The Vault

The Alexander Technique and Its Application to Back Pain

By Deborah Caplan


My phone rings and I hear a frantic voice on the other end saying, "Help! My back just went into spasm and I can't move. What should I do?"

Or another caller may ask "Can the Alexander Technique help the painful pinched nerve in my neck?"

Or I may be asked if the Alexander Technique will help someone with multiple sclerosis.

Since I specialize in teaching the Alexander Technique to those with physical problems, I receive phone calls such as these all the time. Following are some of the ways of dealing with physical problems that I have found most useful.

Acute Lower Back Spasm

Let's go back to the frantic soul making the first phone call given above. I will call him Paul.

Paul's problem is a sudden attack of immobilizing, acute back pain—a dreadful situation for Paul, but an excellent opportunity for the Alexander Technique to work its wonders once a physician has diagnosed his condition as a musculoskeletal problem with no neurological or systemic complications.

I go to Paul's home if possible, so he can avoid the agony of travelling to me. I place Paul in the resting position that people in acute spasm find most comfortable: on his back with large pillows under his knees, and appropriate Alexander support under his head—books, pillow, whatever you think best. I then work with him for about an hour doing as much of the following as he can tolerate.

The first thing I teach him is the 'whispered ah', which will reduce his panic as well as his overall tension. Then I get Paul on the floor in the crawling position, and have him crawl forward and backward a few times while I'm giving him Alexander directions. Crawling is very effective in reducing spasm in the back muscles and getting the spine centrally aligned.

Next comes the task of teaching Paul 'monkey,' which is essential for him to learn if he has been getting out of bed to eat, go to the bathroom, etc... Knowing how to get into the monkey position will enable him to move around without putting more painful and damaging strain on his back. If Paul is new to the Alexander Technique, I will start with him sitting in a chair (or on the side of his bed) and get him into monkey from the sitting position. I find this easier for most people than going from standing into monkey.

Ironically, I have found that people in acute back spasm learn monkey very quickly because they have instant feedback from their body as to whether they are doing it correctly. When they do monkey with a lengthened spine and free motion at the hip and knee joints, they don't have pain. However, when they lose spinal length and bend at the waist instead of at the knees and hips, pain returns. If Paul has never had lessons, his initial performance of monkey will be quite mechanical, but even in this form it is a very dramatic back-saving technique that I have found enables those in acute spasm to move around and carry out some of daily life's essential activities.

To summarize: doing the whispered ah, crawling, and monkey, will enable Paul to get to the dining room table, the bathroom, and the doctor's office with less pain and trauma to his back.

Chronic Back Pain

The most common form of back pain is referred to as 'chronic'—pain that has been present for a long time and that people live with on a daily basis. I am sure that all Alexander teachers have students with this problem.

I always start the first lesson, and all subsequent lessons, with chair work rather than table, even if a particular student is having a lot of pain. By doing this I find I can most effectively and quickly help the student replace harmful habits of use with beneficial use. I also find chair and movement work (monkey, lunge), help my student consider the Alexander Technique a learning process rather than treatment.

In the first lesson I introduce students to the concept of inhibition. This lets them know that they can make choices about the way they use themselves, and therefore need not think of themselves as passive victims of pain and back problems. I explain that pain increases tension, which in turn increases the pain, thus creating the pain-tension vicious cycle. Inhibition is the way out of this cycle.

I familiarize my students with the basic skeletal structure of the body and how it relates to function: where the hip joints are and how they should be used for bending rather than using the waist. How releasing the head into forward and up will take weight and compression off pinched nerves or arthritic joints in the neck.

Exercises are beneficial because they increase morale and also restore flexibility and strength to the musculoskeletal structure. However, as Alexander teachers, we know that exercises badly performed can be harmful. So I show my students how to apply the Alexander principles to their exercises.

Most of my 'back pain students feel wonderful very quickly, but then call me at some point between lessons, very distressed, saying their pain has returned. I explain to them that a relapse like this is usual and to be expected for the following reason: good use quickly brings relief, and when pain stops it is normal to forget that you have a back problem. Old habits of use, which are still the most familiar, then return and cause pain. I explain that their pain will go away again as they get more skilled at the Technique and learn to listen to warning signals from their back.

Pain in the upper back between the shoulder blades is very common during early lessons in those students who have been slumpers most of their lives. As the spine lengthens, the various structures of the spine undergo changes that can cause pain. One frequent source of pain is the muscles that lie along the spine between the shoulder blades. Sitting slumped for long periods every day results in these muscles becoming too long for their function of supporting the spine properly. I explain to my hurting students that it takes time for these muscles to adjust to the new length—in this case a shorter length—and to develop the endurance needed to give good support to the spine. The spinal joints can also be a source of discomfort since they will be aligned differently as the spine is used in a lengthened, instead of a compressed, manner. A desk or reading chair that gives the back good support and encourages lengthening rather than slumping, will help this 'pain phase' pass more quickly.

I am very practical in what I teach. I introduce monkey and lunge right away, usually by the second or third lesson, because these activities will help eliminate harmful arching and rounding of the spine during daily activities. I explain to my students that doing monkey and lunge every time they bend to pick up something will rapidly strengthen their back muscles, and that good use is one of the best strengthening 'exercises' for the back.

I have found teaching the 'whispered ah' a wonderful way to get students with back pain to reduce body tension and to focus on themselves in a positive way. It also very specifically brings relief from pain in the upper back, neck and shoulder girdle areas.


