Alexander technique and scientific research
Is the Alexander technique quackery? No, it’s not.
There is increasing scientific and medical research into the benefits of the Alexander technique. As the diverse areas of research interest are hard to fully cover, this page provides links to the major research listings below so you can look up your preferred area of interest.
I also highlight some recent research into the potential mechanisms underlying the Alexander technique. In addition, I include a few key studies and scientific reports in the areas of chronic back and neck pain and psychological and non-physical wellbeing outcomes as these are common areas of interest.
Research listings
There has now been research into the effects of learning the Alexander technique in the following areas:
health and wellbeing, including:
back problems
neck pain
osteoarthritis
other pain
repetitive strain injury
Parkinson's disease
other medical conditions
pregnancy
stress, anxiety, and psychological and non-physical wellbeing outcomes
growing old
breathing
postural tone
postural and ergonomic skills
balance and mobility
movement coordination
performance, including:
acting
dancing
playing an instrument
singing
voice work
public speaking
sports and fitness, including:
running
swimming
golf
cycling
horse riding
everyday life and work, including workplace performance and family caregiving
education and children.
Much of the research on the Alexander technique can be searched for on PubMed. However in addition to PubMed, I also draw your attention to the following research listings.
Alexander technique research listings
The Society of Teachers of the Alexander Technique (STAT) in the UK, the original organisation for the Alexander technique worldwide, publishes a full listing of all published research about the Alexander technique that can be filtered according to topic or searched via keyword.
The American Society for the Alexander Technique (AmSAT) also provides an annotated bibliography of research studies involving the Alexander technique.
The STAT Research Group
STAT has an active Research Group that monitors and supports current and up-and-coming medical and scientific research about the Alexander technique. Learn more about the STAT Research Group.
Alexander Studies Online
The website Alexander Studies Online (ASO) is an initiative of the STAT Research Group. Its projects are being developed in collaboration with an international community of supporters and teachers of the Alexander technique. (I am a member of this ASO community.)
Alexander Technique Science
Alexander Technique Science: Peer-reviewed Research on Mind, Movement, and Posture is another useful website listing the scientific research around the Alexander technique. This website was developed by Tim Cacciatore, Rajal Cohen, Patrick Johnson, and Andrew McCann, all experienced scientific researchers and Alexander technique teachers.
The Alexander Technique Science website is devoted to improving scientific understanding of the Alexander technique – its principles, practices, reported and demonstrated benefits, and terminology. The content ranges from descriptions of direct experiments on the effects of Alexander lessons to focused explanations of relevant current science to rigorously researched history of the work. Recent peer-reviewed publications are referenced wherever possible.
Potential mechanisms of the Alexander technique
While the Alexander technique has been practised and has helped people for over 125 years, it has lacked a clear explanation of how it works. The science needed to test its underlying ideas has only recently become available.
Potential mechanisms of the Alexander technique: toward a comprehensive neurophysiological model
In 2020, Tim Cacciatore, Patrick Johnson, and Rajal Cohen published an article in Kinesiology Review where they proposed a new theoretical model of the potential mechanisms underlying the Alexander technique.
The authors propose that the core changes brought about by the Alexander technique are improvements in the adaptability and distribution of postural tone (the ongoing contraction of muscles needed to maintain specific postural stances), along with changes in body schema (our unconscious, internal maps of the body used to guide movement and posture). They believe that these changes to postural tone and body schemas cause many of the technique’s reported benefits.
The authors suggest Alexander technique alters postural tone and body schemas through working with spatial attention and executive processes, which then affect low-level muscular elements. To engage these pathways, Alexander technique teaching uses attention, intention, and inhibition, along with communication through touch. The uniqueness of the Alexander technique comes from the way it combines these different elements. The paper discusses the evidence for the contribution of these elements, drawing on Alexander technique studies and other relevant scientific literature. Read the paper’s abstract here. (The paper is also available from the corresponding author at the University of Idaho.)
This video was commissioned by the FM Alexander Trust to explain the scientific paper by Cacciatore et al. The animation illustrates the paper’s central proposition, that changes to postural tone and body schema underlie many of the technique’s reported benefits. It also includes a summary of clinical trials on the Alexander technique as well as illustrations of what can be expected in an Alexander technique session (or ‘lesson’).
Modern pain science and Alexander technique: how might Alexander technique reduce pain?
