The Alexander Technique for Back Pain

The Alexander Technique is an educational process that takes place over a course of lessons and practice with the goal of teaching the person to become aware of and change habitual ways of using the body. The approach focuses on learning mind-body awareness. The main goal of the Alexander Technique - as it applies to back and neck pain - is to restore appropriate levels of muscle tension during common daily activities, such as sitting, standing up, and walking. Alexander Technique practitioners specifically do not make any claims as to medical benefit of the technique. The theory is that less tension will minimize wear and tear on the muscles and other structures of the spine vulnerable to compression.

Frederick Matthias Alexander, an Australian actor who suffered from hoarseness only when he performed, originally developed the principles and discipline of the Alexander Technique in the late 1800’s. Following years of self-study, Alexander came to the conclusion that patterns of excessive tension originated from the head and neck but led to muscular strain throughout the body as a whole. He also concluded that faulty movement habits led to decreased kinesthetic perception. He developed a system of hands-on assistance as well as verbal cues to help clients stop their physical habit and move in a freer, more efficient manner.

Recent studies suggest that the Alexander Technique may be effective in providing back pain relief.

In 2008, a study published in the British Medical Journal followed 579 patients over the course of a year in the “Randomised controlled trial of Alexander technique (AT) lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain.” The study found that Alexander Technique lessons provided benefit to patients in terms of back pain relief and reducing recurrent back pain.1A subsequent study found that a series of six lessons in combination with a walking exercise program seemed to be the most effective and cost efficient option for the treatment of back pain in primary care.2A case study of a patient with a 25 year history of low back pain was found to have significant improvement in the symmetry of her balance responses and in the intensity and frequency of her low back pain. 3

At the time of this article, there are no studies regarding long term effectiveness of the Alexander Technique for pain relief of low back and/or neck pain.

The Alexander Technique includes a recommended number of lessons with a qualified teacher, usually provided one-on-one. A typical Alexander Technique program teaches topics such as:

How to comfortably sit up straightHow to reduce overuse of superficial musculature in postureHow to increase proprioceptive awarenessHow to become more attuned to the body's warning signs of tension and compression.

Teachers of the Alexander Technique are required to have completed three years of full time training as part of an accredited Alexander Technique teacher training curriculum, and many are certified by one or more of the Alexander Technique professional societies.

Most insurance carriers consider the Alexander Technique to be investigative and inadequately supported by evidence in peer reviewed medical literature, so the therapy is rarely covered by insurance.

References:

Paul Little et al., Randomised controlled trial of Alexander technique (AT) lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain, British Medical Journal, August 19, 2008. Accessed November 1, 2010Sandra Hollinghurst et al., Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain: economic evaluation, British Medical Journal, December 11, 2008. Accessed January 5, 2011Cacciatore et al., Improvement in automatic postural coordination following Alexander technique lessons in a person with low back pain. Physical Therapy Journal, 2005; 85:565-578. Accessed January 5, 2011More Resources in the Alternative Care Center

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Doctor Perspectives: Chiropractors Discuss Spinal Decompression for Back Pain

November 8, 2010
by: Sylvia Marten

Photo courtesy of Dr. Eben Davis

Non-surgical spinal decompression is a treatment that uses a pulling force on the spine to relieve pressure on the discs and vertebrae in either the lumbar or cervical spine regions. It is used to treat a variety of common causes of back or neck pain, such as a herniated lumbar disc, bulging disc, spinal stenosis, degenerated disc, facet syndrome, or sciatica/leg pain. Spinal decompression can be delivered with the hands or by devices that essentially pull to separate the lower body from the upper body.

The concept of spinal decompression has been around for a number of years, but some feel that it still lacks enough clinical evidence to support the effectiveness claims of the treatment. Others say that the positive results of many patients speak for themselves. To shed some light on this topic through real-world experience, we interviewed two chiropractors from opposite ends of the United States, Dr. Eben Davis in San Francisco and Dr. Steven Shoshany in New York City, who have used spinal decompression in their practices for several years. We asked them about their experiences with spinal decompression in this exclusive Spine-health interview.

Question: How long have you used spinal decompression in your practice? What percent of your patients receive spinal decompression treatment?

