The Alexander Technique as a Complement to Physical Therapy By N. Brooke Lieb

The Alexander Technique is an educational modality which aims to provide the client (student) with tools to retrain faulty sensory awareness and enhance safety in activity by identifying and correcting misuse in the musculoskeletal system. 

BACKGROUND: F. M. Alexander, (1869-1955) was born in Australia.  At the age of 19, he embarked on a professional career as a solo orator.  Very early in his career, Alexander began to suffer from chronic laryngitis.  Doctors gave him many diagnoses, one of which was chronically inflamed mucous membranes.  The treatments available to him consisted of gargling or inhaling steam with various mixtures.  While he would improve for a short time, it was clear that the problem was becoming progressively worse.

After booking an engagement that could be a turning point in his career, Alexander once again sought the advice of a doctor.  Alexander was aware that his difficulties only seemed to result from stage performance, and that his voice was fine during daily conversation.  The doctor felt Alexander’s problems were caused by vocal fatigue and ordered F. M. to rest his voice for two weeks before his engagement.  Alexander complied with his doctor’s instructions and was given a clean bill of health the day of his performance.  Still, F. M. lost his voice completely by the end of the evening, and was unable even to whisper by the time the curtain came down.

Determined to solve his problem once and for all, Alexander returned to the doctor and put forth his conclusion: there something was he did while performing onstage which was causing his problems.  The doctor agreed with his theory though could not offer any insight into to what F. M. might be doing wrong or how to change it.  Unwilling to continue with an ineffective course of treatment, F. M. decided to solve his own problem.

He began a 9-year exploration of how he used himself (body and mind) to recite Shakespeare, and to perform all his activities.  The tools he discovered during this exploration make up the foundation of the principles taught in The Alexander Technique.

The first observation F. M. made was that, although everything he was doing felt completely right, it must be wrong because he was experiencing progressive loss of his voice.  He had studied voice and elocution and was following his teachers’ instructions for effective sound production, yet he was getting the opposite result. 

Since he knew he could not feel what would be the right way to use himself to speak, he decided to observe himself in the mirror.  He saw that when he was about to speak (or carry out any activity, for that matter) he would rotate his head “back and down” and exert a downward compression through his whole joint system.  When he could alleviate this downward compression, a variety of other symptoms would disappear, such as compression on his voice box and an audible gasp whenever he took a breath in.  As he became more skillful at interrupting the automatic habit of compressing his head onto his spine, his vocal problems lessened until they were completely gone.

While he was exploring and refining his method of improving how he used himself, he began to teach others the same principles.  His brother, A. R. Alexander also taught the work.  They became highly skilled in the use of their hands on their students to help bring about this more efficient, healthy balance within the body.  People with a variety of conditions, including asthma, angina pectoris, dropped viscera, anxiety, depression, polio, stuttering and arthritis studied the Technique with the Alexander brothers and improved greatly.


Habits & Misuse: In the same way Pavlov’s dogs were classically conditioned to salivate when a bell rings, much of the way we think, move and use ourselves is classically conditioned.  We refer to this as habit in the Alexander Technique.  Habits allow us to walk, talk, chew gum and make great art.  That is the positive side of habit.  On the negative side, very often our habits involve inefficient or even harmful excess muscle tension that puts pressure on joints, nerves and discs.

In the Alexander Technique, the teacher helps the student recognize habitual movement patterns that may be inefficient, or even contrary to how the body is designed to move.  When we decide to stand up from a chair and walk to the kitchen to get a glass of water, we do not have to think about each specific event.  Many things happen, such as transferring weight from the seat on the chair to the feet, coming to upright posture, and taking a number of steps to the kitchen.  The body has a “software” program it runs to perform those activities.  However, habits almost always include unnecessary effort, which doesn’t register because the way each of us moves feels familiar.  When something feels familiar we often conclude it is correct.  Our habits allow us to get a great deal done, but with a cost. 

The Alexander Teacher will assist the student in understanding his or her habits and teach tools to begin to move more in accordance with the body’s innate balance and efficiency.  In essence, the student is learning how to over-ride classically conditioned response, or habit.

