Potential Mechanisms of the Alexander Technique: Toward a Comprehensive Neurophysiological Model

By Timothy W. Cacciatore, Patrick M. Johnson, and Rajal G. Cohen

Editor’s note: This is an excerpt of a new scientific model of the Alexander Technique published in the Kinesiology Review. A pdf of the full paper can be read here.

Read the Japanese translation here


The Alexander Technique (AT) has been practiced for over 125 years. Despite evidence of its clinical utility, a clear explanation of how AT works is lacking, as the foundational science needed to test the underlying ideas has only recently become available. The authors propose that the core changes brought about by Alexander training are improvements in the adaptivity and distribution of postural tone, along with changes in body schema, and that these changes underlie many of the reported benefits. They suggest that AT alters tone and body schema via spatial attention and executive processes, which in turn affect low-level motor elements. To engage these pathways, AT strategically engages attention, intention, and inhibition, along with haptic communication. The uniqueness of the approach comes from the way these elements are woven together. Evidence for the contribution of these elements is discussed, drawing on direct studies of AT and other relevant modern scientific literature.

Keywords: body axis, body schema, muscle tone, musculoskeletal pain, postural tone, somatic practice


Evidence is mounting that practicing the Alexander Technique (AT) has a range of benefits. Clinical research suggests that it can help alleviate common musculoskeletal complaints such as chronic back, neck, and knee pain (Little et al., 2008; MacPherson et al., 2015; Preece, Jones, Brown, Cacciatore, & Jones, 2016). AT may improve responses to stress (Glover, Kinsey, Clappison, & Jomeen, 2018; Gross, Cohen, Ravichandra, & Basye, 2019; Gross, Ravichandra, & Cohen, 2019; Klein, Bayard, & Wolf, 2014; Valentine, Fitzgerald, Gorton, Hudson, & Symonds, 1995; Zhukov, 2019) while also improving motor performance on tasks as specialized as playing a musical instrument or as basic as standing, walking, and breathing (Austin & Ausubel, 1992; Cacciatore, Gurfinkel, Horak, & Day, 2011; Cacciatore, Mian, Peters, & Day, 2014; Cohen et al., 2020; Cohen, Gurfinkel, Kwak, Warden, & Horak, 2015; Hamel, Ross, Schultz, O’Neill, & Anderson, 2016; O’Neill, Anderson, Allen, Ross, & Hamel, 2015). See Woodman and Moore (2012) for a fairly recent clinical review. Until now, however, a comprehensive explanation for the mechanisms by which AT operates has been lacking (Woodman & Moore, 2012).

Because of its century-long history, AT suffered scientifically from being “ahead of its time.” Initial investigations into possible mechanisms of AT had to rely on sparse scientific literature (see Barlow, 1946; Jones, Hanson, Miller, & Bossom, 1963) that referenced reflex models of posture that are now known to be out of date (Davidoff, 1992). In addition, the comprehensive and multifaceted nature of AT does not lend itself to simple experimental designs, and the foundational science and technology needed to test the underlying ideas have only recently become available.

In recent decades, our collective understanding of neuroscience and psychology has progressed immensely, such that there are now solid bodies of research in which to ground our theories and research. In the last 15 years, some reports addressing possible mechanisms of AT have been published (Becker, Copeland, Botterbusch, & Cohen, 2018; Cacciatore, Gurfinkel, Horak, Cordo, & Ames, 2011; Cacciatore, Gurfinkel, Horak, & Day, 2011; Cacciatore et al., 2014; Cohen et al., 2015, 2020; Hamel et al., 2016; Loram, 2013; O’Neill et al., 2015), while other research has elaborated on concepts relevant to AT’s function.

In this paper, we propose a comprehensive model of the underlying mechanisms of AT. Based on published evidence, we posit that mental phenomena such as intention and spatial attention influence postural tone, the background muscle activity that stabilizes body configuration—and that these changes in postural tone in turn affect many aspects of the motor system. We further posit that broader research on interconnections between postural tone and body schema may help explain changes in body-based self-perception through AT training. Although AT affects pain and is likely to affect mood, our model suggests that those effects are downstream from (or at least interdependent with) changes in the motor system.

A key purpose of our model is to explain AT’s generalizability, meaning that something learned in one task carries over to other activities. By explicating the role of postural tone in motor activity, we can start to understand how AT can have such a wide range of effects.

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About the Authors

Cacciatore is with Society for Teachers of the Alexander Technique, London, United Kingdom. Johnson is with the Dutch Society for Teachers of the Alexander Technique, Amsterdam, the Netherlands. Cohen is with the University of Idaho, Moscow, ID, USA. Cohen (rcohen@uidaho.edu) is corresponding author.

3 thoughts on “Potential Mechanisms of the Alexander Technique: Toward a Comprehensive Neurophysiological Model

  1. Thank you, Tim, for responding to my communication. I only just discovered it last night, or I would have tried to add these words sooner.

    Since I don’t possess enough understanding of the technical vocabulary that scientists use for discussing the points you make, I don’t feel qualified to respond properly or adequately, even though my experience of the Technique itself is fairly extensive.

