Tag: Back pain

Tom Koch Pain and injury, Sitting, Sports and fitness

Sitting is bad for your health, but corrective exercises can be just as bad.

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The Washington Post today has a nicely illustrated look at the health hazards of sitting.

At the bottom you will see some tips from “the experts”. Approach these with caution! Sitting on a large ball as recommended is no guarantee that you will not slump and slouch into the same habitual position as in a chair. And the benefit of any exercise is completely dependent on how you do it, but there are no instructions provided regarding the how, nor are there any warnings regarding the possible hazards of doing them in a harmful way.

Instructions for how to do exercises are frequently incomplete in that they just assume if you are told what to do, you will know how to do it in a healthy, coordinated way. That is really just magical thinking and not at all true. For example, very few people will be able to perform a hip flexor stretch as shown in the article in a way that maintains the easy balance of the torso. While stretching the flexors of the right hip they will unconsciously pull down the left side of the torso, resulting in a tightening of the hip flexors of the left leg. This is like taking one step forward and one step back, resulting in getting nowhere fast!

It is of course possible to do all the exercises shown in a manner that is not counterproductive. But if you can do that, you probably do not sit in such a counterproductive manner that you need to do the exercises in the first place. Want proof? Book a lesson with me and I’ll show you. It’s easier in the long run to prevent the bad sitting than it is to repair the damage it does.

Tom Koch Pain and injury, Performing Arts

Questions about dancers and low back problems


Back pain can affect anyone of any age, even young dancers!

A young dancer who attended an introductory workshop of mine is writing his thesis on the subject of low back problems amongst dancers. As part of his research he sent me the following 5 questions:

  1. Can you describe what the Alexander technique is in approximately 100 words?

    The Alexander Technique is a systematic approach to organizing and improving one’s proprioception in order to gain more conscious control of habitual thoughts and behaviors that interfere with health, balance, well-being and performance. It is based on the discoveries of F.M. Alexander (1869-1955) regarding the use of the head and neck in relation to the trunk and its effect on overall coordination and functioning. It is usually learned with the hands-on guidance of a teacher, although its basic principles can be effectively communicated in a group setting.

  2. What is your opinion, thinking from the Alexander Technique, on the cause of low back problems with dancers?

    I would say that almost all low back problems are the result of faulty habits in one’s postural behavior, and that there is no fundamental difference between dancers and non-dancers in that regard. Common to most low back pain sufferers is the habit of habitually hyper extending the knees, thus causing more strain on the low back. If a dancer uses too much effort to obtain “stretched knees”, combined with too much effort to “pull up”, then the result will be a shortened, narrowed back with increased pressure on the lumbar spine, a hollow back and ribs that are pushed forward. The dancer then tries to correct all this by increasing tension throughout the abdominals and intercostals, thus adding yet more pressure and stiffness to the trunk. This tendency to do more (tighten this, hold that, strengthen this) rather than do less (stop distorting yourself) is a very strong contributing factor to low back problems.

    Another common source of low back pain is using the lumbar spine as a bending joint rather than using the hip joints, which are considerably lower. This habit results in the feeling that the legs begin at the top of the pelvis, rather than below the pelvis, and so causes excess strain on the low back in all movements involving the legs. Many dancers first get this mistaken idea from a dance teacher who tells them to “feel as if your legs begin in the middle of your back”, or similar. These types of instructions in which the teacher asks the student to “try to feel something like” are almost always anatomically incorrect and can therefore lead to rather severe distortions of healthy coordination.

  3. What can the Alexander technique generally do for dancers with low back problems?

    The Alexander Technique works first to release unnecessary tension in order to free the postural reflexes to a more neutral state. From this neutral state the student then learns a new and easier way to initiate movement using conscious direction rather than habit or imitation. It is in the initial undoing process that most people stop experiencing pain.

  4. How would you treat a dancer that has low back problems?

    I don’t treat dancers differently just because they are dancers. Nor do I treat those with back problems very differently from someone with, say, neck pain or RSI. I first work with a student to notice how they tense the neck unconsciously when initiating movement, even though that tension is not necessary and often hinders the desired movement. Changing this use of the neck in relation to the head and back is recognized in the Alexander Technique as a fundamental misuse. As the head-neck-back relationship improves, all types of problems are resolved automatically, including low back problems in most cases. If a student is in severe pain, I will focus lessons more on how to perform daily movements in an easier way.

