onsdag 24. desember 2014

Same procedure

Same procedure as last year?

Same procedure as every year!

Unless

you decide to stop and
think before you act

to make it 

an even better Xmas
and a happier New Year!

søndag 14. desember 2014

Research on health benefits

Health claims from Alexander Technique teachers were recently labelled "wishful thinking" by an expert on research on complementary and alternative medicine (CAM). In the following discussions in social media there were some instances of argumentation not conducive to a constructive debate, something which I described as unwanted "habitual reactions". Most of the discussions, however, were engaging, stimulating thought provoking and instructive. The discussions made me think about the fundamental question: should we bother about research on health benefits? The Alexander Technique is after all an educational method.

Ulterior motives
One of the things that perplexed me in the recent discussions was that there seemed to be an underlying assumption that the reason for doing research on health benefits from the Alexander Technique was for the technique to be 'accepted by science'. Again and again this theme cropped up. I think this is entirely the wrong reason for doing research.

What does 'accepted by science' mean anyway? As I mentioned in my last article I have followed the debate on CAM in recent years. This thing about being accepted seems to be a recurring theme. Alternative health practitioners seem to have a yearning for being accepted, probably because research on CAM for the most part have yielded negative results, so they feel rejected. They haven't really got the hang of how science works. If the hypotheses of claimed health benefits fail the test they have to go somewhere else for acceptance.

I believe there is economical reasons for wanting to be 'accepted by science'. Health claims are made to promote methods of alternative therapies. Promotion is a necessary element of trying to make money to earn a living. This is fair enough, but should not be the main motive for doing research.

The reason for doing scientific research is for gaining knowledge. With a better knowledge about to what extent the Alexander Technique can benefit people healthwise we can give more correct information. This will help people to take more informed decisions.

As an Alexander Technique teacher I seek to be professional. To be professional about health claims I would find it very useful to have some knowledge beyond personal experience and shared anecdotal evidence. There are some questions I would in particular like to have some more clarity in. There are claims of health benefits out there made by Alexander Technique teachers which I think there could be reasons to question.

In the Cochrane database of systematic reviews there is one mention of the Alexander Technique. This is on asthma. Evidently someone have found the claims made on behalf on the Alexander Technique concerning asthma prevalent to such a degree as to be worthy of inspection. As there is yet no research the effects of Alexander Technique on asthma the conclusion in the Cochrane paper is that: "Robust, well-designed randomised controlled trials are required in order to test claims by practitioners that AT can have a positive effect on the symptoms of chronic asthma and thereby help people with asthma to reduce medication."

Another issue I would like to have some more clarity in is the effect the Alexander Technique might have on 'frozen shoulder syndrome' (adhesive capsulitis). As mentioned in the article Wishful thinking, the very experienced Alexander Technique teacher Walter Carrington once said that the technique had limited effect on such conditions. Was he right? And what about the Alexander Technique and trigeminal neuralgia, or what about torticollis or focal dystonia?

There is information on the internet indicating that the Alexander Technique may give help with these conditions. I think it is only natural and right that these claims should be put to the test so that sufferers can have better information about to what extent the Alexander Technique may help.

But to do my work as an Alexander Technique teacher, do I really need to know in detail what conditions the technique can help or not? No, not really.

Should we stop making health claims?
One teacher in the recent discussion concluded that: "Let's just stop making claims. Period. We don't need them". Coming to the Alexander Technique via the field of music making and teaching I have great sympathy with this view. and if possible I think it is also the best position to take.

As Alexander Technique teachers we help people using themselves to their best advantage in anything that they do. Health benefits are incidental. We teach, we don't cure.

The problem is that the claims of health benefits are out there, and we have to deal with them. Putting forward claims of health benefits has been part of the tradition of Alexander Technique teaching during all its history. I think it is unrealistic to believe that the Alexander Technique profession as a whole is going to follow an admonition about stop making claims.

There is also another reason why stop making claims is not realistic, and that is the fact that the Alexander Technique actually give health benefits. The results from the ATEAM trial on Alexander Technique and back pain is a strong indication of this.

It is very natural to point out that the Alexander Technique may have an impact on health. We just have to make sure that it is done in an appropriate manner. I would expect all professional organisations to have some rules about what is appropriate. In addition the practice of Alexander Technique teachers is subject to the laws and regulations of the country of the teacher. I think the regulations in Norway which allows general claims but rules out claims of helping specific conditions gives a good general guideline.

The problem with only making claims of general nature is that it becomes like the claims from anybody else. Have a look at any web site for any 'alternative health method' and you often cannot discern between them. They all give the same promise of general wellbeing. So, maybe claims of health benefits are not, or should not be, our 'unique selling point' anyway?

It could be that the question about what constitute reasonable claims of health benefit is a question that Alexander Technique teachers in general should be more conscious about, and which needs to be discussed more.

Upcoming research
One very important reason for the need to deal consciously and constructively with the research on possible health benefits is that new research is under way. There is no way we can ignore it.

For teachers, who teach performers and who don't focus on health in their advertising or teaching, this may be not that important. But any teacher who has put claims of health benefits on their website and/or advertising material, or who puts forward claims in articles etc, are in my opinion obliged to deal consciously and constructively with information about the Alexander Technique and research on health benefits.

In the recent debate, there were teachers who were very negative towards the article by Edzard Ernst on claims of health benefits from AT teachers, and also negative towards science in general, but who had the information youtube video from the British Medical Journal on the ATEAM back pain trial prominently featured on their website. This is hypocrisy.

Dealing constructively with scientific research does not mean that we should necessarily accept everything. It means we should be able to criticise research without making mistakes like the ones I described in my article about "habitual reactions". This requires some literacy about how science works and about how medical research is carried out. It is not my impression that this kind of literacy is widespread in the he Alexander Technique community.

Defining ourselves
One thing that was striking in the recent discussions on the Alexander Technique and claims of health benefits was that there seemed to be a confusion between research on health effects and research on the mechanisms of the Alexander Technique.

To carry out research on health benefits of the Alexander Technique, it is not necessary to know the working mechanisms. What is necessary is to test something that is a representative version of Alexander Technique teaching. This poses a challenge to the Alexander Technique profession. There is no common definition of the Alexander Technique and no common agreement about what constitutes good quality Alexander Technique teaching. These are questions that themselves could benefit from scientific research.

