A Curriculum in Alexander Technique for Orchestral Musicians

A CURRICULUM IN ALEXANDER TECHNIQUE FOR ORCHESTRAL MUSICIANS

ABSTRACT

The author was asked to devise a series of Alexander Technique classes specifically for orchestral musicians as part of Sydney University’s Sound Practice Posture Trial. [] This paper presents the background and rationale for the design of this curriculum. Paradoxically, the future evaluation of the results of this Alexander Technique intervention would necessitate determining if any results were the effect of the Alexander Technique itself, the method of delivery through the structured curriculum, or both. Testing of the students’ perception of usefulness of elements of the curriculum in applying AT to playing showed that the traditional Alexander Technique elements were consistently the most useful, and the structured curriculum and group format were supportive of the effects of the Technique, providing teachers were comfortable working with them.

 

Alexander Technique classes were considered for inclusion in Sydney University’s Sound Practice Posture Trial [] to investigate if, through ‘posture correction’, playing-related musculoskeletal disorders (PRMDs) in orchestral musicians could be reduced. A range of secondary outcomes associated with performance-related benefits would also be tested: posture, ease of movement, work stress, concentration, confidence, energy levels, learning of playing techniques, strengthening of playing muscles, and the rate of perceived exertion (RPE) and general playing capacity during private practice, rehearsal and performance.

The author designed a series of sixteen thirty-five-minute Alexander Technique classes for recruited players in eight of Australia’s major orchestras. The directive was to structure the Alexander course as tightly as possible, so that for the purposes of research validity it could be reproduced Australia-wide by other Alexander teachers. A purpose-specific Pilates-based core-strengthening exercise class, previously developed by the Sound Practice team[], was to serve as a model.

PART. 1 – ORCHESTRAL MUSICIANS

Thirty years of research in the field of Music Medicine demonstrates conclusively that musicians are susceptible to playing-related pain and other symptoms at higher rates than other professions (Paarup 2011, Ackermann & Driscoll 2012, Kok 2013), yet this research has done little to positively affect incidence and prevalence (Fry 1986). Regarding orchestral musicians, data from a recent study by Ackermann et al investigating 370 Australian orchestral players (the population to whom the Sound Practice classes were being offered) shows that rates of injury are very consistent with an earlier study investigating professional musicians in Sydney, from which the data for the orchestral players has been extracted. See table.

Most commonly affected sites were the shoulder, neck and upper back.

In both studies, posited risk factors are also quite consistent, and players themselves are clear that, whilst dangerous levels of playing load may trigger injury, the most important background predictors are excessive playing-related muscle tension and stress as well as poor posture.^4-6  “Playing related stressors” and “playing-related tension” were robust predictors in the multivariate model when other factors (such as age, gender, instrument, years playing, attitudes to pain, ergonomic conditions, warm-up behaviours and exercise behaviours) were taken into account.

Stressors particular to orchestral musicians:

Unpublished data from this earlier study shows that, relative to professional non-orchestral musicians, the orchestral players were more likely to have a higher playing load, to have experienced greater injury severity, to have taken more days off work, to report their work environments as more stressful and to have played in both rehearsals and concerts with mild, moderate AND severe pain. They were also less likely to take time off because of pain when they really needed to.

The  following reasons for not taking time off were cited significantly more times than non-orchestral players

Need to practice *

Not wanting to cause inconvenience *

Fear of reputation as unreliable *

Orchestral players were also significantly more likely to agree with the statement “When I practise, I can’t relax until everything is perfect.” More to do with environment than character?

It is clear orchestral musicians have particular stresses due to the constant need to maintain a high standard within an extremely competitive work environment and they often have little control over the amount and intensity of playing

• Appear to have higher injury and stress rates than other musicians
• Have particular ergonomic conditions
• Tend to have more stress than other professional musicians, probably because of the

Part 2 – The Alexander Technique

2.1.1. Origins  

In the 1890’s, the Australian reciter and actor Frederick Matthias Alexander resolved his own vocal overuse injury over a ten-year period of investigation and self-observation using a three-way mirror system [46]. He discovered that while he was reciting he unwittingly stiffened his whole body, this tension manifesting in postural faults, as well as forced breathing and strained speech.[8] Alexander  initially tried to rebalance his positioning by contracting other muscles, but this resulted in greater rigidity[C 13]. He eventually realised that these observable tensions were interrelated parts of a total pattern, the most crucial part of which was the stiffening of the neck and change in the axis of his head’ 10[J17]

Ultimately he found the solution by paying attention to certain kinaesthetic cues and relinquishing the muscular effort [] and even the idea of ‘standing well’. he could create a global condition of dynamic freedom within himself. Alexander had discovered an inherent mechanism for dynamic self-organization and self-regulation, or anti-gravity response, which he later described as the ‘primary control’.[Bt08] He believed that people universally and inadvertently interfered with this inherent mechanism, because of a failure to successfully adapt to the increasingly civilised conditions of life. [B14][J24].

