Tomsterdam - a touch of technique

From the December issue of Family Practice, an international journal aimed at practitioners, teachers, and researchers in the fields of family medicine, general practice, and primary care:

Patients’ views of receiving lessons in the Alexander Technique and an exercise prescription for managing back pain in the ATEAM trial

Background. Lessons in the Alexander Technique and exercise prescription proved effective for managing low back pain in primary care in a clinical trial.

Objectives. To understand trial participants’ expectations and experiences of the Alexander Technique and exercise prescription.

Methods. A questionnaire assessing attitudes to the intervention, based on the Theory of Planned Behaviour, was completed at baseline and 3-month follow-up by 183 people assigned to lessons in the Alexander Technique and 176 people assigned to exercise prescription. Semi-structured interviews to assess the beliefs contributing to attitudes to the intervention were carried out at baseline with14 people assigned to the lessons in the Alexander Technique and 16 to exercise prescription, and at follow-up with 15 members of the baseline sample.

Results. Questionnaire responses indicated that attitudes to both interventions were positive at baseline but became more positive at follow-up only in those assigned to lessons in the Alexander Technique. Thematic analysis of the interviews suggested that at follow-up many patients who had learned the Alexander Technique felt they could manage back pain better. Whereas many obstacles to exercising were reported, few barriers to learning the Alexander Technique were described, since it ‘made sense’, could be practiced while carrying out everyday activities or relaxing, and the teachers provided personal advice and support.

Conclusion. Using the Alexander Technique was viewed as effective by most patients. Acceptability may have been superior to exercise because of a convincing rationale and social support and a better perceived fit with the patient’s particular symptoms and lifestyle.

Since the earliest days of the Alexander Technique, teachers and students have known from their own experiences that back pain responds very well to private lessons in the Technique. Constant back pain was in fact one of the main reasons I myself began taking lessons. The relief of that pain was the main reason I continued lessons, and why I decided to become a teacher. Yet in all these years of anecdotes, the hard evidence to prove this claim was nowhere to be found.

All that changed yesterday with the publication in the British Medical Journal of “Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain“. This 5-year study of 579 patients revealed what AT teachers have suspected all along: Alexander Technique is more effective in relieving back pain than massage or exercise, the current standard medical treatments.

A series of 24 lessons in the Alexander technique taught by registered teachers provides long term benefits for patients with chronic or recurrent low back pain. Both six lessons in the Alexander technique and general practitioner prescription for aerobic exercise with structured behavioural counselling by a practice nurse were helpful in the long term; classic massage provided short term benefit. Six lessons in the Alexander technique followed by exercise prescription was almost as effective as 24 lessons.

New York Magazine has a very interesting article about shoes and how they are ruining our feet.

Last year, researchers at the University of the Witwatersrand in Johannesburg, South Africa, published a study titled “Shod Versus Unshod: The Emergence of Forefoot Pathology in Modern Humans?” in the podiatry journal The Foot. The study examined 180 modern humans from three different population groups (Sotho, Zulu, and European), comparing their feet to one another’s, as well as to the feet of 2,000-year-old skeletons. The researchers concluded that, prior to the invention of shoes, people had healthier feet. Among the modern subjects, the Zulu population, which often goes barefoot, had the healthiest feet while the Europeans—i.e., the habitual shoe-wearers—had the unhealthiest. One of the lead researchers, Dr. Bernhard Zipfel, when commenting on his findings, lamented that the American Podiatric Medical Association does not “actively encourage outdoor barefoot walking for healthy individuals. This flies in the face of the increasing scientific evidence, including our study, that most of the commercially available footwear is not good for the feet.”

One of the newest designs discussed in the article is the Vivo Barefoot, which has a surprising link to the Alexander Technique.

Tim Brennan [is] a young industrial-design student at the Royal College of Art. Brennan was an avid tennis player who suffered from chronic knee and ankle injuries. His father taught the Alexander Technique, a discipline that studies the links between kinetics and behavior; basically, the connection between how we move and how we act. Brennan’s father encouraged Tim to try playing tennis barefoot. Tim was skeptical at first, but tried it, and found that his injuries disappeared. So he set out to design a shoe that was barely a shoe at all: no padding, no arch support, no heel. His prototype consisted of a thin fabric upper with a microthin latex-rubber sole. It wasn’t exactly a new idea. It was a modern update of the 600-year-old moccasin.

Brennan brought his shoe to Clark [inventor of the Wallabee shoe], and after some modifications, they came up with a very flexible leather shoe with a three-millimeter sole made of rubber and puncture-resistant DuraTex that they call the Vivo Barefoot.