Regardless of quality there are many different approaches one can take when teaching the technique. This also poses many questions that have to be taken into consideration when performing research on the technique, and which teachers who are involved should be aware of.

Kathleen Ballard, one of the teachers involved with the ATEAM trial, suggested in the article Public Misperceptions in Statnews (January 2008, vol . 6 issue 24), that we should make a distinction between the Alexander Technique itself, and the methods of teaching it, that is, between the skill taught (and used by the Alexander Technique teacher in the process), and the methods of teaching this skill.

This is a distinction not made by Alexander himself. To him it was all 'The Work'. I believe that for us to be clear about what the Alexander Technique is, and what we do as teachers, it is vital that we make this distinction.

A technique for prevention
Some say that the research on health outcomes of the Alexander Technique puts the technique in a too narrow frame. They are correct. But it is not medical research that do this in the first place. It is the AT teachers who put the claims forward.

Alexander himself was adamant that he did not propose a cure. His technique improved general functioning, which in turn would tend to improve health indirectly. We may use the same argument. The problem is that anyone not acquainted with the Alexander Technique will bring their own understanding to it and probably only take it as a promise for a cure. 

Alexander also stressed the importance of prevention. He argued it was prevention in a wider sense, not in the sense the term was used by doctors and others (see beginning of chapter IV, Universal Constant in Living).
Some have suggested that pointing out the possibility of prevention would be more tolerable than making claims of improvement. I think the opposite is the case. Claiming to prevent could be an even more widesweeping claim than promising improvement or relief. And maybe even harder to prove. We would still be making a claim and it would still be reasonable to wish for more than just anecdotal evidence.

Conclusion
To conclude. To practice as teachers we don't necessarily need verification of health effects. The Alexander Technique is an educational method. But as the technique arguably influences health, and health claims are made, the Alexander Technique community should feel an obligation to engage constructively towards the effort of research on health effects. This requires a minimum of knowledge about science and research methods, which the majority in the Alexander Technique community don't have. It also presents a challenge to the Alexander Technique teaching profession in terms of defining quality standards and explaining what we do and why we do it.


Please feel free to comment below!


Related articles:

mandag 8. desember 2014

Habitual reactions

- impressions from discussions on the Alexander Technique and medical research (written with the Alexander Technique teacher in mind)

Alternative therapies have come under scrutiny in recent years, following books like Trick or Treatment by Ernst & Singh. In Norway we have had similar books, and a very popular TV series on the same subject. Since the Alexander Technique is commonly categorised as an alternative therapy I have followed the debate on alternative treatments closely. I have to say that in my opinion practitioners of CAM (complementary and alternative medicine) have difficulties in dealing constructively with criticism.

Some time ago Edzard Ernst, an expert on CAM research, posted an article on his blog where he said that health claims from Alexander Technique teachers mostly were 'wishful thinking'. It was with some apprehension I posted a link to the article on social media. How would Alexander Technique teachers respond?

There was a great variation in responses and interesting discussions followed, but there were also signs of the typical habitual reaction of the average CAM practitioner.

Ignorance
It is not uncommon for CAM practitioners to want to ignore results from scientific research when they don't like them. Several in the Alexander Technique community said we should ignore Ernst's article. This is an ignorant thing to do. Ernst points out the fact that most of the health claims made by Alexander Technique teachers are not backed up by scientific evidence. Ignoring him does not make this fact go away.

Others claimed that Ernst was the ignorant, saying that as he had no experience of the Alexander Technique, he would ''not know what he was talking about''. I hope we Alexander Technique teachers aren't that bad at explaining the technique in words. You don't need first hand experience of the technique to assess research papers. The only caveat I would put down is that you have to understand that the Alexander Technqiue is something you learn. This understanding you can get from reading about the technique.

Someone commenting on Ernst's blog asked him if he had taken lessons, and if so, what his experiences were. Clearly, the person asking is ignorant about how science works. Ernst's experiences, or lack of experiences, changes absolutely nothing about the state of research on health benefits from the Alexander Technique. Even if Ernst had had lessons in the technique, and found them valuable, he could still have had the opinion that Alexander Technique teachers exaggerates their claims.

Some even answered Ernst's critique with the 'argument from ignorance', an example of fallacious argumentation. They said that lack of proof of effect didn't prove that the Alexander Technique doesn't have health effects. They also said that Ernst, if he disagreed, was free to disprove it. Yet another fallacious argument. The burden of proof is on the claimant. The only thing achieved by using this sort of argumentation is proving your own ignorance.

And someone was even in complete denial, arguing that since we don't regard the Alexander Technique as a therapy, we are not making health claims either.

Ad hominem
Ad hominem arguments is a speciality among CAM practitioners. Fortunately there were few of them from Alexander Technique teachers. One said that Ernst didn't seem to ever have had "an internal experience of positive change that made him wonder".

Another commentator said Ernst's blog was an example of hubris, presenting a façade of credibility with a list of degrees and "impressive databases" acquired through google. Quite a few others were eager to discuss Ernst's possible (hidden) agendas, seeing it necessary to find "enough information to make an evaluation of Ernst".

Even if there were few ad hominem arguments, there were sadly also very few comments that directly addressed what Ernst had written on his blog. Of hundreds of comments, only two or three criticised Ernst constructively.
There were comments which were emotional in character, Alexander Technique people finding Ernst ''dismissive'' or ''unfair'', his reporting ''irresponsible'' and ''insulting to the AT''. How can the Alexander Technique be insulted? The technique is not a person.

Unscientific
One commentator said Ernst's article was ''unscientific''. Labelling something as ''unscientific'' is, ironically, a very popular strategy among CAM practitioners. Ernst's article was further described as ''quack science'' with ''no scientific method'', ''no rigour of analysis, erroneous conclusions, and obvious bias presented as facts''.

Other commentators said Ernst had an ''opinion based attitude'', that there was''bias in his approach'', that he could be ''more objective'' and that he was ''not such a rational person as he likes people to think''.

This critique falls flat on its face because this was a blog article, not a scientific paper. It is perfectly all right to express ones opinion in a blog. The critics also fail to present arguments that supports their view. They are themselves only expressing an opinion, which as a matter of fact only ends up being empty words.

