The Head Neck Back Relationship

I have mentioned that one explanation of the mechanism by which the AT helps with back pain is simply that it improves posture, balance and coordination.  This is done by teaching the student to stop interfering with their inherent reflexes.  But this explanation does not explain the full effect of the AT and does not adhere to modern pain theory.

To begin to have a more robust understanding of the AT, we need to look more closely at reflexs. Again, the reflexes of most importance are the righting reflex and the startle reflex.  The righting reflex begins after an activity has been performed and, if working correctly, brings us back to a neutral,  upright, poised, relaxed but ready position.  This reflex works by comparing the desired ideal upright position with the current sensory information.  These inputs include the somatosensory inputs from the neck which are rich with stretch receptors.
   These and other reflexes were investigated by Rudolph Magnus.  He now has one of them named after him.   Magnus was very clear about the pivotable role the head-neck-back (HNB) relationship plays in our reflexes.  So much so that his work is frequently summarized as "the head leads and the body follows."  The HNB relationship is central to guiding the cascade of movements seen in reflex behavior   This might suggest that the HNB relationship is some kind of control center.  Of course, it is not.  The HNB relationship is part of the peripheral, not central, nervous system and as such it controls nothing.  But it is enormously influential.
    Significant problems arrise should the brainstem be conditioned to replace a default upright and neutral reference posture with some other default state.  This happens as habits influence our reflexes.  We can even see this happening over time by viewing the old frontal and sagital photos of disrobed children as the progress through grade school.  It is very sad to see this.

FM Alexander, independently of Magnus but at about the same time, also concluded that the HNB relationship was of primary importance.  The work in the first few classes of the AT focuses on improving the use of the HNB relationship, replacing the unconscious use patterns with a new consciously directed ones.  Alexander found that once the HNB relationship is improved, other habits of use of the self (such a stuttering, taking the eye off the ball durring a golf swing, etc.) are easily delt with.
But the process of improving the use of the HNB pattern is not trivial.  The skilled hands of the AT teacher can bring the student into an improved relationship, and this typically produces a sense of lightness, ease and uprightness.  But at the same time it can also feel unfamiliar and even wrong.  Student will invariable fall into their old accustomed patterns quickly.  So students are taught to rely, not on what is felt to be right, but on the tools provided by the AT teacher.

The second reflex of concern is the startle reflex.  This is both a unique and central reflex.  It is also of great interest clinically.
     The Veterans Administration is very interested in post traumatic stress dissorder.  The DSM-IV definition of PTSD is a blend of historical, psychological and behavioural factors.  But also central to the diagnosis is one neurological finding: an elevated startle response.
    Wikipedia defines the startle reflex as a reflective response.  That is, the stimulation goes directly into the brainstem and the brainstem in turn stimulates the cranial nerves: blink and the shortening of the sterncleidomastoid and trapesius muscles.  The shortening of the HNB relationship is first postural change one sees on highspeed photos of the startle reflex.  One would not think such a reflectory reflex could by influenced, but indeed it seems to be.  On one extreem PTSD heightens the response, and on the other, meditation seems to inhibit the response.
    The link between PTSD and pain is well established, and multiple theories on the relationship exist.  These theories lack an understanding of the primacy of the startle response (and modern pain theory that I will discuss later).
    Repeated and/or extreem triggering of the startle reflex creates a chronic shortening of the HNB relationship.  This chronic tension produced by the effort to shorten the HNB relationship is the cause of the neck and back pain that is very commonly seen in PTSD sufferers.
   The effects of the startle reflex do not stop with the HNB relationship but extend in a characteristic fashion throughout the body.

Durring lessons in the Alexander Technique students are taught, in part, to direct the use of themselves against the characteristic pattern seen in the startle response.

It is to Alexanders credit that he found that improvement in the use of the HNB relationship will lead to a less reactive nervious system and a lessening of the "fear response".  This is quite remarkable since he knew nothing of theories regarding reflexes or PTSD.

In sum, the HNB relationship is important for the following reasons:
- It is the first region of the body to respond to the startle reflex
- The sensory apparatus gives the HNB relationship primary importance in deciding how to orienting the rest of the body and thus is very influential.
- the HNB relationship is the gateway through which the not only the startle reflex must pass to influence the entire organism, but also fear and anxiety.
- Our use of the HNB relationship can either amplify the startle response (and the emotions of fear and anxiety) or suppress the response.

The above is an introduction to the importance of the HNB relationship.  The argument will be fleshed out once modern pain theory is reviewed.