The Brighton Alexander Technique College, UK

These columns, written by Carolyn Nicholls, first appeared in the Brighton Evening Argus Women’s section 'Body and Soul' and are reproduced by permission.

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Frozen Shoulder

Frozen Shoulder is a very painful condition, affecting about 2% of the population, commonly in the 40-60 age group. Your shoulder becomes painful and stiffens up, and mobility is restricted. The pain can be so severe everyday tasks such as combing your hair, or getting dressed become very difficult. The cause of a frozen shoulder is not known, but it can last for up to two years. Although it is a very specific condition, it responds very well to the holistic approach of the Alexander Technique. When Peter rang me to say he’d been diagnosed with a frozen shoulder he was very fed up. His pain had come on gradually and he had ignored it until he couldn’t tie his tie in the morning. He tried heat treatment and was taking anti-inflammatory drugs, which he disliked as they upset his stomach.

Peter came for an introductory lesson. His first surprise came when I showed him how much compensation he was doing throughout his body because his shoulder hurt. He was twisting his neck to one side, pulling the painful shoulder round so his shoulder blade stuck out and curling the fingers of his hand so tightly it was difficult to straighten them. We started his lesson with him lying on my teaching table with extra support under his shoulder. He was surprised when I asked him to think about his back and neck rather than his shoulder, but gradually he began to release the additional tension that had built up in his muscles. Even his legs were tense. Every bit of unnecessary tension makes it more difficult for a particular ‘bit’ of us to fully release. So learning to release your legs and back really does make a difference to shoulder problems.

At the end of the first lesson Peter said he felt calmer and noticed his breathing was easier. His shoulder was still stiff and painful but he felt he had learned something about how his whole body played a part in his tension. Peter had 2 lessons a week for a 6 week period, saying that if he was going to do it he would do it properly. In that time his pain levels decreased enough for him to stop taking his pain killers, he learned to notice when tension was building up in him and how to release it, his mobility improved and he was delighted with how much easier his breathing was.

He continued to have weekly lessons for over a year. His shoulder healed completely and he found all his mobility much improved. He said he wished he’d discovered this self help technique years before as it offered him a positive way to manage his stress levels.

One thing I have noticed amongst my clients is an increase in the number of them complaining of neck pain. This includes young people in their 20’s and 30’s who are often doing a great deal of computer work either as students or in their job. So what is it about the neck and why does it so often give us pain?
Your neck has seven vertebrae, so does a giraffe and so does a mouse. As a human being your neck and the whole of your spine is vertical, whereas if you were a mouse, your spine would be horizontal. This simple change of direction means your neck has different mechanical challenges to cope with compared to other mammals. Your neck is very slender and has to balance your heavy head on top. The only way you can support your head so you can see where you are going, is by using the muscles of your neck and back to hold it up. Everyone knows when you fall asleep on the train, your head falls forward-you literally ‘nod-off’ because you no longer generate the muscle tone needed to support you.

Our problems can start because of two factors. First of all we simply don’t employ the full range of movement available to us. If we sit at desks all day we spend most of the time with our head, neck and shoulders held in one position staring at the computer screen. Wearing glasses further rigidifies us, as our visual field is restricted. Our necks are very flexible and designed so we can look all around us all of the time, but we rarely do, except perhaps on a walk.

The second factor is we tend to use an excessive amount of tension in our necks and backs, far more than we really need. This tension is mostly unnoticed by us and is so much of a habit we accept it as normal, but it’s not and over time can lead to problems. Some of my clients who have neck pain know why it happened, usually an injury; but for many people neck pain seems to have no cause, either coming on gradually or stiffening up slowly until the point comes when it’s a serious problem. Restricted neck mobility means you can’t reverse your car easily, or look over your shoulder to see what is around you; it has a knock-on effect through your whole body leading to you tightening up more muscles and restricting your breathing.

As an Alexander teacher my approach to neck pain, after ensuring my client has sought appropriate medical opinion, is to help them learn to release excessive tension in a way that allows their whole body to lengthen. It’s a question of understanding how the head, neck and back all influence each other and how you can make the best use of your body to minimize pain and maximize flexibility. For my younger clients, simple changes in habits of tension, plus the awareness exercise of semi-supine can make a huge difference to them. For older clients it can take a little longer simply because they have more muscle habits to undo, but I have taught people in their 70’s and 80’s who have rediscovered a more natural use of their bodies and been all the better for it.

