In the most comprehensive study of the Alexander technique yet published, researchers in England recruited 579 men and women with chronic low back pain from 64 primary care clinics. Participants were randomly assigned to receive 24 lessons in the Alexander technique over nine months, six lessons in the Alexander technique over one month, or six sessions of therapeutic massage over six weeks. Others were assigned to a control group that received none of these therapies.

Half of all people in each group were given a formal aerobic exercise prescription from their doctor along with counseling from a trained nurse. Participants filled out a variety of pain and disability questionnaires at the beginning of the study, at three months and at one year.

Results, published in the August 19, 2008, issue of BMJ (British Medical Journal), showed that all groups with the exception of the control group improved at least slightly. But not all therapies provided consistent long-term relief.

Massage showed some initial benefit, but it quickly fizzled once the sessions stopped. And after one year, the exercise-only group reported 17 percent less disability from back pain than the control group but did not report less pain. In contrast, people who completed 24 lessons in the Alexander technique reported 42 percent less disability and 86 percent fewer days of pain at one year. Even just six lessons in the technique were associated with 17 percent less disability and 48 percent fewer days of pain.

Points to Consider

While some have hailed this study as justification of the Alexander technique, keep in mind that the theory behind it—that it decompresses the spine and that spinal decompression relieves chronic back pain—wasn't proven in the BMJ study. Also, researchers didn't take a close look at people who responded favorably to see if they shared the same type of back pain or chronic back condition. So there's no way to know if you are one of the people who might benefit from the Alexander technique.

Another concern is cost. Chances are you'll have to pay out of pocket for lessons, which can get expensive—$45, often more, per lesson. And it may take up to 30 lessons to fully integrate the Alexander technique into your everyday movements, according to some estimates.

But judging by the results of the BMJ study, you can probably get away with less. Why? People who combined regular exercise with just six lessons in the Alexander technique benefited about 70 percent as much as those who took 24 lessons but didn't exercise. Put another way, with exercise, the six-lesson group achieved nearly three-quarters the benefits with one-quarter the number of lessons.

A separate cost-benefit analysis published in the same issue of BMJ confirmed that although exercise was the cheapest approach to back pain, six Alexander lessons plus exercise provided the most relief for the least money. So as long as you exercise, you may be able to learn enough from six lessons to practice and integrate the techniques on your own.

Source: Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50

Publication Review By: the Editorial Staff at

Published: 06 Jul 2013

Last Modified: 02 Sep 2015