This 2024 article published in Kinesiology Review by Hodges, Cohen, and Cacciatore brings together research from the fields of pain science and Alexander technique to investigate the mechanisms by which the Alexander technique helps reduce pain. The authors describe the Alexander technique as a cognitive embodiment practice and a method for intentionally altering habitual postural behaviour.
The authors note that studies show the Alexander technique helps with various kinds of pain, although the mechanisms of pain reduction are currently not well understood. Advances in pain science may give insight into how this occurs. Modern interventions with efficacy for improving pain and function are consistent with active approaches within kinesiology. They also share similarities with the Alexander technique and may have common mechanisms such as learning, mind–body engagement, normalisation of sensorimotor function, improvement of psychological factors, and self-efficacy, as well as non-specific treatment effects.
The authors suggest the Alexander technique likely has additional unique mechanisms, including normalisation of muscle tone, neuronal excitability, and tissue loading, as well as alterations to body schema, attention redirection, and reduction in overall reactivity. Read the abstract and access the paper here. (The paper can also be accessed from ResearchGate.)
Alexander technique and chronic pain
There have now been a number of studies and scientific reports related to the Alexander technique and chronic pain, including neck pain and back pain and pain associated with knee osteoarthritis. Below, I draw your attention to a few publications.
The ATEAM trial in the British Medical Journal on Alexander technique and back pain
One particularly important trial was a randomised controlled trial to evaluate the effectiveness of Alexander technique lessons for people with back pain that was published in the British Medical Journal (BMJ).
The BMJ validated the use of the Alexander technique in back pain in 2008 when it reported on the ATEAM (Alexander Technique lessons, Exercise, and Massage) trial, a large trial showing long-term benefits at 1 year from 24 Alexander lessons for people with chronic and recurrent back pain. These long-term benefits were measured as a 3.4 point reduction in Roland Morris disability score (a measurement of the number of activities impaired by pain) from 8.1 to 4.7 and a median reduction in days in pain from 21 days per 4 weeks to 3 days per 4 weeks. Read the full BMJ article about the trial.
The BMJ produced a number of videos about the ATEAM trial due to the extensive public interest. These videos interview some of the patients, Alexander technique teachers, and medical researchers involved in the ATEAM trial.
Benefits of Alexander technique lessons for pupils with back pain.
Summary of a research study done in the UK to evaluate the effectiveness of training in the Alexander technique for relief of back pain.
How does the Alexander technique work?
What are the authors findings about the clinical and cost-effectiveness of the treatment? Watch this video to find out (1 of 2).
How does the Alexander technique work?
What are the authors findings about the clinical and cost-effectiveness of the treatment? Watch this video to find out (2 of 2).
Other research on chronic pain
The positive results of the ATEAM trial on back pain led to further scientific and medical interest in the Alexander technique. Some of the most important research is listed below.
A mixed-methods study developing a course of both individual and group Alexander lessons for low back pain
A 2022 publication in BMJ Open looked at the development of a mixed course of individual and group lessons in the Alexander technique for low back pain, and to explore its effectiveness and acceptability to both participant Alexander technique teachers and patients. Read the study here.
Alexander technique group classes versus targeted exercise group classes for neck pain
In 2021, Becker et al. published a small preliminary study in Applied Sciences comparing Alexander technique group classes with targeted exercises classes for neck pain. One-on-one private lessons in the Alexander technique have been shown to reduce chronic neck pain and are thought to work by different mechanisms than exercise. Group classes may also be effective and would be cost-effective. This study had a two-group pre-test/post-test design. A total of 16 participants with chronic neck pain (aged 50 ± 16 years) were assigned to either a general Alexander technique class or an exercise class designed to target neck pain. Both groups met over 5 weeks for two 60-minute sessions a week.
The Alexander class used awareness-building methods to teach participants to reduce habitual tension during everyday activities. The exercise class was based on physical therapy standard of care to strengthen neck and back muscles thought to be important for posture. Neck pain/disability, pain self-efficacy, activation of the sternocleidomastoid muscles during the cranio-cervical flexion test, and posture were assessed while participants played a video game. Both groups reported decreased neck pain/disability after the interventions. Sternocleidomastoid activation decreased only in the Alexander group. In this preliminary study, Alexander classes were at least as effective as exercise classes in reducing neck pain and seemed to work via a different mechanism. Larger, multi-site studies are justified. Read the paper here.
