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Alexander Technique & the Medical Profession

Alexander Technique alexander technique & the medical profession Alexander Technique & the Medical Profession Alexander TechniqueNot Just “Posture”

I’m going to explain a few basics about the Alexander Technique as I would to a lay audience so that you can see where it fits into Performing Arts Medicine. Performers are already familiar with the concept of oneself as an instrument and the Alexander Technique teaches us how to play that instrument. It is literally about how you use yourself and how you react in everyday situations at work, rest and play. How you sit, how you stand, walk, dance, sing or play an instrument. It is rather like driving lessons for human beings, teaching us how to drive ourselves around better in the world, how to sit, stand, walk, dance, sing etc. The lessons teach us to react in the most appropriate way to whatever is coming at us; they also teach us, perhaps more importantly, how not to react. Like driving, it’s best taught on a one to one basis.

We work with hands-
on (like dual controls). It’s not just a postural technique. The teacher’s hands convey a specific quality of muscle tone – the most appropriate muscle tone for the task being undertaken. Like driving lessons, it is best to have the initial lessons close together. As time goes on, the pupil takes more and more responsibility for how he uses himself, and more and more responsibility for how he reacts to what is coming at him on the roads of life. He is driving his own human vehicle and once a basic course of 20 or 30 lessons has been completed, the pupil has enough knowledge and skill in the Technique to be well on the way to working on his own and putting the Technique into practice for ever afterwards. It’s a thing that you can take as far as you like: we don’t set a limit on it. After all, even virtuoso pianists have piano lessons’

Anybody here know how to drive a car? When you learn to drive, you learn a set of excellent driving habits. Some people acquire extra driving habits, like resting an arm on the window frame, like riding the clutch, like leaving the hand on the gearstick, like leaving the hands in the twenty five past five position instead of the “official” quarter to three, like driving over the speed limit. Nobody here does any of those, I am sure! But if we were to teach you to drive better again, it would involve unlearning some of the extra inappropriate habits which you had superimposed on the original “good” patterns. The Alexander Technique can help like that. We teach people to stop doing the wrong things, and the right things tend to happen by themselves, as physiological functioning returns towards that happy state of truly normal functioning that we had as tiny children. We are in a way re-educating physiological functioning. So you can begin to see that this is not a therapy in the ordinary sense of doing something to somebody.

So how did it originate, this re-education of physiological functioning? Well, it started with a performer. F M Alexander was a very successful young actor giving recitations from Shakespeare on the stage in Australia in the late 1880’s. He kept losing his voice and was troubled with recurrent hoarseness; so he went to specialists and after various treatments, including vocal rest, he found that the problem came back as soon as he started to recite again. So, he went back to the doctor and asked “Could it possibly be something that I am doing with myself as I recite that is causing the problem?” And the doctor said ‘Yes’, Alexander said ‘What?’, the doctor said ‘I don’t know’; and so, as there were no voice and speech therapists in those days, he was thrown back on his own resources – a situation familiar to him from his upbringing in the Tasmanian outback. He had only a mirror in front of him and he started to look to see what it could be that he was doing wrong while he was reciting.

One mirror soon gave way to three and his observations became more and more minute as he uncovered a constellation of deleterious habits. These included pulling the head back, i.e. head extension on the Atlanto-occipital joint, (which you can hear alters my voice immediately), depressing the larynx, throwing the breast forwards, hollowing the back (lumbar lordosis) and stiffening the leg muscles, to name but a few. He decided that he would stop doing all of those things, and he at once ran into a formidable obstacle, the power of habit. This is a very strong force in human affairs and I would just like to illustrate it for you. Would you please cross your arms and, firstly, just notice how that feels. Notice which wrist is on top. Now can you change over to the other arm. One or two people are having slight problems with that. How does it feel? Anatomically there is no difference between these two positions but one is what we are used to, a familiar habit and the other is something unusual. Does it feel uncomfortable? Have you ever tried to change habits, for instance drinking less or stopping smoking? Has anyone ever had to sleep in a different position at night in bed, maybe due to an injury? If you haven’t, try it tonight I have, and I was wide awake at 3 am convinced I’d never sleep. That’s the power of habit for you.

As if that wasn’t enough, Alexander ran into a second obstacle: the phenomenon called faulty sensory appreciation. I’ll give you an example of this: you feel you are walking upright along the road and when you look in a shop window, you see that you are slumped but you feel that you are walking along quite upright. What you are doing is not what you feel you are doing This is why so much so-called “posture advice” fails, because it doesn’t take into account faulty sensory appreciation, What the person (performer) feels he is doing is not what he is actually doing. The Technique helps us to get round the problem of faulty sensory appreciation in a way that gradually restores reliable sensory appreciation.

