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.

I currently have three pregnant students, all at slightly different stages, so the following item captured my attention. I think this might also explain why women dancers – not to mention gymnasts – can bend backwards so much further and easier than men.

Nature has a new article detailing the recent discovery that women’s spines have evolved to be more flexible and supportive than those of men to increase comfort and mobility while bearing the weight of a developing child. The adaptations can be traced back as far as Australopithecus, more than two million years ago.

A female australopithecine, like today’s moms, used her spine to support baby’s weight.
John Gurche

Katherine Whitcome and Daniel Lieberman from Harvard University in Cambridge, together with their colleague Liza Shapiro of the University of Texas at Austin, measured the centre of mass of 19 pregnant women and found that they leaned back by as much as 28º beyond the normal curve of the spine, they report in Nature 1. The researchers found this lowers the torque around the hip created by the baby’s weight by roughly eight times.

Exaggerating the curve in the lower back can place more stress on the spine: vertebrae are more likely to slip against each other, leading to back pain or fractures. Whitcome and her colleagues found that a woman’s spine has several features that help to prevent that damage. In women, the curve in the lower back spans three vertebrae; in men, it encompasses just two. The added vertebra helps distribute the strain over a wider area.

In addition, specialized joints located behind the spinal cord, called zygapophyseal joints, are 14% larger relative to vertebrae size in women than in men, suggesting that the joints are well adapted to resist the higher force. The joints are also oriented at a slightly different angle in women, allowing them to better brace the vertebrae against slipping.