The ATLAS randomised controlled trial
In 2016, the Annals of Internal Medicine published results from the ATLAS (Alexander Technique Lessons, Acupuncture Sessions or usual care for patients with chronic neck pain) trial, which validated the use of acupuncture and Alexander technique for chronic neck pain. The ATLAS trial, funded by Arthritis Research UK, found that both acupuncture and Alexander technique were associated with statistically significant and clinically relevant long-term reductions in neck pain and associated disability at 12 months compared with ‘usual care’ (ie, medications and physical therapy).
In this trial, researchers found 12-month Northwick Park Questionnaire (or NPQ – a self-report questionnaire measuring the degree of neck pain and associated disability) score between-group reductions of 3.92% for acupuncture (95% CI, 0.97–6.87; p = 0.009) and 3.79% for Alexander lessons (95% CI, 0.91–6.66; p = 0.010). The 12-month reductions in NPQ score from baseline were 32% for acupuncture and 31% for Alexander lessons. Both Alexander technique and acupuncture resulted in greater self-management for participants compared to those receiving usual care, and these improvements were associated with better NPQ outcomes. Read the study abstract and access the Annals of Internal Medicine article about the ATLAS trial.
A secondary publication related to the ATLAS trial described pre-specified self-efficacy and other self-care-related outcomes for the Alexander technique group compared with usual care. Participants reported on 11 self-efficacy/self-care-related outcome measures at 6 and 12 months.
The Alexander group (n = 172) reported significantly greater improvements compared with usual care alone (n = 172) in most of the self-efficacy/self-care measures (9/11 measures at 6 months and 8/11 measures at 12 months), including the ability to reduce pain in daily life. At 6 months, 81% (106/131) of Alexander participants reported significant improvement in the way they lived and cared for themselves (vs 23% for usual care), increasing to 87% (117/135) at 12 months (vs 25% for usual care). NPQ scores at both 6 and 12 months were related to improvement in participant self-efficacy and their ability to reduce pain during daily life. Alexander lessons promoted self-efficacy and self-care, with consequent reductions in chronic neck pain and led to long-term improvements in the way participants lived their daily lives and managed their neck pain. Read the publication here.
Reductions in knee co-contraction and associated pain in people with knee osteoarthritis with Alexander lessons
A 2016 paper in BMC Musculoskeletal Disorders by Preece and colleagues reported reductions in knee co-contraction and associated pain in people with knee osteoarthritis with Alexander technique lessons. Both increased knee muscle co-contraction and alterations in central pain processing have been suggested to play a role in knee osteoarthritis pain, but the recommended clinical management has not targeted these mechanisms, focusing primarily on muscle strengthening instead.
In this study, the first to investigate the potential effectiveness of an intervention aimed at increasing awareness of muscle behaviour in the management of knee osteoarthritis, 21 participants with confirmed knee osteoarthritis were given 20 Alexander lessons. In addition to clinical outcomes, electromyography data quantifying knee muscle co-contraction were collected. All data were compared between baseline and post-intervention time points with a 15-month clinical follow up. Biomechanical data were also collected from healthy controls and compared with the data from the osteoarthritis subjects.
Following the Alexander lessons, the mean Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score reduced by 56% from 9.6 to 4.2 (p < 0.01) and this reduction was maintained at the end of follow up. There was a clear decrease in medial co-contraction at the end of the intervention, towards the levels observed in the healthy controls, both during the pre-contact phase of gait (p < 0.05) and during early stance (p < 0.01).
Decreases in WOMAC pain were associated with reductions in medial co-contraction during the pre-contact phase of gait. These data suggest a complex relationship between muscle contraction, joint loading, and pain, and support the idea that excessive muscle co-contraction may be maladaptive in patients with knee osteoarthritis. These data also provide evidence that, if the activation of certain muscles can be reduced during gait, this may lead to positive long-term clinical outcomes. Read the article here.
The ASPEN randomised feasibility trial
The Efficacy and Mechanism Evaluation Board of the UK Medical Research Council funded a feasibility study comparing outcomes from Alexander technique and physiotherapy in back pain. Read more about ASPEN (Alexander technique and Supervised Physiotherapy Exercises in back paiN): a four-group randomised feasibility trial. (Download the full October 2014 ASPEN trial report as a pdf.)
