New research finds both acupuncture and Alexander Technique lessons can relieve chronic neck pain
Published on 06 July 2016
Finding the help or treatment that works best for you is essential to living well with arthritis. Many people successfully manage their symptoms through medication and exercise, but others are unable to do so and are exploring different ways to help control their pain and improve their quality of life. That’s why we're committed to funding innovative research investigating a range of approaches for arthritis, in the hope that patients will have greater choice in the future.
One of the research projects we've funded, the Alexander Technique Lessons or Acupuncture Sessions (ATLAS) trial, assessed the effectiveness of two complementary interventions for people with chronic neck pain. The research has produced strong evidence that both
acupuncture and Alexander technique lessons have long-term benefits for many people living with this condition.
What is the Alexander technique?
Alexander technique lessons involve working one-to-one with a qualified teacher who will help you to increase your awareness of body position and movement, eliminating bad habits of posture, muscle tension and movement.
The lessons aim to teach you to recognise harmful habits, giving you the tools to stop, think and then choose a better response during your everyday activities.
Dr Hugh MacPherson, senior research fellow at the University of York and Principal Investigator on the ATLAS Trial, explains:
"Our research was inspired by the fact that there are thousands of people in the UK living with long-term chronic neck pain for whom medication isn't working.
"Neck pain is the second most common musculoskeletal condition after back pain and it's a huge problem, both for those living with it and for GPs. We wanted to find out if a different approach – providing acupuncture or Alexander technique lessons – could reduce pain and improve quality of life for patients, as well as provide additional referral solutions for healthcare professionals struggling to offer effective treatment.”
The ATLAS trial
Dr MacPherson continues: "We recruited 517 patients from GP practices in Leeds, Manchester, Sheffield and York, representing a typical cross-section of the population visiting their doctor.
"Each patient had disabling problems with chronic neck pain, and for many the neck pain had been going on for years. Three quarters of the group were using pain-related medication, but continued to experience their symptoms."
People taking part in this large-scale investigation were randomly split into three groups:
One group received usual care alone.
Another was offered up to 20 half-hour Alexander technique lessons with teachers from the Society of Teachers of the Alexander Technique.
The third group received up to 12 sessions of 50 minutes of acupuncture with practitioners from the British Acupuncture Council.
The acupuncture and Alexander technique sessions all took place within the first six months of the study.
"For the first time we have clear evidence that acupuncture and Alexander technique lessons provide long-term benefits for chronic neck pain." Dr Hugh MacPherson
All three groups continued to receive usual care throughout the trial, which included prescribed medication and visits to GPs, physiotherapists and other healthcare professionals.
Researchers assessed each person taking part in the study after three, six and then 12 months. Improvement was assessed using the Northwick Park Pain and Disability Questionnaire and the Chronic Pain Self-Efficacy Scale – a method of measuring how well people are managing their pain without resorting to medication.
The research showed that after a year, neck pain was reduced by 32% for those receiving acupuncture and 31% for those undertaking Alexander technique lessons. Participants in these two groups were also found to have improved self-efficacy, being better able to cope with, or reduce, their pain levels without medication.
Dr MacPherson says: "As researchers, we consider anything more than a 25% reduction in pain as a good outcome. For the first time we have clear evidence that acupuncture and Alexander technique lessons provide long-term benefits for chronic neck pain."
Learning strategies to cope with pain
In 2009, acupuncture was recognised in the National Institute for Health and Care Excellence (NICE) national guidance as an effective treatment for persistent back pain. Four million acupuncture treatments are delivered each year in the UK. A quarter of these are given on the NHS, usually at physiotherapy departments and pain clinics.
Dr MacPherson continues:
"It’s now more widely accepted that acupuncture offers significant benefits to people suffering with back pain. Chronic neck pain is almost as big a problem for patients in primary care, so we knew there was an urgent need to conduct research which would tackle the evidence gap in this area."
"We saw an opportunity to devise the trial so we could test more than one active intervention for neck pain in comparison to usual care. We chose the Alexander technique because, like acupuncture, it’s about learning.
"Both approaches teach people appropriate non-pharmacological strategies to help them cope with their pain and to develop their insight into what causes or aggravates it. When receiving acupuncture or learning the Alexander technique, people discover strategies for actively managing their symptoms."
"Acupuncture is more than just putting in needles. An acupuncturist talks to the patient to make a diagnosis, to try to understand what is causing the symptoms and what might be making them worse. For example, stress is a common cause of chronic neck pain, with tension storing up in the neck and shoulders over many years."
"Acupuncturists engage with patients and give advice about changes they might make to manage their stress, an approach designed to address the underlying cause of their pain. Needling alone can create a powerful change in people, but the best results come when the full treatment package is provided and patients actively engage in their own recovery."
"Similarly teachers of the Alexander technique observe people’s habits and behaviour patterns to identify any that might be causing or aggravating neck pain. They help people become less tense using gentle hands-on contact, and show people how to remain calmer and reduce pain-producing habits. Attention is directed toward allowing the spine and neck to occupy their full length, to sit and to stand tall.
"Teachers guide and encourage people to learn and practice the Alexander technique in simple ways during lessons and suggest how they might continue to do this at home and at work. Lasting benefit is gained when people continue to apply what they have learnt in the lessons to their daily lives, and actively engage in their own recovery."
Looking to the future
"We want to ensure people living with ongoing neck pain are aware of other options that have potential to reduce pain and help to manage symptoms."
In terms of the implications of this research for people with chronic neck pain, Dr MacPherson concludes:
"The ATLAS trial results offer strong scientific evidence for healthcare professionals when considering alternative interventions for patients with chronic neck pain. By sharing our findings, we want to ensure people living with ongoing neck pain are aware of other options that have potential to reduce pain and help to manage symptoms."
"Acupuncture or Alexander technique lessons are worth trying if you're experiencing chronic neck pain and don’t feel medication is solving the problem. They don’t work for everyone, but we’ve seen for ourselves the difference they’ve made to both pain levels and quality of life for many patients involved in our trial."
If you’re interested in trying acupuncture or Alexander technique lessons, first discuss with your GP or healthcare professional, then visit
British Acupuncture Council and Society of Teachers of the Alexander Technique to find a fully qualified practitioner.
Having suffered from chronic back pain and neck pain since her teenage years, Julie started learning the Alexander technique. It's made a dramatic difference to her life.
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