Chronic Pain-using Alexander Technique to manage pain conditions

Chronic Pain-using Alexander Technique to manage pain conditions

Chronic Pain-using Alexander Technique to manage pain conditions

Alexander Technique for chronic pain

The Alexander Technique is an educational method, not a health-care intervention. Alexander teachers do not diagnose medical conditions, nor do lessons typically target specific medical problems. Lessons teach cognitive and attentional strategies that help cultivate postural skill. As a result, Alexander teachers traditionally conceive of health benefits as a side-effect of effective learning, rather than the goal of instruction. However, one of the most common reasons people study the Alexander Technique is to overcome or cope with chronic pain. This article will firstly talk about the relationship between physical and mental/emotional elements of chronic pain and then give a brief discussion of how the Alexander Technique is applied.


The Neural Basis of Chronic Pain

chronic pain cycle.jpg

Feedback loops between pain, emotions, and cognition
Pain can have a negative effect on emotions and on cognitive function. Conversely, a negative emotional state can lead to increased pain, whereas a positive state can reduce pain. Similarly, cognitive states such as attention and memory can either increase or decrease pain. Of course, emotions and cognition can also reciprocally interact. The minus sign refers to a negative effect and the plus sign refers to a positive effect. 2

Chronic pain is a complex and multifaceted condition, often characterized by persistent discomfort lasting beyond the expected healing time. While acute pain serves as a protective mechanism, alerting us to potential threats and injuries, chronic pain appears to involve maladaptive neural plasticity. The Alexander Technique offers a promising intervention to improve these maladaptive patterns and enhance pain management.

Pain has several important dimensions: a sensory dimension — where does it hurt and how much does it hurt; an emotional dimension — how unpleasant is the experience; and a cognitive dimension — how do we interpret the pain based on our previous experience, does it cause fear and anxiety, and how do we respond to the threat posed by pain.1

Long-term pain experiences can lead to alterations in the brain’s structure and function. These changes can affect areas responsible for pain perception, emotion regulation, and cognitive processing. Neuroplasticity, the brain’s ability to reorganize and form new neural connections, plays a significant role in the development and persistence of chronic pain. This means that treatments just targeting the pain pathways may not be effective.

The Vicious Cycle of Psycho-Physical Chronic Pain

Psycho-physical chronic pain represents a complex interplay between physical symptoms and psychological factors, such as anxiety, depression, and stress. Habitual neuronal programs contribute to the perpetuation of this cycle, reinforcing maladaptive pain behaviors and outcomes. Stress can be related to work factors, relationships, financial stress, health-related stress, etc.

Pain-Related Fear and Avoidance

Habitual neuronal programs can lead to the development of pain-related fear and avoidance behaviors. When an individual experiences pain, the brain may establish associations between certain movements or activities and pain, leading to an avoidance of those actions. This avoidance can exacerbate physical deconditioning, further fueling chronic pain. Avoidance of certain movements that have been identified as pain causing, can lead to rigidity, poor postures and compensatory guarding movements.

Catastrophizing and Amplification

Habitual cognitive patterns, including catastrophizing and amplification of pain signals, can intensify the perception of pain. Catastrophizing involves magnifying the perceived threat of pain and its potential consequences, leading to heightened distress and disability. Amplification, on the other hand, involves a heightened awareness and focus on pain sensations, making them feel more intense than they might be.

The legend of Boot Nail Guy:

A builder aged 29 came to the accident and emergency department having jumped down on to a 15 cm nail. As the smallest movement of the nail was painful, he was sedated with fentanyl and midazolam. The nail was then pulled out from below. When his boot was removed a miraculous cure appeared to have taken place. Despite entering proximal to the steel toecap, the nail had penetrated between the toes: the foot was entirely uninjured. 4

The story, which is now a part of “pain study legend” gives an idea of the key role that our minds and thoughts have in processing pain experiences.

