The Alexander Technique: Mindfulness in Movement Relieves Suffering

With more than 40 years of experience as an Alexander Technique teacher and physical therapist, Judith C. Stern, MA, PT, CTAT, has combined her skills to help people find relief from a wide variety of musculoskeletal conditions and other medical conditions such as Parkinson's disease. By improving posture and mobility, reducing muscular tension and applying mindfulness to movement, Ms. Stern stated that through simple techniques people truly can get better. In this column she describes the Alexander Technique and how it can help patients heal.

Q: What is the Alexander Technique? Please share with us some background and how it is being used with patients today.

Judith C. Stern, MA, PT, CTAT: The Technique is a mindfulness-based approach to improving posture and mobility, reducing muscular tension and maintaining beautiful posture and alignment. The Alexander Technique elicits psychophysical integration. A phrase I often use to describe the Technique is that “how you think is how you are.” There is no thought you have that does not elicit a neuromuscular response. The neurology of muscular activity is an intricate part of how we respond. To be really concrete, one could say that the Alexander Technique is an approach to changing automatic physical and mental reactions—it allows for choice about how one responds to stimuli.

For example, if I have a habit of yelling at my children when I am frustrated, and I do not like that habit, I cannot just change it. I can be intellectually acutely aware that it is a bad idea and that it gets me the wrong result every time. How does one change one's habitual reaction to things? Changing habits is something that every human being on this planet would love to be able to do quickly and easily. One might say, “I am going to eat well today and be conscious of what I put in my mouth, and I am going to choose what I eat rather than eat habitually.” What prevents a person from actualizing that wish? Habit is subliminal. It is below our level of awareness, it happens before we choose. To change a habit we first have to become aware of the habit. Then we have to be able to stop before we actually do the habit.

If you think about yourself and your favorite habit and what you have tried to change recently, or continuously, you will be able to relate to the idea that habits cannot be changed intellectually. They actually have physicality, a neural biology, and in order to change them, awareness must come first. So the very first principle of the Alexander Technique is to develop an awareness of our habits.

The second principle is to learn how to stop, or pause. I am about to yell at my children, but I give my kids permission to raise a hand or give me a signal when they catch me getting angry. I learn slowly over time that I can actually feel myself getting angry earlier and pause and do more listening and less reacting. That is the essence of the Alexander Technique. Stimulus, pause, response is the aspiration that all of us would have the ability to be in relationship with our habits in a way that is not judgmental, to learn how to pause and be curious, and then to learn a new response, one that perhaps gets us a better result.

Frederick Matthias Alexander—the creator of the Alexander Technique—noticed for himself that the primary behavioral muscular tension we notice in individuals with any kind of discomfort is the tension between the head and the spine. He wrote his first books in the early 20^th century and started training people during that time. The Alexander Technique has been around for more than 100 years and requires study and commitment. I think of the Alexander Technique as a practice, and that is certainly how it works in my life.

Q: As an informed physical therapist with years of experience, please share with us how you use the Alexander Technique with patients.

Ms. Stern: I came to the Technique, through working with people with chronic back pain. That was my specialty as a physical therapist. I was very good at helping people get better, but I could not help them to stay better. Muscular tension is a reflection of thought, temperament, and the environment that we all live in, and we all live with a certain habitual level of muscular tone. Often it can get to the point where we are in pain all the time. The low back and the cervical spine are very common places for that to occur. I could add temporal mandibular joint (TMJ) disorder into that category as well. These are places that are reflective of the level of muscle tension we carry that is actually pathological and creates tension in a joint or compresses a nerve root enough to cause someone to become debilitated. I spent years helping my patients learn to exercise and stretch, but once they were better, they would return to their habits, and then five months or a year later, they would be back in my office in pain.

When I learned about the Alexander Technique, I was thrilled with the idea that I could teach my patient how to use thinking and awareness to help them notice and be aware of what they are actually doing to themselves that is causing their pain and discomfort. The Alexander Technique is applied mindfulness and addresses the psychophysical aspect of a person's suffering. I changed my trajectory as a medical person when I learned about meditation, but thought I could never be a meditator. The Alexander Technique felt to me like meditation in motion. It was this ability to watch my thinking, to become aware of my thought habits, to then link them to the physical discomforts that I had and learn how to pause and take a different approach and modulate my thinking. These are the Alexander Technique principles that I now share with other students.

Q: In a patient with low back pain who is experiencing a lot of stress and has no obvious underlying pathology, what might a typical session look like?

Ms. Stern: I am often the practitioner of last resort, so such a person often comes to me tearfully or very skeptical. Because I have a medical degree after my name, they are a bit more trusting than they might be. I first ask the client about what they would like to change and their medical history. Then I introduce a very straightforward habit that is not related to their pain as a way of introducing them to the Technique. This is a sit-to-stand activity.

