The effect of the Alexander Technique on pain intensity in patients with chronic low back pain: A randomized controlled trial

Abstract

Objective

The present study was performed to determine the effect of the Alexander Technique on the intensity of pain in patients with chronic low back pain (LBP).

Methods

This study is a clinical trial that was performed on 80 patients with chronic LBP in Kashan, Iran. Participants were randomly assigned in control and intervention groups. To assess the participants’ LBP, a visual analog scale of pain (VAS-Pain) was completed by both groups. In the intervention group, in addition to routine care for LBP patients, the Alexander Technique was performed in three 60-min sessions per week for 12 weeks. The control group participants received routine care for LBP patients. The two groups completed the VAS-Pain scale immediately after and one month after the intervention.

Results

The results showed that there was no statistically significant difference between the two groups in terms of demographic characteristics and mean pain intensity score before the intervention (p > 0.05). Immediately after and then one month after the intervention, there was statistically significant differences between the two groups regarding the mean scores of pain (p < 0.05). The results of repeated measures ANOVA showed that, in the intervention group, the mean score of pain had decreased over time (p < 0.05).

Conclusion

The results of the present study showed that the Alexander Technique was effective in reducing the intensity of pain among the participants. We recommend the Alexander Technique as a useful and effective intervention for reducing chronic LBP.

Introduction

Low back pain (LBP) is a common musculoskeletal disorder. About 80% of people in the world have experienced this disorder at least once during their life (Chanplakorn et al., 2012). LBP usually involves the spasming of the supportive muscles along the spine. In addition to the back pain, symptoms such as numbness, pain, and tingling in the buttocks or lower extremities can be related to LBP. There are multiple causes associated with LBP, such as damage to the intervertebral discs, compression of nerve roots, and improper movement of the spinal joints (Matsudaira et al., 2015). Chronic LBP is defined as LBP that lasts longer than three months (Wilder et al., 2011). In about 90% of patients, chronic LBP is not associated with pathological conditions, such as infection, fractures, and tumors. The origin of pain may vary as bone pain, nerve pain, or muscle pain (Miyamoto et al., 2018). The sensation of pain may also vary; for instance, the pain may be aching, burning, stabbing, or tingling. Additionally, the pain can be sharp or dull and well-defined or vague. The intensity of pain may range from mild to severe (Lara-Palomo et al., 2013; Ulger et al., 2017).

Back pain is one of common reasons for absence from work, disability, and job compensation (Simmons, 2011). In the United States, approximately 30% of people develop chronic LBP per year (Bauer et al., 2016). In Iran, chronic LBP is the third leading cause of disability in the age group of 15–69 years old (Mousavi et al., 2011). People with LBP frequently experience poor physical and social functioning as well as poor general health (Tavafian et al., 2007). Pharmacological interventions for LBP frequently include nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen. These medications have gastrointestinal side effects, such as indigestion, heartburn, and diarrhea, as well as chest pain, dyspnea, abnormal sweating, and dizziness (Hall et al., 2016). Due to undue effects of pharmacological treatments, complementary therapies for the management of chronic diseases have been recommended (Mahdavipour et al., 2019; Rahimimoghadam et al., 2019). Shipton (2018) indicated that complementary therapies for the management of chronic LBP include laser, acupuncture, massage, and movement therapy (Shipton, 2018).

The Alexander Technique is a therapeutic method that was developed by an Australian actor, Frederick Matthias Alexander in 1869–1955 (Alexander, 1985). He began using positions and movements that challenged postural coordination, such as “positions of mechanical advantage” (for example, a semi-squat) and functional movement such as sit-to-stand. At the same time, Alexander rejected common understandings of posture—including the idea of posture as a correct position, or that exercise was required to improve posture. Just as importantly, Alexander became focused on how habit challenged self-control and distorted self-perception. In lessons, a student's foremost responsibility became the “inhibition” of habits, not the assumption of a correct position or the performance of a correct action. An overarching goal of a course of study was to improve the accuracy of the student's body awareness—or “sensory appreciation (Murray, 2015; Harer, 2008).

With the Alexander Technique, the first step for changing maladaptive postures and movements as well as releasing chronic pain is identifying and avoiding habitual reactions to pain stimuli (Alexander, 1985). In regard with back and neck pain, the main goal of the Alexander Technique is to reduce muscle tension during regular daily activities, such as sitting, standing up, and walking. Alexander Technique practitioners believe that less tension can reduce wear and tear on muscles and other structures of the spine that are vulnerable to compression (Hollinghurst et al., 2008; Little et al., 2008). A typical Alexander Technique intervention consists of training programs; the programs include training the participants to comfortably sit up straight, to reduce overuse of superficial musculature in posture, to increase proprioceptive awareness, and to become more attentive about the body's warning signs related to tension and compression (Hollinghurst et al., 2008; Little et al., 2008).

Research teams have shown the Alexander Technique was beneficial for the management of musculoskeletal problems, LBP (Little et al., 2008; Cacciatore et al., 2011), and neurological pathologies, such as Parkinson's disease (Pourkamali et al., 2016). Also, it has been shown that the Alexander Technique was effective in improving body function in older adults (Hamel et al., 2016). Furthermore, regarding individuals' attitudes toward healthy behaviors, Yardley et al. reported that patients have more favorable attitudes toward the Alexander Technique compared to exercise in the management of LBP (Yardley et al., 2010). In a qualitative study on patients with chronic LBP, the results showed that participants reported the Alexander Technique was more useful compared to massage and exercise (Beattie et al., 2010). Beattie et al. (2010) also indicated that the Alexander Technique was more effective in improving the quality of life compared to other methods. Jain et al. (2004) also showed that the Alexander Technique had a significant effect on the quality of life among patients with LBP (Jain et al., 2004).

However, research findings regarding the Alexander Technique are contradictory. In their study, Lauche et al. (2016) compared the effects of local heat therapy, the Alexander Technique, and guided visualization among patients with chronic neck pain. Their results showed that local heat therapy and guided visualization were more effective to reduce pain compared to the Alexander Technique (Lauche et al., 2016). Gleeson et al. (2017) investigated the effects of the Alexander Technique on older adults' pain and well-being. Their results indicated that the Alexander Technique had no significant effect on older adults’ pain intensity and well-being (Gleeson et al., 2017).

There are an increasing number of people with musculoskeletal diseases and the diseases’ adverse effects can lead to poor physical, mental, and social function and quality of life (Lauche et al., 2016; Gleeson et al., 2017). Moreover, findings of studies on the effectiveness of complementary therapies, including the Alexander technique, among patients with chronic pain are controversial. Therefore, this study was conducted to investigate the effect of the Alexander Technique on pain intensity among patients with chronic LBP.