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The Alexander Technique for Back Pain

The Alexander Technique is an educational process that takes place over a course of lessons and practice with the goal of teaching the person to become aware of and change habitual ways of using the body. The approach focuses on learning mind-body awareness. The main goal of the Alexander Technique – as it applies to back and neck pain – is to restore appropriate levels of muscle tension during common daily activities, such as sitting, standing up, and walking. Alexander Technique practitioners specifically do not make any claims as to medical benefit of the technique. The theory is that less tension will minimize wear and tear on the muscles and other structures of the spine vulnerable to compression.

History of the Alexander Technique

Frederick Matthias Alexander, an Australian actor who suffered from hoarseness only when he performed, originally developed the principles and discipline of the Alexander Technique in the late 1800’s. Following years of self-study, Alexander came to the conclusion that patterns of excessive tension originated from the head and neck but led to muscular strain throughout the body as a whole. He also concluded that faulty movement habits led to decreased kinesthetic perception. He developed a system of hands-on assistance as well as verbal cues to help clients stop their physical habit and move in a freer, more efficient manner.

Effectiveness of the Alexander Technique for Back Pain

Recent studies suggest that the Alexander Technique may be effective in providing back pain relief.

  • In 2008, a study published in the British Medical Journal followed 579 patients over the course of a year in the “Randomised controlled trial of Alexander technique (AT) lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain.” The study found that Alexander Technique lessons provided benefit to patients in terms of back pain relief and reducing recurrent back pain.1
  • A subsequent study found that a series of six lessons in combination with a walking exercise program seemed to be the most effective and cost efficient option for the treatment of back pain in primary care.2
  • A case study of a patient with a 25 year history of low back pain was found to have significant improvement in the symmetry of her balance responses and in the intensity and frequency of her low back pain. 3

At the time of this article, there are no studies regarding long term effectiveness of the Alexander Technique for pain relief of low back and/or neck pain.

Alexander Technique Approach

The Alexander Technique includes a recommended number of lessons with a qualified teacher, usually provided one-on-one. A typical Alexander Technique program teaches topics such as:

  • How to comfortably sit up straight
  • How to reduce overuse of superficial musculature in posture
  • How to increase proprioceptive awareness
  • How to become more attuned to the body’s warning signs of tension and compression.

Teachers of the Alexander Technique are required to have completed three years of full time training as part of an accredited Alexander Technique teacher training curriculum, and many are certified by one or more of the Alexander Technique professional societies.

Most insurance carriers consider the Alexander Technique to be investigative and inadequately supported by evidence in peer reviewed medical literature, so the therapy is rarely covered by insurance.

Acupuncture: An Ancient Treatment for a Current Problem

Acupuncture is widely understood to be a non-traditional (not a traditional part of western medicine) treatment option for back pain or neck pain. While acupuncture is often not the first line of treatment sought for most back or neck problems, an increasing number of patients, as well as physicians and other health professionals are starting to use acupuncture as a means to reduce neck pain and back pain.

Acupuncture is a form of Chinese medicine that can be traced back at least 2,500 years. The general premise of acupuncture is that the body contains patterns of energy flow. The vital energyor life force of the body is referred to as qi (pronounced “chee”), and proper flow of qi is considered to be necessary to maintain health.

The theory of acupuncture is that there are over 2,000 points on the human body that connect with 20 pathways (meridians). These pathways conduct the qi throughout the body. With acupuncture, hair-thin metallic needles are inserted into specific combinations of these 2,000 points in an attempt to correct and/or maintain a normal flow of qi.

How Acupuncture Works

The mechanisms of acupuncture, though not solidly proven, have exhibited several commonly accepted effects to the body. Most notable is that acupuncture stimulates the central nervous system—the brain and spinal cord. Most people report a tingling sensation, feeling relaxed or even energized. Again, this is largely based on the individual receiving the acupuncture treatment and how he or she perceives it.

During an acupuncture treatment session, anywhere from 1 to 20 FDA-approved, metallic needles are inserted into the body, ranging from just breaking the surface to up to 1 or several inches long. The longer acupuncture needles (such as 5 to 9 inches) are inserted into areas of deeper muscle/fat layers or along, under the skin or even scalp, depending on what is being treated and the required depth or penetration. The acupuncture needles are often left in for approximately 15 to 30 minutes. Some practitioners insert needles, turn them either in one direction or the other or both, depending on what they are attempting to achieve, and these needles are inserted for perhaps 10 seconds only, removed and the same needle is used for treatment of other points on that same patient. In certain instances, needles are warmed or electrically charged after insertion. The electrical acupuncture can be used with needles or through the use of a non-penetrating probe.