The highlight of my late summer is a weekend of singing with the English Consort Singers. Each year we tackle a choral work only possible with a big choir. This year we sang Handle’s “Israel in Egypt” and our conductor, Roy, asked if I would offer the choir some Alexander Technique tips.

Alexander teachers work on a one-to-one basis, using their hands to guide stiff muscles into a new co-ordination. With a choir of a hundred expectant faces looking at me this wasn’t possible. We began by thinking about standing. Performers are often packed into tight rows like so many sardines; using your body well in this situation is difficult, most people tense up, and pull themselves forwards, griping their legs and feet. This shortens them and makes singing difficult. So we imagined magnets above our heads and below our feet, gently unfolding us to our full height, and more magnets on our shoulders, encouraging space inside our chests.

Rehearsals are usually done sitting and this too makes problems for singers. We uncrossed our legs and let our feet rest flat on the floor. This gives a balanced sitting posture and makes it easier to hold music up so you can see the conductor. Simple tips, but they had a profound effect. One singer told me the idea of lengthening had eased her back pain. You don’t have to be a singer to benefit from simple changes in your posture-if you stand in your job, or at the bus stop-try it and see what happens. You have only your stiffness to lose.

Posture and body language are the first thing people notice about us. Confident people use their bodies differently to those who are diffident. A lack of confidence makes us shrink physically into ourselves. Our shoulders narrow, our neck droops forward on our shoulders and our head is retracted down onto our neck. This gives a defeated look and people are less likely to listen to us if we project that bodily message. When my pupil Brian asked for lessons he hoped the Alexander Technique would help his confidence and went on to say he knew he had terrible posture and his girlfriend thought it made him look shy.

On meeting Brian, I could see what his girlfriend meant-he was tall and slender and very collapsed, his upper back was rounded and his lower back pulled in. It made him look a lot older than he was. He had a very slight scoliosis. He’d had an enormous growth spurt as a teenager and became very lanky, uncoordinated with back and leg pain. His mates nicknamed him spider because of his long arms and legs, which he hated. Now in his early 30’s he still had mild back pain, and that lanky look.

Teaching Brian to support his back and neck differently was a challenge. He was so used to the way he carried himself that all his efforts to move differently felt wrong and occasionally painful.

Brian persisted with lessons, was diligent with his semi-supine practice and came in for lesson 10 with a huge smile on his face saying his back felt completely different. He had both lengthened and widened and his shoulders had opened out. He looked much more relaxed and confident. He said he had some Alexander tools to help him in difficult situations, whenever he felt tense or nervous, instead of shrinking into himself-which was his old response, he released the tension in his neck muscles, reminded himself to ‘think up’, checked out what he was doing with his feet and made sure he wasn’t holding his breath.

Brian’s awareness of his body use continued to improve as he had more lessons. He took up the guitar again, something he’d enjoyed but stopped because it gave him back pain. He was more outgoing, confident and willing to try new things. He had started lessons because of back pain and lack of confidence, and now he applied his new knowledge to all sorts of aspects of his life, including a career change. He decided to give up being a banker and train to be an Alexander Teacher, as he commented-you never know what doors open when you start changing your body.

Today’s busy lifestyle can be stressful for some people and give rise to anxiety. Whilst everyone gets anxious from time to time, it can become a more permanent condition. When this happens, your nervous system is in a state of constant over stimulation and small things become big obstacles. Symptoms include restlessness, inability to concentrate, poor, shallow or irregular breathing and a general feeling of irritability. This is often accompanied by muscular stiffness such as clenching the muscles of the neck, jaw, face and abdomen. Most people are completely unaware of this tightening and only notice that they feel stiff or tired.

This was the case for my pupil Rebecca. She couldn’t pinpoint any reason for her anxiety but was aware that she got easily agitated, tendered to get panic attacks if she got upset and had back pain. She hadn’t associated the back pain with her anxiety, but when I pointed out to her that her anxiety was making her clench all her muscles to an extraordinary extend she saw the connection.

