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
Competing interests:
No competing interests
10 November 2008
P.S. Little
Professor of Primary Care Research
George Lewith, Fran Webley, Maggie Evans, Angela Beattie, Karen Middleton, Jane Barnett, Kathleen Ballard, Frances Oxford, Peter Smith, Lucy Yardley, Sandra Hollinghurst, Debbie Sharp
Community Clinical Sciences Division, Aldermoor Health Centre, University of Southampton SO16 5ST
Rapid Response:
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
Competing interests: No competing interests