique is most commonly taught in a series of twenty to forty private lessons which may last from thirty minutes to an hour. Its principles have also been adapted to be taught in groups, often using short individual lessons demonstrated in turn which act as examples to the class.^[2]

Scientific evidence

A 2008 randomised controlled trial published in the British Medical Journal found marked improvement in addressing back pain with this technique. Those receiving 24 lessons had 3 days of back pain in a four week period, 18 days less than the control median of 21 days. The cohort receiving 6 lessons had a reduction of ten days in days-of-pain reported. Outcomes were also measured by Roland disability scores, a measure of the number of activities impaired by pain, with a control baseline of 8.1. 24 lessons reduced this by 4.14 points, while six lessons combined with exercise produced a reduction of 2.98.^[7] A subsequent analysis and comparative study of the economic implications concluded that "a series of six lessons in Alexander technique combined with an exercise prescription seems the most effective and cost effective option for the treatment of back pain in primary care."^[17]

In 1999, Dennis ran a controlled study of the effect of Alexander Technique on the "Functional Reach" (associated with balance) of women older than 65. He observed a significant improvement in performance after 8 sessions, but this improvement was not maintained in a one-month follow-up.^[18] Further, in 2004 Maher concluded that "Physical treatments, such as ... Alexander technique ... are either of unknown value or ineffective and so should not be considered" when treating lower back pain with an evidence-based approach.^[19] (Note that Alexander Technique teachers recommend more than three times or more as many lessons than 8 to retain educational benefits.) In 2002, Stalibrass et al. published the results of a significant controlled study into the effectiveness of the technique in treating Parkinson's disease. Four different measures were used to assess the change in severity of the disease. By all four measures, Alexander Technique was better than no treatment, to a statistically significant degree (both P-values < 0.04). However, when compared to a control group given massage sessions, Alexander technique was only significantly better by two of the measures. The other two measures gave statistically insignificant improvements (P-values of approximately 0.1 and 0.6). This appears to lend some weight to the effectiveness of the Technique, but more studies and data are required.^[20]

With regard to the claims made for reducing the need for medication in patients with asthma, (in 1999,) Dennis concluded that additional "robust, well-designed randomized controlled trials are needed."^[21]

Already in 1973 Nikolaas Tinbergen had given references to scientific evaluations of the Alexander technique, in his Nobel prize acceptance speech.^[22]