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People experience acupuncture differently, and rarely do they describe it as ‘painful’. Unlike needles used for injections, the tip of an acupuncture needle comes smoothly to a point, instead of by way of a sharp edge. Acupuncture needles are also extremely thin—about 20 times thinner than a typical hypodermic needle used for injections. The acupuncture needles are solid and do not remove tissue as would occur with a hypodermic needle, making them safer. Some practitioners also use moxibustion and burn this on the needles during insertion. This is an herb compound that is often used.

Acupuncture also has a cupping component to it, whereby cups are heated and applied to the skin to create suction and bring blood close to the surface.

There are areas on the body that are considered a micro system and some acupuncturists may treat only those micro systems, such as treating only the ear (auriculotherapy), only the face, only the hand, only the foot, etc.

In the US, only sterile, one-time use needles (that are sealed prior to use) are allowed. After use, the acupuncture needles must be disposed in a proper hazardous waste receptacle.

During the course of the acupuncture procedure, specific chemicals release into the body, supposedly affecting back pain and neck pain physically and psychologically.

Acupuncture is thought to operate by:

  • Release of opioid peptides. Opioids are naturally occurring chemicals in the brain that have an analgesic effect. The release of these opioids plays a significant role in the reduction of pain. There has been considerable evidence to support that acupuncture stimulates the central nervous system, releasing these chemicals.
  • Alteration in the secretion of neurotransmitters and neurohormones. Acupuncture is said to activate the hypothalamus and pituitary gland and thereby alter secretion of these chemicals. These particular chemicals play a direct role in the sensation of pain as well as the activity of an organ or organs. Evidence has shown that acupuncture alters this secretion in a manner that reduces pain. Documentation has also shown that acupuncture positively affects immune functions in the body.
  • Stimulation of electromagnetic points on the body. The 2,000 points of the body that acupuncture focuses on are theorized to be strategic conductors of electromagnetic signals. Stimulation of these areas is believed to start the flow of endorphins—the body’s natural painkillers.

While there are many experts in the medical field who believe acupuncture is an effective way to treat certain conditions, there is no true consensus. Some define the benefits of acupuncture within the realm of traditional Chinese theories such as qi and meridians. Others understand and attribute acupuncture’s benefits to certain scientific and biological changes they bring about in the body (as mentioned above). Alternatively, some question the ability of acupuncture to have any impact at all. The skeptics should give it a chance and seek proof for themselves.

Acupuncture Considerations

Acupuncture is considered a safe medical treatment. For this reason, many physicians and practitioners believe that acupuncture is a beneficial treatment as an adjunct to other medical treatments, and/or as an alternative to medical treatments. In certain situations, acupuncture may be used in combination with conventional painkillers, or to replace them all together.

In 1998, the National Institutes of Health (NIH) released a statement that said there is enough evidence to demonstrate that acupuncture had beneficial pain-relieving qualities in adults experiencing postoperative dental pain, as well as nausea from chemotherapy. The NIH also found that acupuncture might be useful as a treatment for low back pain, as well as many other conditions, such as headache, myofascial pain,osteoarthritis, and carpal tunnel syndrome.

In China and other countries in the orient, acupuncture is sometimes used in many other ways, such as in some surgical cases including brain, abdominal and other surgeries. Sometimes part acupuncture and part anesthetics may be used for surgery.

However, as with any treatment option acupuncture is not without its risks and costs. One should be well aware of the factors involved in acupuncture before making any sort of decision as to whether or not it is a possible treatment option.

Here are some guidelines regarding acupuncture:

  • Get a referral from a health care practitioner or reputable source. Many physicians understand the theories behind acupuncture and may refer their patient to a licensed acupuncture practitioner upon request.
  • Research the acupuncture practitioner’s background and qualifications. Just as one would do with any health care practitioner, it is important to research the background and qualifications of an acupuncture practitioner. Generally in the U.S., a Medical Doctor (MD), Doctor of Osteopathic Medicine (DO), Doctor of Chiropractic (DC), or Physical Therapist (PT) may be able to obtain a license to perform acupuncture. In certain areas, other health professionals (such as registered nurses) may also qualify qualify to be licensed acupuncture practitioners. In the US, each state has different requirements to be allowed to practice acupuncture. Some states require a degree in acupuncture and passing a Board examination, and other states have much less stringent requirements.
  • Consider costs and benefits. It is advisable to ask about the success rates of acupuncture and the probability of achieving desired levels of pain relief. It should be a red flag to anyone if the acupuncture practitioner is unfamiliar with the patient’s specific condition, or if the acupuncture practitioner’s expectations for a successful outcome are low.