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June 9, 2009

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Back to basics

Jorgen Josefsson explains how a technique that has been around for more than a hundred years is still relevant to the modern workplace and can contribute to the well-being of today’s workers.

Last year, the British Medical Journal published the findings of a trial jointly funded by the Medical Research Council and the NHS Research and Development fund1 to determine the effectiveness of treating chronic and recurrent back pain with a combination of four therapies. A total of 579 patients with chronic or recurrent low back pain were randomly split into four equal-sized groups and assigned to the following therapies: normal care, six Alexander Technique lessons, 24 Alexander Technique lessons, and massage.

So why incorporate a process that was first developed in the 1890s — by an Austrian actor? Human beings are creatures of habit. We brush our teeth twice a day, mirror-signal-manoeuvre when out and about in the car, go to the gym twice a week, etc. but not all habits are so beneficial. How often do you bend with your back and not your knees when you’re lifting something heavy, for example, or reach for something in the back seat when you’re driving, eat from a tray on your knee, or simply slouch while you’re sitting? 

The Alexander Technique is less a series of lessons and more of a re-education of the mind and body; simple methods of improving balance, and supporting coordination and freedom of movement. It can be applied to sitting, lying down, standing up, lifting, and many other daily activities.  It sounds very much like a cure-all technique so why does half of the UK population still suffer from lower back pain every year?2  The situation in the US is no better, with sufferers of lower back and neck pain increasing from 3.2 per cent of the population in 1997 to 8.3 per cent in 2006. 

There seems to be a lack of awareness that back and neck pain are no longer just an issue for health-care specialists, GPs, chiropractors or physiotherapists. Part of the reason for this lack of awareness is that few people outside of health and safety circles recognise that there are any real risks associated with, for example, simply sitting down. Because such risks are not immediately visible, or as obvious as something like loose wires, or precariously-balanced hot drinks, they are often forgotten or disregarded — at least until studies reveal the full extent of the problem. 

Lower-back problems are among the top causes of workplace sick leave, so anything that can minimise their occurrence is welcome. According to a report by PPP Healthcare, back pain costs the country up to £3.5 billion a year in lost production, medical treatment and sickness benefits.3 The sheer scale of the problem means it is now very much a management issue, too. There really is no excuse not to do something about these huge numbers, to support each and every worker experiencing problems and, at the same time, save money — these are tough times. But with such a breadth of research and opinion on how to achieve the best results, and new studies being conducted each year that promote the benefits of this or that ‘new’ technique, exercise or seating position, it’s no wonder workers are sometimes unclear about what is best practice. 

What is clear is that the issue is not being ignored. The aforementioned BMJ research concluded that a series of six lessons in the Alexander Technique, combined with an exercise prescription, was the most effective and cost-effective option for the NHS. In addition, the National Institute for Health and Clinical Excellence (NICE) recently put forward recommendations that the NHS should offer alternative treatments for sufferers of chronic lower back pain.4  Those whose pain lasts for more than six weeks should be prescribed a course of acupuncture, spine manipulation, or exercise classes, it said.

Against the grain
The Alexander Technique is part of a suite of alternative therapies that work alongside conventional medicines, and not against them. But it is that word ‘conventional’ against which the Alexander Technique vehemently works — that, and ‘habitual’, or ‘natural’ reactions in everyday life.  Practising posture, breathing and learning to control those reactions that have become ‘natural’ are all things that the Alexander Technique encompasses.

A typical Alexander session is one-to-one and does not involve learning a range of postures. Instead, it shifts the focus from posture to movement. The teacher will use a series of techniques to learn more about an individual’s patterns of movement and reaction, followed by a series of gentle guidance with the hands and verbal instruction to help calm the mind and restore the body’s natural reflexes.

People need variety and options to move and change position throughout the day in order to maintain a good oxygen supply around the body, and avoid pain and lethargy. Current guidelines on breaks for workers are a good starting point but by themselves are not enough. According to the British Chiropractic Association, posture change is “as important as posture correctness, as it helps re-introduce essential fluid into the inter-vertebral discs found in the spine”.5 When this fluid dissipates — as happens when people sit or stand still for too long — the result is usually back or neck pain. 

In the workplace, reg.2 of the Health and Safety (Display Screen Equipment) Regulations 1992 holds that employers should perform suitable and sufficient analysis of workstations.6 This is especially important in today’s office environment; with the increase in the number of mobile workers, home-workers, and hotdesking a workstation can no longer be considered suitable for use by one particular individual. The focus should therefore be on adjustability to better suit the needs of individuals rather than for uniform items. 

The need to create healthier and happier workplaces is more important now than ever, as businesses try to retain key workers and increase productivity through the tough times.  This means keeping abreast of the information on what you can do as managers to ensure the well-being of your staff.  It means highlighting to employees the potential benefits of such techniques as Mr Alexander’s, and increasing the provision of flexible work patterns, task management and equipment. From a relatively small investment should come a very large reward

Jorgen Josefsson is country manager of RH Chairs UK — to find out more, visit

1    BMJ 2008; 337:a884 — — includes a 12-minute video on how the technique works
2    Lower Back Pain retrieved 30/04/09
3    How can a back-friendly chair benefit you and your company? — The office Back Care Centre — Retrieved on 30/04/09
4    Full guideline — Early management of persistent non-specific lower back pain — NICE — retrieved on 30/04/09
5    British Chiropractic Association — retrieved on 30/04/09
6    HSE: Working with VDUs —

Further information

What makes us susceptible to burnout?

In this episode  of the Safety & Health Podcast, ‘Burnout, stress and being human’, Heather Beach is joined by Stacy Thomson to discuss burnout, perfectionism and how to deal with burnout as an individual, as management and as an organisation.

We provide an insight on how to tackle burnout and why mental health is such a taboo subject, particularly in the workplace.

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