Ask the doctors: Lower back pain could be helped with Alexander technique

Dear Doctor: I’ve had lower back pain for years, and nothing has helped. I’ve tried physical therapy, yoga and chiropractors, and I’ve even contemplated surgery. My sister suggests something called the Alexander technique. What do you think? I’m willing to try anything, but I don’t want to chase after treatments that aren’t useful.

Dear Reader: When our ancient ancestors stood up and became bipeds, they gave humans a crucial evolutionary advantage. They also left us with another lasting legacy – back pain. It’s a near-universal complaint, and it ranks among the largest contributors to disability throughout the world. Yet, because the spine is a complex structure, the specific causes of back pain often remain elusive. This can make finding an effective treatment both difficult and frustrating.

The majority of back pain affects the lower back, which supports much of the weight of the upper body. The most common causes of pain in the region are the mechanics of how we stand and move, injuries to the tissues and structures of the back and spine and, often, a combination of the two. Poor posture, poor alignment and the ergonomics of the tools and objects in our daily lives all play a role. Put too much stress or torque on the spine, and you’re at risk of injuries to the muscles, ligaments, tendons and nerves in the region.

A back injury can make itself known suddenly, as with a muscle spasm or a slipped disc, or may emerge over time. Either way, the pain and disruption can be daunting. Yoga, physical therapy and chiropractic care can indeed lessen lower back pain, and we’re sorry to hear that none of these approaches brought you relief. Massage, acupuncture and mindfulness exercises also can help. Some of our patients living with lower back pain have had success using topical heat, as well as over-the-counter creams, gels and patches.

All of which brings us – at last! – to your sister’s suggestion, the Alexander technique. It’s a series of posture lessons that focus on alignment, balance, breathing, coordination, spatial awareness and the release of tension, particularly in the neck, shoulders, spine, back and hips. Developed in the 1890s by Frederick Matthias Alexander, the technique has been used for chronic back pain, arthritis and Parkinson’s disease. In this method, students relearn how to sit, stand, walk, bend, reach and move, all with an awareness of gravity’s downward pull. A single session may focus solely on the proper alignment for rising from a chair, or it may be spent lying on the ground methodically assessing and releasing areas of tension.

Classes typically are one-on-one, carried out by a certified teacher who observes the student and guides them with both verbal explanations and gentle, hands-on adjustments. Several studies have confirmed the benefits of the Alexander technique for back pain, including one published in the journal BMJ. In that study, researchers found that one-on-one lessons with a certified teacher had long-term benefits for patients with chronic back pain. We recommend the Alexander technique to our own patients who are dealing with back pain. If lessons are available in your area, we think this approach to dealing with lower back pain is worth exploring.