I use a mirror and chair, and I ask them to experience themselves coming to standing and coming to sitting, to observe themselves and explore how they do that, and if they actually know what their strategy is in this daily activity. Most people have no idea how they execute habitual movements. I then use the time to help them notice the tension between the head and the spine as they move.

Alexander's discovery was that we all tighten our necks and pull our heads back and down on our spine to do almost everything that we do. It is the place where we hold excess tension. If you think about the fight-or-flight response or when somebody comes up behind you and scares you, one of the first things you do is pull your head back and down in your spine and go into a full-extension pattern. That is the startle response.

This head-neck relationship experience was the habit that Alexander discovered when trying to solve his own medical problems, hoarseness and loss of voice. During a lesson I ask people to put their own hand on their head and neck and notice that even in the most mundane activity of sitting and standing they are tightening their neck and compressing their whole spine. Next I challenge the client to try to get out of the chair or into the chair without tightening their neck. Of course, most people cannot do that because we know that just because we intellectually know we do something does not lead us to being able to stop doing it, especially if it is a deeply ingrained habit.

Then I use thinking and my hands to give the student an experience of moving in and out of the chair without pulling their head back and down. What that usually leads to is a very big “aha” moment in almost every person I have ever worked with—the possibility for movement that feels light and easeful and decompressed and often pleasurable.

Most people will turn to me and say, “How did you do that?” What I say is, “I did not do it. You just did not do your habit. We just have to take off the layers of learned behavior for you to experience it.” This ease and lightness is how children sit and stand. I often show pictures of children between the ages of about 1 and 3 years old going into a squat and reaching for a toy, and there is never a hint of pulling the head back and down on the spine or any undue compression in those movements. The Alexander Technique is a way of removing layers of learned behaviors in movement and posture that are often harmful.

It is very tangible for a student to start with the body. Alexander understood that starting with something mundane was a good entryway into people understanding that this idea of becoming aware of one's habits, learning how to pause and not judge the habit, and then learning a new response was actually a key to living. There is a reward, and the reward for people with the Alexander Technique is this feeling of lightness and pleasure and a decompression of the system that often leads to a change in breathing.

People often come once a week for a session; however, if a person is in a lot of pain, twice a week is always better. I believe that in the first ten lessons a person can learn the skills: how to become aware, how to pause and what the new behavior could be and how to access that more easeful behavior. It is like learning to play a musical instrument. In 20 lessons one can learn to play “Twinkle, Twinkle, Little Star.” In 30 lessons, one might take on a little early Beethoven. The Alexander Technique is a skill that one learns, and it needs reinforcement at least weekly and practice in between. I have clients who leave after the first lesson and say, “Thank you very much. That is brilliant.” I also have had clients who studied weekly for many years.

Q: What are some other medical conditions that people experience that may be helped by utilizing the Alexander Technique?

Ms. Stern: Scoliosis is one condition. Parkinson's disease is also a condition that has been researched. People with Parkinson's disease find great benefit from learning the Alexander Technique. I have found that people post-stroke benefit, because ambulation can be awkward and challenging. If you take away the old habits, things are there that you can work with that often make walking much easier if a person is hemiplegic.

People with asthma and chronic obstructive pulmonary disease benefit from utilizing the Alexander Technique. Alexander started out in the world of speech and elocution. He was a reciter before the time of microphones and amplification. Projecting one's voice was his interest. The issues of stuttering and laryngitis—found in people who speak to earn their living—is another area where the Technique is brilliant and works extremely well. There is a wonderful review article written by Dr. Julia Woodman regarding the efficacy of Alexander lessons for medical and health-related conditions that answers this question well. ¹

Q: How does the Alexander Technique work as a mind-body therapy?

Ms. Stern: As I sit here during this interview, very excited to be able to share my work with you, I feel myself tightening my neck in my excitement to share. My ability to pause and to reorganize myself allows me to think more clearly and answer questions more effectively as I quiet my system and attend to my breathing. My thinking becomes more fluid and more coherent.

The Alexander Technique is not a quick fix. Teachers of this Technique think of it as a skill, and we actually call ourselves teachers, not therapists. We are Alexander Technique teachers and when people come to me for a lesson, they are studying with me to learn this skill, to be able to apply it on their own so that they eventually do not need me to apply the Alexander Technique to their life. It is a mindfulness approach to health and well-being. It offers the student a mindful approach to life.

Q: Tell us briefly how you became interested in this field of work.

Ms. Stern: I had a friend who was a musician in New York, who despite pain medication could not sit comfortably at the piano to earn a living and was about to have spine surgery for sciatica. Her friend at the Juilliard School of Music recommended, “Before you have the surgery, you should have an Alexander lesson.” At Juilliard, the Alexander Technique is a required course for actors, musicians, opera singers and dancers. Your body is your instrument if you are a dancer or an actor or a violinist. So mastering habits of tension and overwork through the Alexander Technique became a treasured course at Juilliard early on.