Over time he recognised that, by paying attention to certain kinaesthetic cues and releasing the muscular effort associated with trying to ‘stand well’ he could create a global condition of dynamic freedom within himself. Alexander had discovered an inherent ‘anti-gravity’ mechanism, which he later described as the primary control.  Eventually he developed the tools to actively organise and regulate this mechanism by systematically observing and inhibiting those reactions and responses which led to mal-coordination and tightening.⁹

He was able to gain ‘constructive, conscious control’ (CCC) of this mechanism through the re-education and refinement of his proprioception[1] and kinaesthetic sense, which allowed him to observe and then reliably prevent (inhibit) the reactions and responses which would inevitably led to the malcoordination and tightening.

Alexander began teaching this conscious control, developing, with his brother Albert Redden, procedures and words to describe the unique way of by working. Eventually they began teaching the Technique to others, describing it as “a method of psycho-physical re-education”[]. After working in Melbourne and Sydney for a time, where he was known by medical specialists as “the breathing man”, Alexander moved to London in 1904. [J18] He later developed a very specific method of conveying this new dynamic self-organisation through sensitive manual guidance, known as ‘hands-on work’.[]

Alexander and his brother trained teachers in UK and USA from 1931 until Alexander’s death in 1955, and those teachers have carried on AT teacher training. Currently AT teacher certification involves three years full time study, or the equivalent of sixteen hundred contact hours, the majority of those hours spent in gaining practical proficiency [].

and as his Technique evolved, he clearly identified what he believed to be the most healthful way to use the body for any activity.

2.1.2. Alexander Technique principles: 

Use of the self

By 1932 Alexander had broadened the concept of use (‘use’ of the respiratory mechanism etc.) to become ‘use of the self’ [UOS],

Underlying unity of causes of problems

“The term “use” covers the total pattern that characterises a person’s responses to stimuli”. [J46], including the tonic muscular activity involved in postural co-ordination and movement, the sensory feedback system and habitual reactivity to internal and external stimuli.

Alexander observed that ‘use of the self’ was generally habitual and unconscious, but conscious control of one’s use could override the influences of hereditary, prior experience and environment. [J46]

PA

 

Primary control

 

Rather than position or posture Alexander used the phrase primary control to designate optimal use: “a control that depends on a certain use of the head and neck in relation to the rest of the body”[] which allows for lengthening of the whole spine and calibration of optimal muscular tone throughout the rest of the body. [J46]

This emphasis on maintaining this toned and lengthened axis, or anti-gravity response, is crucial in the integration and regulation of all other postural, balance, movement and sensory demands, [J46] and is the key to any potential benefits of practising Alexander Technique. UOSpp.59-60.] posture disappears 1923 [46]

In practical application it means that tension and malcoordination in breathing and limb use are approached first indirectly, through the restoration of a functional primary control.

 

Faulty sensory awareness

Alexander realised he was gridlocked in his early efforts to change his habitual use because the misuse itself had resulted in an unreliable [J21] kinaesthetic (muscular sense), which was “unable to gauge accurately the amount of muscular effort required to perform certain acts, the expenditure of effort always being in excess of what is required.”

This miscalibration of muscle effort was just part of a complex, unconscious set of errors in sensory awareness resulting from instincts and prior learning (including imitation of those around us). [J26] Some other examples of FSA are incorrect body mapping (e.g. mis-mapping the position of and mis-conceiving the function of: the AO joint, lungs, diaphragm, hip joints etc, faulty notions of correct alignment, having limited awareness of other options for movement and alignment, having a very narrow attentional field, or focusing on wrong stimuli, as in ‘the golfer who can’t keep his eye on the ball”. [uos]

AT lessons create a contextual framework where students learn how to pay attention to subtle but significant kinaesthetic and proprioceptive cues in order to restore these senses to reliable function.

Inhibition and means-whereby:

jones 25

Alexander noted that compulsiveness to achieve an end can produce extreme tension which then blocks the desired outcome [?]. The crux of FM’s work became to expand awareness to include inhibition as well as excitation of the nervous system– (‘not-doing’ as well as doing). Emphasis is placed on the observation of the detrimental increases in muscle tensions that are triggered by various internal and external stimuli, ie. thoughts as well as events. [C04] Alexander used example from the animal kingdom to illustrate inhibition, for example the way in which a cat will wait perfectly still until the exact ideal moment to leap on its prey : [J25-6] description of cat

Releasing the neck is thus crucial, since Alexander observed that the neck is the ‘distribution point’ [J10] at which the total tension pattern begins.

“it is what man does that brings about the wrong thing,…,and it is only by preventing this doing that he can ever begin to make any real change”.  [B11]

 

 

Directions or ‘Orders’

The AT directions or orders: ‘neck release, head to go forward and up, back to lengthen and widen’ were FM’s best attempt to linguistically explicate the conscious, directed awareness that enabled him to keep the new organisation of his head-neck-back at the forefront of his attention whilst he inhibited the old patterns. ‘Orders’ were the main tools of instruction before Alexander had developed tactile guidance, and were the means for students to develop the ability to work on themselves, and later they were introduced after he had established in the pupil the ‘kinaesthetic effect of lightness to contrast with the habitual pattern of tension’.

These directions or orders are anatomically correct in conveying an expanded relationship of the parts of the body within the whole; however they should be not used as a positioning tool, where there is a danger of achieving the lengthening, the widening, or the forward and up by muscular doing.