As for the ''biased position'' as someone called it, it is clear that Ernst's attitude is that claim of health effects should be based on sound evidence. One can disagree with this position, but I don't think it is correct to call it ''biased''.

Cherry picking
When it comes to the much loved sport of 'cherry picking' I'm not sure if CAM practitioners are most zealous of practicing it themselves or of accusing others for practicing it. In the debate on Ernst's article on health claims made by Alexander Technique teachers, I'm happy to say that there was only a little hint about Ernst practicing 'cherry picking'. It was alluded that by 'not supported by evidence' he actually meant 'not supported by the studies he cited'.

To support a claim that Ernst was cherry picking, one would have to show that he had omitted relevant studies of sufficient quality. Since his article is based on systematic reviews there is very little material he could have omitted. I don't know about any further studies that could have shown a more positive effect for the Alexander Technique.

CAM practitioners very often blame it on cherry picking when trials with positive results are omitted. The reason for the omission is normally bad quality trials. Studies of bad quality is a big problem in CAM. When only studies of good quality is included, the positive results tend to disappear. Homoeopathy is the prime example.

There are a lot of other factors that can reduce the reliability of a study. Size is one such factor. A case relating to the Alexander Technique was mentioned in the discussion. A pilot study on musicians in Denmark indicated that the technique was effective against high blood pressure. For years this study has been cited by Alexander Technique teachers. Later it has come to light at this is an over interpretation of the results. We have no evidence after all.

Failed medicine
Attack is the best form of defence, as the saying goes, and CAM practitioners, when criticised, routinely point out the failure of doctors, the health service and the pharmaceutical industry.

Someone posted a rant on Ernts's blog about the problem with opoid drug addiction in the US. This is a real problem and it is easy to sympathise with the writer. But the comment is entirely misplaced. Both because Ernst is writing about CAM and has nothing to do with conventional drugs or the use/misuse of it, and because even if the Alexander Technique were to be found effective against more than just back pain, the technique will never be an alternative to analgesics.

It is easy to point out failures in the practice of medicine. In the discussion about Ernst's article, among the examples given were the failure of a doctor to see the connection between arrhythmia and digestive issues, or the link between voice problems and the locking of the knees.

It is easy to agree with this, especially as an Alexander Technique teacher. I see regularly how people for instance are aggravating their problem by the exercises given to them by physiotherapists. Some basic understanding is lacking.

But what do this mean for health claims made by Alexander Technique teachers? Sharing the understanding that 'use affects functioning' might have made Ernst think twice before he wrote ''wishful thinking''. But if by that he only meant 'not supported by evidence', it wouldn't change a thing.

If we Alexander Technique teachers present claims, the burden of proof is on us. The fact that doctors make mistakes does not change this.

Too subtle
A claim often made by practitioners of CAM is that their method is too subtle to the object of scientific research. Among the objections made towards Ernst's article were that the Alexander Technique : ''is more subtle than to be subject to this matter-of-fact testing'', and that ''the Technique is an exceptionally difficult thing to build a scientific test for''.

In relation to testing claims of health benefits, this is nonsense. You don't need to know or understand the working mechanism to test the health benefits of a method. Of course, you need to make sure that what you are putting to the test is a representative version of the method. In the case of the Alexander Technique this can be a challenge, but this is a problem on another level.

And if the method is too subtle to have a measurable effect, then the claims of effect definitely are wishful thinking.

Double standards
There seems to be a myth among CAM practitioners that, when it comes to the requirement of evidence base, there are double standards in their disfavour. In the discussion on Ernst's article it was said that the established health care system should ''go under same scrutiny as is used towards alternative approaches" and that they wished that ''the same degree of scrutiny were applied to drug treatments''.

It was also said that Ernst was criticising health professionals for using CAM, but that there was ''no looking into how evidence based is the normal practice''.

This gives the wrong impression. It is true that a considerable part of what is done in 'normal practice' is not evidence based. But that there is no scrutiny is positively wrong. The practice of medicine is constantly changing, and, thanks to an evidence based approach, mostly improving.

If there really are double standards, they work the other way round. Practitioners of CAM can for the most part do whatever they like, someone in the health care system can't. CAM practitioners can do what they have done 'for thousands of years', someone in the health care system may have to change their practice due to increased knowledge. CAM practitioners can sell sugar pills and claim it is 'medicine', the pharmaceutical industry are not allowed to. (Not that they are not trying). CAM practitioners should be very pleased with having double standards.

Big medicine and Big business
If CAM practitioners feel they are not getting the aknowledgment they believe they deserve from scientific research, they tend to blame someone else for it. Big pharma, Big medicine and Big business are the usual culprits. This is also so according to voices in the Alexander Technique community.

It was said that large corporates have no interest in doing research on the Alexander Technique. This is true. And why should they? The Alexander Technique is tiny, probably only a few thousand teachers world wide. Why spend money on the Alexander Technique when there is so much else to study? The technique is tiny even when compared to CAM, which is a global billion dollar industry.

Someone criticised Ernst for not pointing out this fact. I'm afraid that sounds more like an attempt at excusing making claims of health benefits.

CAM practitioners often point to ulterior motives. It was claimed in the discussions that the Alexander Technique would be a threat to the '' thousands of scientists and billions of dollars'' in medical research. Amusing thought.

What is not so amusing is when some CAM practitioners come up with conspiracy theories to explain why their claims are not accepted. There were some glimpses of conspiracy theories in one of the discussions I followed. The problem with conspiracy theories is that they imply that a lot of people are evil. Such a position is ethically questionable. Most CAM practitioners come across as very nice people. All they want is to help others. But there is a dark side to CAM. Conspiracy theories is a sign of this. We shouldn't go there.

Failed science
When scientific medical research does not support the claims of health effect of an alternative method, CAM practitioners sometimes come to the conclusion that then it must be science that is wrong.

One of the discussions on Ernst's article I was following, hardly touched upon the question of validity of health claims by Alexander Technique teachers before heading into debating the limits of science. It was interesting stuff in the view of science philosophy, but in the context of questionable health claims it looked more like an attempt at avoiding the problem.

It was said that the 'scientific method' does not exist as such,, which is true at some level. But randomised controlled trials, which are normally used to test an hypothesis of treatment effect, is very close to being an example of what is commonly known as 'the scientific method'. Arguably randomised controlled trials exists.

