Alexander Technique as a Pain Self-Management Tool in Hypermobility Syndromes

Alexander Technique as a Pain Self-Management Tool in Hypermobility Syndromes

Background:

The Kent Community Chronic Pain Service provides a comprehensive specialist multi-disciplinary, multi-modality biopsychosocial model of pain management, with an aim to improving patient self-management skills. The Alexander Technique (AT) teaches body awareness leading to improved posture and movement, which is believed to help reduce and prevent problems caused by unhelpful habits. Our service offers this Mind-Body modality in individual sessions up to a maximum of 12 sessions (optimal number determined by previous auditing).

Purpose/Objectives:

Approximately one third of new patients are being referred to our service with widespread body pain, including Fibromyalgia and Hypermobility Syndromes. These patients anecdotally seem to do well with AT. The aim of this data interrogation, conducted in 2019, was to determine whether our service outcome measures could confirm the usefulness of the modality in patients who are hypermobile.

Method:

The clinical data base was searched for all patients who were referred to the service with an existing hypermobility-related diagnosis (search words Ehlers-Danlos syndrome, joint hypermobility, hypermobility syndrome and suspected hypermobility syndrome) AND also completed AT lessons between June 2016 and June 2018. 

Pain Self-Efficacy Questionnaire scores (PSEQ), at the start and completion of therapy were noted.

The AT teachers have a 14-question treatment completion questionnaire with ratings: not at all, a little, moderately, quite a lot, or very much.  Four of these questions could be relevant to pain management: applying technique in everyday life, understanding influence of posture on pain, increase in overall wellbeing, and actively finding ways to manage pain.

From the specific symptom check list during initial assessment; the answers to the following were reviewed:  known diagnosis of Fibromyalgia, having widespread pain, labelled as being anxious, joint subluxations or dislocations, digestive issues, bladder issues and fainting.

Results:

One hundred thirty-one patients were identified, ratio of female to male =16:1. The commonest age range was 26 to 35 years old and most patients required 9 to 12 lessons.

91 % of patients had widespread body pain, 75% labelled as anxious, 63% had Fibromyalgia.

Average PSEQ scores improved from 22/60 at the start, to 36/60 on completion of lessons.

Answering either ‘quite a lot or ‘very much’ on the completion questionnaires;84% on using the techniques in daily life, 83% on understanding how posture influences pain,71% on improved wellbeing and 79% on finding ways to manage their pain.

Conclusions: Results indicated that Alexander Technique is a useful pain self-management modality in patients with Hypermobility Syndromes, of whom a large number present with both widespread pain and anxiety.
It should be noted that our experience indicates that there might have been more patients in the service with hypermobility syndromes during the elected time period but the data system in use at the time could not extract diagnoses that were added later on in a patient’s pathway. ‘Hypermobility Spectrum Disorder’ was not an existing search word.
The data collection inspired the AT teachers to adapt their questionnaires, with more direct questions around pain management.

References: Davies, J (2020) Alexander Technique classes improve pain and performance factors in tertiary music students. Journal of Bodywork & Movement Therapies; 24: 1-7

Russek L, Stott P and Simmonds J (2019) Recognizing and effectively managing Hypermobility-related Conditions. Physical Therapy; 99: 1189-1200

Wenhan, A et al (2018) Self-efficacy and embodiment associated with Alexander technique sessions or with Acupuncture: a longitudinal qualitative study within the ATLAS trial. Complementary Therapies in Clinical Practice, 31:308-314