Emotional Regulation and Chronic Pain

The relationship between emotions and pain is bidirectional. (see illustration above.) Habitual emotional responses can influence pain processing, while chronic pain can also impact emotional regulation. Habits of rumination (excessive, repetitive thinking focused on the same, usually negative, idea or theme), emotional suppression, or avoidance can exacerbate pain experiences, creating a self-perpetuating cycle.

Although chronic pain may often have root in physical injury or disease, it appears that there may be many habits, postures, emotions, and ideas that underpin the condition. This gives an indication of why Alexander Technique has been shown to be so effective in working with chronic pain management.

Mind-Body Connection

Central to the Alexander Technique is the recognition of the interconnectedness between the mind and body. By addressing the mind-body connection, the Alexander Technique encourages individuals to challenge habitual, cognitive and neuronal patterns associated with chronic pain. Alexander Technique is characterised by its gentle, non-judgemental exploration of what may be possible in a person’s movement set. Due to the use of “discovery” rather than exercise or imposition of right or wrongs, Alexander students learn to uncover safe movement and posture outside of the normal habitual set. With the help of a trained teacher, the Alexander student begins to explore those movements and postures that provide a different physical and psychological description of body awareness. This often leads to a reduction of pain days that can become a significant proof that even chronic pain can be abated and overcome.

Mindfulness and Self-Reflection

Another  foundation element of the Alexander Technique is the practice of mindful attention– the practice of being fully present and aware of one’s thoughts, feelings, and physical sensations. Through mindfulness, individuals can identify maladaptive cognitive patterns, such as catastrophizing or negative self-talk, that may exacerbate chronic pain.

By cultivating self-reflection, Alexander Technique students become aware of how their thoughts and emotions influence physical tension and pain. Alexander students are taught to recognise and interrupt maladaptive patterns of thought, emotion and movement. This can open the door to new, more constructive responses to pain.


A number of studies looking at the efficacy of Alexander Technique have shown it to be a promising approach for pain sufferers. For instance:

The Effectiveness of Alexander Technique and Massage Therapy on Chronic Non-Specific Low Back Pain: A Randomized Controlled Trial (2015) Published in the International Journal of Clinical Practice, investigated the effectiveness of the Alexander Technique and massage therapy in managing chronic non-specific low back pain. The results showed that both interventions led to significant reductions in pain and improved functioning compared to usual care.

A Comparison of the Effects of 6 Weeks Alexander Technique Training and Aerobic Exercise on Functioning in Adults With Chronic, Non-Specific Musculoskeletal Pain (2007) This study, published in Clinical Rehabilitation, compared the effects of six weeks of Alexander Technique training and aerobic exercise in adults with chronic, non-specific musculoskeletal pain. Both interventions were found to be effective in improving functioning and reducing pain, suggesting that the Alexander Technique can be a valuable alternative to exercise-based interventions for chronic pain management.

The Long-Term Effects of Alexander Technique Lessons in the Treatment of Chronic Back Pain (2005) Published in the British Journal of Medicine, this study examined the long-term effects of Alexander Technique lessons on chronic back pain. The researchers found that individuals who received Alexander Technique lessons reported sustained improvements in pain, disability, and quality of life even one year after the intervention.

A complete list of research can be found here 5



1. Crofford LJ. Chronic Pain: Where the Body Meets the Brain. Trans Am Clin Climatol Assoc. 2015;126:167-83. PMID: 26330672; PMCID: PMC4530716.

2. Taken from Bushnell MC, Ceko M, Low LA. Cognitive and emotional control of pain and its disruption in chronic pain. Nat Rev Neurosci. 2013 Jul;14(7):502-11. doi: 10.1038/nrn3516. Epub 2013 May 30. PMID: 23719569; PMCID: PMC4465351.


4.A Tale of Two Nails | Psychology Today Australia

5.Alexander Technique Science website

6. Emilio J. Puentedura & Timothy Flynn (2016) Combining manual therapy with pain neuroscience education in the treatment of chronic low back pain: A narrative review of the literature, Physiotherapy Theory and Practice, 32:5, 408-414, DOI: 10.1080/09593985.2016.1194663

More Alexander Technique articles

Yoga and semi-supine

Yoga and semi-supine

Yoga and semi-supine

In yoga it’s called “savasana”.  In Alexander Technique it’s called “semi-supine” or “constructive rest”. There are many similarities between the savasana pose in yoga and semi-supine.