It was argued that no matter how many randomised control trials that are being performed, they will always be within the context of the framework for the research, which is true of course, but beside the point. Alexander Technique teachers putting forward health claims have already put themselves within the scope of medical research, and within the very narrow frame of the question: does it work?

It was also argued that there is no common agreement of what constitutes a good quality trial. This is not quite true when it comes to assessing the quality of randomised controlled trials in medical research. Anyway, pointing to the fact that scientists disagree is usually an indication that the person has not got the hang of how science works.

Celebrity based medicine
Edzard Ernst wrote a paper together with another scientist, tongue in cheek, about ''celebrity based medicine". This could be seen as a comment on the fact that CAM practitioners love to use famous people as case stories to prove the trustworthiness of their method. Alexander Technique teachers are not much different. When it was revealed that Victoria Beckham had lessons, the story was all over the place.

Someone put a comment on Ernst's article saying that a Dr so an so, M.B, B. Ch, BAO, FRCS, D.L.O., Senior Surgeon, president of this and that, was of the opinion that the Alexander Technique should be part of medical trening of doctors. I don't think Ernst was much impressed.

This is called appeal to authority and is a fallacious argument. It does not say anything about the veracity of the health claims made by Alexander Technique teachers. I also find it embarassing. This is not the way we should put our arguments forward.

What now?
What I have written here does not show the whole scope of the discussions that have taken place in response to Ernst's article on the Alexander Technique and claims of health effect. I have only quoted fragments, rephrasing comments with my own words, and according to my own impression of the meaning. It is totally subjective and not based on science.

My aim has been to try to show examples of what we as Alexander Technique teachers should not do in a discussion about the technique and medical research. More discussions will take place in the future. My hope is that we will do better next time.

But should we bother about medical research at all? The Alexander Technique is an educational method, not a therapy. This is a question I'll discuss in my next article.


Please feel free to comment below!


Related blog posts:
Research on health benefits

Related blog posts in Norwegian:

søndag 30. november 2014

Wishful thinking

Edzard Ernst is a leading expert on the research on CAM (complementary and alternative medicine). He writes an entertaining and informative blog which I recommend to anyone interested in this field of research.

Recently he wrote about the Alexander Technique pointing out discrepancies between the claims made by Alexander Technique teachers and the existing scientific evidence. The blogpost had the title Alexander technique: some evidence and plenty of wishful thinking.

The evidence
In his blog Ernst draws on two systematic reviews. A systematic review aims at collecting, evaluating and summarizing the result of all existing research.


"Strong evidence exists for the effectiveness of Alexander Technique lessons for chronic back pain and moderate evidence in Parkinson's-associated disability. Preliminary evidence suggests that Alexander Technique lessons may lead to improvements in balance skills in the elderly, in general chronic pain, posture, respiratory function and stuttering, but there is insufficient evidence to support recommendations in these areas."


"Evidence from RCTs and CTs suggests that AT sessions may improve performance anxiety in musicians. Effects on music performance, respiratory function and posture yet remain inconclusive."

Ernst's conclusion is that:
"So, there you are: if you are a performing artist, AT seems to be useful for you. If you have health problems (other than perhaps back pain), I would look elsewhere for help."

I think it can be said that Ernst's conclusion did not go down well with Alexander Technique teachers.

The claims
Ernst is comparing the existing evidence from research to a list of health claims found on the highest ranking Alexander Technique website on google search, The Complete Guide to the Alexander Technique which says that the Alexander Technique can help you if:
  • You suffer from repetitive strain injury or carpal tunnel syndrome.
  • You have a backache or stiff neck and shoulders.
  • You become uncomfortable when sitting at your computer for long periods of time.
  • You are a singer, musician, actor, dancer or athlete and feel you are not performing at your full potential.
Ernst is a little lenient when saying that the Alexander Technique may be useful for performing artists. The evidence at present only supports helping musicians with performance anxiety, not for improving performance. The claim that the Alexander Technique can help against backache is actually the only claim on this list that at present is backed up by scientific research.

Now, are these claims only 'wishful thinking'?

According to Merriam-Webster Online, wishful thinking is:
"an attitude or belief that something you want to happen will happen even though it is not likely or possible".

Lack of scientific evidence does not in itself justify labelling a claim 'wishful thinking'. It has also got to be unreasonable or unlikely to be true.

If it is reasonable to say that the Alexander Technique can improve quality of movement, then it is not unreasonable to say that it can help performers. If it is reasonable to say that the Alexander Technique can improve body awareness, then it is not unreasonable to say that it can help the office worker. And if it is reasonable to say that the Alexander Technique helps people to "do everyday tasks with less muscular and mental tension", as Ernst himself says in his definition, then it is not unreasonable to suggest that the technique may be of help against stiff neck and shoulders.
For the same reason it can even be said that it is not entirely unreasonable to suggest that the Alexander Technique may give some help to people suffering from repetitive strain injury or carpal tunnel syndrome.

It might seem as if Ernst chose the wrong list for his criticism.

Medical conditions
I think, however, that Ernst raises an important question. In principle I do agree with him. In my view health professionals like Ernst, should as far as possible only give advice based on evidence. When he does not recommend the Alexander Technique, apart for back pain, he is entirely correct in doing so.

What we do as Alexander Technique teachers is a different thing. But we face a challenge: what are reasonable claims and what is 'wishful thinking'?

The Alexander Technique has a long tradition for making unsubstantiated and even unreasonable claims. Alexander himself had the idea that his technique could be of help against tuberculosis and the common flu. Wishful thinking, if there ever were any.

Where should the line go ? This is an ethical question. What do we say to our pupils? What kind of expectation are we entitled to give them?

In Norway the law that regulates CAM says that one is not permitted to claim to treat specific conditions. You may say that you improve breathing, but not that you cure asthma. In light of this I feel it is questionable to have repetitive strain injury and carpal tunnel syndrome on a list claiming health benefits for the Alexander Technique. Explaining the technique in an article and giving a reasonable suggestion for why it might work is slightly different. On lists claiming health benefits I think we generally should avoid listing specific medical conditions.

