‘97% of people with back pain could benefit by learning the Alexander Technique’

You’ll find this quote all over the internet:

97% of people with back pain could benefit by learning the Alexander Technique. It is only a very small minority of back pain sufferers that require medical intervention such as surgery.

Dr Jack Stern, spinal neurosurgeon

I haven’t tracked down the source of this quote, but Dr Jack Stern is a renowned New York-based neurosurgeon of some 40 years’ standing with a specialization in the spine. So, I wanted to know, what is the basis of his 97% claim?

Recently, I was able to watch an online talk given by Dr Stern entitled ‘The role of the Alexander Technique in the treatment of low back pain’ and hosted by the Judith Leibowitz Scholarship Fund. Watching his presentation, it seems that Dr. Stern’s claim for the efficacy of the Alexander Technique is based on clinical evidence that 97% of low back pain is due to ‘mechanical’* causes. Here’s what the data looks like:

Included under those mechanical causes of low back pain is lumbar strain or sprain which accounts for a massive 70% of cases. This is by far the most common cause of back pain and, in Dr Stern’s words, ‘the diagnosis most readily treated by the Alexander Technique.’ And then there are also a number of further diagnoses under this category such as degenerative processes of disc and facets (usually related to age) (10%) and herniated disc (4%). Congenital diseases such as severe kyphosis and scoliosis are also included.

And why, as Dr. Stern claims, is the Alexander Technique of such benefit to these 97% of people with back pain? The reason is that, in the vast majority of cases, poor use of the musculoskeletal system contributes to poor functioning, which in turn causes pain – and this is the generally unacknowledged factor which the Alexander Technique seeks to address. In other words, the Alexander Technique retrains us to use our bodies in the most efficient and non-damaging manner, which in turn alters how we function – in short, use affects functioning. Dr. Stern puts it in the following way:

Low back pain is almost always a benign self-limiting problem related to poor use.

It would of course be reckless to make such claims for an intervention without evidence, but the evidence is there. It’s contained in the results of a large-scale randomized control trial of the effects of Alexander Technique on back pain. This study, published in the British Medical Journal, concluded that Alexander Technique had ‘long term benefits for patients with chronic back pain’. You can read here my own short summary of its remarkable findings.

I’ll leave the final few words to Dr Stern who, in another interview several years ago, commented:

For me as a neurosurgeon who sees thousands of patients with low back pain, it’s really a very important tool to have as one of my consultants an Alexander Teacher for those large number of patients who really don’t need surgery, don’t need chiropractic, don’t need physical therapy, don’t need acupuncture, don’t need medication, but who have the ability to relearn and be taught by an Alexander teacher how to use their bodies most efficiently and with the least amount of pain.

*defined by the authors of the paper as ‘an anatomic or functional abnormality without an underlying malignant, neoplastic [tumorous], or inflammatory disease’