Savasana has the outward appearance of something easy and yet it is described by some as one of the most difficult poses to master. At the heart of the matter is the meditative state required to completely let go of physical tension and the mental tension that accompanies it, while still remaining present and aware in the moment.

Proponents of the Alexander Technique use a version of this pose to cultivate a neutral state of balance and poise, enjoying a presence in the moment that flows into movement as well.

Semi supine

We call it ‘Active Rest’ or ‘semi supine, a daily practice of awareness and self-care, which is particularly beneficial for sufferers of back pain.

The semi-supine position maximises sensory feedback through full contact of the head and torso with a firm, flat surface. This feedback helps to build up kinaesthetic awareness of the width, length and depth of the spine as the core structure that is so vital to balance in movement.

You may be familiar with a popular, but often misunderstood, idea that we are about an inch shorter in height in the evening than in the morning. This has some basis in a specific physiological process at work in the spine and which semi-supine can counter to our benefit. The intervertebral discs are a remarkable part of the larger strong and beautifully integrated structure of the spine and have a unique ability to absorb and hold fluid – up to forty times their own volume! During four or five hours of being upright, however, this shock absorbency system is gradually compromised as fluid is pressed out of the discs, resulting in less cushioning between the vertebrae.

Spending fifteen to twenty minutes in semi-supine allows the load to come off the whole spine and gives the discs the time they need to fully rehydrate. This means our spine gains a slight increase in overall length, letting us enjoy our full height and our buoyancy in movement at any time of the day.


In both yoga and semi-supine the benefits of a lengthening spine go further. A spine without undue compression is also our pathway into the healthy operation of our Automatic Postural Patterns or APPs. APPs refer to involuntary muscular activity that facilitates voluntary movement. APP’s help to reorganise soft tissue surrounding our bones so that the muscular work of both supporting and moving parts is distributed evenly and appropriately throughout our whole body. Whenever a movement is sensed as light, easy, effortless – that’s when your Automatic Postural Patterns are at play. The desire to trigger the APPs by lengthening the spine in Active Rest explains some of the recommendations for the practice. 


Firstly, the addition of a head rest of some kind is used to foster an easy relationship of the head with the torso, gently allowing for the natural curve of the cervical spine and avoiding over-straightening the neck. The balancing of the head in relationship to the spine is crucial to ensuring that neck muscles are free to release from attachments on the skull itself right through to their attachments to the collar bones and other parts of the arm structure and ribs. The plumping up of the intervertebral discs, as described above, spaces out the articulations of the ribs with the vertebrae opening the way for full rib excursion, deepening the experience of the breath. The arms themselves are positioned palms down on the abdomen, elbows releasing gently out to the sides. This facilitates an expansion through the upper torso and shoulder girdle from side to side and from front to back. It makes any pulling back of the shoulders (and as a consequence, narrowing of the back) less likely. Resting the palms on the abdomen and the contact of our back with the floor also draws our awareness to the movement of the breath.

In semi-supine we ‘listen’ with our feet on the floor, enjoying a dynamic balance between hips, knees and ankles. The soles of our feet, with their large number of sensory nerve endings, play an important role in the operation of APPs. They sense the detail of the surface we are in contact with, as well as telling us about the relationship of our leg joints. This information is then sent to our central nervous system where it becomes integrated with signals coming from the rest of our body and guides the body’s determination of easy balance throughout our system. Remembering to include our ‘listening’ feet is an essential part of achieving healthy functional motor patterns.


Semi-supine offers the benefits of ease and improved alignment before or after yoga asana practice and can be used independently as a regular meditation to promote integrated movement and functioning. The combination of both physical and mental rebalancing offered by this pose can enhance the moment-to-moment quality of our everyday movement and our life. There are some differences in approach between savasana in yoga and the semi-supine, but the wisdom is that there are benefits to be had from doing one or both.

Alexander Technique for back pain relief

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