Limitations
The easiest solution to the problem of unreasonable claims would be to stop making health related claims entirely. After all, the Alexander Technique is not a therapy, but an educational method. It is unrealistic, however, to believe that Alexander Technique teachers would stop making claims of health benefits. It is part of how most of us are trying to make a living.

The Alexander Technique does have an influence on health anyway, as confirmed by the ATEAM trial. The technique influences health indirectly by improving general use. This also means that there are limitations to the health effects. Even though 'manner of use' will impact most conditions, the influence will vary. In the case of repetitive strain injury, for instance, it could be that managing work load by taking frequent breaks is more important than improving manner of use.

The truth is that we don't know the limitations of the Alexander Technique. There is no agreement either. Walter Carrington, one of the most experienced Alexander Technique teachers in the world, said that it was limited what the technique could do in the case of a 'frozen shoulder'. Despite this there is an abundance of websites on the Alexander Technique claiming that the technique is effective against 'frozen shoulders'.

What is the truth? We don't know. At present we have only anecdotal evidence, and anecdotal evidence is not sufficient for drawing a conclusion.

Faulty sensory appreciation
It should be apparent to any Alexander Technique teacher why anecdotal evidence is not sufficient. Unmasking self delusions is part of our daily work. We do this by making it possible for the pupil to have new experiences of being and moving, so that they can compare the new to their habitual way of doing things.
  • Anecdotal evidence is normally an individual case story. Since it is not compared to cases not having Alexander Technique lessons it is impossible to say whether improvement of for instance a 'frozen shoulder' is due to the technique or not.
  • Conditions tend to improve over time anyway, and, added to that, the Alexander Technique more often than not is not in the first line of treatment. By the time the person comes to us improvement could have been inevitable.
  • When considering the condition it is also possible that the pupil gives a more positive description than warranted because of a subconscious wish to please the teacher. We can in the same way chose to interpret what we hear in the most favourable way.
  • We normally only see the pupil while he/she is taking lessons. This means that we can't tell whether the improvement was permanent or only temporary, or if there was a subsequent deterioration.
  • We are humans and we tend to remember the success stories. To make a real assessment we have to include all the cases where we did not succeed. How often do we do that?
Conclusion
The conclusion must be that for the most part we don't really know how much effect or how large influence the Alexander Technique has on health problems. That the Alexander Technique influences health is a reasonable proposition. Use is bound to affect functioning. We just don't know how much.

If you find information about the Alexander Technique that contains what you consider to be unreasonable claims or 'wishful thinking', you will do the Alexander Technique profession a service by informing the teacher in question about your views, or by taking contact with the relevant professional organisation. It is not in our interest to be seen making unreasonable claims based on 'wishful thinking'.

I have wondered, by the way, if Ernst actually knows quite a lot about the Alexander Technique and that 'wishful thinking' is a pun alluding to the process of thinking 'directions'. Anyway it is quite a fitting expression in several ways I'm afraid. There is quite a lot of 'wishful thinking' going on in the Alexander Technique world. Scientific research will challenge that kind of thinking, and Alexander Technique teachers, like all human beings, are making every possible effort to hold on to their delusions. I'm not that sure that the Alexander Technique profession is up to the challenge posed by scientific research. More about that in my next article.

Please feel free to comment below!




søndag 23. november 2014

Nytt kontor

Fram og med i morgen flytter jeg min undervisning til mitt nye kontor i C.J. Hambros plass 7.

På fredag hadde jeg mine siste undervisningstimer i kontor 413 i Tullingården, Kristian Augusts gt. 19. Jeg har hatt kontor i Tullingården i over 12 år. Det blir rart å flytte derfra.

Da jeg begynte som Alexanderteknikk-lærer underviste jeg først litt forskjellige steder. Jeg leide et rom hos min kollega Nigel Hornby i Huitfeltdsgate 8b et års tid. Det var noe spesielt å gi timer på samme adresse hvor jeg selv hadde hatt mine første Alexanderteknikk-timer høsten1990.

I 2002 fant jeg kontoret i Tullingården. Til å begynne med delte jeg kontoret med min venn og kollega Johan Koefoed. (Han er nå dramalærer i Grimstad). Senere har Birgitte Elfving og Hege Falch Irgens også benyttet kontoret, men det er hele tiden jeg som har undervist der mest. Med årene har det blitt ganske mange undervisningstimer jeg har gitt der.

Tullingården, eller «Tulling-gården» som jeg har hatt moro med å kalle det, har huset Alexanderteknikk-lærere i mange år. Både Hege Falch Irgens og John Walker har hatt kontor der. Jeg hadde timer med begge av dem på 90 tallet. Begge hadde kontorer i 6. etasje om jeg ikke husker feil. Da jeg flyttet inn hadde også Hege kontor i 4. etasje.

Tullingården var tidligere et familieeid AS som eide både nr 15 og nr 19. (Nr. 17 forsvant dengang nr 19 ble bygd en gang på 50-tallet). Bårdar danseinstitutt var leietaker i nr 15 i mange år. Mest kjente leietaker i nr. 19 er Tronsmo bokhandel, som de fleste av mine elever sikkert har vært innom om de har vært tidlig ute til timene.

For noen år siden ble Kr. August gt 15 solgt til Entra eiendom Da var planen at Tullinløkka skulle huse det nye Nasjonalmuseet + diverse andre museer. Det medførte at forretningsfører Scheldererup flyttet fra nr. 15 til et kontor i 4. etasje i nr. 19. Han pleide å sitte på sitt kontor å røyke med døren på vidt gap. På kontorpulten hadde han et skilt hvor det stod: Ikke røykere forbudt!

Like etter at jeg flyttet inn i 2002 flyttet installerte Sentrum røntgeninstitutt i etasjen under en MR-maskin. Jeg måtte avbryte en av mine første timer for å be arbeiderne ta en pause i arbeidet med å pusse betonggulvet i 3. etasje. Senere ble jeg vant til lyden av MR-maskinen. Da den flyttet ut for noen år siden var jeg blitt så vant til å ha den som en påminnelse om å holde fokus i arbeidet at det var noe som om noe manglet. Fokus er alfa og omega i Alexander-teknikken.