So the Alexander Technique is about how you use yourself and how you react to what is coming at you on the roads of life, what is coming at you as you prepare to perform and what is coming at you as you perform. It enables you to create a space between the stimuli that life deals out to you and your own automatic habitual reaction – a space in which you have some choice about how you respond. This is not a therapy or a mindless posture training but a process of psychophysical re-education with therapeutic and preventive consequences. Just as driving well has therapeutic and preventive consequences on the roads, so the Alexander Technique has in life. Age and disability are no barrier. It doesn’t matter whether you are driving round in a brand new Rolls Royce or a clapped-out old Mini: if you drive it better, it will function better.

One last point. There is nothing “alternative” about the Alexander Technique. As you will gather from Kathleen Ballard’s presentation, it is in every way consistent with orthodox medical and physiological theory and practice. There is nothing in modern Alexander teacher training which in any way conflicts with what I learned in Medical School, rather, this knowledge greatly enhances my understanding of human functioning. So the Alexander Technique is psychophysical re-education with therapeutic and preventive consequences. We are not in competition with therapists (speech therapists, osteopaths, doctors etc.). Within the limitations of the analogy, they are more like garage mechanics for the human vehicle and we are the driving instructors.

Right from a hundred years ago when Alexander first began to teach, doctors who knew and understood the Technique have always been supportive and encouraging, both practically and politically. It’s a shame that it’s not better known in the medical profession – obviously we are doing what we can to remedy that situation.

Alexander lessons are also available in the private sector, privately and individually from teachers but also through many of the medical insurance companies. The Society of Teachers of the Alexander Technique have been negotiating with the six major medical insurance companies, and some of them have agreed to pay for Alexander lessons where these are prescribed by a consultant as part of his or her treatment plan for the patient. WPA, Prime Health, Norwich Union, Iron Trades Insurance Company, Cigna, Orion Healthcare and other smaller companies have all paid for Alexander lessons, so don’t be shy in suggesting them for your insured patients.

MEDICAL APPLICATION OF THE ALEXANDER TECHNIQUE

The Technique is primarily educational in nature, but learning and applying it has therapeutic benefits and preventive consequences for the health of the individual. In particular, patients with the following conditions will benefit from applying the Technique to the extent that the way they use themselves (their cerebral and neuro-muscular systems) is a factor in the causation and/or continuance of the particular disorder.

  • Backache, neckache, where posture is a factor
  • Some voice disorders and vocal cord nodules
  • Stress
  • High blood pressure
  • Asthma
  • Hyperventilation
  • Anxiety states (including performance anxiety)
  • Functional disorders

Osteo-arthritis

  • Temporo-mandibular joint dysfunction
  • Scoliosis
  • Spondylosis

Migraine – some types

  • Tension headaches
  • Cerebral palsy
  • Multiple sclerosis
  • Parkinson’s disease
  • Rehabilitation after stroke, injury, operation or other treatment
  • Prevention of backache in pregnancy
  • Dystonias

Non-specific regional pain syndrome

Information Courtesy of Dr Miriam Wohl MBChB

ALEXANDER TECHNIQUE FOR PERFORMERS
(Questions and answers)

By Dr Miriam A. Wohl MB ChB JCC Cert MSTAT
Q. Do you consider it to be a therapy or a teaching method?
A. It is a teaching method. It’s a psychophysical re-education which happens to have therapeutic and preventive consequences.

Q. Some of my friends swear by the Alexander Technique: they say using it makes them feel more relaxed and confident and move more freely and easily. What is it exactly and who can benefit from it?
A. As a performer, you will already be familiar with the ides of yourself, as the human instrument you play when you perform. The Alexander technique teaches you to play that instrument better. It is literally about how you use yourself and some doctors describe it as driving lessons for the human vehicle. Just as you may have bad habits in the way you drive a car, so you can develop bad habits in the way you drive your own human vehicle around the world, in rehearsal and on the stage. Just as we can react inappropriately to what’s coming at us on the roads, so we can react inappropriately to what’s coming at us on the “roads” of our work and of life itself.

Learning and applying the Alexander Technique enables you to put a space in between what life deals out to you and your habitual automatic (“knee-jerk”) reaction, so that you can respond appropriately to whatever is happening around you. It enables you to tackle faulty patterns of tension and collapse which are an important factor in many performers’ problems such as:

  • vocal disorders
  • performance anxiety
  • non-specific upper limb disorders (so-called ‘overuse’)
  • back/neck/mouth pain where posture is a factor
  • dystonias

Q. Is it an alternative therapy then?
A. There’s nothing alternative about it: it’s entirely consistent with orthodox medical understanding of how the body works. It’s not exactly ‘therapy’ either. Therapy is like a repair to the human vehicle, whereas the Alexander technique is more like driving lessons. (In fact, nowadays, it’s considered so central a discipline that a new drama school Can’t get accreditation unless it has an Alexander teacher on the staff)

Q. So it’s more a way of life then?
A. Yes. Although the problem you first came with is solved, you may wish to continue using the Technique to improve the way you use yourself and so enhance your performance, not only on stage but in everyday living as well.

