Lifestyles

Alternative Medicine

Body Work, Manual Medicine and the Alexander Technique

BY RUSSELL FIROR, M.D.

Twenty years ago, as a young medical student filled with curiosity about alternative medicine, I found myself in a chiropractic office experiencing the typical "thrust" technique.

The doctor found it significant that I had some spinal deviations, moderate abnormalities to him, and a slightly elevated blood pressure. To my comment that I didn't have any particular muscle pain he responded "but that's because you're still in fairly good shape."

He then proceeded to pop every joint in my spine. After that, I persisted with, to me, gentler forms of body work: cranial sacral osteopathy and yoga.

Cranial sacral techniques were diametrically opposite from the thrust method, sort of a subtle balancing of the skull, pelvis, legs and spine. Several days after a treatment, while exercising or doing yoga, I'd notice muscle tension that I never knew I had but which was clearly a chronic pattern. Better yet, through that awareness, I was able develop better movement and posture ridding myself of pain.

Over the years, the commonality of my experience and many others can be summarized as follows: With any effective body work, you will experience changes in your relationship to gravity, mechanical pain and level of stress. Put in other words, integrating muscular and bony structure along ideal lines should improve function. Then, the stress on that sore knee, neck or back should let up. As we perform a walk or a run using less sub-optimal movement, our use of energy is more efficient, and we have less stress throughout the day. Hopefully as well, less pain.

Body work techniques range from the highly focused, applied to specific injuries as in sports medicine and physical therapy, to highly general, for the improvement in overall physical structure and function, such as Rolfing, cranial sacral manipulation, massage and so on.

Conventional, double blind studies proving any of these methods for reproducible effects are lacking, even for the most widely known - chiropractic. In fact, in the long run, lower back pain will improve 80 percent of the time regardless of what you do. What many subjects also find with chiropractic is that results hold for several weeks, then pain returns, in keeping with study results. Thus, the patient tends to rely on the chiropractor and has to return for more visits, sometimes without end in sight.

I believe that even many chiropractors have realized that addressing only the skeleton is not enough and that attention needs to go to movement and muscular balance. Many are now including stretching exercises, yoga or massage as part of their overall treatment.

Some therapies are specifically geared to permanent change, repatterning muscle function, movement in general and giving the patient a system that can be self-sustaining. Yoga is the classic example. In fact, many systems can conceivably trace their origins to such an ancient science, and newer therapies often are simplified versions presented in a pragmatic and altered form. Rolfing, for example, might be described as 10 sessions of a therapist shifting muscle planes through very deep, and some claim, painful massage-like intervention. Both, in theory, do not push the body beyond it's specific ability to adjust. But, in 10 Rolfing sessions, the hope is to achieve results that might take years of yoga.

My first two Alexander lessons impressed me as being very oriented to the gentle side of body work, but also, like yoga, to the input from and sensitivity of the student. Our first exercise involved me standing in front of a stool, then sitting, and again standing, watched by instructor Neil Schapera. Then, I simply repeated this movement with guidance from his hands on the back of my head where it rests on my neck. The movement in sitting and standing immediately changed to one which was weight directed: leaning forward before trying to stand from a chair, instead of pushing up with arms and shoulders, being initially too light on my feet and off balance. Instead, my weight remained over my feet throughout, and I used muscles that felt sadly out of shape from my previous habits. Oddly enough, this method of movement translated itself to other situations throughout the week, such as picking objects up off the floor. It just so happens that this movement appears to fit in with proper back care as taught by physical therapists, but in this case, the teaching was far more innate: not broken into discreet steps, immediately becoming more automatic.

From this description you might get an idea of the extensive array of possible benefits from such a therapy. Less stress on the body, less inappropriate movements overall, and thus, the potential for less injury. Many of our body pain problems are the result of repeated wear and tear, small injuries over and over until a joint or something else wears out. Also, energy conserved through efficient function leaves energy free for additional needs of the individual.

Alexander, in fact, developed his technique in response to such subtle injury, the chronic abuse of his voice as an actor, resulting in chronic laryngitis. By adjusting his body, especially his neck, through his methods, the problem was alleviated. This personal investment in the development of solutions is also common to both Rolfing and Feldenkrais as body work therapies. Many alternative therapies, in fact, invite the healthier person's participation due to an emphasis on prevention and health maintenance. To this end, a negative movement pattern might be more easily corrected early, instead of late.

Documented effects of body work therapies include the optimization of the pelvic angle - a measure of mechanical efficiency - and reduction in measures of excessive sympathetic tone. This is better known as the fight flight response, increasing heart rate and blood pressure. It is fun to speculate as to a therapy's effect on, say, the type A personality. If we can indeed teach someone to break the fight flight, internal stress cycle, then we have removed one predisposition to heart attacks, a major killer.

Specific problems addressed by the Alexander Technique have included repetitive stress injury, back pain, neck pain, ringing in the ears, musical performance improvement, poor posture and poor breathing. One study specifically showed a significant improvement in lung function in Alexander Technique subjects compared to a control group. Another interesting study specifically delineated benefits to victims of Parkinson's disease, including reduction in depression.

One client I talked to recovered from neck pain caused from complicated movements done in dance class. Conventional physical therapy had only temporary benefits, sometimes as little as one hour of relief.

As to the knee, back or neck problems, Schapera says that "many people come to us after all other methods have failed them."

To provide successful intervention in such cases is a feat in and of itself. In fact, Schapera and his wife, Vivien, both provide therapy and instruction in becoming a practitioner of the method.

Treatment initially requires 10 sessions and might take as many as 30 sessions in harder cases. The cost is $60 per session, which is comparable to the cost of Rolfing and somewhat less costly than going to a private physical therapist. I like to compare the cost to individuals I know who see a chiropractor twice a month, and will for the next five years at a total cost of $5,000 with, perhaps, still no end in sight. Compare this to as little as $600 for Alexander lessons.

If you are lucky enough to be involved in one of the health systems that the Schapera's consult to, you will have reimbursement coverage. And, Alexander therapy, also being instruction, teaches something that the client eventually maintains for him or herself. As Schapera says, "Although the Alexander technique has therapeutic consequences, and many people come for lessons to help with back pain, the format is that of a lesson or re-education, rather than a therapy."

In choosing a type of physical therapy or manual medicine, then, I would ask, of course, does it work? But also, is there a defined course of treatment and an end in sight? Does it give you a method of enhancing your physique on your own? Does the result have the potential to be long-lasting? Can it be applied when you are injured? And, does it reduce stress and give a sense of well-being? Choosing a therapy that you have confidence in is important. Bouncing from therapy to therapy would obviously incur greater and greater cost to you.

Finally, commitment to change is most important. As human beings, we tend to become comfortable with known misery. To reintegrate structure and movement involves changes in habits, effort and, at times, emotional release as pain is released. We often tend to fear this type of improvement in that we are initially facing the unknown. Trust in the therapist, and confidence in oneself become important here.

Based on current evidence, case histories and personal experience, I would answer yes to all of the questions above for the Alexander Technique. What sets it apart is its emphasis on educating the patient in movement on a mind/body level, instead of manipulation.

To contact the Alexander Technique of Cincinnati, call 542-1010.

Russell Firor, m.d. is a doctor of internal medicine practicing in Cincinnati. Contact him at CityBeat, 23 E. Seventh St., Suite 617, Cincinnati, OH 45202 or e-mail at letters@citybeat.com

CityBeat, Vol. 4, Issue 49; October 29-November 4, 1998