Kontor 413 som jeg har hatt, har tidligere vært del av et legekontor. I bakgården står det også et gammelt skilt med henstilling om å være stille da «leger har tilhold i bygget». Kontoret har vært tilknyttet naborommet med en dør, og det er bare en lettvegg mellom rommene. For noen år siden, i 2007 om jeg ikke husker feil, ble det installert ventilasjonsanlegg i bygget og det ble enda mer lytt mellom rommene. Til å begynne med var det greit nok siden naborommet lenge stod tomt, men så leide et firma flere rom i 4-etasje, inkludert naborommet, hvor de har holdt NAV-kurs i helsefag. Jeg har etter det overhørt flerfoldige timer om anatomi, fysiologi og pasientpleie. Ikke helt irrelevant for en Alexanderteknikk-lærer, men det har også gjort at jeg lenge har hatt planer om å flytte kontor.

Etterhvert ble også Tullingården, Kristian August gt nr 19 solgt til Entra. Hele tiden har planen vært at kvartalet skulle videreutvikles. Vi leietaker har merkelig nok ikke fått noe informasjon. Det var helt tilfeldig at jeg leste i lokalpressen at Tullingården skulle rives og at et nytt bygg var planlagt. Ført i sommer fikk vi brev om at renovasjon/rivning ville begynne i 2015 og jeg begynte for alvor å lete etter nytt kontor. Det første jeg befarte var kontoret i C.J. Hambros plass nr. 7. Det er en god del mindre enn kontoret jeg har hatt, men det virket som et koselig sted, og like sentralt. Dermed slo jeg til.

En ulempe ved det nye kontoret er at det er for lite til å arrangere små introduksjonskurs for grupper slik jeg har gjort i Tullingården. Introduksjonskurs må jeg derfor arrangere andre steder. Mitt kontor i Tullingården har også vært åsted for månedlige samlinger, «Alexanderteknikk-forum», for Alexanderteknikk-lærere. Nå er vi ikke så veldig mange Alexanderteknikk-lærere i Oslo, så kanskje kan det nye kontoret også være et samlingssted for Alexanderteknikk-lærere. Men på sikt håper jeg at vi blir flere Alexanderteknikk-lærere, og da trenger jeg kanskje et større kontor?

Fordelen med det nye kontoret, i tillegg at det er veldig sentralt, er at takhøyden er stor. Både i konkret og overført betydning er det en fordel.

C.J. Hambros plass er plassen foran Oslo tinghus. På C.J. Hambros plass møtes Pilestredet, Rosenkrantz gate og Kr. August gt. Det nye kontoret er bare tre minutter lengre ned i gata fra det gamle kontoret.

Ved Tinghuset stopper trikk nr 11, 17 og 18, og det er kort vei til Stortinget T-banestasjon (utgang Akersgata). Dessverre er det dårlig med parkering i nærområdet, men inngangen til Europark sentrum (tidligere Ibsen parkeringshus) ligger rett på andre siden av gata fra inngangsporten til C.J Hambros plass 7.

I første etasje av C.J. Hambros plass 7 ligger klesforretningen Adéle med klær for «voksne og unge damer». Går du forbi klesforretningen, inn gaten som er stengt for biltrafikk, er du i Pilestredet. På venstre side, mellom Adéle og Baker Nordby finner du porten til C.J. Hambros plass nr. 7. Porten er åpen fra kl.8 til kl. 18. Har du time etter kl.18 må du ringe på og dytte hardt på porten når den åpnes, den er ganske tung og treg. Inngangsdøren til nr. 7 er til venstre like innenfor porten.

Mitt kontor ligger i 3 etasje. Bygget har heis, men den er antagelig ikke original da bygget er ganske gammelt. Heisen er liten og innebygget i det som engang var midten av vindeltrappen. Når du kommer inn i tredje etasje tar du til høyre, forbi tannlegekontoret «gode tenner». Fortsetter du til høyre ser du nødutgangen rett fram, i en egen liten gang. Den siste døren på venstre hånd er mitt kontor. I det du passerer toalettene, som ligger på høyre hånd, vil du sikkert legge merke til at gulvet heller sjarmerende mot høyre, noe som kan gi et snev av følelsen av å være på sjøen. Toalettene er vanligvist avlåst. Bank på min dør for å låne nøkkel, om jeg ikke har hengt den ut på forhånd.

Et datafirma var tidligere leietager i det som nå er mitt kontor. De hadde mye datautstyr og ble utsatt for innbrudd. De installerte derfor en ekstra metalldør med to låser. Antagelig kommer jeg til å ha den ytre døren åpen når jeg er på kontoret.
I Kr August gt kunne folk sitte i trappen om de måtte vente. På det nye kontoret vil jeg antagelig sette ut en stol. Vis a vis mitt kontor er kontoret til et «Natur og helsesenter» som drives av en hyggelig dame som er «heilpraktiker» (eller «heksedoktor» som jeg kaller det). Hun pleier også å sette ut en stol til ventende klienter. Min stol vil derfor eventuelt stå på «min» side av gangen.

Jeg vil sikkert savne det gamle kontoret, selv om jeg ser fram til å begynne i det nye. Til nå har jeg vært mest opptatt av å gjennomføre flyttingen. Jeg vil sikkert savne å gå gjennom slottsparken slik jeg har gjort på veien til kontoret. Nå blir korteste vei en litt annen rute. Jeg får litt lengre vei også. Men det blir ikke noe stort problem. Jeg skal være tidlig ute for å ønske deg vel møtt i mitt nye kontor!

søndag 16. november 2014

Se nøye

Se nøye, så skal du øyne det store i det små.

Jeg lærer mye av å følge diskusjoner om Alexanderteknikken på nettet. Jeg lærer ikke så mye om Alexanderteknikken, men jeg lærer mye om hvordan Alexanderteknikken kan forklares og forstås, eller misforstås.

En av deltagerne i en diskusjonsgruppe på google er et helt spesielt tilfelle. Han har lang erfaring med Alexanderteknikken, men ett eller annet ser ikke ut til å gå inn. Siden jeg ikke har møtt vedkommende fysisk er det ikke mulig for meg å definere helt sikkert hva årsaken er, men ut ifra det han skriver får jeg inntrykk av at han bare er ute etter følelsen av avspenning. Han vil ha så mye avspenning som mulig. I det siste har han skrevet om «katarsis».