 

Use of manual guidance in teaching AT

Through the application of inhibition and direction, by 19… Alexander had developed a way to use his hands that was very different from ordinary manipulations or postural adjustments []. Jones describes his first STS with AR Alexander guiding as: “not that I was being moved by someone else, but that I was being moved by a set of reflexes (within myself) that I knew nothing about”. J7 With the hands-on guidance a familiar movement such as STS can feel extremely different, pupils usually reporting that guided movements feel contrastingly lighter, smoother and less effortful, in other words there is an absence of the sensations of compression and disorganisation which usually accompany the movement. [J8]. Hands-on guidance is able to assist in widening the student’s attention through acute realisation of the limitedness of current movement patterns and responses.

Essentially the teachers’ hands provide what 10 years of mirror-work did for Alexander in providing reliable and accurate sensory feedback and keeping the primary control at the forefront of attention.

 Thinking in activity

Again, ‘thinking’ can imply a narrowing or focusing of attention, but the result of activating the Alexander principle is to establish a unified attentional field where sensing, moving and thinking occur simultaneously, (“thinking in activity”), [B96] and which encompasses awareness of both the self and the environment and the whole body and its parts.[J9] “The field of attention has a set of kinaesthetic co-ordinates which supply a framework for thinking”, not simply a theoretical construct but a perceptible state of ‘tonus’. [J]

A wider attentional field counteracts obsessive thinking (over-focus), which can interfere with the smooth behaviour of the autonomic nervous system (“wisdom of the body”), and also under-focus, as in boredom or mind-wandering. “A true hunter takes in the whole landscape with his eyes and is prepared for anything. Mind wandering in a ‘savage’ would be fatal.”[J40]

FPJ describes his first guided STS in a way that brings to mind notions of Flow []: “It took less time than usual but seemed slower, there was a sudden expansion in both dimensions, so that more time and space were available for the movements.’ [J7]

Part 3  – Inclusion of Alexander Technique in Posture Trial for Orchestral Musicians

 

3.1. Rationale

Alexander Technique has always been popular with musicians and is offered at most tertiary institutions worldwide[2]. It helps players and performers in at times intangible ways to feel more ‘relaxed’, calm and ‘in the moment’. Anecdotally, musicians who have done AT get less pain on the job, and Alexander lessons can contribute to successful rehabilitation for injured musicians. []

From the Alexander Technique perspective there is specificity as to what constitutes healthy psychophysical ‘use’ when playing a musical instrument, since Alexander discovered an inherent mechanism for healthy neuromuscular co-ordination and AT involves unlearning interferences with this mechanism. Specifically, Alexander recognised that his vocal injury had been caused by recruiting too much muscle tension⁸ – by ‘trying too hard’ to have good posture, to take deep breaths, to project his voice and to convey emotion. “You translate everything, whether physical or mental, into muscular tension.”⁹

3.2. Relevant Research 

Efficacy of Alexander Technique

Alexander and his pupils always encountered difficulty in describing the technique to people who had not had lessons,¹⁰ and to date this remains a problem, since the kinaesthetic feeling of lightness and associated changes in the attentional field are the crux of Alexander Technique (AT), and AT lessons are essentially an experiential mode of learning. Though at pains to accurately describe the anatomic and physiological processes in his writings¹⁰ Alexander consistently declined offers to have his work scientifically validated.[3] He had no confidence in the validity of the methods that would be employed in testing his work as he believed that the training of the researchers would prevent them from an apprehension of mind-body unity.¹⁰ He thus preferred to emphasise the educational effects of his teachings rather than the therapeutic, referring to the work as “psychophysical re-education”.⁹

However, in recent decades empirical studies have shown promising results for a standard ‘dosage’ of twenty private lessons in Alexander Technique, demonstrating it to be effective for pain relief, pain management and improvement in disability scores in patients with chronic back pain and Parkinson’s Disease,^14,15 balance problems in the elderly,¹⁶ respiratory function¹⁷ and posture and performance in surgeons.¹⁸

Although the exact mechanism of the AT is still unknown, Batson gives a concise account of research supporting the importance of the head/neck relationship in motor control, [B] and the neuroanatomic mechanisms involved. [B] More recently, Cacciatore et al. have shed light on the possible mechanisms of AT through several studies using a unique “twister” device that measures hip torque by fixing the upper body in space while oscillating the surface in yaw, [Fra2012]. Measuring with this device, AT has been found to alter postural tone, observed as a reduction of stiffness along the spine and hips in response to slowly applied torsion during unsupported stance [6]. As well, a study measuring controls against short and long term AT practitioners showed that AT training increases the ability to dynamically modulate postural muscle tone in the body axis during anti-gravity postural maintenance, this dynamic response being inversely related to axial (trunk) stiffness. [C]

In an investigation of the STS movement, marked differences were found between AT teachers and matched control subjects in coordination (phasing, weight-shift and spinal movement), hypothesising the difference to be the result of lower hip joint stiffness and increased power transmission through the spine. [C2011]

In musicians, studies have shown statistically significant improvements in outcome measures in Alexander Technique groups (relative to controls) in heart rate variance, self-rated anxiety, positive attitude, musical and technical quality,¹⁹ blood pressure (with effect comparable to Beta Blockers)²⁰ and awareness and executive skill function.²¹

Two studies have tested the feasibility of using group classes in AT instruction incorporating Body Mapping, demonstrating positive outcomes. {Dennis 1999]. Batson, Barker 2008.