Dr. Shoshany: I made the decision to add spinal decompression to my practice seven years ago when it was still very new. I believe that I was one of the first practitioners in New York City to have a DRX9000. I became interested in spinal decompression because my father had a really bad disc herniation issue that caused him terrible sciatica. He was helped by a chiropractor that used the DRX9000. I was sold and added this tool into my practice. Currently, spinal decompression makes up 30% of our practice.

Dr. Davis: We started using spinal decompression around 2005. At that time, I was the first individual in the San Francisco area to offer spinal decompression. Today there are at least 10 machines in the city.

Out of my total business, about 5% of my patients have spinal decompression as part of their treatment plan.

Question: When do you use spinal decompression? When do you not use it?

Dr. Shoshany: We use spinal decompression mostly for patients that tried chiropractic care, physical therapy, had epidurals, and previous back surgeries with little results. We also consider spinal decompression when a patient presents us with a recent MRI that confirms herniated discs causing nerve pressure. It works particularly well for patients that suffer with chronic back pain, sciatica and spinal stenosis. The patient age range varies widely from 20-90 years of age. We do not use spinal decompression when a patient is either pregnant or has a metal implantation in their spine.

Dr. Davis: A good patient age range is between 25 and 55. It is important to manage expectations, as results may not be as immediate as one expects. This is especially true when performing spinal decompression on elderly patients.

Question: What results do you typically see from spinal decompression treatment? How do you measure the results?

Dr. Shoshany: Results vary depending on the severity of the condition. Obviously the patient is looking for both a reduction of pain and the ability to return to their daily life and activities. We usually have patients feeling better by visit number five or six. Patients usually have complete relief from their symptoms when they are on the table being decompressed. There have been patients that did not notice any improvement until after we completed the protocol.

When a patient has an MRI, one objective finding is to do a comparative study to see if there has been any reduction in the size of the disc herniation.

Dr. Davis: Each individual may have different results. Some notice a difference within their first five to six treatments and others will find improvements after 20 visits.

Question: What other treatments do you typically combine with spinal decompression?

Dr. Shoshany: We like to combine spinal decompression with an effective core-strengthening program. I use the SpineForce®, which is a dimensional trainer that targets postural muscles.

Dr. Davis: Sometimes we will include manual therapies, such as the Active Release Technique (ART), Graston Technique, and other soft tissue techniques. A newer treatment that can be combined is deep tissue laser. The deep tissue laser is used to reduce inflammation and help with herniated discs.

Question: What is a typical spinal decompression treatment time frame?

Dr. Shoshany: The typical program calls for 20 visits over a course of six weeks, three to four times a week.

Dr. Davis: It depends on the patient’s complexity and extent of the rehabilitation needed. Typically a patient is treated between 12 and 20 times. During this time, it is important to continually evaluate the treatment and adjust the treatment protocol as needed.

Question: What are the pros and cons of spinal decompression for patients and for chiropractors? What advice do you have for other chiropractors considering getting into spinal decompression now?

Dr. Shoshany: The pros of spinal decompression for the patient are that it is a non-surgical and non-drug approach. In addition, spinal decompression is extremely safe with little chance of hurting a patient. In fact, most patients fall asleep during spinal decompression treatments. Spinal decompression addresses the underlying structural issue that is causing a patient’s pain and dysfunction and is the most direct way to treat a problem. A con may be that treatment is out of the price range for some insurance plans and they will not pick up the cost of treatment.

My advice to any chiropractor getting started with spinal decompression is to invest in a solid table as opposed to cheaper models that claim to do everything. Today there are many tables in the market that claim to do spinal decompression. Do your homework and talk to doctors that are currently using different tables and understand their likes and dislikes of particular tables. I like both the DRX9000 and SpineMED® tables. This is a tool that you will use every day and therefore it needs to be strong, sturdy and well designed to deliver results.

Dr. Davis: The main cons to consider are costs of the initial machine, the ongoing maintenance that is needed to keep it in running condition and the required insurance. The machine also takes up room. In addition, it can take time to educate a patient on spinal decompression, which increases the amount of time one spends in a consultation.