The Startle Response: Also referred to as the fight or flight syndrome, the startle response is an involuntary reaction to perceived danger.  The startle response causes contraction of the head “back and down” onto the neck, the shoulders to elevate, and compression throughout the skeletal system. 

An infant reacting to a loud noise is a classic example of the startle response.  After the perceived danger has passed, the infant will fully release the pattern.  As the child grows, he or she is constantly subjected to situations that elicit the startle reflex.  In our current culture, there are pre-school classes, expectations from parents, classroom learning, testing, peer groups, video and computer games, television and more.  The child is sent into startle response at such an ever-increasing rate, that he or she is unable to fully recover.  The child begins to experience a near constant state of startle response and must learn new motor skills with a compromised nervous system. 

Alexander felt that our post-industrial culture, where so much time is spent sedentary, was a major factor  in our habits of compression.  Another theory Alexander had to explain our state is that in our school system, we ask young children to sit still for long periods, when their bodies prefer movement.  We introduce handwriting before the motor skill for fine movements in the hands and fingers develops in most children; to compensate, they generate tension in their necks and shoulders.

The Alexander Technique teaches the student to calm this lifetime of over-excitation and perform activities in a more efficient manner, with muscular effort appropriate to the activity.

Awareness, Inhibition, Direction: Students will learn to develop skill in three specific ways.

Awareness: Alexander had to be able to observe what he was doing in order to change it – by developing his awareness.  By deepening awareness of the excess muscle effort carried into simple activity, students learn to monitor how they prepare, execute and recover from activity.

Inhibition:  This is the tool that made it possible for Alexander to perform his activities in a non-habitual way, without pulling his head back and down.  Inhibition means interrupting the familiar muscular pattern when performing common activities.  The teacher works with the student in movement, such as sitting down and standing up from a chair, to help him or her develop the ability to recognize habits and learn to inhibit the habitual response to stimuli. 

Direction:  Alexander knew that he did not want to pull his head back and down.  He recognized that this active tightening was interfering with the natural balance of his head on his spine.  He described this balance as the “head moving forward and up” (a forward rotation and vertically up).  He discovered that if he could think about allowing the head to move forward and up - by giving up the muscular activity that pulled it down - he experienced a decompression through his spine, which he described as lengthening.  He did not actively reposition his head.  Instead, he gave up the action that created the compression.  Alexander is quoted as saying “If you don’t do the wrong thing, the right thing does itself.”

Unreliable Sensory Appreciation: As mentioned above, we perform activities in the most familiar way, since what feels familiar must be right.  Alexander realized that although he was doing everything his voice and speech teachers instructed him to do, and it “felt” right, he was causing harm and interfering with effective use of his voice.  This is why he began to use the mirror to make his discoveries. 

The Alexander Teacher helps the student recognize areas where he or she over-works muscularly, and helps the student learn how to do less.  Often, until the teacher brings the student’s attention to the area, the amount of effort there feels correct, or perhaps it feels like no effort at all.  Alexander is quoted: “When the time comes that you can trust your feeling, you won’t want to use it.”  Through the study of the Alexander Technique, students learn tools to help bring about change, rather than relying on what feels right.

The Body Mind Connection: Much of the skill a student learns in the Alexander Technique occurs with thinking.  Thought has an immediate and dynamic impact on our state of being.  When we decide to do something, at some level it passes through us as thought.  Thirst registers in the body and mind and we get a glass of water.  We are taking a test and as we read the test question, we retrieve the information from our memory and write it down.  If we decide to wiggle a pinky toe, it takes no time for the impulse to reach the muscles – this is the longest any nerve impulse has to travel in the body. 

In the Alexander Technique, the act of directing, which is a form of thinking, happens quickly.  Often, students forget to continue thinking their directions and begin to feel for whether or not they have freed their neck to release their head away from their spine.  Rather than feeling for it, students learn to practice thinking the thoughts - this is the tool that brings about change.

APPLICATION: How does The Alexander Technique aid in the Student’s recovery process?