Of interest, a recent study asked 3 groups of PD patients to perform quiet standing and step initiation using three types of verbal self-instruction (i.e. no hands-on guidance): AT ‘lighten up’ language (not compressing), effortful posture correction language (‘switch on core’, ‘shoulders back’) and language encouraging ‘relaxation’, showing that only the Lighten Up instructions led to measurements indicating greater movement efficiency and adaptability and less postural rigidity. [Cohen, Gurfinkel & 2015]

A broad range of secondary outcomes has been reported in the above studies, including reduced muscle tension [L] improved ‘coping’ [L] tools for prevention [L] and helpful in daily life. [L, B&B]. Benefits to energy levels [], balance, posture, ease of movement, body awareness and self-confidence were also reported [B]. Learning new information and techniques were seen as a positive effect. [B&B]

               Other relevant research

For Alexander, muscle tension, pain, stress, poor posture, faulty movement patterns, mal-coordination and nervous mental states[4] were not viewed as discrete syndromes, but rather as part of a person’s total “misuse of oneself”.  There is a growing body of relevant research elucidating these interconnections.

Regarding the reduction in muscle tension brought about by AT lessons, there are several studies from the researcher Frank Pierce Jones showing that, for example, using force platform measurement, AT manual guidance subtracted 25lbs from the force needed to initiate the STS (Sit-to-stand).²⁴ Recent research in the field of neuroscience describing the neuroanatomic mechanisms in posture regulation confirms Jones’ results,²⁵ also showing that AT training increases the ability to dynamically modulate postural muscle tone in the body axis during anti-gravity postural maintenance, this dynamic response being inversely related to axial (trunk) stiffness.²⁶

            Muscle Tension and Pain                                                                                                                                             A recent study of workers in the general population showed that participants who were “sometimes or often tensed” had a 2.9 and 4.4 times higher risk, respectively, of becoming a future neck-shoulder case than those who were never tensed, with similar findings for arm-wrist-hand symptoms.²⁷ This finding is confirmed in research with musicians, where two studies in Australian populations showed self-reported muscle tension while playing to be the strongest predictor of pain after measures of playing load.^4-6 Reverse causality may also be operative, in that acute pain can lead to ‘guarding’ (tensing) of involved structures, creating limitations in movement patterns and reinforcing the tendency to chronic pain conditions. Chronic pain creates further limitation of movement, as demonstrated by data providing the first evidence of primary motor cortical adaptation in the transition to sustained muscle pain.²⁸ In work with musicians McCrary et al also found evidence of the possibility of altered biomechanical responses to physical symptoms.²⁹

Stress, anxiety and tension – ‘fight-flight-freeze’       As early as the 1960’s the Alexander Technique researcher FP Jones worked with eliciting the ‘startle pattern’ [fight-flight-freeze] in a number of subjects, demonstrating that there was a consistent tendency to tighten the upper trapezius and sternomastoid (neck) muscles in response to a frightening stimulus such as a sudden loud noise.¹⁰                                                                                                   It can also be seen from Figure 2 that the stimulus has created a global tension (guarding) pattern similar to the one described by Alexander as the cause of his vocal problems – “stiffening the neck, pulling the head back and down (on the top of the spine), shortening and narrowing the back, depressing the larynx, and stiffening the thorax”.⁸

Figure 2: Startle Pattern10 A. Most comfortable posture B. Posture after startle stimulus Electomyograph of: Upper trapezius Sternomastoid
	A                         B

Regarding the control and maintenance of such guarding patterns, recent scientific interest in the connective tissue fascia shows that this tissue may be much more significant than previously thought in mediating this global ‘fight-flight-freeze’ response, in that it has been shown that fascia can contract independently of muscle (thus faster) in response to stress.³³  Web throughout body.

3.1.2. Contextual considerations 

With regard to the development of an Alexander Technique curriculum within a research context where physiotherapists would in large part be devising methodology and conducting data collection and analysis, the main contextual considerations would be the notion of ‘posture correction’[5] itself, and the nature of AT as a ‘physical intervention’[6].

Posture correction                        Though poor posture is posited by many musicians as a reason for the development of their pain, several studies show however, that, as measured by physiotherapists³⁰ there are no significant differences in the number of postural disorders in musicians and the general population, unless the musicians are playing their instruments.³¹                                                                      Interestingly, a study by Jones et. al.³² showed that advice to assume the ‘best sitting posture’ or ‘greatest height’, or to ‘sit up straight’ showed a significant increase in lower trapezius and sternomastoid activity, that is, more unnecessary muscular effort or tension.