  5. What advice would you give a dancer to prevent low back problems?

    Learn to stop tensing your neck so that you can stop shortening and narrowing your back so that you can stop hyper extending your knees so that you can stop pressing down. That is easier said than done, but it really is that simple.

Tom Koch Pain and injury, Scientific research

New study shows Alexander Technique preferred over exercise

From the December issue of Family Practice, an international journal aimed at practitioners, teachers, and researchers in the fields of family medicine, general practice, and primary care:

Patients’ views of receiving lessons in the Alexander Technique and an exercise prescription for managing back pain in the ATEAM trial

Background. Lessons in the Alexander Technique and exercise prescription proved effective for managing low back pain in primary care in a clinical trial.

Objectives. To understand trial participants’ expectations and experiences of the Alexander Technique and exercise prescription.

Methods. A questionnaire assessing attitudes to the intervention, based on the Theory of Planned Behaviour, was completed at baseline and 3-month follow-up by 183 people assigned to lessons in the Alexander Technique and 176 people assigned to exercise prescription. Semi-structured interviews to assess the beliefs contributing to attitudes to the intervention were carried out at baseline with14 people assigned to the lessons in the Alexander Technique and 16 to exercise prescription, and at follow-up with 15 members of the baseline sample.

Results. Questionnaire responses indicated that attitudes to both interventions were positive at baseline but became more positive at follow-up only in those assigned to lessons in the Alexander Technique. Thematic analysis of the interviews suggested that at follow-up many patients who had learned the Alexander Technique felt they could manage back pain better. Whereas many obstacles to exercising were reported, few barriers to learning the Alexander Technique were described, since it ‘made sense’, could be practiced while carrying out everyday activities or relaxing, and the teachers provided personal advice and support.

Conclusion. Using the Alexander Technique was viewed as effective by most patients. Acceptability may have been superior to exercise because of a convincing rationale and social support and a better perceived fit with the patient’s particular symptoms and lifestyle.

Tom Koch AT in the news, Pain and injury, Scientific research

Alexander Technique aids back pain: now we can prove it!

Since the earliest days of the Alexander Technique, teachers and students have known from their own experiences that back pain responds very well to private lessons in the Technique. Constant back pain was in fact one of the main reasons I myself began taking lessons. The relief of that pain was the main reason I continued lessons, and why I decided to become a teacher. Yet in all these years of anecdotes, the hard evidence to prove this claim was nowhere to be found.

All that changed yesterday with the publication in the British Medical Journal of “Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain“. This 5-year study of 579 patients revealed what AT teachers have suspected all along: Alexander Technique is more effective in relieving back pain than massage or exercise, the current standard medical treatments.

A series of 24 lessons in the Alexander technique taught by registered teachers provides long term benefits for patients with chronic or recurrent low back pain. Both six lessons in the Alexander technique and general practitioner prescription for aerobic exercise with structured behavioural counselling by a practice nurse were helpful in the long term; classic massage provided short term benefit. Six lessons in the Alexander technique followed by exercise prescription was almost as effective as 24 lessons.

Tom Koch Evolution, Pain and injury

Bending backwards for babies and ballet

I currently have three pregnant students, all at slightly different stages, so the following item captured my attention. I think this might also explain why women dancers – not to mention gymnasts – can bend backwards so much further and easier than men.

Nature has a new article detailing the recent discovery that women’s spines have evolved to be more flexible and supportive than those of men to increase comfort and mobility while bearing the weight of a developing child. The adaptations can be traced back as far as Australopithecus, more than two million years ago.

A female australopithecine, like today’s moms, used her spine to support baby’s weight.
John Gurche

Katherine Whitcome and Daniel Lieberman from Harvard University in Cambridge, together with their colleague Liza Shapiro of the University of Texas at Austin, measured the centre of mass of 19 pregnant women and found that they leaned back by as much as 28º beyond the normal curve of the spine, they report in Nature 1. The researchers found this lowers the torque around the hip created by the baby’s weight by roughly eight times.

Exaggerating the curve in the lower back can place more stress on the spine: vertebrae are more likely to slip against each other, leading to back pain or fractures. Whitcome and her colleagues found that a woman’s spine has several features that help to prevent that damage. In women, the curve in the lower back spans three vertebrae; in men, it encompasses just two. The added vertebra helps distribute the strain over a wider area.

In addition, specialized joints located behind the spinal cord, called zygapophyseal joints, are 14% larger relative to vertebrae size in women than in men, suggesting that the joints are well adapted to resist the higher force. The joints are also oriented at a slightly different angle in women, allowing them to better brace the vertebrae against slipping.