Alexander technique reduces low back pain disability

Clinical Question

Can the Alexander technique reduce disability and pain in patients with chronic or recurrent low back pain?

Bottom Line

The Alexander technique, a system of teaching self-awareness of body posture and movement, was more effective than usual care in reducing disability in patients with chronic or recurrent low back pain. It also decreased the number of days with back pain and improved quality of life. Teachers of the Alexander technique can be found in many communities. (LOE = 1b)


Little P, Lewith G, Webley F, et al. Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain. BMJ 2008;337:a884.  [PMID:18713809]

Study Design

Randomized controlled trial (nonblinded)






Outpatient (primary care)


Given the frequency of back pain and the disability it can cause, researchers are looking for combination approaches that might help return patients to higher functioning. These British researchers enrolled 579 patients with chronic or recurrent back pain drawn from 64 general practices in England. The patients had a score of 4 or more on the Roland Disability index (average score = 10.7 - 11.2) out of a possible 28 and had current pain lasting for at least 3 weeks. The patients were randomly assigned (concealed allocation) to 1 of 8 groups of approximately 70 patients each. The control received normal care, and the other groups received either 6 sessions of massage, or 6 or 24 sessions of Alexander technique, with or without a prescribed exercise program with up to 3 sessions of behavioral counseling. The Alexander technique consists of individualized instruction to help patients be more aware of their movements in order to produce better body habits that reduce muscle tension. Its origins are in the training of actors to promote better posture for proper voicing. After 3 months, the combination of exercise and lessons in the Alexander technique reduced disability more than usual care, adding an additional decrease of 1.71 to 2.91 points in the Roland Disability score as compared with usual care (P < .005). Six Alexander lessons, combined with exercise, was nearly as effective as 24 lessons. Patients in the usual care group reported a median 21 days of pain over 4 weeks; the Alexander technique decreased this number by 11 to 16 days (in both 6 and 24 lesson groups). Massage was similarly effective, decreasing the disability score by 1.96 and the median days of back pain by 13 days.