Alexander Technique as a physical intervention      Showing considerable prescience, Alexander rejected the Cartesian notion of mind-body duality, and his work bears very little resemblance to any current exercise system such as Yoga, Feldenkrais or Pilates or any commonly held notions of posture correction[7].              Instead Alexander’s concept of the ‘use of the self’ resonates with the more recent notion of neuroplasticity[8] [], in that it can be described as “an active form of neuromuscular re-education and reorganisation” [B]. In fact, AR, FM’s brother, used the Technique over an eighteen month period to rehabilitate from a horse-riding injury after a medical diagnosis of permanent paraplegia, [Jones pp 68-69] and Alexander used the method to restore full functioning after a stroke at 78 years old. [B36] In this regard, Alexander considered the influence of both nature and nurture to be insignificant in relation to conscious learning and direction of the ‘self’.                                                                                                                                                          The non-doing nature of AT work and teacher hands-on guidance contrasts with physical therapy concepts of muscular strengthening for position correction. Inhibition

As a preventive tool for musicians its uniqueness may not be fully understood however, as it is often put in same category as yoga or Feldenkrais as an alternative health therapy for ‘body awareness”.

3.1.3. Discussion

Currently there is a scarcity of studies examining AT as used by musicians, though there are numerous positive first hand accounts. Historically, funding for ‘complementary therapies’ may not have been easily obtainable and musicians not a priority population. Additionally, measuring the effects of psychophysical re-education on the complex skill of playing a musical instrument is not necessarily straightforward [J]. There is however some evidence for AT’s positive effects on musicians’ stress and performance, as well as showing that private Alexander Technique lessons can improve chronic pain and disability, as well as promising results for teaching AT in groups and for using AT language cues.

Several studies confer that excess muscle tension is a strong predictor for musicians’ playing-related injuries [], and that “poor posture” is a strong self-reported factor[]. In AT, there is a reduction in the muscle effort required to carry out the full dynamic range of movements required to play an instrument, and the resultant postures and alignment are thus beneficially influenced.

First hand accounts from a range of AT students (particularly musicians), over more than a century indicate the psycho-physical benefits – the widening of the attentional field, the sense of physical competence, the perception of unhurried movements akin to flow conditions, warrant the trialling of AT to measure effects on Perf Related Factors such as confidence and .

Because AT is a self-help modality, the reported increasing independence in physical competence and pain management is an added benefit, as well as the learning of a skill that can be applied to all other activities. No Alexander Technique intervention has resulted in any negative effects.

Therefore a trial investigating AT’s effects on musicians’ PRMDs is long overdue. However, as a preventive tool for musicians its uniqueness may not be fully understood, as it is often included in same category as yoga or Feldenkrais as an alternative health therapy for ‘body awareness”. Within a physical therapy model therefore, measuring the effects of AT on pain and posture and their correlation may be somewhat unwieldy.

 

 

PART 4 – THE CURRICULUM IN ALEXANDER TECHNIQUE FOR ORCHESTRAL MUSICIANS.

4.1. Considerations for the design of the course:

4.1.1. Standardisation

The first challenge in designing the classes came from the need to parallel the model of the core stability exercise class curriculum, which comprised carefully graded and timed lists of exercises to be taught and practised in each class. [] Since AT is not a series of exercises or movements it is not normally taught in a structured or standardised way, Alexander teachers tending to work with the specific issues presented by each student, hence the preference for one-on-one lessons.

 

4.1.2.Diversity of teaching styles

Secondly, Australian AT teachers in particular have been exposed to a wide variety of training influences, including descendants of prominent first generation exponents Walter Carrington[], Patrick MacDonald[] and Marjorie Barstow[]. This has lead to a wide diversity of teaching styles, particularly in relation to the use of group work, practical application, ‘lying down-work’ (semi-supine) and the use of AT directions in the standard format. The curriculum design would have to pre-empt these differences sufficiently to enable participating teachers to work at maximum effectiveness, and be formatted in a manner able to be imparted in the 6-hour training session provided.

4.1.3.Minimal one-on-one hands-on time

Thirdly, since AT is primarily a kinaesthetic experience and skill, and the fundamental teaching tool for teachers is hands-on, or manual guidance, it seemed the class format of 6 students per 35 min class would leave little time for this individual hands-on work. (The normal ‘dose’ of lessons in order to gain basic proficiency is considered 24 one-on-one 35-45 minute lessons)[9]. []

 

4.1.4.Particular needs of musicians

Lastly, musicians have particular needs as AT students, since the success of the Technique’s application will ultimately not only be measured in physical terms (pain prevention, ‘the musician as an athlete’ []) but in its translation into expressive, artistic playing and performance. (Subsequent data collection showed that of the 22 participants in the AT Posture Trial classes who had previously had exposure to Alexander work, only 3 were consciously applying the Technique to playing their instrument often, 4 sometimes, 10 occasionally, and 5 were never applying it.)                                                                                                                  A difficulty in application is that the new Alexander directions, specifically as they apply to breathing and arm use, will almost certainly contradict the intricate neuromuscular patterns which have been deliberately cultivated by players, hours a day for decades, to serve a purpose in the playing. [TRB] These instrumental techniques are the norm amongst extremely talented and successful players, to whom the difference between healthy and unhealthy techniques may not be as obvious as it is to Alexander teachers.                                                                      Whilst learning AT, it is not always possible to prioritise good use in a performance, where accuracy is of the essence. As well, orchestral musicians have a particular set of ergonomic stresses, often including unsuitable chairs, cramped conditions and impaired sightlines.                                                                                                                                                          However, musicians also have particular advantages working with AT, often having an instinctive sense of the value of psychophysical unity (being in the ‘zone’), and are highly motivated to this end. Though they may be unaware of the primary control, they are usually accustomed to observing habits of use and to micro-refining neuromuscular coordination. Finally, improvements in use usually give immediate feedback in the instrumental tone as well as in a range of less tangible performance measures.