Rebecca quickly took to the semi-supine procedure, finding that lying on her back with her head supported by books and her knees bent allowed her to release the tension in her back and neck. During her first lesson, we concentrated on paying attention to her breathing and how neck tension is bound up with it. Like many people suffering from anxiety Rebecca held her breath out of habit, it felt normal to her, even though it was damaging to her health. Learning to allow her breathing to move freely in and out of her ribs was a big challenge, but enabled her to relax in a much deeper way that she could previously.

Over the course of several more lessons we looked at the way she reacted to things. Almost any stimulus caused her to react in the same way, she almost froze, her neck and back went rigid and she held her breath. Breaking this deeply ingrained habit took time but gradually she did and her anxiety reduced. Rebecca can now manage her condition, she recognizes when muscular tension is building up and immediately releases her neck and back and allows her ribs to move. She practices semi-supine regularly and find it both calming and energizing.

Anxiety is not simply a mental condition, it has a profound affect on the body and the Alexander Technique can help reduce anxiety by highlighting the relationship between mental states and muscle states.

When Suzie rang to ask about Alexander lessons she said she suffered from tension headaches and eyestrain. She had been to an optician who reassured her there was nothing wrong with her eyes, “I always have pain behind my eye balls.” she said.

When I met Suzie for her first lesson, I noticed she frowned all the time and had an intense expression, as if she were concentrating hard on everything I said to her. The tension in her face and jaw was obvious, but she didn’t notice the accompanying tension in her neck, shoulders and back. At the end of the lesson, Suzie was delighted to discover the pain behind her eyes had faded and was keen to learn how to do this for herself. A specific pain, in one area of the body is usually accompanied by a tension pattern through the whole body. Suzie’s tension pattern was in her back, legs, her breathing and how she walked.

All of this was bound up with her use of her eyes. As she learned to release excessive tension in her neck and jaw, her face began to relax. At that point we were able to work more directly with her eyes. The first thing I encouraged her to consider was not straining her eyes forward, but to allow her eyeballs to ‘sit back’ in her eye sockets. Suzie didn’t think she was straining her eyes forward, until she stopped doing so, and was shocked when she realised the levels of tension she had become used to.

The next step was to encourage her eyes to widen away from each other. At first Suzie tried to do this physically and of course, you can’t. You can influence your muscles by thinking messages to them. This sounds strange, but it’s the way the body works naturally, your brain tells your muscles what to do. This thought had the effect of undoing deeply held tension around her eyes and nose, her frown disappeared and her whole face looked lighter and happier. Suzie practiced her eye directions at odd moments during the day and identified activities that caused her particular tension, such as being in meetings or working on her computer.

She was able to use her new knowledge to prevent the build up of tension. Suzie’s headaches began to subside and she felt an improvement in her general wellbeing. Colleagues began to comment that she looked calmer and she was less stressed at work and improved her performance. Suzie’s social life improved too as she no longer had to cancel social engagements because of headaches.

Did you know you can practice tension? If you habitually clench all your muscles, after a while you don’t notice it-but you carry on practicing tension until you are really good at it-then trouble begins. David is a postman-he works in the sorting office moving parcels from place to place. Despite following the standard advise to bend hips and knees and keep his back straight whilst lifting, David suffered from both back and shoulder pain. At first, his pain stopped when he was not at work but things escalated until he was in pain most of the time, which interfered with his entire life. “I have to be careful even lifting the newspaper now.” he told me over the phone when asking about lessons.

In his first lesson I introduced David to the Alexander Technique practice of semi-supine. He lay on my teaching table in such a state of tension that his lower back was arched right up off the table. When I pointed this out to him, David immediately flattened his back down. This is a common response but it doesn’t help the situation. I explained to him our approach of undoing the tension that caused his back to arch in the first place. Using my hands I encouraged his back and neck musculature to undo long held tension patterns and start to lengthen out. This made David aware of how tense he actually was and his next response was to try to relax. He did this by making himself floppy and heavy. I explained that we didn’t view relaxation as our goal, instead we looked at changing how we used our bodies so we didn’t need so much effort and tension, going floppy didn’t change the way he was coordinating his back so it didn’t get to the real problem.
After his first lesson, David felt lighter, taller and in less pain. He was intrigued and signed up to a full course of lessons.