Before you incorporate spinal decompression, do a cost analysis. Don't assume others are making money. It's a competitive market and it takes time to get results. You may not get great results initially. Clinics and demographics of your area may also play a role. For example, pro athletes and golfers may already have spinal decompression in their sports clinic.

Question: What are good alternatives to spinal decompression if a patient doesn't want it or can’t afford it?

Dr. Shoshany: A good alternative might be inversion therapy at home if a patient can get into that position.

Dr. Davis: An alternative that may benefit patients looking for spinal decompression at home might be the use of an inversion table.

If you want to learn more about chiropractic care, visit the Chiropractic Health Center. You can also use the Spine-health doctor directory to find a chiropractor near you.

To learn more about the interviewees:

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Back Pain and Tendons

The skeletal muscles supplies us movement, which is supported by the posture. Our muscles will shorten, tighten, contract, and promote mobility. The muscles join with bones that attach to the tendons. Once the muscles begin contracting, the muscles are stimulated and join the fibers through our motor neuron cells. The nerves makeup axon, body of cells, dendrites, etc, and these elements transmit impulses to the nerves, sending the impulses to the major components of our system, such as Central Nerve System. The network joins with cells, fibers, muscles, etc, and conveys messages, transmitting them through sensations that stop at the brain. The brain transmits signals that are sent from motor impulses and carries onto the organs and muscles. Collagen is produced from the muscle fibers, which the tendons surround the fibers via the softer tissues. (Paratenon)

Injuries in this area occur when a person suddenly stretches, or overexerts the tendons. The back muscles in the leg make up the gluteus medius, (Hamstrings) biceps femoris, (Hamstrings), gluteus maximus, iliotibial tract, Sartorius, adductor Magnus, gastrocemius, semitendinosus, and the soleus. In this area, the muscles can be completely ruptured, or incompletely ruptured. The soleus, tibia, fibula, Achilles, etc, is the areas that are usually strained, or ruptured. The pain can caused from the injury can also affect the back. Since the legs are limited, as well as the tendons, muscles, etc, mobility is limited, which restricts muscle movement. This means that muscles are not exerting daily on the level it requires to function properly. Tendons operate akin to the ligaments.

Ligaments are vigorous bands that mingle with threads of collagen fiber. The fiber connects to the bones. The fiber bands and bones connect and encircle the joints. We get our strength from these joints. Tendons are ligaments and muscles respectively, since tendons join with the muscles, which make up connective proteins and/or collagen. Tendons make up fiber proteins. The protein fibers are created in the cartilages, bones, skin, tendons, and interrelated connective tissues. Tendons are affected when various conditions interrupt its actions, including simple tendonitis, and peritendinitis.

Tendons are also interrupted when spinal or neck injuries occur. Neck injuries include whiplash, which many people believe is a head injury. Contrary to their notions, whiplash is a neck injury usually caused from rear-ends motorized collisions. Whiplash is neck damage, which can cause disjointed, fractures, ruptured spines, etc. Whiplash can lead to edema, hemorrhaging, and so forth. The problem causes pain around the neck and shoulders, but extends to the back. Whiplash can also depress the nerves, which leads to linear and/or comminuted difficulties. Comminuted difficulties arise from bone damage.

Spinal injuries often occur during falls, slips, inappropriate movement, muscle exertion, automobile accidents, trauma, and so on. In fact, the coccyx lies at the bed of the second spinal column. Damage to this baby can lead to serious problems, which the coccyx is non-supported. The coccyx creates the fused bones. The fused bones reside at the baseline of the spinal columns. The bones in summary are the tailbone.

The coccyx is at greater risk than any other element within the skeletal structure, since the coccyx can break easily from falls, thus leading to coccygodynia. Coccygodynia is a condition of the spinal that can create damning pain. Back injuries and injuries to the neck can affect the airway, breathing, and blood circulation. Some injuries require resuscitation.

Resuscitation is the process of clearing the airway. The act is performed by smoothly tilting the head back and lifting the chin. The tongue is pulled clear so that air can travel to the lungs. If neck injuries are present, you want to take extra precautions if resuscitation is necessary. Once you clear the airway use your ear, placing it over the mouth and listen for breathing. You can also put the hand over the mouth to feel breathe. If you cannot get results after testing for breathing, you will need to test the carotid pulses located in the neck to check for circulation.