Through re-education, the student comes to understand how her or his spine and skeletal system are ideally designed to function.  She or he becomes able to recognize the unique patterns of misuse (habits) which have been contributing to tension, stress, and perhaps even the injury itself.  These habits are more often than not the result of compensation, developed over a lifetime of managing less than ideal circumstances.  Long hours spent sitting in study, learning to hold a pencil and write at a young age, typing at a computer, driving a car, or even lifting groceries or a toddler, can contribute to compression and irritation of joints and nerves along the spine.  Imbalance in muscles groups can cause over-articulation in the lumbar or cervical areas of the spine, poorly distributed weight-bearing which requires more effort for upright posture, and a subtle, yet constant tension which creates compression in joints.

By learning to ease this stress through direct inhibitory action, the student can learn to relieve these internal pressures throughout the day, and combat some of the long-term effects of compression.

Releasing Secondary Stress: In certain cases where there is an injury, post-injury pain and stress, or a chronic condition, such as arthritis or joint deterioration, the Alexander Technique may not have any direct effect on the primary injury.  However, it can teach students a valuable tool to release secondary stress.  Secondary stress is the response to the pain or imbalance resulting from the condition.  For example, if you have a weak ankle joint, which sometimes turns over, or you experience unpredictable sharp pain in your knee, you can learn to let go of the overall body response after the pain has passed.  Over time, secondary stress can begin to cause chronic compression throughout the joints.  The Alexander Technique can help the student learn to monitor and let go of the unnecessary muscle tone resulting from secondary stress.

The Alexander Technique can be highly effective in helping people reduce muscle and joint pain, stress and fatigue.  People often enjoy improved skill in specialized activities, such as golf, skiing, playing a musical instrument, or dealing with performance anxiety.

What happens in the lessons:

To work with someone dealing with an injury, I begin the same way I would with any other student: exploring habits.  The Alexander Technique is a unique tool to learn to bring greater and greater efficiency and ease to the task of living by knowing how to identify overuse of muscles, mental and physical energy, and lessen that overuse.

With any new student, I am going to begin with the simple activity of moving in and out of a chair (chairwork).  This is a rich “laboratory” in which to bring habits of thought and movement to light for a student and teach them how to interrupt those habits, allowing for new and more effective patterns to become available.

The process of learning the Alexander Technique asks the student to suspend their interest in being right.  F. M. Alexander learned through his exploration that in trying to reason out a solution to his vocal problem (chronic hoarseness) he was using his sensation to tell him whether he was right or not.  He was relying on his sensation to tell him he had the correct amount of muscle energy; the proper alignment; and the appropriate volume of voice to gain his end: reciting text.  However, how he used his voice habitually had always felt right to him all along, and using his voice that way was how he had created his vocal problems to begin with.  F. M. soon realized he would have to “ignore” sensation to find a solution to his self-created mis-use.  That meant things would very probably feel wrong.  So, I repeat: The process of learning the Alexander Technique asks the student to suspend their interest in being right.  

Examples of working with injured students:

Example #1: Dierdra was told she had torn the disc between her sacrum and lowest lumbar vertebrae.   When we had our first lesson, she had been experiencing progressively worsening pain for over three months.  Dierdra was lying on her couch when I arrived, and she winced in obvious pain as she changed positions on the couch, and when she was walking.  When we began the first lesson, she was walking bent forward at her waist, with sciatica pain referring down her left leg.

I began working with her at her desk chair, since she spent a lot of time sitting at work.  She was able to stand and sit using her legs, and change her habit of arching her lumbar spine.  She immediately understood how using her hip joints instead of bending her waist could help stop some of the irritation and compression on her nerves. 

In walking, I helped Dierdra locate how high the top of her spine is and helped her release some compression from the top down.  When I showed her where her knees are and how her legs could move, she was able to walk without pain.  She saw how her anticipation of the pain and her attempt to keep weight off the sore leg was actually causing her to use her waist to lift the sore leg to move it for each step.   When I showed her how she could let her leg swing in the hip joint to take a step, the waist area was no longer being bent back and forth and there was less irritation to the nerves.

When we finished, Dierdra felt much better.  She said she also felt more hopeful about her recovery.  She'd started feeling depressed and was emotionally as well as physically relieved after our work together.  She was quickly able to understand how the tools she was learning helped her situation.  As dramatic and immediate as her relief was (and not everyone will get results as quickly) it made sense to her that the new awareness could have such a direct impact on her pain level.

