Judith Stern is a certified physical therapist, a teacher of the Alexander Technique. This interview was conducted on November 16, 2010. The views stated in this interview are those of the person interviewed only and have not been peer-reviewed by the Spine-health Advisory Board. All information shared is done so with the consent of the interviewed party.
Spine-health – At a basic level, how would you describe the Alexander Technique?
Judith Stern – I would describe it as a method of self-care and as one of the effective approaches to access the mind-body connection that assists the healing process.
Spine-health – Would you call the Alexander Technique an “alternative treatment”?
Judith Stern – I call it “Integrative Medicine.” It is not a treatment, nor a therapy, it is an educational process with therapeutic results.
Spine-health – What is your background with the Alexander Technique and also with treating back or neck pain?
Judith Stern – My career in health care began as a physical therapist – I spent 18 years – with most of my focus on patients with back pain. I also specialized in ergonomics and consulted with companies to tailor working environments to be less hazardous to the lumbar and cervical spine.
My first introduction to the Alexander Technique was when my cousin was being treated for severe sciatica. She had seen no results from 4 months of regular treatment – physical therapy, exercise, medications – she then visited an Alexander Technique teacher on a recommendation. Within a couple of lessons, she had “no more sciatic pain”. This sparked my curiosity – I am rather curious when it comes to the human body and how it works – and I flew from Florida to New York to learn more about what had happened, and if it could be useful for my patients who were struggling with pain relief.
I accompanied my cousin to her Alexander Technique lesson and I was able to see the difference in her body almost immediately. I asked the teacher “what are you doing?” and she then put her hands on me to explain “kinesthetically”. It was such an astounding experience, that I asked the teacher “do you feel this way all the time?” I seriously questioned my professional skills and if they were the most effective way to help patients. This was in 1979, before many of today’s integrative treatments like acupuncture, yoga, or other methods were accepted by the medical community, and many of my colleagues thought I was pretty “nuts” to follow this path. I retrained and have worked as an Alexander Technique teacher for over twenty years now.
Spine-health – What is the cause of back/neck pain that the Alexander Technique is designed to help with?
Judith Stern – When there is no finding from an MRI, or x-ray, and no neurological signs to pinpoint a cause of pain, as can be the case in up to 80% of patients, the Alexander Technique seems to work best. The technique is designed to reduce unconscious tension in muscles during movement and at rest. This tension we put on ourselves causes compression in the spine and leads to pain in the all the delicate structures (facet, nerve root, or nerves) of the spine. By teaching the body to move with less tension (compressive force), healing speeds increase and the pain can be removed or reduced.
Spine-health – So, do people get back/neck pain because of tension or is it that people who already have the pain are tense, creating a difficulty healing?
Judith Stern – It works both ways. For some people, their tension causes pain in the back or neck and it won’t resolve until the cause is stopped. For others, an injury or other event will cause the initial pain, then the pain creates a tense response when they move their back or neck.
Spine-health – What other conditions has the Alexander Technique been shown to help with?
Judith Stern – The best results come with repetitive strain injuries (RSI), also known as tendinitis, which are common in many professions including performing artists, athletes and computer users.
The Alexander Technique is also commonly studied to improve performance for actors, musicians, and all performers. There was a pilot study done at Cincinnati Children’s Hospital with the Alexander Technique for pediatric urological surgeons who perform long operations where it was shown to help them with fatigue reduction and proficiency during surgery (Reference). I have helped two dentists who were ready to retire because of cervical pain return to their practice.
Neurological issues such as multiple sclerosis or Parkinson’s disease have also shown positive results with the Alexander Technique where the practice helps them maximize what is still available to them psychophyisically. I am currently working on designing and implementing a study dealing with Multiple Sclerosis and the Alexander Technique with a major research hospital here in New York.
Spine-health – Are there people with back or neck pain you would NOT recommend this technique for?
Judith Stern – Even though a patient may have an identifiable structural cause of their pain, the Alexander Technique can still resolve some of the secondary issues that come from these conditions. Now if there is a severe herniated disc, with neurological changes, or a loss of bowel control, these are emergency conditions where a surgical consult should be the first consideration, in order to prevent nerve injury, and to stop a progression of symptoms.
The Alexander Technique helps people develop a subtler kinesthetic awareness, which allows them to identify what they are doing to themselves to cause pain. I don’t believe the Technique would be harmful to anybody.
