Back pain trial

After 1 year, individuals with back pain who had undertaken Alexander lessons had only 3 days of pain per month compared with 21 days for similar patients who were receiving the usual standard-of-care from their GP.1

In 2008 the British Medical Journal published the results of a large, well-designed clinical trial that evaluated the effectiveness of Alexander Technique lessons compared with other health interventions for chronic low back pain.1

What the trial did

A total of 579 people with chronic or recurrent low back pain were randomised to one of the following groups:

  • usual care from their GP
  • 6 sessions of therapeutic massage
  • 6 one-to-one Alexander Technique lessons
  • 24 one-to-one Alexander Technique lessons.

The massage and Alexander groups also continued to receive usual care from their GP. All Alexander lessons were delivered by registered teachers belonging to STAT. Half of each group were also randomised to GP-prescribed aerobic exercise (30 minutes of brisk walking five times a week, or the equivalent).

At the beginning of the study (before any of the above began) all participants completed evaluation forms to describe their level of pain, ability to carry out daily tasks and quality of life. These evaluations were repeated at 3 months and at 1 year after the beginning of the study.

Trial results

After one year, people who had undertaken Alexander lessons had significantly less back pain, less incapacity and a better quality of life compared with those who received usual GP care alone.

The group who did best were those who had 24 Alexander lessons. The figure below shows the amount of back pain this group had after 1 year, compared with those who had received either usual GP care alone or therapeutic massage:

In addition to having less pain, those who had taken 24 Alexander lessons were able to carry out at least three more types of common daily tasks without limitation from back pain than those in the usual GP-care group; they also had a significantly better quality of life.

The group who had taken 6 Alexander lessons also experienced significant benefits in back pain, incapacity and quality of life compared with those who received usual GP care alone, particularly if they also took regular exercise. The level of benefit (in terms of pain and incapacity) of 6 Alexander lessons compared with 24 lessons was just under 50% but this increased to just under 70% when combined with exercise.

In comparison, the group who received therapeutic massage initially experienced a significant reduction in incapacity compared with the usual GP-care group but this benefit had been lost by 1 year. While back pain was significantly reduced at both 3 months and 1 year in the massage group, the level of benefit decreased during this time.

Exercise on its own did not make a significant impact at 1 year compared with usual GP care. However, looking at the overall effect of exercise (i.e. whether combined with usual GP care, Alexander Technique or massage) it did provide some benefit, with a modest but significant reduction in incapacity at 3 months and 1 year. Similarly, pain was significantly reduced at 3 months but this benefit was, however, lost by 1 year.

The trial design included in-depth interviews with participants. Patients reported an increased ability to cope with and prevent their back pain following their Alexander lessons. They described the Alexander Technique as something that ‘made sense’ that could be practised while carrying out everyday activities.2 GPs and nurses in the trial perceived Alexander lessons as more beneficial and acceptable than massage, linking this to the educational and self-care nature of the Technique.3


  • Lessons in the Alexander Technique lead to significantly reduced pain and incapacity, and improved quality of life in individuals with chronic or recurrent back pain.
  • Most benefit was provided by 24 Alexander lessons. After 1 year, compared with usual GP care alone, 24 lessons led to:
    • 86% reduction in number of days in pain
    • ability to carry out on average 3 more types of daily task without limitation from back pain
    • significantly improved quality of life.
  • Six Alexander lessons also gave benefit, particularly when followed by exercise, but were not as effective as 24 lessons (either with or without exercise).
  • There are now two large randomised controlled trials published that demonstrate the effectiveness of one-to-one Alexander lessons for people with chronic musculoskeletal conditions: one for chronic back pain and one for chronic neck pain. 1,4

Find out more

Watch the videos on Alexander Studies Online where I am interviewed about what the back pain trial tells us.

Further details of the trial are discussed in the Review of evidence paper.

Watch the BMJ video about the trial.


  1. Little P, Lewith G, Webley F, 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.
  2. Yardley L, Dennison L, Coker R et al. Patients’ views of receiving lessons in the Alexander Technique and an exercise prescription for managing back pain in the ATEAM trial. Family Practice 2010; 27: 198–204.
  3. Beattie A, Shaw A, Yardley L, Little P, Sharp D. Participating in and delivering the ATEAM trial (Alexander technique lessons, exercise, and massage) interventions for chronic back pain: A qualitative study of professional perspectives. Complementary Therapies in Medicine 2010; 18: 119–27.
  4. MacPherson H, Tilbrook H, Richmond S, Woodman J, Ballard K, Atkin K, Bland M, Eldred J, Essex H, Hewitt C, Hopton A, Keding A, Lansdown H, Parrott S, Torgerson D, Wenham A, Watt I. Alexander Technique lessons or acupuncture sessions for persons with chronic neck pain: A randomized trial. Annals of Internal Medicine 2015;163:653-62.