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bibliography * The PainScience Bibliography contains plain language summaries of thousands of scientific papers and others sources, like a specialized blog. This page is about a single scientific paper in the bibliography, Lauche 2016.

Alexander Technique no better than heat for treating chronic neck pain


Tags: neck, bad news, biomechanics, head/neck, spine, etiology, pro

PainSci summary of Lauche 2016?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided at the bottom of the page, as often as possible. ★★★☆☆?3-star ratings are for typical studies with no more (or less) than the usual common problems. Ratings are a highly subjective opinion, and subject to revision at any time. If you think this paper has been incorrectly rated, please let me know.

Alexander Technique fails this test, right in its wheelhouse: treating neck pain. Alexander Technique is a decades-old method of achieving “good posture” (oversimplification!) by teaching people how to avoid allegedly muscular and mental tension. Many people believe that it’s an effective treatment neck and back pain; many of them “swear by it.”

Many of them will probably swear at me for reporting these results.

In this study, a couple dozen people practiced Alexander Technique for several weeks. Their results were compared to another few dozen patient using heat or guided imagery. Alexander Technique was (slightly) better than guided imagery, but no better than heat, and “cannot be recommended as routine intervention at this time.”

It’s possible that more or better training would have done the trick, and the short duration of training is certainly the most obvious weakness of the study. However, in pain treatments that require truly expert training and serious effort just to beat a damn hot bath. Any treatment that requires much more than a few weeks of disciplined effort starts to have an effectiveness-vs-efficacy problems (how well the it works in typical clinical settings and patients’ lives, versus ideal testing conditions, see Beedie), and it starts to compete with regression to the mean and/or the benefits of any kind of exercise. Thus, to establish effectiveness, a specialized training regimen like Alexander technique must either produce particularly robust effects in the short term, or compared to general exercise over the long term. This study clearly shows a failure on the first point, and doesn’t even attempt the second.

Some other studies of Alexander Technique have had more promising results (e.g. Little 2008).

~ Paul Ingraham

original abstractAbstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

OBJECTIVE: To test the efficacy of the Alexander Technique, local heat and guided imagery on pain and quality of life in patients with chronic non-specific neck pain.

DESIGN: A randomized controlled trial with 3 parallel groups was conducted.

SETTING: Outpatient clinic, Department of Internal and Integrative Medicine.

SUBJECTS: A total of 72 patients (65 females, 40.7±7.9 years) with chronic non-specific neck pain.

INTERVENTIONS: Patients received 5 sessions of the Alexander Technique — an educational method which aims to modify dysfunctional posture, movement and thinking patterns associated with musculoskeletal disorders. Control groups were treated with local heat application or guided imagery. All interventions were conducted once a week for 45 minutes each.

MAIN MEASURES: The primary outcome measure at week 5 was neck pain intensity on a 100-mm visual analogue scale; secondary outcomes included neck disability, quality of life, satisfaction and safety.

STATISTICS: Analyses of covariance were applied; testing ordered hypotheses.

RESULTS: No group difference was found for pain intensity for the Alexander Technique compared to local heat (difference 4.5mm; 95%CI:-8.1;17.1;p=0.48), but exploratory analysis revealed the superiority of the Alexander Technique over guided imagery (difference -12.9mm; 95%CI:-22.6;-3.1,p=0.01). Significant group differences in favor of the Alexander Technique were also found for physical quality of life (P<0.05). Adverse events mainly included slightly increased pain and muscle soreness.

CONCLUSION: The Alexander Technique was not superior to local heat application in treating chronic non-specific neck pain. It cannot be recommended as routine intervention at this time. Further trials are warranted for conclusive judgment.

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