Of the many holistic approaches that proliferated in Western culture throughout the nineteenth century, AT is distinguished among body-based systems for promoting active self-care in everyday functioning.⁴ For more than 100 years, AT has been used to help people promote personal well-being by altering stressful postures and movements that interfere with ease and efficiency.^1,⁵ An active process of neuromuscular reeducation, AT uses kinesthetic cues and cognitive guidance to decrease pain associated with stressful movement behaviors and to improve balance and coordination.⁶

Frederick Matthias Alexander (1869-1955) was the oldest of the generation of twentieth-century movement educators (along with Gerda Alexander, Charlotte Selver, Moshe Feldenkrais, and others),⁷ who developed an approach to the study of human experience (“somatic learning”)⁸ by investigating his own physical problems. An actor by profession, Alexander suffered recurrent bouts of laryngitis early in his career, for which conventional medicine offered only temporary relief. A radical shift occurred in his thinking when he turned from a passive vantage point of self-inquiry (“What’s wrong with my voice?”) to a proactive one (“How am I using my voice?”).⁹ Alexander explains the 10-year evolution of his method in one of his five classic books, The Use of the Self, written in 1932.¹⁰

Through self-observation, he sensed that the source of his dysfunction was a small yet perceivable reaction to the stress of speaking, much like a startle reflex.^1,¹⁰ The startle reflex in humans is a stress response¹¹ associated with processing of novel or aversive stimuli and involves a wide range of responses in the autonomic and somatic nervous systems.¹² Alexander’s reaction manifested as a global tightening of the spinal extensors, which caused increased postural fixation and associated chest wall depression, cranial extension, and exaggerated cervical lordosis (forward head posture). Increased effort of breathing and speech resulted. On closer reflection, Alexander noticed the startle reaction had habituated, namely that it was triggered by the intent to act, intensifying with performance anxiety. Alexander first tried to “correct” his problem using a co-contraction strategy of contracting the antagonists (the flexor muscles) to keep the extensor muscles from exerting the greater force. He did this by tucking the chin to alter forward head posture. This strategy resulted only in misdirected energy and greater movement fixation.¹⁰ When he stopped trying to change his posture by sustained muscular force and instead responded to proprioceptive feedback from exploring head balance, he experienced a spontaneous redistribution of tension throughout his body that signaled an overall improvement in coordination and neuromuscular control. Alexander had discovered an inherent mechanism for dynamic self-organization and self-regulation. The crux of his discovery was that by “re-educating the kinesthetic systems associated with posture and respiration,” Alexander could voluntarily alter this maladaptive response to stress and improve his coordination. Known initially as the “Founder of a Respiratory Method,”⁵ Alexander first applied his work to reeducating dysfunctional patterns of breathing and speech. Among the doctors and scientists of Alexander’s day who were intrigued by his discovery were Sir Charles Sherrington, George Coghill, Aldous Huxley, Raymond Dart, and John Dewey.^4,⁵ Alexander began training teachers in London in the 1930s, five of whom are still teaching today.

Two basic theoretical assumptions underlie AT: (1) use affects function and (2) noninterference with the natural, coordinated action of the head and back governs use.^10,¹³ Within the community of Alexander Technique teachers the term “good use” which refers to mental instructions for directing movement of different parts of the body is considered an expression of adaptive psychophysical behavior, not “posture.”^5,^9,¹⁰ “Good use” connotes balanced use of the tonic and phasic musculature of the spine as well as appropriate application of muscle force within the context of the environment and the task. Good use also is associated with freedom from conditioned reactions to life’s stresses, of remaining openly adaptive to change, whatever the environmental demands.^1,⁴ Second, good use is governed by natural postural responses that provide a state of renewable responsiveness of the neuromuscular system underlying dynamic postural control.¹⁴ Alexander called this state of neuromuscular responsiveness the “primary control,”^10,¹³ or simply, “poise.”^5,¹⁰ Good use implies efficient postural control and timely neuromuscular coordination for graded force output commensurate with the needs of the task: neither too floppy or unsupported nor too tense or restrictive.¹⁵ Ongoing proprioceptive awareness (what Alexander called “the means whereby”¹⁰) is the key feature in engaging primary control. “Misuse” is associated with habituated, stressful reactions to environmental stimuli that result in inefficient neuromuscular patterns.^1,^11,¹⁴ When stressful reactions become habituated, altered sensory perception and compensatory movement result, which can lead to movement dysfunction and injury.^1,⁵

