Alexander technique

March 22, 2017


Alexander technique

Natural Standard Bottom Line Monograph, Copyright © 2013 (www.naturalstandard.com). Commercial distribution prohibited. This monograph is intended for informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.

While some complementary and alternative techniques have been studied scientifically, high-quality data regarding safety, effectiveness, and mechanism of action are limited or controversial for most therapies. Whenever possible, it is recommended that practitioners be licensed by a recognized professional organization that adheres to clearly published standards. In addition, before starting a new technique or engaging a practitioner, it is recommended that patients speak with their primary healthcare provider(s). Potential benefits, risks (including financial costs), and alternatives should be carefully considered. The below monograph is designed to provide historical background and an overview of clinically-oriented research, and neither advocates for or against the use of a particular therapy.

Related Terms

  • Feldenkrais method, guided movement-awareness, physical therapy, physiotherapy, proprioceptive musculoskeletal education, psycho-physiological reeducation, Rolfing®, tai chi, yoga.


  • The Alexander technique is an educational program that teaches movement patterns and postures, with an aim to improve coordination and balance, reduce tension, relieve pain, alleviate fatigue, improve various medical conditions, and promote well-being. Actors, dancers, and athletes use the Alexander technique with the goal of improving performance. This technique is available through wellness centers, health education programs, and from individual teachers.

  • The Alexander technique can be traced to F.M. Alexander, an Australian-English actor, who attributed his own intermittent voice loss to poor head and neck posture. Alexander believed that people could be trained to detect and eliminate harmful movement patterns and positions.

  • Musculoskeletal approaches like the Alexander technique are advocated by many behavioral scientists and physiologists, although there are few scientific studies of this technique specifically.


  • An assumption underlying the Alexander technique is that people can be trained to alter habitual patterns of movement, including movements that are thought to be involuntary. Improving the position of the head and spine is felt to be important to achieving optimal health. It has been suggested that musculoskeletal movements and relationships can have direct effects on other aspects of health or function, and that beneficial movement patterns can be reinforced through repetition.

  • The American Center for the Alexander Technique was founded in New York in 1964 in order to provide teaching certification. To become certified, individuals must complete 1,600 hours of training over a minimum of three years in a program approved by the American Society of the Alexander technique (AmSAT). In 1987, the North American Society of Teachers of the Alexander technique was formed to educate the public and to establish and maintain standards for the certification of teachers and teacher training courses in the United States.

  • Most Alexander technique teachers instruct students by using both verbal directions and light touch. Students are encouraged to understand and sense what they are doing, and to make use in everyday life of what they have learned.

  • Sessions last up to an hour, and usually make use of a mirror for instruction. Lessons are usually private, although group instruction is also available. A gentle hands-on approach is used to teach movements with the head leading and the spine following, for example with stand-to-sit movements, walking, turning, breathing, or speaking. It may take 10 to 30 lessons before students become proficient, and some individuals continue lessons over extended periods of time.

Scientific Evidence


These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.


Asthma (chronic)

There is not enough scientific evidence to make a strong recommendation for the use of the Alexander technique in asthma patients. More study is needed in this area.


Back pain

There is limited evidence in this area, and no firm conclusion can be drawn based on scientific research.



Limited research suggests that functional reach performance may be improved through Alexander technique instruction, particularly in people older than 65 years. Better quality evidence is needed before a firm conclusion can be drawn.


Lung function

There is a small amount of research on the effects of the Alexander technique on lung function in healthy people and musicians who play wind instruments. Until better evidence is available, it remains unclear if the Alexander technique improves lung capacity.


Parkinson's disease

Early research suggests that Alexander technique instruction may improve fine and gross movements and reduce depression in patients with Parkinson's disease. Additional human research is needed before a clear recommendation can be made.


Posture in children

The Alexander technique has been suggested as a means to improve children's postural development. The long-term effects of such instruction are not known.



There is not enough scientific evidence to make a strong recommendation for the use of the Alexander technique in patients who stutter. More study is needed in this area.


Temporomandibular joint (TMJ) chronic pain

Early case series data suggest that Alexander technique instruction may reduce symptoms in people with TMJ chronic pain. More human research is needed before a clear recommendation can be made.


*Key to grades:A: Strong scientific evidence for this use; B: Good scientific evidence for this use; C: Unclear scientific evidence for this use; D: Fair scientific evidence against this use (it may not work); F: Strong scientific evidence against this use (it likely does not work).