Example #2: When Patricia first came to me for lessons in February of 2001, she was dealing with inflammation in her right elbow.  Her doctor had given her a forearm brace to help her avoid overusing the arm.  She was already noticing a similar irritation developing in the left arm, now that she was using it to perform most of the activities she had done with her right arm.  In the seven months we have been working together, she has observed her condition worsen overall.

I heard each week for months about her progress and setbacks.   I asked her if she felt the lessons were helping.  She told me she left every single session feeling better in her arms and enjoying an overall relaxed state. As we worked together each week, it was clear to me that Patricia had a good deal of skill in applying the Alexander principles when she had the assistance of my hands-on support in my studio.  Our challenge was to get her to a level of skill where she could and would replicate this improved use on her own.

Patricia finds it most challenging to retain her new use in her familiar environment, where she is less likely to slow down and yet most in need of improving her way of doing things. She has begun to recognize that she performs daily activities with such excess tension in her arms that this irritates them.  The challenge for her, as for all of us, is that she can’t feel this excess tension.  Her habitual way of doing things feels right, yet she knows her habits are harmful because her arms feel inflamed and fatigued.  It is an incremental process to fully grasp the fact that she is not accurate or aware of how she actually does things

At our most recent lesson, Patricia said she began releasing her habitual reaction to the subway (gripping her shoulders, locking her knees and tightening her jaw) on her way to my studio.  She began to achieve the relaxed state she looks forward to at each lesson before she got here.  At her lessons, we work to apply her Alexander tools to her stretches and exercises for her arms; fine motor activities such as writing, typing, grasping and lifting objects; exercises she does with her personal trainer; and stretching and self work on the floor.

How the Alexander Technique complements Physical Therapy: Physical therapy often uses exercise to increase strength, improve flexibility or improve posture.  The challenge is that when translated through the familiar kinesthetic habit of the patient, he or she often carries out the exercises with poor coordination or inefficient muscle deployment. 

The Alexander Teacher re-educates the patient to move more in accordance with the design of the skeleton.  People often over-articulate the cervical or lumbar region, unable to access full mobility at the atlanto-occipital joint or full range of motion in the hip joint.  Often, students have no knowledge or frame of reference to know whether or not they are accurate.  Those who do have an academic knowledge of anatomy rarely consider that their actual mechanical movements may feel right but are not.

While in the recovery process, patients often develop compensation patterns due to limitations in movement or because of pain.  Examples of this include favoring use of an uninjured arm or leg; minimizing movement or stiffening in a tender or sore region; or contracting in response to momentary pain, then maintaining the tension after the pain abates.  The Alexander Teacher is skilled at recognizing the asymmetry and patterns that are taken on as compensation and can help the student recognize and release these newly established habits when they no longer serve a purpose. 

Students are often inefficient in using muscles during exercises.  Most effort to perform an exercise is accompanied by a tightening and shortening in the muscles of the neck and upper back.  Many students grip around joints before exercising them, contributing to compression and wear in the joint.  Without understanding the elastic quality of muscles, students often maintain a baseline of isometric contraction when in repose, and don’t know the sensation of fully lengthening a muscle.  As the Alexander Teacher works with them, they learn tools to account for their unreliable sensory feedback and how to move more fully through the muscle’s range of motion in activity.

CONCLUSION: As a teacher, I do not diagnose or treat physical conditions.  I educate my student in the principles of the work of F. M. Alexander.  When someone comes to see me who has pain, I always recommend they be evaluated by a medical professional and seek the appropriate treatment available.  If they are already in treatment, I tell them to continue to pursue their treatment with their healthcare providers while we work together.  I am able to help my students develop strategies to use their new skill to minimize compression and stress to their spines; to observe and avoid injurious positions or motions during everyday activities; and to practice constructive rest periods throughout the day.

©2001, N. Brooke Lieb, C.T.A.T.; Director and Senior Faculty Member, Teacher Certification Program, ACAT; Member, American Society for the Alexander Technique (AmSAT)