Changing such deeply ingrained habits as David’s is not a quick fix. By the time someone gets to the point of debilitating pain they have be carrying themselves around badly for a long time. If you have the tension habit, you constantly practice it! Every time you practice it, it feels more natural and undoing it takes time and can be a strange experience. For David, using less effort initially made him feel he wouldn’t be able to hold himself up, but after a while he experienced the freedom that good body organization brings. He realized that it wasn’t so much what he did, or what position he got into, it was more about how he set about things. Previously he used to make enormous effort to stand up straight, now he recognized that effort as misplaced and released instead of stiffening.

One of the first things an Alexander teacher will teach you is how to stop. For many people this seems very puzzling and irrelevant to their problem. If you have back pain- you want to stop the pain but you have no idea how-so what do we mean?

It comes down to unpicking the tangle of our reactions to our situation. If you are in pain, you hold your body in a way that minimizes the problem. You won’t be aware of doing it-but you compensate for back pain by stiffening up muscles around your back and neck. You will do other things too, such as holding your shoulders rigid, restricting your ribs as you breathe and locking your jaw. All these tensions over stimulate your nervous system. Even if you move slowly or carefully to avoid pain, your whole system is on the body equivalent of ‘red alert’ and ready to jump in with even more tension at the slightest movement. This is what we want to stop. What happens is the tension quickly becomes a habit and part of your reaction to almost anything from answering your phone to the act of walking, everything is attempted with excessive and unfelt effort.

Learning to stop this involves learning to take time. For many of us this is an enormous challenge. We live in a ‘fix-it’ world that leads us to believe that solutions should be quick, if not instant. Our bodies are simply not like that. Whatever caused your back pain, whether it was a recognized injury, or something that came on gradually, or something that happened quickly, your response will have included a clenching right through the core of your being. Learning to ‘undo’ this is what takes time.

You could easily think this is just relaxation but it’s more than that. Alexander lessons will teach you to undo in a precise way so your whole body lengthens and opens out. It isn’t about lowering levels of tension, it’s about finding the appropriate level of tone required for your activity. If you are walking around, you need a lot less effort than you think. If you are engaged in a tug of war then you will make a great deal of effort. Our problem is that we bring the same effort to things like cleaning our teeth.

So give yourself time to stop and think about what you are doing and how you move. Do you really need to lock your jaw muscles when you walk up the stairs? Have your shoulders migrated up round your ears as you sit at your desk? What would life be like without those tensions? Well, you’d be calmer, a little taller because tension makes you shrink, and most important you will have learned the value of taking your time.

The best thing about the Alexander Technique is that it is a sophisticated self-help technique. You don’t go to a therapist for a treatment, you go to a teacher to learn something. This mind shift from 'patient' to 'learner' is a valuable and empowering one.

First of all an Alexander teacher doesn’t diagnosis, either conventionally or alternatively, and this in itself is liberating. If you have back pain, or other muscular problems, you have probably sought different kinds of help. Most approaches start by trying to find out what is wrong with you and then setting out to put it right. This approach inevitably hands responsibility to the therapist and takes it away from you. It also views you in 'bits', some of which have gone wrong and need fixing. When you have Alexander lessons, your relationship is a different one. You are learning skills to help yourself and the teacher is offering you a set of tools to do just that. It’s a dialogue between you rather than a one-way street.

You learn skills of balance and awareness that make it clear to you that you have a profound impact on the way you move around. At first this seems almost trivial, but it isn’t. Balancing over the tiny platform of your two feet is a skill only available to human beings and how you set about it has all kinds of consequences. If you have back pain, it is likely that you unconsciously use muscle tension to guard your back. This tension will be far more than you actually need to hold yourself up and has the effect of compressing you, particularly in the back.

This then is what you teach your body to do with every step you take. That excessive tension not only puts unwanted pressure on your poor back, it increases the mechanical load on your joints, compresses your internal organs, and generally makes you uncomfortable. What you are doing is maintaining your balance by excessive tension and effort instead of allowing your natural balance mechanisms to work for you.

The lesson process deals with this difficulty by increasing your awareness of what you are actually doing to yourself as opposed to what you think you are doing. It’s a journey of discovery made with the help of your teacher. The nice thing about it is you learn at your own pace. There are no expectations of you, or goals to meet, no tests to undertake, no manipulation of your body. Instead you explore movement, breathing and co ordination from a holistic viewpoint that acknowledges mind and body as partners in the dance of life.