En time i Alexanderteknikk kan gi en ubeskrivelig opplevelse av ro, avspenning og letthet. Slike opplevelser kan være viktige milepæler i læringsprosessen. Du får et glimt av hva som er mulig. Problemet er bare at det er ikke på dette nivået arbeidet gjøres.

Alexanderteknikken går (enkelt sagt) ut på å organisere oppmerksomheten på en slik måte at du unngår å skvise kroppen enten du beveger deg eller er i ro. Ofte er avspenning del av effekten. «Arbeidet» går ut på å bruke oppmerksomheten. Den følbare effekten dette har fra det ene øyeblikket til det neste er svært liten. Du opplever neppe noen «katarsis». Tvert imot er det om å gjøre å legge merke til de aller aller minste forskjellene. En fiolinist må legge merke til de minste forskjellene for å kunne spille rent, store forskjeller er opplagte.

Når du ligger i aktiv hvilestilling kan du kanskje oppdage at det skjer noe i muskulaturen bare du flytter oppmerksomheten fra en del av kroppen til en annen. Forskjellen kan være som når skyer skygger for sola et øyeblikk. Tanker og muskler er så intimt forbundet at det er nærmest umulig at endring i oppmerksomhet ikke gir endringer i muskelspenninger.

Strengt tatt behøver du ikke merke forskjell i kroppen engang. Den viktige forskjellen er mellom å være oppmerksom eller ikke å være oppmerksom. Det fine med det er at selv om du ikke merker forskjell i form av endring i muskelspenning så vet du antagelig om du er oppmerksom eller ikke.

Du kan øve på bevisst bruk av oppmerksomheten ved å være oppmerksom på for eksempel hva du gjør med hodet ditt når du pusser tennene. Du behøver ikke å gjøre noe annerledes, bare vær oppmerksom. Neste steg er å gå fra å bare være oppmerksom til å ha en intensjon. Det skal jeg skrive mer om en annen gang.
Å bruke tankene/oppmerksomheten på denne måten er noe du lærer i Alexanderteknikk-timene. Hvis du vil prøve en time kan du ta kontakt med meg på mobil nr 41 41 90 96 eller epost: halvard@alexanderinfo.no

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lørdag 8. november 2014

Kaffekoppen

Dette er det tredje blogginnlegget i en serie på tre skrevet for deg som allerede er godt kjent med Alexanderteknikken.

Møter er en nødvendig og uunngåelig del av arbeidslivet for mange. Noen møter er viktige, mange er bortkastet. Å sitte på møter kan være slitsomt også. Du kan ende opp med å føle deg sammensunket eller anspent, eller begge deler. Det behøver ikke å være slik.
I blogginnlegget Effektiv møtetid fortalte jeg om hvordan jeg utnyttet tiden på et rutinepreget møte til å øve Alexanderteknikk. I innlegget kalt Omorganisering fortalte jeg videre hvordan jeg utnyttet bevegelser for å omorganisere muskelskjelett-systemet og redusere muskelspenning. I dette siste blogginnlegget skal jeg fortelle om hvordan jeg brukte et hjelpemiddel. Som tittelen avslører var hjelpemiddelet en kaffekopp.

Alt henger sammen med alt
Mennesker kan ikke eksistere i et vakuum. Når vi vurderer hvordan vi organiserer muskelskjelett-systemet må vi også ta hensyn til hvordan systemet fungerer i forhold til omgivelsene. (Når jeg skriver «muskelskjelett-systemet» er det en sterk forenkling siden muskelskjelett-system ikke kan fungerer uten nervesystemet og vår «mentale» aktivitet.) Den sterkeste ytre faktoren er tyngdekraften og den resulterende kontakten vi har med underlaget. Føtter og bekken er oftest vektbærende. Delene av muskelskjelett-systemet som ellers har mest aktiv kontakt med omgivelsene er hendene.

Med hendene påvirker vi omgivelsene. Vi arbeider, bruker redskaper og manipulere objekter. Med hendene kan vi utforske mange egenskaper ved ting vi berører. Vi kan for eksempel kjenne formen til en kaffekopp, tyngden og tyngdefordelingen, overflaten og egenskapen ved materialet. Men vi kan også bruke hendene til indirekte å få mer informasjon og økt bevissthet om oss selv.

Retning, forhold og avstand
Fordi sitteknuter og føtter er vektbærende, er de viktige utgangspunkt for å tenke «retning» eller «lengde» i Alexanderteknikken. Hender er nyttige utgangspunkt fordi de er så følsomme. Store deler av den sensomotoriske hjernebarken er opptatt av hva hendene driver med. Hendenes aktivitet og kontakt har derfor innvirkning på organiseringen av muskelskjelettsystemet. Følsomheten er lettest å utnytte når hendene er i kontakt med noe, for eksempel en kaffekopp.

Jeg drikker lite kaffe til vanlig, bare 2-3 kopper i løpet av uka i snitt. Lange møter er en av de få anledninger hvor jeg skeier ut og tyr til kunstige stimuli. Fordelen med å drikke så lite kaffe til daglig er at effekten blir desto sterkere. Jeg var dermed lys våken der jeg satt med koppen i hånden og fulgte med på møtet, samtidig som jeg øvde Alexanderteknikk.

Kontakten jeg hadde med kaffekoppen brukte jeg som et utgangspunkt for å tenke lengde til andre deler av kroppen. Mest av alt tenkte jeg tenkte lengde fra fingrene til hodet. 
Når noen prøver å «slappe av» i skuldre eller nakke prøver de vanligvis å gjøre noe direkte med det aktuelle området. Men muskler brukes alltid i sammenheng. Å slappe av i enkeltmuskler er ineffektivt. Å tenke indirekte er mye smartere. Ved å være oppmerksom på avstanden mellom hodet og fingrene, gjennom arm og skulder, påvirkes tonus i alle musklene som går mellom hodet og fingrene. Å ønske mer lengde, å tenke at hodet og fingre går i hver sin retning, hjelper til å redusere eventuell unødvendige spenninger.

Nakken kan være et særlig diffust område når det gjelder spenning. Delvis kan det ha med å gjøre at vi alltid må ha noe spenning i nakken for å balansere hodet. I stedet for å prøve å «slappe av» i nakken direkte er det mye lettere å påvirke nakkemusklene på en positiv måte ved å tenke på nakken i forhold til andre deler av kroppen, for eksempel hånden du holder kaffekoppen i. På en måte kan du si at jeg brukte kaffekoppen til å være mer bevisst hva jeg gjorde i nakken.

