Helped By a Better Body Language

IN 1904, a 35-year-old Australian actor, Frederick Matthias Alexander, left Sydney for London, armed with letters of introduction and support from several prominent doctors. Alexander traveled to London to build a practice and spread news of his technique.

What is the story behind this technique?

Alexander had had persistent voice loss during recitations, which wasn't resolved by rest or medication. By closely observing the preparatory movements he made before vocalising, he developed a conscious approach to movement, posture and breathing that not only proved effective in resolving his own problem, but he believed was also useful for a range of other chronic conditions. From 1893 to 1904, his work in Australia and New Zealand was largely concerned with elocution and breathing, and increasingly with the treatment and prevention of tuberculosis, which was then the single most common cause of death.

At the turn of the century, the only treatment for TB was rest, a rich diet, fresh air and sunshine, leading to the construction of many sanatoriums. Alexander asserted that prevention and cure could be obtained by learning "the art of breathing" which, through developing the "motive power" of the thorax, would secure effortless breathing and improve oxygenation of the blood. He wrote a lengthy article, 'The Prevention and Cure of Consumption', which was first published in Sydney's Daily Telegraph on 12 December 1903.

Once in London, Alexander's work was well received, especially in the performing arts, where many of the most celebrated actors of the day took lessons from him. Later enthusiastic advocates of his work included author Aldous Huxley, playwright George Bernard Shaw, educational philosopher John Dewey, Nobel laureate neurophysiologist Sir Charles Sherrington and anthropologist Professor Raymond Dart. During Alexander's lifetime many doctors also testified to the effectiveness of his technique in both the Lancet and the BMJ. These journals also reviewed Alexander's books. In 1937, 19 medical doctors wrote to the BMJ urging, unsuccessfully, the inclusion of the Alexander Technique in medical training.

In the 1930s Alexander began to train other people to teach his technique. Forty five people completed a three-year training program under his supervision. Several of these are still teaching his technique today, despite being older than 80. Alexander himself continued to teach until he died in 1955. He had a stroke in 1947 at 78, but recovered and taught in London until a few weeks before his death at 86.

Today there are more than 2000 Alexander Technique teachers in more than 30 countries. In the UK, lessons in the technique are available on the National Health Service when referred by a GP, and the technique is taught in specialist hospital departments, such as pain clinics and for breast cancer rehabilitation. The technique is also taught in many of the leading colleges for the performing arts around the world, including the Metropolitan Opera, the Juilliard School and the Menuhin School. In Australia, it is taught at the National Academy of Music, the Victorian College of the Arts, the WA Conservatorium of Music and the National Institute of Dramatic Art.

What is the Alexander Technique?

The Alexander Technique is an educative technique that does not set out to be curative, but may often have useful effects on musculo-skeletal and psychological states. Practitioners say it is a subtle form of postural re-education, where people learn how to allow the whole body to work in an unrestricted, more natural way.

The late Dr David Garlick, (formerly) director of sports medicine programs at the University of NSW, has undertaken extensive research into aspects of the technique, mentioned in his book, The Lost Sixth Sense — A Medical Scientist Looks at the Alexander Technique. Dr Garlick writes that Alexander observed that the brain is designed to control the musculoskeletal system at a subconscious level, allowing the person to direct their attention to a variety of other stimuli. He says the problem for the upright human is that various other muscle strategies may become employed, in regard to being upright and in carrying out movements, that are inappropriate — for instance, overcontracted muscles around the neck, shoulders, buttocks and thighs, and undercontracted postural muscles such as in the lumbar region and deeper trunk musculature.

Proponents of the technique say such problems lay the basis for a range of chronic musculoskeletal dysfunctions — chronic neck or back pain, tension headaches and some chronic respiratory conditions. Alexander believed a person's attention could be directed to the state of their muscles (the proprioceptive sense), learning how to begin to stop inappropriate muscle strategies. He said this could lay the basis for easier, reflex responses to gravity for being upright and undertaking movements.

For this process, Alexander developed a set of "directions" related to the neck being free or relaxed, the head in a direction of "forward and up" and the back "lengthening and widening". Practitioners say this learning process is of value to any individual, as well as benefiting those with musculoskeletal and stress-induced conditions. As with any learned skill, applying the technique to everyday life requires lessons. Most people would require at least 10 sessions, although practical benefits may be experienced from the start.

A typical lesson involves lying semi-supine on a table while the teacher applies guiding, non-invasive hands to encourage a releasing and lengthening of the muscles. Then everyday movements — such as standing, walking and sitting in a chair — are performed, with the teacher encouraging a more mindful awareness of the unconscious habits evoked by these familiar movements. An Alexander teacher brings a person's attention to their particular fixed patterns, and uses a combination of verbal instruction and gentle manual guidance to allow them to change unhelpful habits of movement, posture and breathing, by removing hindrances to the body's natural postural reflexes.

Lessons are taught one-on-one to address specific individual patterns. A stated aim of the Alexander Technique is to make people aware they have some control and choice over their conditions, and that this can have a substantial beneficial effect, regardless of their diagnosis. After Alexander's departure from Australia, it was many years before the technique was taught again in this country. There has been a growing number of teachers since the early 1980s. The Australian Society of Teachers of the Alexander Technique has almost 150 teaching members, and there are now three internationally accredited courses in Australia for the three-year, full-time training to become a teacher.

Research

Because of the wide scope and diverse application of the Alexander Technique, there have been few large-scale scientific studies into its effectiveness for specific conditions. It should also be remembered that the technique is educational in nature, and only therapeutic as a consequence.

A UK study into the evaluation of the Alexander Technique for the management of Parkinson's disease is expected to be published soon. The randomised controlled trial involved 90 Parkinson's disease patients, and was conducted at the University of Westminster, London, with funding from the Parkinson's Disease Society and the Foundation for Integrated Medicine. This followed a pilot study which concluded that for patients with Parkinson's disease on drug therapy, the Alexander Technique reduced depression and improved the management of disability.

Several studies into sway analysis have also been conducted, concluding that experienced Alexander students were significantly more stable than untrained subjects. Respiratory function has also been studied in relation to the technique. Spirometry demonstrated that people learning the technique showed significant increases in all test parameters, including lung capacity and peak expiratory flow rate. No such improvement was apparent in the control group.

Dr David Garlick has also compared respiratory movements in a laboratory setting on people with and without Alexander Technique instruction. Breathing was deeper and slower in people who had received the instruction. Another study was made of the use of the technique in a pain clinic. Patients rated it the best of 13 activities used on a course on pain management. Questionnaires measuring this were administered at the end of the course, three months later, and one year later.

Performance stress in musicians has also been studied. Results showed the technique was as effective as beta blockers in controlling the stress response during an orchestra performance, but without the adverse effects on quality or performance associated with the use of beta blockers.

In March 2001, the UK Medical Research Council announced a £600,000 ($A1,613,000) grant to the University of Southampton to test the technique's effectiveness for back pain. GPs from Bristol and Southampton will refer 550 patients with back pain, to be randomly allocated to one of four groups — normal care, a short course of six Alexander Technique lessons, a longer course of 24 lessons, or a course of therapeutic massage. All patients in the study will be followed up for a year.

Dr Rathbone is a GP practising in Wynyard, Tasmania, the birthplace of Frederick Matthias Alexander.

Copyright: Dr Megan Rathbone. Permissions: An article printed in Australian Doctor Magazine, 12 April 2002 Reproduced by kind permission of the author. © Australian Doctor Magazine