Q. How long does it take and how much does it cost?
A. Although top prices will be £25 for 30-40 minute lesson, most teachers operate a sliding scale, and you will not be turned away because of the money factor alone. Performers with medical problems may get lessons paid for on the NHS, and the Technique is available through most of the private medical insurance companies on a consultant’s recommendation

BAPAM – the British Association for Performing Arts Medicine runs a helpline and clinics through which performers who are having problems with the way they use themselves can be referred for lessons.

A typical course of lessons would be 20-30 sessions, but you can take it as far as you wish – after all, even virtuosi have lessons! It’s best learned on a one-to-one basis. Group teaching for beginners is a poor second to individual work – as with, for example, singing lessons.

Q. How would I find a reputable teacher?
A. Alexander teachers should have undergone a 3 year full time training course and have a certificate from the recognised professional body Society of Teachers of the Alexander technique (STAT Cert or MSTAT). Alexander teachers are used to teaching performers and understand the stresses and strains of a life centred around the stage.

Q. What is the purpose of the Alexander technique
A. The Technique is primarily educational in nature, but learning and applying it has therapeutic benefits and preventive consequences for the health of the individual. In particular, patients with the following conditions will benefit from applying the Technique to the extent that the way they use themselves (their cerebral and neuro-muscular systems) is a factor in the causation and/or continuance of the particular disorder.

  • Backache, neckache, where posture is a factor
  • Some voice disorders and vocal cord nodules
  • Stress
    High blood pressure
  • Asthma
  • Hyperventilation
  • Anxiety states (including performance anxiety)
  • Functional disorders

Osteo-arthritis

  • Temporo-mandibular joint dysfunction
  • Scoliosis
  • Spondylosis

Migraine – some types

  • Tension headaches
  • Cerebral palsy
  • Multiple sclerosis
  • Parkinson’s disease
  • Rehabilitation after stroke, injury, operation or other treatment
  • Prevention of backache in pregnancy
  • Dystonias
  • Non-specific regional pain syndrome

Alexander Technique
By Jenny Daisley

F Mathias Alexander (1869 – 1955) was motivated to develop his way of working to improve mind and body co-ordination by his own respiratory and vocal problems. As a child he was not expected to live. As a youth he was educated at home because he was too ill to attend school. When he became a reciter on the Victorian stage he frequently lost his voice. He tried everything that was suggested by medical and other practitioners of the day, even re-maining totally silent for two weeks, but to no avail. Then he began a seven year long, detailed study of what he was doing with his body which prevented his voice from flowing. And so he discovered and developed the technique which bears his name. It is a technique to be learned, not a therapy to be given. Its practitioners are teachers and those who seek to find out more about it are pupils. But often the process of re-education leads to a cure of some ailments.

Who seeks Alexander lessons?

The majority of pupils (about 65-70 per cent) come because they have pain of one sort or another, most frequently back, neck or shoulder pain. These pupils usually also report stress and tension.

The next main group (about 25 per cent) are those who perform: actors, musicians, dancers, athletes and sports enthusiasts, both amateur and professional.

The remainder are people who feel that they need some boost to help them take steps in their development as individuals, to take more charge of their lives in some way.

The Alexander Technique aims to help people to rid themselves of habits in the way in which they use their bodies which may be harmful to health and well-being.

What is the Alexander Technique and how does it work?
In Alexander lessons we are working mainly with the kinaesthetic sense. The experienced cook knows the ‘right’ thickness of a batter, the nurse knows the tightness of a bandage, the driver knows the pressure on the pedals to achieve a certain result. In one way in Alexander work we are helping people to be more economical in the effort that they put into doing things. To begin to achieve this, pupils first have to observe how they do things now, decide which activities they might do in a better way and try to put the new and better way into effect.

Without moving, observe how you are reading this passage now.

Let’s assume that you are sitting. Notice first of all how your body is balanced. Is the weight evenly distributed or is it more on one sitting bone (ischial tuberosity) than on the other?

Where are your feet? Do they support your legs? Are they tucked under the chair or round each other? Do you notice any pressure points? What about your back? Is it curving laterally as you perhaps rest an elbow somewhere? Does it curve quite a bit in the upper spine as you read? If you note your observations you are almost certain to discover some ways in which you are using your body right now, which conflict with its design.

People often sit slouched with pressure on the coccyx, slanting to one side, causing the muscles of one side to work much harder, with excess of pressure on crossed legs cutting off the blood supply or nervous system. Now move (if you have resisted the temptation) and sit in what you would consider to be a more balanced way. Stay there for a few moments as you read and see how it feels.