A service evaluation report of Alexander technique for pain clinic patients
In the aftermath of the ATEAM trial, a service evaluation of Alexander technique lessons within a UK National Health Service (NHS) out-patient hospital pain clinic was published in 2012. This evaluation used four widely used, validated questionnaires to capture changes in health, wellbeing, quality of life, and resource use among the service users: the Brief Pain Inventory to measure pain, the Measure Your Medical Outcome Profile to measure patient-reported outcomes, the 5-dimension European Quality of Life Questionnaire (EQ-5D) to assess quality of life, and the Client Service Resource Inventory to measure resource use. The questionnaires were administered at baseline, 6 weeks, and 3 months after baseline. Semi-structured qualitative telephone interviews with service users were also carried out at 3 months, and the views and experiences of pain clinic staff and Alexander teachers were explored in face-to-face interviews.
The evaluation's findings suggested the Alexander technique was feasible, acceptable, and beneficial in improving service users’ quality of life and improving their management of pain. The greatest changes were found in how service users managed their pain (eg, over half stopped or reduced their medication) and the impact pain had on their daily life. This also led to some changes in behaviour and in awareness and self-knowledge from service users. These changes in attitudes and behaviour may explain the finding that users of the Alexander technique teaching service appeared to reduce their pain-related NHS costs by half. The evaluation recommended that Alexander lessons be seen as a useful adjunct to other pain management services provided in out-patient pain clinics. Download the report here.
Alexander technique and psychological and non-physical outcomes
Note the term ‘non-physical outcomes’ is used to include psychological and wellbeing outcomes (eg, changes in mood, sense of self, confidence, emotions, and cognitive processes and the ways people think). Some of the most important research in this area is listed below.
A realist review into how the Alexander technique leads to psychological and non-physical outcomes
Most research on the Alexander technique has focused on areas such as musical performance, physical change, and health outcomes, such as back pain. This 2021 systematic review in the European Journal of Integrative Medicine examined evidence from 36 documents reporting on 34 studies to investigate whether the Alexander technique leads to psychological and other non-physical outcomes, and, if so, how. The review used a realist approach to answer these questions. (Realist approaches are used to develop theories to help understand how outcomes come about, how they may be connected, and whether there are particular contexts in which an intervention might work.) The results showed having Alexander lessons can lead to beneficial non-physical outcomes, including:
a sense of control or confidence to address present and future challenges
increased self-efficacy
improved general wellbeing
increased quality of life
improved relationships
increased self-acceptance
increased optimism and hope for the future
a more holistic sense of self
decreased fear and anxiety
decreased depression and low mood
decreased anger
decreased stress
for some, it was also about a changed relationship with pain or difficult emotions (such as fear), rather than a decrease in symptoms.
It was also noted that difficult emotions can arise in lessons and can help or hinder the learning process.
Eight evidence-informed theory statements were formed from the analysis about how and for whom these non-physical outcomes can be generated by Alexander lessons. These were in relation to:
psychological wellbeing from physical improvements and reduced emotional stress from changed physical response
the experience of mind–body integration
becoming aware of increased possibilities and making informed choices
the ripple effect of positive changes
confidence to resume avoided activities
the use of touch eliciting positive and difficult emotions
loss of familiar coping strategies
difficult emotions being managed or unmanaged.
Two main causal pathways for non-physical outcomes were identified. Firstly, improvements in physical wellbeing lead directly to psychological wellbeing. Second, the experience of mind–body integration and a holistic sense of self leads people to apply Alexander technique skills to non-physical areas such as habits of thought, noticing physical tensing in emotionally driven situations, and change in habitual responses (behaviour change).
The review suggests that the Alexander technique may be useful in a range of settings for long-term psychophysical outcomes, and may provide a significant way to improve mental wellbeing and increase agency. The authors also make recommendations for practice and further research. Read the full paper for more detail.
Some other research into psychological and non-physical outcomes
A mixed-methods study exploring the psychological processes underlying Alexander technique touch
In 2014, the journal Clinical Psychology and Psychotherapy published a study on the psychological processes underlying Alexander technique touch. (Read the abstract and access the full study; study also accessible through ResearchGate and Sci Hub.) This was a mixed-methods exploratory study using semi-structured interviews with Alexander technique pupils to generate qualitative data combined with a questionnaire survey to produce quantitative data and triangulate findings.