Spine-health – How does an instructor go about an Alexander Technique lesson?
Judith Stern – The first thing I address is the nature of the pain to determine how to proceed. Mainly I focus on the atlanto occipital joint, where the cervical spine meets the atlas, as a starting point. The “head-neck-spine” relationship is very important. I work with students to become aware of the movement at the top of the spine so it is not rigid. They learn to let go of tension in the neck muscles. We then apply that ease at the head - neck relationship to sitting down, standing up, walking, and bending. With back pain patients in particular, sitting and standing can be challenging, so starting there can be effective in teaching people to change their behaviors.
Students with back pain often demonstrate a startle pattern in activity. If somebody were to come behind you and startle you, your head would pull back, your neck would compress and your spine would extend back with your arms naturally moving out protectively. When somebody is in pain, this occurs during most movements and can cause pain. The body gets used to this and people learn to live with this startle pattern, but it can cause damage to the spine over time. The Technique develops more muscular freedom and relaxation if it becomes a regular practice. It is taught with gentle guidance verbally and with hands-on to impart muscle memory.
Spine-health – How long does a typical lesson last and how many lessons does it take to generally see results?
Judith Stern – The lessons are 30 -45 minutes. As far as results, there are a wide variety of outcomes. Some people take one lesson and it is enough for them to feel better and they never return, others keep taking lessons for over twenty years.
The Alexander Technique is a skill, similar to learning to play the piano. With 10 lessons, I can teach you how to play the notes and scales; with 20 lessons, you are playing a little Mozart. To relieve pain and recreate the freedom that allows the back or neck to heal may take only a few lessons, but it usually takes 30 total lessons for it to become a part of you. Lessons are taken 1-2 times per week and practice outside of the lesson is expected.
The people who stay for years enjoy learning more about the way their mind and body work together. They often associate the lessons with the loss of their pain, so after setbacks practicing by themselves, they return for reinforcement and to make the technique their own.
Spine-health – What is the relationship like between the instructor and the student in the Alexander Technique?
Judith Stern – The student is a learner, not a patient. They study how to become aware of their own mind/body and how to do normal behaviors with muscle relaxation and awareness. As a teacher, I need to meet the student’s needs by identifying the actions causing pain and the student needs to be willing to change their way of thinking and acting, so it is a very give and take relationship. Observational skills are very important for both the teacher and the student.
I will say people with back pain or neck pain have been some of the best students of mine because they have such incentive; they are willing to try new things even if they are skeptical. For me, about seventy-five percent of my students are people with pain, mostly because of my background, contacts, and the word of mouth that I have helped others with their pain.
Spine-health – What other treatments or practices do you encourage people with back or neck pain to do in conjunction with Alexander Technique?
Judith Stern – I think the most important thing they can do is safe exercise. I often suggest people find a physical trainer or a physical therapist to guide them in ways to exercise safely. A healthy exercise regimen is the key to staying well when it comes to back and neck pain. While the Alexander Technique can make you feel better, it does not necessarily make you strong. I also collaborate with massage therapists and physiatrists; in fact I would say working with a physiatrist would perhaps be the most complementary to the Alexander Technique.
Spine-health – You are a physical therapist, is that typical for people who teach the Alexander Technique?
Judith Stern – Not at all. Most teachers come from the world of theatre, dance or music. They learned the Alexander Technique to help themselves perform better and are passing on the practice to their students. The AT is part of the curriculum at Julliard, for example. It is also common in athletic training to enhance performance.
Spine-health – Where do you get most of your students from, how would a back/neck pain patient find and begin working with an Alexander Technique instructor?
Judith Stern – Most of my students come through word of mouth. After that, the most common referrals are from MD’s and physical therapists. Referrals from doctors often come when they have a patient they were treating independently who finds me and then reports back to their doctor that they have healed. The doctors who have seen the results do make some referrals. One of their main concerns is making a referral for something that is not covered by insurance.
I do reach out to doctors letting them know about the benefits of the Alexander Technique can bring to their patients, but my best results have come from letting my patients be the proof of the technique’s effectiveness.
Besides word of mouth and referrals, people can contact one of the Alexander technique societies, such as the American Society for the Alexander Technique or the Society of Teachers of the Alexander Technique, to find an instructor in their area.