Many teachers, myself included, have often heard the following: "I used to have terrible sciatica-then I took Alexander lessons and haven't had the problem since.'

Sciatica is a term that describes a type of pain; it does not tell us the cause of the pain. All it tells us is that the sciatic nerve is being irritated somewhere along its path. The sciatic nerve travels down through the deep buttock musculature. One reason the Alexander Technique is so helpful in reducing sciatic nerve pain is that it teaches us to release these deep muscles, thereby reducing pressure on the nerve. Perfectly simple and logical. But unfortunately there are many health care professionals who still tell their patients with sciatica to squeeze the buttocks while walking, standing, etc...

Learning to widen the lower back also reduces sciatic-type pain if the pain is coming from the little joints in the back of the spine. If the sciatic nerve is being irritated by pressure from a bulging spinal disc, widening the back may significantly reduce this pressure.

I tell my students with painful sciatica to rest periodically during the day in the following position: lying on the back with large pillows under the knees. Many also have found relief when walking by specifically thinking of the buttocks releasing as each leg swings forward to take a step.

Physical Disabilities

For teachers not used to working with someone with a significant disability or physical impairment, the prospect of doing so may seem more difficult than it need be. Here is a suggestion: have the student sit, stand, walk, bend, etc... at the beginning of the first lesson, noticing how the mechanics of their movement may be different from that of someone without a disability. Perhaps they have to hold on to something while getting in and out of a chair, or shift their weight in a particular way, or walk with crutches. My approach is to work with these students with the aids they are used to having. As the lessons progress, there are some students who will find they have the physical ability to rely less and less on outside support. Others, of course, will continue to need outside support, but will be able to use it with more efficiency and less compromising of the rest of their body.

One of my students, a man in his middle fifties, presented an unusual problem as far as his medical history was concerned Thirty years ago he was in a serious accident which severely damaged his left knee. The knee joint was virtually demolished so that the only recourse the doctors had was to fuse the left leg with the knee in the straight position. The left leg, therefore, could not bend; moreover, it ended up being 4 inches shorter than the other leg.

The student was very concerned, not with the previously injured left knee, but with the good right one, which was becoming increasingly more painful to use. This is not surprising since, for the last 30 years, his good knee had been doing all the bending and straightening normally shared by two knees. He was also having more and more lower back pain.

In the first lesson, before introducing any Alexander concepts, I watched the student sit and stand (Try, yourself, to sit and stand with one knee kept straight to appreciate the different mechanics involved). The mechanics he used of course, differed from that used by someone with two normal knees, but the head back and down, and lack of torso lengthening, were all too familiar.

Working within the mechanics necessary because of the fused knee, the student learned to improve his overall use. The difference this made for him was astounding: his good knee had much less torque and pressure on it as it bent and straightened, and the painful strain on his lower back was eliminated.

One day a new student came to my office with a most unusual way of walking. Even though she was walking forward, she was leaning her torso way back from the waist. I thought to myself: "Here is a habit of use that needs to be changed." But I soon found out that the leaning back when standing and walking was a pattern of use I could not take away from this person.

The student had had polio many years ago and was left with significant weakness in the muscles that go across the back of the hip joints (the hip extensors) and the muscles of the back (the back extensors). In order to stay upright she had to keep the weight of her upper body behind her hip joints or she would jackknife forward ana fall. Her body had instinctively found a way to stay upright and I could not take that away from her. With lessons, however, I was able to help her compensate for her muscle weakness in the most efficient manner possible. She found that she could lean back less and still be stable, and that she could maintain more spinal lengthening so there was less compression in the structures of the spine.

However, I could not work with this student with monkey and lunge because both these activities require the torso to incline forward from the hip joints. She simply did not have the muscle strength to do this particular motion.

Progressive Problems of Neuro-muscular Disorders

Multiple sclerosis and muscular dystrophy are the most common conditions in this category. There is a lot the Alexander Technique can do to help people with progressive neurological problems, but we must be very clear about what we cannot do. We cannot cure these conditions, nor in any way slow down or reverse their gradual progression.

It is important to know that multiple sclerosis is characterized by periods of getting better (remission) and periods during which the symptoms get worse. In other words, the severity of the condition can be expected to fluctuate, and its doing so is not related to taking Alexander lessons.

But the Alexander Technique can definitely be helpful. When someone is coping with the problems of muscular dystrophy or multiple sclerosis, Alexander lessons can help them achieve the most efficient use they are capable of at the time. It can reduce fatigue and prevent the student from compensating in a harmful way that may cause muscle and joint pain.

Giving Alexander lessons to students with significant physical problems opens the door to the unexpected. My mother, who was an Alexander teacher, loved to talk in aphorisms. Here is one of my favourites: "When in doubt, direct."


Deborah Caplan received her Alexander certification in 1953 from Alma Frank, and her MA in Physical Therapy from New York University in 1956. She studied with F.M. Alexander, and is a founding number of The American Center for the Alexander Technique, Inc., where she is a senior faculty mamber of the teacher certification program. Deborah was affiliated with New York University Medical Center for eight years, and lectures extensively to physical therapists throughout theU.S, on the Alexander Technique. She is the author of Back Trouble: A New Approach to Prevention and Recovery based on the Alexander Technique (Triad, 1987). Deborah specializes in teaching the Alexander Technique to people with back problems.


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