Randomised control trial of Alexander Technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain

Community Clinical Sciences Division, Southampton University, Aldermoor Health Centre, Southampton, UK.
British Journal of Sports Medicine (Impact Factor: 5.03). 01/2009; 42(12):965-8. DOI: 10.1136/bmj.a884
Source: PubMed


To determine the effectiveness of lessons in the Alexander technique, massage therapy, and advice from a doctor to take exercise (exercise prescription) along with nurse delivered behavioural counselling for patients with chronic or recurrent back pain.
Factorial randomised trial. Setting 64 general practices in England.
579 patients with chronic or recurrent low back pain; 144 were randomised to normal care, 147 to massage, 144 to six Alexander technique lessons, and 144 to 24 Alexander technique lessons; half of each of these groups were randomised to exercise prescription.
Normal care (control), six sessions of massage, six or 24 lessons on the Alexander technique, and prescription for exercise from a doctor with nurse delivered behavioural counselling.
Roland Morris disability score (number of activities impaired by pain) and number of days in pain.
Exercise and lessons in the Alexander technique, but not massage, remained effective at one year (compared with control Roland disability score 8.1: massage -0.58, 95% confidence interval -1.94 to 0.77, six lessons -1.40, -2.77 to -0.03, 24 lessons -3.4, -4.76 to -2.03, and exercise -1.29, -2.25 to -0.34). Exercise after six lessons achieved 72% of the effect of 24 lessons alone (Roland disability score -2.98 and -4.14, respectively). Number of days with back pain in the past four weeks were lower after lessons (compared with control median 21 days: 24 lessons -18, six lessons -10, massage -7) and quality of life improved significantly. No significant harms were reported.
One to one lessons in the Alexander technique from registered teachers have long term benefits for patients with chronic back pain. Six lessons followed by exercise prescription were nearly as effective as 24 lessons.

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Available from: Kathleen Ballard, Oct 28, 2015
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    • "Unfortunately, these issues often do not give rise to any immediate symptoms but present themselves much later in life when accumulated damage has already happended to the musculoskeletal system. Somatic re-education techniques, such as the Alexander Technique (AT) [2], which aim at increasing body awareness, have been clinically shown to have long-term benefits for several conditions including chronic back pain [8] [3] and Parkinson's disease [13]. However, such practices are not widely adopted because of several reasons, including cost, lack of insurance coverage and limited numbers of certified practitioners [1]. "
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    ABSTRACT: We propose SomaTech, a Kinect-based system that encourages users to expand understanding and awareness of their everyday movements. The system creates real-time auditory feedback based on the user's whole action, aiming toward re-education of habitual, potentially unsound movement patterns which are often ingrained within the brain. To do this, we draw inspiration from the field of somatics, which has well-studied prophylactic benefits. Our initial evaluation shows promising results that users become more aware of movement choices and are able to improve their efficiency after using the system.
    ACM CHI Extended Abstracts; 04/2014
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    • "The effectiveness of exercise for LBP appears modest and not consistently associated with any particular form of exercise [30-32]. No consistent differences in LBP outcomes have been observed for highly individualised exercise programs that aim to alter lumbo-pelvic kinematics or postural patterns such as those based on the Alexander Technique [33,34], the Feldenkrais Method [33] or Pilates [35] compared with non-specific exercise. Similarly, reviews of interventions designed to alter patterns of specific muscle activity, variably described as motor control, trunk stabilisation or core stabilising exercise, have concluded little difference between outcomes achieved with motor control exercise compared with general exercise regimens [36-40]. "
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    • "Most clinical guidelines recommend that primary care practitioners give advice to remain physically active, prescribe appropriate medication, and, when symptoms persist, provide referral for nonpharmacological therapies [1] [20] [31]. Advice to remain active is better than usual general (family) practice [24] but has a short-lived effect [28]. Exercise, acupuncture, manipulation , and postural approaches produce small to moderate shortterm (64 months) benefits; but longer-term (P12 months) benefits are typically small or not statistically significant [19] [21] [22] [33]. "
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