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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    • "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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    ABSTRACT: Physiotherapy for people with low back pain frequently includes assessment and modification of lumbo-pelvic movement. Interventions commonly aim to restore normal movement and thereby reduce pain and improve activity limitation. The objective of this systematic review was to investigate: (i) the effect of movement-based interventions on movement patterns (muscle activation, lumbo-pelvic kinematics or postural patterns) of people with low back pain (LBP), and (ii) the relationship between changes in movement patterns and subsequent changes in pain and activity limitation. MEDLINE, Cochrane Central, EMBASE, AMI, CINAHL, Scopus, AMED, ISI Web of Science were searched from inception until January 2012. Randomised controlled trials or controlled clinical trials of people with LBP were eligible for inclusion. The intervention must have been designed to influence (i) muscle activity patterns, (ii) lumbo-pelvic kinematic patterns or (iii) postural patterns, and included measurement of such deficits before and after treatment, to allow determination of the success of the intervention on the lumbo-pelvic movement. Twelve trials (25% of retrieved studies) met the inclusion criteria. Two reviewers independently identified, assessed and extracted data. The PEDro scale was used to assess method quality. Intervention effects were described using standardised differences between group means and 95% confidence intervals. The included trials showed inconsistent, mostly small to moderate intervention effects on targeted movement patterns. There was considerable heterogeneity in trial design, intervention type and outcome measures. A relationship between changes to movement patterns and improvements in pain or activity limitation was observed in one of six studies on muscle activation patterns, one of four studies that examined the flexion relaxation response pattern and in two of three studies that assessed lumbo-pelvic kinematics or postural characteristics. Movement-based interventions were infrequently effective for changing observable movement patterns. A relationship between changes in movement patterns and improvement in pain or activity limitation was also infrequently observed. No independent studies confirm any observed relationships. Challenges for future research include defining best methods for measuring (i) movement aberrations, (ii) improvements in movements, and (iii) the relationship between changes in how people move and associated changes in other health indicators such as activity limitation.
    BMC Musculoskeletal Disorders 09/2012; 13(1):169. DOI:10.1186/1471-2474-13-169 · 1.72 Impact Factor
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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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    ABSTRACT: Group cognitive behavioural intervention (CBI) is effective in reducing low back pain and disability over a 12-month period, in comparison to best practice advice in primary care. The aim was to study the effects of this CBI beyond 12 months. We undertook an extended follow-up of our original randomised, controlled trial of a group CBI and best practice advice in primary care, in comparison to best practice advice alone. Participants were mailed a questionnaire including measures of disability, pain, health services resource use, and health-related quality of life. The time of extended follow-up ranged between 20 and 50 months (mean 34 months). Fifty-six percent (395 of 701) of the original cohort provided extended follow-up. Those who responded were older and had less disability and pain at baseline than did the original trial cohort. After 12 months, the improvements in pain and disability observed with CBI were sustained. For disability measures, the treatment difference in favour of CBI persisted (mean difference 1.3 Roland and Morris Disability Questionnaire points, 95% confidence interval 0.27 to 2.26; 5.5 Modified von Korff Scale disability points, 95% confidence interval 0.27 to 10.64). There was no between-group difference in Modified von Korff Scale pain outcomes. The results suggest that the effects of a group CBI are maintained up to an average of 34 months. Although pain improves in response to best practice advice, longer-term recovery of disability remains substantially less.
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