Traditionally, the Alexander Technique has been taught in a one-to-one setting but, in recent years, more and more of us are also offering group classes. One big advantage of group classes is that they are more affordable. They also bring benefits such as sharing ideas and experiences, learning from watching others, and a sense of mutual support. One-to-one lessons have different advantages such as the capacity to tailor the lesson for the individual and for how they are right now, as well as the much greater amount of hands-on work possible. Nonetheless, the cost of lessons can be a significant limitation for some. The different benefits of one-to-one and group classes means that a mix of the two could be a promising way forward for many people.
All of the research evidence for long-term effectiveness of the Alexander Technique currently relates specifically to one-to-one lessons taught by STAT-registered teachers. Most notably, randomised controlled clinical trials have demonstrated that one-to-one Alexander lessons lead to long-term reductions in pain and disability for people living with persistent back or neck pain, as well as in the disabilities associated with Parkinson’s [1,2,3]. In addition, these clinical trials have demonstrated how self-confidence and agency have increased through the lessons. For example, after learning the Alexander Technique, the participants in the neck pain trial reported a greater ability for self-care, including being much better able to manage their neck pain [4,5].
Until recently, there has been comparatively little research done on group teaching of the Alexander Technique. However, new research from Professor Paul Little and his team from the University of Southampton has evaluated a mix of group and one-to-one Alexander sessions for people with persistent or recurring neck, hip or knee pain [6]. These issues were selected for study because they are among the most common musculoskeletal conditions, and because there are limited treatment options available.
In this small feasibility study, GP practices recruited patients with persistent or recurring pain in one or more of neck, hip or knee. Twenty three participants followed a specified Alexander programme of 6 group classes and 4 one-to-one lessons over 10–12 weeks. The programme included home practice and study (active rest and reading). Near the end of the course, participants were interviewed by the researchers.
From the participant interviews, some common themes emerged about the experience of group and one-to-one learning. Participants with several areas of pain, who experienced similar benefit across them all, often understood the Alexander Technique as relating to the whole person. For others, varying degrees of benefit were experienced for their different issues. Those participants who gained least benefit from the course were those with knee pain who perceived this as being caused by underlying structural damage.
Here are a couple of example extracts from the interviews:
“Alexander Technique has made me think differently, which I think is a fundamental change ……it is the awareness, well, becoming more aware of how your body responds in day-to-day tasks, that you don’t actually realise you are screwing yourself up like a ball in various parts of your body, and causing yourself pain or increased sensitivity to pain.”
“I feel it’s holistic and I feel that it helps my mood as well as physically… I feel it isn’t just a physical activity, but it is actually having an effect upon my whole body, but also having an effect on my mind and my spirit.”
Overall, both group and one-to-one learning were found to be valuable ways of learning, though some participants had a preference for one or the other. Learning in a group environment often enhanced understanding of the Alexander Technique, as well as creating mutual support; whereas, one-to-one lessons were appreciated for the tailored teaching received.
Several quantitative outcome measures were also used in the study, although no statistical analysis was carried out due to the small number of participants involved. When assessed after 3 months, modest decreases were seen in the measures of pain and disability. The more holistic quantitative measures (enablement score and global improvement) showed a greater degree of improvement. This is reflected by the interview findings, as some participants felt that the quantitative measures did not adequately capture all the benefits experienced, for example, improved recovery from pain episodes, ability to manage pain, and improved energy levels as a result of Alexander practice.
This study suggests that a mix of group and one-to-one Alexander lessons could be a promising way forward for people living with recurring or persistent neck or hip pain, as well as for some people with knee pain. Perhaps a more intensive approach (e.g. more than 10 sessions in total, and with more one-to-one lessons) should be researched for people with long-term knee issues who perceive the pain as being caused by underlying structural damage?
More generally, different models for learning the Alexander Technique are worth exploring as different approaches are likely to suit different people. Alexander lessons are available from the NHS at only two pain clinics in the UK, so most people need to pay privately to learn the Alexander Technique. This means that group teaching, or a mix of group and one-to-one lessons, is a way of increasing accessibility to the benefits of the Alexander Technique.
If you have been interested in the Alexander Technique but put off by the cost, check out the STAT website to see if a teacher near you is offering group classes, or get in touch with a teacher and see if this is something they may offer. Like many teachers, I’m also really happy to run a course for you, if you want to bring together your own group of friends or colleagues; or perhaps you’re involved in a community or sports group that may wish to come together?
References
- Paul Little, George Lewith; Frances Webley, et al. Randomised controlled trial of Alexander Technique lessons; exercise and massage (ATEAM) for chronic and recurrent back pain. British Medical Journal 2008;337:a884.
- Hugh MacPherson, Helen Tilbrook, Steve Richmond, Julia Woodman, Kathleen Ballard, et al. Alexander Technique lessons or acupuncture sessions for persons with chronic neck pain: A randomized trial. Annals of Internal Medicine 2015;163:653−62.
- Chloe Stallibrass, P Sissons, C Chalmers. Randomized; controlled trial of the Alexander Technique for idiopathic Parkinson’s disease. Clinical Rehabilitation 2002;16:695–708.
- Aniela Wenham, Karl Atkin, Julia Woodman, Kathleen Ballard and Hugh MacPherson. Self-efficacy and embodiment associated with Alexander Technique lessons or with acupuncture sessions: A longitudinal qualitative sub-study within the ATLAS trial. Complementary Therapies in Clinical Practice 2018;31:308–14.
- Julia Woodman, Kathleen Ballard, Catherine Hewitt, Hugh MacPherson. Self-efficacy and self-care-related outcomes following Alexander Technique lessons for people with chronic neck pain in the ATLAS randomised, controlled trial. European Journal of Integrative Medicine 2018; doi: 10.1016/j.eujim.2017.11.006
- Joe Little, Adam Geraghty, Carolyn Nicholls, Paul Little. Findings from the development of a novel course of both group and individual alexander technique lessons for neck, hip and knee pain. BJGP OPEN 2025. DOI: https://doi.org/10.3399/BJGPO.2024.0295.