AT is an indirect method of motor learning. In AT people are not taught how to sit or stand. Rather, people learn to identify their own effortful patterns of use and avoid practicing them, which results in greater ease in activity. AT teachers help clients recognize, proprioceptively, the difference between good use and misuse by offering an experience of improved postural support and ways of avoiding stressful behaviors.¹⁶ A hallmark of an AT lesson is the subjective experience of efficient movement: light, buoyant, and effortless movement of the body as a coordinated whole, in which extraneous or misdirected muscular effort has been eliminated.¹⁶

Description of Alexander Technique

During a typical AT lesson clients come dressed in comfortable clothes to allow for full mobility. A lesson normally takes 45 minutes to 1 hour, in which ADL, such as sitting, standing, walking, and lying down, are practiced with the AT principles embedded. The goal is to enhance individuals’ perceptual awareness of somatosensory feedback within the context of functional activities. Alexander was insistent that clients use his principles in everyday life so that persons would be able to direct their effort appropriately in activity, rather than simply learn to relax or release tension.⁵

AT teachers engage clients in an active verbal dialogue that addresses the degree of awareness of their body movement. Simultaneously, light touch focuses attention and trains kinesthetic perception, particularly around the head, neck, and back, which are key areas for activating primary control. Repetition of activities is gauged according to clients’ levels of understanding of their movement and their ability to sustain attention to kinesthetic feedback. Teachers remain in a state of good use, avoiding forceful manual manipulation, so that their own good use can communicate kinesthetically about the nature and means of postural change.¹⁷

Alexander devised three major “steps” to the technique, which he called “the means-whereby,” “inhibition,” and “direction.”¹¹ Although none of those steps truly can be isolated from the whole process of motor learning, Alexander teachers may follow a stepwise process to apply Alexander’s principles and to assess and guide a client’s patterns of use. First, teachers direct clients to form an image of how they move (the “means whereby”). This is referred to as a client’s “body map,”¹⁵ which represents a body image or schema. Second, the practitioner uses “inhibition” to redirect a client away from patterns of effort in simple, functional activities, such as sitting, standing, walking, talking, and reaching, to modify them. Inhibition is not the suppression of habits associated with misuse but rather the ability to reorganize the motor system.^5,¹³ The goal is not to correct the client or point out what is “wrong” but to promote curiosity and self-awareness in activity so that the client can begin to make more informed choices about movement. Misdirected efforts emerge in the conception and execution of the action. Enhanced sensory feedback is believed to help clients expand their sense of their “body map”¹⁵ and to distinguish between misuse and an experience of greater support within task demands. Clients are taught to pause between intending to move and initiating the movement, to observe and reorganize a habitual response, and to choose a more optimal, coordinated course of action. Inhibition at once helps people learn to avoid excessive and superfluous effort, while making room for more adaptive movement options to be brought to conscious awareness.^1,⁴

The third step, “direction,” naturally evolves out of intentional, voluntary action. Alexander developed four “directives,”¹⁰ thought patterns that through repetition serve as kinesthetic cues to maintain optimal joint movements in response to gravity and muscle forces shaping movement. These directives are to “let the neck be free,” so that the head will “balance forward and up,” so that the back will “lengthen and widen,” and the “knees free out and away.”¹⁰

AT teachers use light manual guidance to pro-vide feedback about the status of neuromuscular tensions interfering with activation of the primary control. Energy medicine proponents ^18,¹⁹ explain that light touch allegedly influences the energy field of the body through induction of fascial plasticity, energy flow, and expansion of previously fixed and contracted tissues. Further, touch activates spindles and Golgi tendon organs that influence neural feedback systems to regulate muscle tone throughout the body and increase the overall integration of neuromuscular balance.^18,¹⁹ Preliminary research from cognitive neuroscience has shown that light touch helps preserve postural support and balance in young and elderly persons,²⁰ those congenitally blind,²¹ and persons with vestibular disorders.²² The proposed mechanism is that light touch stimulates the “graviceptors” of the spinal muscles,²⁰ proprioceptors in the deep spinal muscles responsible for orienting the spine in gravity. This theory appears to support the type of manual guidance used in AT.