4.2. Principles of course design

Thus five principles emerged as crucial in the course design:

1.The first was to establish what would most likely be (for all AT teachers) the non-negotiable core concepts and procedures of Alexander’s Principle and Technique (listed under section 2.2.2), which would be embedded into every aspect of the curriculum.

2. To elucidate these AT principles constantly throughout the course, over-arching learning goals were established. These were for students:

• to gain conceptual understanding and knowledge of Alexander Technique
• to be able to bring about the working of the Alexander Principle within themselves in fundamental activities
• to develop basic skills in AT procedures, and
• to have experience with applying AT to playing their instrument in an orchestral setting.

Using the curriculum development model of backward design, [] the most effective learning tools to achieve these goals were identified.

3. In the absence of class-time for extensive one-on-one hands-on work, as many resources as possible would be used to clarify basic concepts and to guide the students’ kinaesthetic awareness.

4. In order to cover all the basic playing movements and functions in the detail necessary for players to meet the technical and musical demands of their instrument with the improved use, emphasis would be placed on working directly with sitting, breathing, hand and arm use as they occur in playing in an orchestral setting.

5. The group dynamic would be used as an advantage to maximise learning through listening to and watching other players.

4.3. Course structure and content

4.3.1. Alexander Technique procedures: 

Three of Alexander’s most common teaching activities or procedures were included:

Semi-supine involves lying on the floor (or a table) for about fifteen to twenty minutes with the head on about 8cm width of paperback books and the knees bent at right angles. The position neutralises the weight of the head and legs in relation to the spine, and allows for maximum lengthening of the spine to take place, maximum release of postural support musculature (since the body is not supporting its own weight against gravity), increased awareness of the entire back and rehydration of the intervertebral discs.

Monkey is the nickname given to Alexander’s ‘position of mechanical advantage’ for bending from the hips, knees and ankles whilst the head-neck-back relationship is maintained. Work can be carried out more effectively in this position than in bending from the ‘waist’.

Chair work, or STS (sit-to-stand, stand-to-sit) was a popular educational procedure used by Alexander. The pupil practises inhibiting the recruitment of habitual muscle pre-sets before moving, instead maintaining the primary control.

4.3.1. Resources

The resources used included anatomy models and charts, other images and a series of procedures and concepts developed over 25 years of working with musicians called The Resonant Body, a carefully graded practical application of AT to all aspects of playing.

The anatomical concepts and images were derived from the author’s ongoing study of anatomy as well as exposure to the work of Gorman (Learning Methods) [] and Conable’s Body Mapping (self-representation in the brain). The directions were clarified anatomically and visually to prevent confusion from semantics and to support the hands-on guidance. For example, a common impediment to releasing the neck and ‘sending’ the head forward and up is the mis-mapping of the atlanto-occipital joint. Mis-mapping of the hip joint can interfere with ‘back lengthening and widening’, a direction which can be further elucidated with visual images showing the interrelationship of muscular systems. Most inefficient breathing involves serious misconceptions regarding the positioning and function of lungs, ribcage and diaphragm, and many arm and shoulder tensions are caused by attempting movements contrary to the physiological design (such as trying to rotate the ulna instead of the radius).

Other images were used to counteract the typical assumptions of beginner AT students. Images of slightly built persons carrying extremely heavy loads on their heads []

show that the strength of the human design does not rely on muscle development. Images of musicians and athletes with excellent use re-train concepts of postural correctness and lead to perceptions of use as a quality, not a position.

The Resonant Body procedures address the phenomenon of reverse causality. If the contact points with the instrument (hands, embouchure, arm movements) contain deeply embedded patterns of malcoordination which form crucial functions in the playing, then AT primary control is very difficult to maintain whilst playing. Players needs to be shown alternative movements and contacts which are characteristic of good global use but which also precisely perform the necessary functions on the instrument.

 

4.3.2. Content

The content was divided into 16 Units (1 Unit per class), with foundational material presented first then developing in complexity and also moving from general principles through to instrument-specific ones. Although the same material had to be covered by all teachers and orchestras in each session, there was some leeway for individual teacher strengths and pupil needs. [Appendix 1 shows the Unit structure.]

The first two units explained what AT was not, since uninitiated pupils usually think they are attending in order to correct their postural faults and learn to ‘stand up straight’. They also often have notions of the AT being about ‘relaxation’. It was important to re-educate these concepts in order to immediately teach inhibition of the preconceived ‘good posture’ neuromuscular ‘set’.

The AT directions were introduced immediately in their standard format (“neck free, head forward and up, back lengthen and widen”), with pupils being given a preliminary experience of the resultant sense of kinaesthetic lightness in standing, walking and sitting.

The introduction of semi-supine was delayed till the third class, so that the players’ initial association with AT was the ability to modify their co-ordination during activity, immediately giving them a tool to explore in the orchestral setting.

