I’m in pain. I’m always in pain. Listeners my podcast, Skeptics with a K, will know that. I feel it in lots of different parts of my body. A dull ache in the front of my ribs and my lower back. Something sharper around the back of my neck and into my upper back. My ankles hurt when I walk. My hips, shoulders, even one of my fingers at the time of writing.
My thighs and knees don’t hurt right now, but they feel weird. I think most people would describe it as pain but I have a weird pain threshold that doesn’t always register painful stimuli.
I know the cause of it. I have a health condition that causes chronic pain and acute injuries. But I also work full time. Sitting in an office chair for hours at a time is good for no one. It’s especially bad for me.
I have plenty of modifications to help. I use an ergonomic office chair at home – padded with memory foam and with a heating element I can turn on when needed. I use a sit-stand desk riser so I can stand up when sitting hurts too much. I have an external screen and a laptop riser to bring up my laptop screen – it’s portable so I can use it from my work office as well. I have an ergonomic keyboard and a trackerball mouse.
I remind myself to walk around every 50 minutes or so. Even if it’s just to the kitchen and back to make a cup of coffee. I try not to slouch. I sit back in my chair so I have back support. When I worked in a lab, I cleared out a space under my bench so I could sit with my knees straight instead of skewed to one side. I go for a walk as many days as possible.
It all takes a lot of conscious thought. It also takes a lot of self-advocacy – to insist on a break in longer meetings so I can walk around, or to explain why I can’t just “take the stairs” to that meeting, because my version of “healthy” is different to yours.
It also takes a lot of unconscious thought – thought I forget to explain, so when I refuse to embark on that walk up the stairs in order to go to the bar, and instead give someone else my money to go get my round, people forget that that is an access thing. Or when I leave things piled up at the bottom of the stairs waiting for the next I need to go up, instead of nipping them up now. Or when I don’t put away the clean dishes that live in bottom drawers, because bending can be hard. Sometimes, assumptions are made.
Similarly, there are unconscious habits that aren’t so good for me. As an autistic person, I stim. As an autistic person with poor proprioception and bad joints, sometimes my stims cause my pain. My ankles are bad right now because I go through phases of twisting and turning them to create a particular sensation. Without realising. Until it hurts to walk.
Like many people with chronic pain and mobility issues, I am extremely aware of how I use my body. And how easy it is to use it in a way that causes pain. Which can be useful for others – when a friend writing a thesis complained their back was hurting, I could point out to them that using a laptop might be the culprit, and they found that stacking their laptop on some books solved the issue.
It also means that I frequently come across a particular treatment that is offered to people with conditions like mine: the Alexander Technique.
The Alexander Technique was invented by F Matthias Alexander, an actor from Australia who lived from 1869 to 1955. He developed the process when recurrent laryngitis was affecting his voice.
The Alexander Technique is a training method that supports patients in being aware of the way they use and hold their body. From that perspective, it can be valuable. My proprioception – that is the sense of where my body is in space – isn’t great. That’s common both for people with my joint condition and for autistic people. It means I walk into things quite a bit. I’m constantly covered in scuffs and bruises from some innocuous interaction with a door frame or banister. But it also means I can be prone to overextending a joint without realising it. Taking a moment to recognise how I’m sitting or standing is an important part of managing my condition.
There is some evidence that postural and proprioception training can help manage pain in certain conditions – particularly low back pain. It might also be part of the reason some people find benefit in yoga or pilates exercises. We also know physiotherapy helps with some pain conditions – not least because stretching out tension or building strength in weaker muscles can be very beneficial. Any exercise that helps us move our muscles a little more consciously can be helpful for that.
There is some evidence that the Alexander Technique might help with the motor effects of Parkinson’s disease for some patients. But there’s evidence that exercise in general can help with Parkinson’s disease, so using the Alexander Technique as a guided exercise method makes sense if that’s the thing that helps patients maintain an exercise regimen.
However, that is not the full extent of claims made by some Alexander Technique practitioners. Some make claims around breathing. It’s easy to see why, given Alexander himself was struggling with his voice and projection when he developed the technique – it’s why he came up with the idea to change how he held his head and neck.
But chronic laryngitis – inflammation of the voice box – is a condition that can actually be helped by changes in behaviour. If you’re distressed enough to invent an entirely new therapy, maybe you’re also trying other things which might cause changes in the inflammation of the voicebox. Maybe you stop acting for a while, to focus on developing your new technique… and therefore you rest your voice and allow the inflammation to come down a little. Maybe you stop smoking, or spend more time outdoors away from the dusts which might be irritating the voice box. Maybe the posture changes help manage the acid reflux you didn’t realise was exacerbating things.
Despite the possible other reasons for Alexander’s apparent recover, many practitioners today still attribute it to the Alexander Technique, and believe it can help with breathing. One practitioner writes:
“Next time you have a cold you too can breathe freely through your nose as normal. All you have to do is to stop sniffing and uselessly blowing your nose to get rid of the blockage! Don’t open your mouth either. Just ignore the feeling that you’re in dire danger of asphyxiation! Can you do that? I doubt it, but if you do, you will find that you are breathing freely through what was a completely blocked nose. Even if you do succeed for a time, I guarantee that the blockage will be back again shortly after. You see, it is no easy matter to disregard that feeling of asphyxiation. The fact that that feeling is utterly mistaken makes no odds.”
The issue, here, is this is an excerpt from an article about treating asthma. He begins the article:
“Asthma is essentially a breathing problem. No, I lie: asthma is not a breathing problem. Asthma is one’s own inappropriate reaction to feeling unable to breathe.”
This isn’t true. Or at the very least it’s a complete misinterpretation. Asthma is a chronic inflammatory condition which causes difficulty breathing. One characteristic part of it is that the muscles of the lungs react inappropriately to some stimuli. Since Alexander Technique aims to relax certain muscles, you can see how someone might think that it’s an inappropriate reaction that a person can control. But we know that key to the asthma response is smooth muscle. You cannot physically control your smooth muscle. Smooth muscles are those that make up the walls of organs like the stomach and bladder and also the walls of your blood vessels. You can’t consciously relax these muscles. You have no voluntary control over them.
It is true that when you’re struggling to breathe during an asthma attack, panic can exacerbate the symptoms and therefore advice is to try to keep calm. But that advice is for while you are taking your inhaler medication and if there is no improvement – calling for emergency support (in the UK, by calling 999 for an ambulance).
A Cochrane review found no good evidence supporting the use of Alexander Technique for asthma.
Ultimately I think the Alexander Technique is no different to any other exercise program that supports an awareness of your own body in space. The big difference is that it’s much more expensive – classes can cos £35-50 for an hour session. Whereas a yoga or pilates class can be much cheaper, and physiotherapy is available freely on the NHS.
The prices are more comparable to private physiotherapy… but for something that is not grounded in any medical basis. It was just invented one day, by some guy who looked in a mirror at his own body, and then taught some other people to do the same.
I don’t necessarily think the Alexander Technique is a complete waste of time for some people, in some very specific circumstances. But then again, I don’t think it has any real value, either – certainly not more so than many other forms of exercise, forms that don’t also then inappropriately claim to treat or cure serious conditions.