Jeg brukte også håndens kontakt med kaffekoppen til å tenke på avstanden mellom hånden og sitteknutene, og mellom hånden og føttene. Jeg tenkte også på avstanden mellom hendene, gjennom armer, skuldre og rygg. 
Når vi snakker om «lengde» i Alexanderteknikken forbindes det vanligvis med «å bli lengre» og å redusere muskelspenning. Hva nybegynnere i Alexanderteknikk ikke legger merke til er hvor effektiv bare det å være oppmerksom på avstanden kan være, uten at det behøver å skje så mye. Å være oppmerksom på lengde, bredde, avstand og rom, er veldig enkelt, så enkelt at nytten kanskje blir undervurdert.

Koppens tyngde
En kaffekopp er nyttig til mer enn å bare legge fingrene på. Fordelen med en kaffekopp i forhold til andre objekter jeg kunne ha brukt, er at den har en viss tyngde. Tyngde er spesielt interessant i forhold til å tenke «lengde og bredde».

Muskelskjelett-systemet må omorganisere seg i forhold til tyngden på ting vi holder eller løfter. Gjenstandens tyngde forenes med kroppens tyngde. Gjenstandens tyngde går «gjennom kroppen» og ned i bakken. Vi har et valg om hvordan vi tar imot tyngden og integrerer den. Vi kan trekke oss sammen eller ekspandere. Mest effektivt er å la kroppen ekspandere, la tyngden bli mest mulig fordelt utover muskelskjelett-systemet.

Da jeg løftet kaffekoppen lot jeg tyngden av kaffekoppen hjelpe armen til å være lang. Hvis jeg hadde dradd armen «inn» i kroppen hadde det vært tegn på at jeg brukte for mye spenning, og at den gikk i feil retning. Jeg lot tyngden av koppen og armen stimulere ryggen til å bli bredere, slik at skuldrene ble utspent fra ryggsøyla. «Bredde» i ryggen kan være en vanskelig instruksjon. Du må gi slipp på armene, men ofte betyr det å «gi slipp» at armene blir tunge og slappe. Da kan ikke ryggen være bred. «Bredde» kan være lettere å få til gjennom aktive armer og hender.

Stort sett løftet jeg ikke koppen på en synlig måte. Jeg satt med den på låret og lekte med å gå fra å løfte null vekt til å løfte vekten av armen og koppen. Da kunne jeg lettere sjekke at jeg lot armen være lang når jeg begynte bevegelsen.
Jo mer jeg løftet, jo mer økte vekten på sitteknutene, og den forskjellen kunne jeg kjenne. Denne stimulusen brukte jeg til å tenke mer «opp» fra sitteknutene slik at jeg også kunne gi mer slipp på beina. På en måte kan du si at jeg lot vekten av kaffekoppen generere «lengde og bredde» i hele kroppen i en slags god sirkel.

Noen ganger løftet jeg kaffekoppen høyere. For en kaffekopp kan ha en helt spesiell egenskap – den inneholder kaffe.

Kaffetørst
En bevegelse jeg ofte lar elever gjøre i en time er å legge ei hånd på hodet, klø seg på øret eller på nesa. Det avslørende med slike bevegelser er at de, antagelig fordi de indirekte involverer hodet, ofte fører til at vi strammer nakken og fikserer hodet. Det som også er typisk når vi fører noe til munnen er at vi hjelper til ved å skyve hodet forover. Vanligvis er dette veldig uhensiktsmessig og medfører mye ekstra arbeid for nakkemusklene.

Da jeg satt på dette møtet og fikk lyst på en slurk av kaffekoppen, var dette en fin anledning til å være oppmerksom på å la nakken være fri. Som før nevnt er nakken og hodebalansen en diffus greie. En av grunnene til dette er at hodet, i motsetning til f.eks. føttene, stort sett ikke berører noe. Dermed har vi mindre mengde taktile signaler fra dette området. Men akkurat som jeg kunne bruke fingrenes berøring med kaffekoppen til å være mer bevisst på hendene, brukte jeg koppens berøring med leppene til å være mer bevisst på hva jeg gjorde med hodet. Leppene er kanskje i enda større grad enn hendene, svært følsomme. Med koppen mot leppene kunne jeg derfor lettere merke om jeg lot hodet gå «opp» eller om det gikk «ned».

For å drikke fra en kaffekopp, og det er lite kaffe igjen i koppen, kan det være nødvendig å legge hodet bakover. En svært interessant utfordring, som ikke ble mindre interessant av at resten av det som foregikk på møtet ikke var det.

Utfordringen er å la hodet tippe bakover med en «fri» nakke, uten å stramme og uten å strekke. Nybegynnere i Alexanderteknikk kan ha vanskelig for å forstå at nakken kan være «fri» selv om du legger hodet bakover. Ja, selv mer erfarne Alexanderteknikk-lærere kan være skeptiske til å legge hodet bakover for å se i taket. Ganske idiotisk spør du meg. Å legge hodet bakover for å se i taket er en av bevegelsene vi burde gjøre hver dag, i likhet med å se seg over skulderen, balansere på ett bein, gå ned på huk, og løfte armene over hodet. Use it or loose it. En vakker dag er du så gammel at du ikke klarer det lengre, og da kan du bare angre.

Kaffekos
Som sagt kunne jeg godt brukt en annen gjenstand å eksperimentere med, for eksempel en penn eller mobilen. Men en kaffekopp har andre egenskaper. I tillegg til å kunne veie noe mer og inneholde kaffe, er den som oftest varm. Forskning viser at det å holde en varm kopp i hånden gjør deg mer positivt og vennlig innstilt. Sitter du på et langdrygt og frustrerende møte kan det absolutt være fordelaktig. Jeg fikk i alle fall mye ut av møtet jeg satt på, ikke minst takket være kaffekoppen.

Dessverre må jeg innrømme at jeg ikke husker så mye av det som ble sagt å møtet. Det jeg husker aller best er følelsen jeg hadde da jeg gikk ut. Jeg følte meg så lett i kroppen, akkurat som om jeg hadde hatt en Alexanderteknikk-time.


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