This musician friend consulted me and asked my opinion about having an Alexander lesson. I was not aware of the Technique and asked if I could talk with the practitioner first. Deborah Caplan was the Alexander Technique teacher she was referred to (she has written a brilliant book called Back Trouble). Strangely enough, Deborah was also a physical therapist, the only Alexander Technique teacher/physical therapist in the United States at that time. Deborah and I had a 20-minute conversation, and I was fascinated and recommended that my friend try the Technique and report back to me. Several weeks later, I received a call and learned that she was pain free at the piano.

I decided I wanted to meet Deborah Caplan. I saw people with back pain all of the time, and although I was very good at what I did as a physical therapist, I had never seen a result like that. Two months later, I went to New York and observed a lesson, and four years later I was in New York training. I helped Deborah write her book, which is a handbook for how to apply the Alexander Technique to people with back problems. I spent three years training at the American Center for the Alexander Technique (ACAT-NY) in New York City, New York, and then opened a practice in Rye, New York, where for 30 plus years I worked with many people with back pain.

Q: How has your work evolved and what are you doing now?

Ms. Stern: Five years ago, I chose to retire from a very busy practice. I was teaching about 20 to 30 people a week. Now, I mentor Alexander Technique teachers locally and in New York City. When a person graduates, after three years of training, there is so much to be learned to become skilled. There is a need for Alexander teachers to have ongoing study/continuing education, and I am now participating in that work.

There is no question that my 20 years practicing as a physical therapist before I worked as an Alexander teacher gave me the confidence and a language for speaking to physicians who refer me their patients. For the past 30 years, I taught the anatomy and physiology course at ACAT in New York City hoping to impart some of my medical knowledge and confidence to the Alexander Technique teachers in training. Now I do that through mentoring.

Q: Are there any interesting research studies that you would like to share with our readers?

Ms. Stern: There are a group of people in the Alexander world, some of them PhDs and some of them physicians, who are working on research. Much of the current research is in the area of Parkinson's disease. Cohen and colleagues wrote a paper in Neurorehabilitation and Neural Repair and studied the Alexander Technique as an approach to improving posture and mobility by reducing muscular tension while maintaining an upright position. ² Cohen discusses evidence associated with improving posture in Parkinson's disease patients. The authors concluded, “Mindful movement approaches such as the Alexander Technique may benefit balance and mobility in subjects with Parkinson's disease by acutely facilitating increased upright postural alignment while decreasing rigidity.” ²

In the Annals of Internal Medicine in 2015, MacPherson and colleagues compared the effects of the Alexander Technique and acupuncture for neck pain. ³ The authors concluded, “Acupuncture sessions and Alexander Technique lessons both led to significant reductions in neck pain and associated disability compared with usual care at 12 months.” ³

Tim Cacciatore, an Alexander Technique teacher who has a PhD in neuroscience and lives in England, is looking at a much deeper level at balance and upright, and what actually allows us to balance on the earth. What is neuro-physical balance, and how do we manage that? How is it inherent in the system and what interferes with it? Tim is a brilliant man who came to the Alexander Technique with back pain himself.

To Contact Judith C. Stern

Judith C. Stern, MA, PT, CTAT

Alexander Technique teacher

Physical Therapist

Rye, New York

Website: judithcstern.com

I believe the neurophysiology of the Alexander Technique is quite simple. Herbert Benson, MD, in his book The Relaxation Response provides the research that validates the efficacy of the Alexander Technique. Although we know this physiology and it has been studied, conventional medicine often prefers to give medication rather than to change one's behavior.

Q: Do you have any final advice that you would like to share with clinicians regarding referring their patients to an Alexander Technique practitioner? When should they be thinking of this, and how might they find a practitioner?

Ms. Stern: For practitioners of family medicine and internal medicine, I suggest that when you see a patient with chronic pain that cannot be managed with medication, and that pain seems to migrate, and you have an intuitive sense that there is something more holistic going on than their back or neck or jaw pain, that clinicians should think about the Alexander Technique, which deals with the whole individual.

If one visits my website (Judithcstern.com) there are some short videos of me working with students that might offer some clarification about the Alexander Technique. Also available on the website is a guided self-lesson, something one could do daily that brings a person's physiology back into neutral, and then one can move back into their daily life. I also have links on my website to valuable Alexander Technique resources.

There is a wonderful book that I think is the best introduction to the Technique called Body Learning, by Michael J. Gelb. It is easily accessible, and I think it is a brilliant introduction to the Technique. The American Society for the Alexander Technique (AmSAT) has a fabulous find-a-teacher option. Their website (www.amsatonline.org) is accessible for research and wonderful explanations about the Alexander Technique. There are online courses that one can take. I would say that AmSAT is the best resource for almost everything Alexander Technique.

Finally, I would say that I left physical therapy because I was unsatisfied dealing with people in parts. I prefer the Alexander Technique approach, which allows me to deal with people as a whole, with their balance and coordination physically, psychologically and emotionally.▪