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EDITORIALS: Maurits van Tulder Conservative non-pharmacological treatment for chronic low back pain BMJ 2008; 337: a974 [Full text]

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the place of Alexander Technique

P.S. Little, George Lewith, Fran Webley, Maggie Evans, Angela Beattie, Karen Middleton, Jane Barnett, Kathleen Ballard, Frances Oxford, Peter Smith, Lucy Yardley, Sandra Hollinghurst, Debbie Sharp   (10 November 2008)

the place of Alexander Technique 10 November 2008
P.S. Little, Professor of Primary Care Research Community Clinical Sciences Division, Aldermoor Health Centre, University of Southampton SO16 5ST, George Lewith, Fran Webley, Maggie Evans, Angela Beattie, Karen Middleton, Jane Barnett, Kathleen Ballard, Frances Oxford, Peter Smith, Lucy Yardley, Sandra Hollinghurst, Debbie Sharp Send response to journal: Re: the place of Alexander Technique	Professor van Tulder's comments on our Alexander technique paper are thoughtful but may possibly lead to some confusion. The editorial discusses different forms of exercise and readers may conclude that the Alexander Technique (AT) may simply be a different form of back exercise. However it should be clarified that the Alexander Technique is not a form of back exercise (see BMJ.com for the full article and the Appendix describing the intervention). The fact that the Technique can be used both during simple activities of daily living, or during more specialist activities such as using a computer or playing a musical instrument, demonstrates that it cannot be a particular form of exercise. Learning the Technique involves learning what not to do as a first priority i.e. learning to become aware of and avoid harmful habits of muscle use, and this sets it apart from other approaches to self-care. It appears from comparison with the UK BEAM study1 which used similar entry criteria to our study, that lessons in the AT may offer more to this group of patients than supervised fitness and strengthening exercises. Whilst technically correct that our patients were not necessarily consulting for this episode of back pain, they had all consulted in the past, so this was not a non-consulting population - and since there are few interventions available for such people it may not be surprising that they had not consulted with this episode. Professor van Tulder is quite correct in suggesting that there is currently no study that directly compares strengthening exercises with lessons in the Alexander Technique and we agree that further research is needed. Reference List (1) UK BEAM trial team. United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care. BMJ 2004; 329; doi:10.1136/bmj.38282.669225.AE :1377. Competing interests: None declared