The interviews revealed the following themes:
there being an incompatibility between Alexander technique touch and the spoken word, with touch being experienced on an subtle, unspoken, and deeper level that words were inadequate in describing
Alexander touch being experienced as a nurturing, healing, and reassuring process that fosters independence
Alexander touch being a relational experience, allowing two-way feedback and being part of the communicative process in the pupil–teacher relationship; Alexander touch is also experienced as being unique to the teacher who gives part of themselves within the intimate yet boundaried relationship
Alexander touch being experienced as changing the pupil’s relationship with themselves and helping them learn about themselves and increase their self-awareness while also improving their view of themselves
however, there were two reservations: some interviewees noted they were comfortable with touch, but others might not be, and some thought they would not like a teacher whose gender differed from their teacher; notably, pupils who had had more than one Alexander teacher had fewer reservations about either topic.
With the survey responses, pupils rated their answers on a Likert scale of 1 (strongly disagree) to 7 (strongly agree). Some points of interest follow with the mean scores and corresponding standard deviation (SD) in parentheses. Mean scores were high for comfort with touch (6.62, SD 0.66), for touch helping pupils understand the technique (6.19, SD 1.12), for touch being for pupils’ benefit not their teacher’s (6.12, SD 1.46), and for touch helping pupils feel relaxed (6.08, SD 1.20). Mean scores were also high for touch increasing feelings of body connectedness (6.06, SD 1.26) and for touch increasing self-awareness (6.00, SD 1.23). Pupils agreed that touch helped them trust their teacher (5.89, SD 1.46), that they felt in control when touch was used (5.70, SD 1.38), that it helped them communicate with their teacher (5.55, SD 1.56), and that it made them feel cared for (5.32, SD 1.65).
A qualitative substudy in the ATLAS trial of self-efficacy and embodiment with Alexander technique or acupuncture
The ATLAS clinical trial included a substudy led by a qualitative researcher aimed at understanding participants’ perspectives and experiences of being in the trial and how it affected their chronic neck pain conditions. A sample of trial participants were interviewed in a series of interviews. Interview findings revealed a growing sense of self-efficacy (a psychological construct associated with positive thinking, improved control of negative affect, and enhanced motivation) following Alexander lessons, with many participants expressing feelings of greater control over managing their neck pain through becoming more self-aware and learning to apply Alexander technique thinking skills. Some participants described re-evaluating their identity (eg, one individual expressed the feeling of being a ‘new person’). For many, the experience of increased self-awareness and a sense of interconnectedness and embodiment were integral to the transformative process. Their perceptions of ‘neck pain’ could no longer be reducible to a ‘body part’. Participants described how they continued to use the understanding and skills they had gained from Alexander lessons after they had finished, to sustain and, in some cases, further improve their reduction in neck pain. Read the paper.
Doctoral dissertation on psychological change and the Alexander technique
A doctoral dissertation on psychological change and the Alexander technique was submitted by Jocelyn Armitage in 2009 at the University of Hull. Part one of the dissertation consisted of a systematic review of the literature on the relationship between body posture and emotion. Part two consisted of a exploratory study using a qualitative, phenomenological approach. Semi-structured interviews were conducted with Alexander technique clients (or pupils) and transcribed using interpretative phenomenological analysis. Study participants described a wide range of psychological changes as a result of learning the Alexander technique, including increased self-awareness, calm, confidence, balance, presence, and the ability to detach from problems. They regarded the process of learning the Alexander technique as rewarding, but for many, also challenging. Download the dissertation for more detail.
Dissertation exploring embodied movement practices as a route to self-compassion
The evidence that embodied movement practices can support self-compassion is measurable, observable, and nuanced. Movement-based embodied contemplative practices help support all aspects of self-compassion; namely, self-kindness, mindfulness, and common humanity. They also offer other benefits and improve self-integration. While the experiential learning they offer is indirect, it leads to a great depth of understanding. As research had not been conducted into whether self-compassion can be cultivated through the Alexander technique, this dissertation, submitted in 2021 by Lisa Harris as partial fulfilment of the MSc Applied Positive Psychology at Buckinghamshire New University, reviewed the relevant research conducted on other embodied practices and self-compassion and how the outcomes of that research correspond with the Alexander technique. Read the abstract and download the dissertation.
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