A Mechanism of Action

There are several mechanisms of action by which the AT helps with back pain.

To explore these mechanisms, I'd like to start again with the cause of back pain.  As I have said in previous posts, the cause of ideopathic back pain is our poor "use".  Use is the accumulations of habits we've aquired durring a lifetime that lend a characteristic pattern which colors how we do everything.

I want to distinguish these habits, which are aquired, from reflexes which are not aquired.  I'm particularly interested in the righting reflex and the startle reflex.  These reflexes are brain stem mediated, hardwired into the reptilian brain.  Based on research by Rudolf Magnus, who studied the decerebrate model, we know that these reflexes operate quite independently of the cerebral cortex.  They are enduring and hardwired.  In fact, wikipedia refers to the startle reflex as a "brainstem reflectory reaction".

This matter is simple in insects and reptiles.  A spider or a frog react reflexively to a fly.  But animals with larger cortexes can alter the expression of their reflexes.  Dogs and cats can be trained.  Human are an extreem example of an organisms ability to influence their reflexes.  We have a large cortex that can exert great influence.  In addition, we have greater neuroplasticity.  Thus we have been able to adapt to a broad range of social and physical environments.

Lets consider a very basic relex, the startle reflex.  Although wikipedia refers to it as "reflectory" humans have found ways to interfere with it.  People who meditate have suppressed startle reflexes and the degree of suppression varies with the type of meditation.  On the other end of the spectrum are those with PTSD.  Part of the very definition of PTSD is the increased startle response.  Meditators and trauma victims have aquired a habit of intefering with their startle response.

Students of the Alexander Technique are given the tools to stop the missuse, or the missaplication, of these basic reflexes.  Some believe that students are given the tools to stop the interference in their reflexes.  I would go a bit further: the AT gives the tools to help bring the students response to stimuli under conscious control.

This might sound confusing or impossible, but the medical care provider does just this - albeit in a crude simplistic way- on a daily basis.  As part of my medical training I was frustrated in eliciting a reliable patellar reflex (knee jerk) response in more experienced patients.  To those nieve to the exam, it was easy to elicit a response.  The more experienced patients get very slightly nervious when they see the rubber mallet moving twards their knee.  They subconsiously (habitually) tense their quadriceps   This tension intefers with my ability to stimulate the patients stretch reseptors.  I suppose it also intefers with the sudden contraction of the muscle that extends the knee in a characteristic fashion.  I tried to instruct the patient to "relax" but I found that the habitual tension in the leg was not under their conscious control.  It was a subconscious habitual response to a stimuli  ie., the presence of a rubber mallet in my hand.  When I mentioned this to my wise preceptor, she recommended that just prior to striking the patellar tendon I instruct the patient to interlock their hand and pull their arms away from each other.  If my timing is good, this works quite well and I was able to elicite a more authentic reflex.  By giving this instruction it confuses the patient, and distracts them from the rubber mallet.  This is a very crude example - only distracting and confusing the patient, but it shows that the cortex can be used to interfere with the habit of interfering with a reflex.

In the AT students are given the tools to use their cortex - their thinking and intention - to stop interfering with the attitudinal and righting reflexes.  Once these basic reflexes are allowed to express themselves without the influence of habit, people have less chronic tension, and move with greater ease and efficiency   With regards to back pain, lessons in the AT have been shown to result in dramatically less disability and pain, even a year after the lessons.

But this is by no means the end of the story.  The AT has other mechanisms of action that need to be explored.  In addition, his formulation of back pain - that it is simply a musculoskeletal problem - relies on a theory of pain has been challenged.

To explore the full scope of how the AT works, we must go deeper into these reflexes, present some missing pieces of the AT, and discuss modern pain theory.