The following Units explored body mapping and directions involved in applying AT to standing, walking, sitting, STS (sit to stand) and breathing. The main goal was to support the process of inhibition by correcting and clarifying body maps and provide an experience of how these parts functioned when the whole ‘self’ was freeing up and expanding.

Next was individual set-up, (5 mins each) where each musician was guided through bringing the instrument into playing position whilst sitting, followed by guidance with the precise arm, hander and finger use needed for particular playing needs.

Then the basic primary control was reinforced with emphasis over two units on whole body co-ordination in monkeys, lunges, spirals and sitting spirals. Focus was on the relevance of spiralling movements to cueing (leading), turning pages, and looking at other players in an orchestral setting. The next 6 Units involved individual work; firstly setup (5 minutes each), this time looking at particular ergonomic issues in the orchestral setting (chair height and position, sharing a stand, avoiding unnecessary body twists). Over the next 5 Units players each had 2 x 10 minute ‘turns’ working with their instrument whilst teachers and players were given the choice of using the rest of the time with revision, semi-supine or both.  415

 

 

4.3.3. Training Manuals

The curriculum documents consisted of:

• Two large books of A4 images for ‘mini’-presentations, (given the predicted absence of available PowerPoint facilities)
• A training manual for teachers and a supplementary manual of the Resonant Body procedures.
• Students’ handouts for each Unit/lesson
• A student’s manual, given out at the end, collating the handouts in a more convenient format.

Teachers’ Manual

Each Unit had up to six sections headed Revision, Goals, Concepts, Knowledge, Teacher Activities, Resources. [Some examples of each section are given in Appendix 2].

Students Handouts

The students’ handouts contained suggestions for self-observation during the week mainly as a focus for inhibition work. Suggested procedures and activities were included to reinforce the Unit learnt, pace the learning activities from simple to more complex and direct revision of past learning [Examples in App.2] Visual aids (anatomy diagrams etc) were often included.

4.3.4. Discussion

Practical emphasis was placed throughout on applying AT in an orchestral context. Even so, due to time constraints and group format, individual hands-on work was very limited, with the total allocated amount of formal individual work with the instrument being thirty minutes. However, it was hoped that the musicians would independently implement the fundamental principals in the lead-up to their individual turns, as well as learning by watching each other.

For the participating AT teachers, delaying the teaching of semi-supine and monkey was somewhat controversial; however priority was given to providing class members with tools for direct practical application of AT, highlighting the difference between AT and other modalities. In this way, orchestral rehearsals and performances became opportunities for the players’ own ‘laboratory work’.

The teaching of the use of various secondary movements directly (arms, hands, breathing, jaw use, tonguing) and at the initial stages of AT lessons is also controversial. The goal was to immediately bring to the fore confusions and apparent dichotomies that arise when AT sensations are applied to common instrumental techniques. For example, many string and keyboard players use ‘arm weight’ to achieve power, yet an AT teacher’s arm is light compared to a tight arm. Most wind and brass players have developed ‘diaphragmatic breathing’, yet Alexander  advocated ‘full chest breathing’. Such paradoxes are serious stumbling blocks to progress in application, but can be resolved and clarified with sound anatomical knowledge which prioritises the working of the primary control.

 

 

 

 

 

PART 5 – EVALUATION OF THE CURRICULUM

5.1. Method

Paradoxically, the evaluation of the results of this Alexander Technique intervention would necessitate determining if any results were the effect of the AT itself, the method of delivery through the structured curriculum, or both. For this reason, a short separate questionnaire was attached to the AT students’ post-trial questionnaire listing various elements of the course, asking them to rate how useful each element had been in helping them apply the AT to playing their instrument. See Appendix. Table 1.

A parallel questionnaire was given to each Alexander teacher, asking the teacher to rank the usefulness of the same elements in helping their students apply the AT to playing.

 

5.1.1. Teacher cohort

The actual teachers’ cohort (excluding the author) was a very homogenous group, comprising 7 senior teachers, with a mean score of 21 years of teaching experience, range = 11- 30 years. All were trained by descendants of first generation teacher Walter Carrington. The mean percentage of teaching that had previously been done in groups was roughly 17% (with a range of 0-50%), and for working with musicians, 15% (range = 0-40%). The author’s teaching experience and training background were consistent with this but group experience was 60% and experience with musicians almost 100%.

 

5.1.2. Teachers’ adherence

The teachers were asked to rank how closely they had followed the curriculum overall on the scale 0 – 11.  Adherence to the curriculum ranged from 4/11 to 11/11. The main reason given for low adherence was lack of training time (due to logistics, actual training time was 3.5 hours), thus some teachers did not feel confident with the unfamiliar material and ways of working from the Resonant Body method.

These 8 scores (one of the teachers taught two courses) allowed the AT students to be divided into 2 groups – those whose teacher followed the curriculum LESS closely – Group A (n=18), and those whose teacher followed the curriculum VERY closely – Group B (n=20).

A mean score for the students’ perception of the usefulness of each element was then taken for each group, where 0 = not useful and 3 = very useful, so 0 was the lowest possible mean score through to 3 the highest possible. The elements were then ranked from 1 to 10 for each group according to how useful they had been found to be in helping them apply the AT to playing their instrument.   Table

.

