Chronic back pain

As we age, bone strength, muscle elasticity and tone tend to decrease. The discs between the vertebrae bones begin to lose fluid and flexibility. When you lift something too heavy or overstretch, this can lead to a sprain, strain or spasm in one of the muscles or ligaments in the back. If the back is strained or compressed excessively, the disc can bulge outwards or rupture. This may then put pressure on one of the nerve roots. When these nerve roots become compressed or irritated, back pain results. Almost everyone above 30 will have experienced some form of back pain. Acute back pain usually resolves after a short period of rest and treatment with analgesia. Chronic back pain is when the back pain has been present for more than 3 months. Chronic back pain is a common problem and gives rise to an inordinate number of days off work worldwide. The usual treatment includes a combination of rest, analgesia, massage, physiotherapy and exercise. These manoeuvres give short term relief but do not normally provide long term sustained relief to the sufferer. So what should people with chronic back pain do?

A group of researchers from the Universities of Southampton and Bristol recruited a total of 579 people with chronic or recurrent back pain through 64 general practices in England (BMJ 2008; 337: a884). In the previous year, 79% of this population had had 90 or more days of back pain. One hundred and forty four were randomized to normal care, 147 to massage, 144 to 6 Alexander Technique lessons and 144 to 24 Alexander Technique lessons; half of the participants of each of these groups were also randomized to exercise prescription. One year after the start of the study, the 24 Alexander Technique lessons group achieved a 42% reduction in the Roland disability score and an 86% reduction in days in pain when compared with the normal care group. The group with 6 Alexander Technique lessons achieved a 17% reduction in the Roland disability score and a 48% reduction in days in pain. Massage had no effect on the Roland disability score but the number of days in pain was reduced by 33%. The effect of 6 Alexander Technique lessons and exercise prescription was almost as good as 24 lessons alone. The effect of combining exercise with 24 lessons on the Roland disability score reduction and days in pain was similar to that seen with 24 lessons alone. The study showed that one to one lessons in Alexander Technique from registered teachers led to long term benefits for patients with chronic back pain.

Frequently, chronic low back pain is due to inappropriate posture, stress and poor physical condition. The Alexander Technique is designed to develop lifelong skills for self care that help people to recognize, understand and avoid poor habits affecting postural tone and neuromuscular coordination. The one to one lessons involve continuous personalized assessment of the individual patterns of habitual musculoskeletal use when stationary and in movement. This allows the teacher the opportunity to instruct you on how to release unwanted head, neck and spinal muscle tension and how to improve musculoskeletal use when stationary and in movement, thus allowing decompression of the spine. As such the Alexander Technique is distinct from manipulation and conventional physiotherapy.

I am not saying that embracing Alexander Technique will cure your chronic back pain for good. However, learning some of the specific exercises to correct some of the stress and strains caused by your inappropriate posture may well give you significant and sustained pain relief. Giving it a try is unlikely to make your problem worse, it might just help. I have certainly benefited from it.

(If you would like to find out more about Alexander technique, a good place to start is at the Society of Teachers of the Alexander Technique website http://www.stat.org.uk/ )