The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious and should be evaluated by a qualified health care professional.

  • Anxiety, arthritis, athletic performance, carpal tunnel syndrome, chronic bronchitis, chronic fatigue syndrome, cognitive performance enhancement, coordination disorders, depression, digestion disorders, endurance, epilepsy, fibromyalgia, frozen shoulder, headache, heart disease, high blood pressure, hip pain, hoarse voice, increased energy, joint disorders, labor and delivery (improving breathing, promoting relaxation), laryngitis, leg cramps, low energy, Lyme disease, migraine, multiple sclerosis, neck pain, osteoarthritis, osteoporosis, panic disorder, performance anxiety, physical endurance, pregnancy (reducing back strain, minimizing compression of internal organs or blood vessels, improving ability to rise from sitting position), repetitive strain injury, rheumatic disorders, sciatica, sleep disorders, spine problems (scoliosis), stiffness, stomach ulcers (peptic ulcer disease), stress/stress-related problems, stroke, systemic lupus erythematosus, tendonitis, tennis elbow, tension-related sexual disorders, voice strain.


Many complementary techniques are practiced by healthcare professionals with formal training, in accordance with the standards of national organizations. However, this is not universally the case, and adverse effects are possible. Due to limited research, in some cases only limited safety information is available.

  • There is a lack of published reports of serious complications as a result of Alexander technique instruction. It has been suggested that this technique may be less effective in patients with learning disabilities or mental illness. The Alexander technique has been used by pregnant women and during delivery without reports of complications, although safety in these situations has not been established scientifically.

  • The Alexander technique should not be used as the only treatment approach for medical or psychiatric conditions, and should not delay the time it takes to consider more proven therapies.

Author Information

  • This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).


Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

  1. Austin JH, Ausubel P. Enhanced respiratory muscular function in normal adults after lessons in proprioceptive musculoskeletal education without exercises. Chest 1992;102(2):486-490. View Abstract

  2. Cacciatore TW, Horak FB, Henry SM. Improvement in automatic postural coordination following alexander technique lessons in a person with low back pain. Phys Ther 2005;85(6):565-578. View Abstract

  3. Dennis RJ. Musical performance and respiratory function in wind instrumentalists: effects of the Alexander technique of musculoskeletal education (abstract). Dissertation Abstracts International 1988;48(7):1689a.

  4. Dennis J. Alexander technique for chronic asthma. Cochrane Database Syst Rev 2000;(2):CD000995. View Abstract

  5. Dennis RJ. Functional reach improvement in normal older women after Alexander Technique instruction. J Gerontol A Biol Sci Med Sci 1999;54(1):M8-11. View Abstract

  6. Ernst E, Canter PH. The Alexander technique: a systematic review of controlled clinical trials. Forsch Komplementarmed Klass Naturheilkd 2003;10(6):325-329. View Abstract

  7. Knebelman S. The Alexander technique in diagnosis & treatment of craniomandibular disorders. Basal Facts 1982;5(1):19-22. View Abstract

  8. 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. BMJ 2008 Aug 19;337:a884. View Abstract

  9. Maitland S, Horne R, Burtin M. An exploration of the application of the Alexander technique for people with learning disabilities. Br J Learn Disabil 1996;24:70-76.

  10. Nuttall W. The Alexander principle: a consideration of its relevance to early childhood education in England today. Eur Early Child Ed Res J 1999;7(2):87-101.

  11. Schulte D, Walach HFM. Alexander technique in the treatment of stuttering-- a randomized single-case intervention study with ambulatory monitoring. Psychother Psychosom 2006;75(3):190-191. View Abstract

  12. Stallibrass C. An evaluation of the Alexander Technique for the management of disability in Parkinson's disease--a preliminary study. Clin Rehabil 1997;11(1):8-12. View Abstract

  13. Stallibrass C, Hampson M. The Alexander technique: its application in midwifery and the results of preliminary research into Parkinson's. Complement Ther Nurs.Midwifery 2001;7(1):13-18. View Abstract

  14. Swinburne C. From the top. Nurs Stand. 1-25-2006;20(20):20-22. View Abstract

  15. Valentine ER, Gorton TL, Hudson JA, et al. The effect of lessons in the Alexander technique on music performance in high and low stress situations. Psychol Music 1995;23:129-141.

Copyright © 2013 Natural Standard (www.naturalstandard.com)

The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.


March 22, 2017