Followed RB Curriculum:
	Group A less closely		Group B more closely
Element	Rank	Mean Score	Mean Score	Rank	p value
AT Procedures	1	2.76	2.80	2	.83
AT Directions	2	2.72	2.95	1	.07
Hands-On	2	2.72	2.75	3	.88
Course Structure	3	2.50	2.60	5	.64
Anatomical Knowledge	4	2.11	2.53	6	.09
Watching Others	5	2.06	2.65	4	.01*
Instructional Images	6	2.00	2.45	7	.04*
RB Concepts and Directions	7	1.94	2.60	5	.01*
RB Procedures	8	1.89	2.60	5	.01*
Other Images	9	1.78	2.45	7	.02*
Handouts	10	1.59	2.24	8	.05*

F
	Group A less closely		Group B more closely
Element	Rank	Mean Score	Mean Score	Rank	p value
AT Procedures	1	2.76	2.80	2	.83
AT Directions	2	2.72	2.95	1	.07
Hands-On	2	2.72	2.75	3	.88
Course Structure	3	2.50	2.60	5	.64
Anatomical Knowledge	4	2.11	2.53	6	.09
Watching Others	5	2.06	2.65	4	.01*
Instructional Images	6	2.00	2.45	7	.04*
RB Concepts and Directions	7	1.94	2.60	5	.01*
RB Procedures	8	1.89	2.60	5	.01*
Other Images	9	1.78	2.45	7	.02*
Handouts	10	1.59	2.24	8	.05*

Followed RB Curriculum:
	Group A less closely		Group B more closely
Element	Rank	Mean Score	Mean Score	Rank	p value
AT Procedures	4	2.00	2.67	2
AT Directions	2	2.50	2.33	3
Hands-On	1	2.83	3.00	1
Course Structure	3	2.40	3.00	1
Anatomical Knowledge	2	2.50	3.00	1
Instructional Images	5	1.83	2.33	3
RB Concepts and Directions	7	1.40	2.67	2	.02
RB Procedures	6	1.50	2.67	2	.02
Other Images	5	1.83	2.33	3

5.2. Results

The top 3 elements are very similar for both groups and are in fact the generally agreed core elements of the Alexander Technique – the AT directions, the AT procedures and individual hands-on work. The course structure and the group format (‘watching others’) were also thought to be useful. The usefulness of the RB procedures, anatomical concepts and images tended to parallel the amount that the teachers had used them – in other words, the teachers in Group A had used them more than the teachers in Group B.

The mean scores of group A tend to be higher than group B for all elements, including the Alexander Technique core elements, but this difference in mean scores was only significant for usefulness of the handouts, watching others, instructional and other images, and the RB procedures and directions, showing again that these were judged useful by students according to the amount they had been used by teachers.

5.3. Conclusion

These figures give no indication as to the efficacy of the curriculum itself either in reducing injury rates or teaching good ‘use’ while playing. They also take no account of individual teacher effectiveness. We can however speculate that any results of the intervention were in fact the effect of the AT, since AT elements were consistently the most useful, and that the structured RB curriculum and group format were supportive of the effects of the Alexander Technique, providing teachers were comfortable working in with them.

FACTOR / ELEMENT	No Opinion/ Unsure	Not Useful	Slightly Useful	Quite Useful	Very Useful
Course structure: i.e.: basic skills & principles followed by application to playing
Student handouts
Individual hands-on work from AT teacher
Watching others in group
Anatomical knowledge (eg. correct location of AO joint & hip joints, points of balance)
Images: 1. instructional: (eg. anatomical drawings, pictures of people in ‘monkey’ or sitting)
2. other: (eg. ‘vertebrae as discs & balls’, ‘smiling discs’, athletes, musicians)
Alexander Technique procedures: (eg. ‘monkey’, semi-supine)
Alexander Technique directions: i.e. ‘neck free, head fwd & up, back lengthen & widen’
Resonant Body procedures (eg: ‘shoulder & arm release’, ‘smiling-space breathing’, ‘flying buttress”, talking to the hands’)
Resonant Body concepts and directions: (eg. ‘billowing’, ‘smiling to release’, space)
Other (please specify): ……………………………………………………

[1] Sherrington coined the term proprioception in 19..

[2] Has been offered at Juilliard and Aspen for 25 years and has been part of curriculum in RCM for decades.

[3] The educational philosopher John Dewey procured support for a scientific investigation from Rockefeller Foundation but Alexander declined.

d as evidenced in the Chapter  “The Golfer Who Couldn’t Keep His Eye On The Ball”.

[5] Before and after photos were to be taken and assessed for improvement, not considering that an ideal AT posture might have a look which is unfamiliar to those who haven’t experienced it.

[6] AT was included in the question: which of these physical activities did you do last week?)

[7] (Early in FM’s career he became careful to not use the words ‘posture’ or ‘position’ in connection with his work). []

[8] the first documented person known to use term Neuroplasticity was Polish Neuroscientist Konorski in 1948

[9] Alexander  required beginning students to come 5 times a week for a month, then 3 times a week for a month, and so on..