Consider any piece of machinery or equipment, if it is used badly or not for the purpose for which it was designed, it is likely to suffer excessive wear and tear. It is the same with our bodies. If they are not used as designed, they wear in the wrong places. But most of us were not taught about the design of our own bodies.

If we can use our bodies in the way in which they are designed we will find that we make less effort. Once we have retrained ourselves, the wear and tear on muscles, ligaments, bones, joints, etc will be reduced. But it is difficult to change old habits! Old habits are comfortable and feel ‘right’.

Try another experiment. Fold your arms in whatever way you normally do. Now look at them. Which hand comes upwards into the crook of your elbow? Now fold them the opposite way. What happens? For a few people it is easy, but most have to stop and think and when it is done in the opposite way, it feels ‘odd’, ‘uncomfortablc’ or ‘not right’. So here we see two barriers that people meet in themselves when they try to do something differently. They have to stop the old habit, which is ingrained and automatic, and replace it with something which is conscious and makes better use of the structure of the body.

Alexander used the word inhibition to describe the stopping part of the process and he devised a set of basic instructions to enable the new movement to be made with the best possible use of the body and mind. He eliminated the use of the word ‘right’ in this sense, because of the dangers of trying to achieve for example a ‘correct’ way to sit down. Once people thought that they could do it ‘correctly’ they would give up trying to improve.

Let us suppose, for example, that you decide to change the way in which you bend to pick things up. First you have to remember each time that you bend that you are not going to do it in your old automatic way. You have to stop or inhibit. Then you have to have a clear and accurate picture of the new way. This is where Alexander’s set of instructions, ‘directions’ he called them, come in. They enable you to free your joints and release your muscles in such a way as to make the movement flow accurately according to your intention and with economy of effort. To begin with it is difficult to trust your sensory awareness, it is so used to the old patterns. That is where the Alexander teacher comes in. at your experiment. How are you sitting now? Have you reverted back a bit to your old pattcrn? Are you feeling a strain staying in a new pattern? (release it if this is so). Did you forget what was happening in your body as you concentrated on what you were reading?

What happens in the Alexander lesson?

Alexander teachers are trained by means of a three year, full time course at a registered training centre. This training is governed by the professional association, the Society of Teachers of the Alexander Technique.

The teachers use their hands in a very gentle way to assist the pupil in releasing excess muscle tension. Learning the directions of freeing joints and lengthening and widening the body is encouraged through the teachers’ hands and conversation. Some parts of the lesson may be conducted lying down on a table so that the teacher is able to effect greater release in areas where it is needed. It is advisable for pupils to wear loose and comfortable clothing during the lesson.

The main part of the lesson is concerned with re-educating the kinaesthetic awareness and applying this to how the pupil undertakes day-to-day activities, such as walking, standing, sitting, bending, picking up and carrying, sitting at a desk, or playing an instrument, if this is appropriate. Pupils learn the basic principles of stopping old habits, getting a new intention clear and directing their bodies to achieve the movement in the best possible way. Attention is constantly paid to the relationship between the head, neck and back, as it is in this area that most people today have too much tension, affecting blood supply and the nervous system.

To begin with, the work feels strange. For most people it is pleasantly relaxing and after a lesson they say they feel ‘calmer’, ‘as if my body is lighter’, ‘more able to move easily’. In the first lessons the strangeness relates to the new ways in which the body is poised and moving. If you were to decide to brush your teeth with your toothbrush in the opposite hand, it would take quite a few days for you to remember to do it each time and probably several weeks to become as proficient with the opposite hand. And so it is over a course of lessons (average 25-30 lessons) that pupils begin to develop greater sensory awareness and a new confidence in their kinaesthetic ability. Gradually the teacher becomes less the teacher and more the helper or catalyst for the pupils, as the pupils learn to apply the Alexander Technique increasingly in their daily lives.

For most people the unhelpful body habit patterns begin to be visible from age three or four onwards. So it is years of habits that the Alexander work is trying to change. Once people learn the basic principles it is a lifetime’s work developing them and applying them to more and more situations and with greater subtlety, referring back to a teacher only for the occasional ‘top up’ or refresher.

Can the Alexander Technique cure people?

It sets out to re-educate. As new ways of using the body become established, various parts of the body gain a greater freedom. Breathing, circulation, digestion and elimination are improved, with the resultant benefits. Applying the principles to the way we use our thinking and feelings as well as to what we do may also contribute considerably to our state of well-being. Some Alexander teachers will help pupils to explore the technique in relation to thinking and feelings. For most of us ill health at some points in our lives is normal — we can expect it. Working in an Alexander way gives us a way of coping with our reaction to the situation.

Dr Miriam WohI, MB BCh