Alexander Technique: Another Tool for Physical Therapists

Benefits for both Therapist and Patient
Physical therapists use their bodies in their work. Often neck, shoulder and back pain results. The patient gets better, but the therapist slowly gets worse. The Alexander Technique is a set of guidelines for using the body efficiently in daily activities. It has proved helpful as an addition to the treatment protocol for patients with back problems. It can also be of benefit to the physical therapist.

Since my mother was trained as an Alexander Technique teacher by the Technique's originator, F.M. Alexander, I grew up with his work as part of my life. I didn't give it too much thought originally, except to consider it a bit odd, as was any mind/body discipline in the 1940s. My first real appreciation of Alexander's work came as I applied it to dancing, an early interest of mine. Some years later, after becoming an Alexander teacher, I chose physical therapy, which required gaining a more detailed technical knowledge of the body's structure.

Alexander did not spring from medical roots. He was, first and foremost, an artist. But his process of self-observation in resolving his vocal problem is a fine example of the scientific method. When I started my physical therapy career, I soon realized that, by applying the Alexander Technique to myself while I treated patients, I could avoid a lot of stress and discomfort in my own body. As I sat in my anatomy classes, I found myself delighting in the harmonious match existing between human structure and Alexander's instructions for improved body movement, what he called "use."
Thinking rather than Doing
The Alexander Technique consists of thinking to the body rather than actively doing anything with it. To overcome his difficulty, Alexander developed four specific mental directions to guide his body into an improved use.
1. Allow your neck to release so the head can balance forward and up.
2. Let the torso lengthen and widen.
3. Let the legs release away from the torso.
4. Release your shoulders out to the sides.

During an Alexander lesson, the student silently thinks these four directions while the teacher uses a gentle touch to guide the student into carrying them out. Therefore, the student learns the Technique on two levels The teacher explains principles of good use so that the student understands them. The student also learns on the kinesthetic level while being guided by the teacher's hands. As movement habits gradually change through a course of lessons, the student's kinesthetic sense becomes more reliable and improved use lasts for a longer period of time.

I believe that Alexander's method and view of the body as one dynamic whole offers great therapeutic value. Following is my exploration of musculoskeletal anatomy in light of Alexander's four directions.

The Elegantly Unbalanced Head
Following Alexander's lead and starting at the top, we can explore how the anatomical components of head-neck balance relate to his first and most important instruction: Allow your neck to release so the head can balance forward and up. If you were to balance a human skull on two fingers the same way it balances on the neck, it would immediately rotate forward because there is more weight in front of the head-neck pivot point than in back. It is, therefore, not in a state of equilibrium. If we allow the body's balancing system to function properly, it is this very lack of skeletal equilibrium that facilitates spinal lengthening. If the head were positioned squarely on the neck, its total weight would act as a compressive force on the spine. However, the head's tendency to rotate forward means that it can cause a beneficial lengthening -- tractive force -- on the neck and total spine.

Compression disappears when the muscles in back work at their optimum length -- a length that allows good spacing beteen the verterbrae, centered alignment of the head, and free movement of the entire body. Alexander's instruction to release the neck muscles allows, when necessary, a corrective forward rotation of the head. This, in turn, eliminates unnecessary neck compression and brings about spinal lengthening -- the "up" part of his instruction: Allow your neck to release so the head can balance forward and up.

The Mythical Waist
One of Nature's most capable inventions is the human spine and all its surrounding structures. The torso is a structural triumph providing both flexibility and strength. However it can only serve us properly when used in a well-integrated way. All too often we misuse the flexibility of the torso by continually bending from the waist as though it were a hinge. Like the unicorn, the waist is a mythical creature. The concept of the divided torso and the use this engenders is bad for the back and goes against the body's structural design. Though the spine is flexible, it has no hinges. Alexander's instruction reminds us that the torso should be used as one functional unit: Let the torso lengthen and widen.

Free-moving Hip Joints
Alexander realized that, in order to use the torso as a functional unit, it is necessary to use the hip joints freely. When the strong muscles that extend from the pelvis to the legs are held tight, they prevent free hip joint motion and cause strain in the low back. This direction encourages better use of the hip joints: Let the legs release away from the torso.

The Floating Shoulder Girdle
Contrary to common belief, achieving good shoulder balance is a matter of doing less work, not more, with the shoulder girdle muscles. Because the shoulders are so flexible, their placement is strongly influenced by alignment and use of the torso; if you slump, your shoulders slide forward; if you sit up too straight, your shoulders will be forced too far back. However, if you think of your torso lengthening and widening, it frees the spine so that it can lengthen up between the shoulder blades. To free the shoulder musculature so that the shoulder girdle can balance correctly, you can think: Release your shoulders out to the sides.

Improved Use Means Increased Effectiveness
I have found that my patients get more effective treatment when I focus first on how I am using my own body before touching theirs. When I take the time to apply the Alexander directions to myself before starting to give a massage, a stretch or neck traction, I find two beneficial things happen: first, my own use becomes more efficient so my own body is less strained. Second, my touch is more sensitive and therefore more receptive to what is happening in my patient. Rather than doing something to my patient, I find I can have a dialogue, through touch, with the body of the person I am treating.

Each time I see a young child running, climbing or dancing, or see new understanding dawn in the eyes of a long-time back sufferer, I appreciate anew our elegant verticality. Alexander has made an important contribution to our realization and enjoyment of this evolutionary gift.

Deborah Caplan is an Alexander Technique teacher and physical therapist. She studied with F.M. Alexander, is a founding member of the American Center for the Alexander Technique, and was formerly affiliated with New York University Medical Center. She is the author of Back Trouble: A New Approach to Prevention & Recovery, (Triad, 1987).

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