    However, I would like to point out one aspect that I feel begs investigation. And that is the fact–in my experience–that there can be a very wide range of competency in the use of the hands to influence the working of another person’s functioning in relation to gravity. And that range–sometimes even within the same person in a matter of moments–can range from quite superb through merely adequate, to ineffective, and even downright barbaric. And that factor seems rarely, if ever, acknowledged.

    It’s hard to imagine, though, that there will ever be an objective, external means for evaluating that skill in the use of the hands to show how it may differ from other manual approaches to fostering human well-being–and particularly to show how it depends upon the quality of the general use of the teacher from moment to moment.

    I suppose that the subject of the difference between conditions of use and manner of use would be another one that would be good for science to address. I have tried to point it out in my article “A CRUCIAL DISTINCTION:
    MANNER AND CONDITIONS OF USE IN TEACHING THE ALEXANDER TECHNIQUE AND ALEXANDER TEACHER TRAINING, ” but I’m not very confident that I did that successfully enough for it to be taken seriously

    Thanks so much for taking the time to address my questions and comments. I really do appreciate it, and I wish you and your team great success with your endeavors to clarify all the components of the Technique.

    Joe Armstrong

  2. Dear Alexander Technique Science,

    I have just finished reading your paper “Potential Mechanisms of the Alexander Technique: Toward a Comprehensive Neurophysiological Model” in hopes that I might find some answers in it to the recent questions I posed;

    “. . . I’m hoping you can tell me if any studies have been done that demonstrate what happens neurocognitively (?) and neuromuscularly when we (not “the brain”) consciously “direct either some part or the whole of ourselves while we are relatively still–as distinct from consciously “executing” a movement/motion through space?

    “And, if such a study has been done, and if it’s been clearly established what happens when we direct some part or the whole of ourselves while we are relatively still, have there been any other studies that demonstrate how this capacity/skill of directing allows us to enhance or alter the quality of muscle tonus in another person’s neuromuscular system (if that’s the correct description for what’s happening) through various manual contacts when the other person is either still or is being moved by us or is moving by his or her own volition?”

    And, especially with those questions in mind, I was interested to read in your section “Speculation on the Nature of Hands-On Instruction in AT” that you write that “AT can be taught without manual contact . . . .” Most of the Alexander teachers that I have known over the last 55 years would not agree with that statement.

    And, in general, the paper seems to avoid any mention whatsoever that a good part of most “traditional” Alexander lessons include some “lying-down
    work” with the student/pupil on a table or on the floor. My own experience with the Technique-both in receiving work from many other teachers and from teaching private pupils and training teachers has included a very great deal of lying down work. In fact, in some cases, the lying-down hands-on work I’ve received from other teachers has been of extraordinary benefit and importance. For instance my long-term exchange of work with first-generation teacher Kitty Wielopolska involved lying-down work exclusively. And that was, perhaps some of the most valuable Alexander hands-on work I’ve ever experienced–especially in terms of its carry-over into “regular upright activity.” And, more recently, I spent three weeks visiting a senior colleague in which I gave her two sessions of lying-down work every day–work that neither of us would have said was not the Alexander Technique because I wasn’t working with her while she was in an upright relation to gravity at any time. Her comment to me about it later was, “That was unbelievable!”

    And, in that regard as well, it may be useful for me to mention that, in teaching, when asking pupils to lie down on a table so that I can give them hands-on work there, I say that I’m not trying to help them to “relax,” but that I’m hoping to bring them as close to standing up as possible while they’re still lying down. And telling them this usually helps to avoid the kind of “collapse” of the supportive function of their musculature in relation to gravity’s constant pull that so many people usually give in to when they lie down (and sit down too, for that matter).

    There’s a good deal more I could say on the subject, but I think this gives you some idea of my view, which I believe is also the generally held view of many other colleagues on these matters.

    I hope my response here may contribute in some way to expanding the scope of your investigations. To view the Technique as something that pertains only to being in the (“behavioral”) upright in relation to gravity seems to be a common feature of many people’s thinking these days that surely needs to be reckoned with for the Technique to be fully investigated.

    All my very best wishes,


    Joe Armstrong

    1. Hi Joe,

      Many thanks for your interest and comments here and on Andrew’s review article.

      The paper doesn’t stress lying down to avoid confusion from AT–naive readers with relaxation or therapy but the effects one observes from lying down are very much incorporated into – if not a defining aspect of – our model. The confusion we wanted to avoid in the text of the paper is that of students being mentally passive.

      Of course it is a common observation that table work changes one’s organisation in action and we agree this is both an important observation to explain and gives key insight into what’s going on. We absolutely think that the postural state that informs the tonic responses to loading when upright or during activity can also be addressed while at rest. This is why we describe the core of the model as a postural state that influences resisting and yielding rather than a learning a skill to specifically match forces in a particular context or way. Even in chair work much of the contact is during quiet periods of sitting or standing so whatever is happening has to generalise from changes occurring during supine or maintaining postures. Moreover, there is evidence that higher level influences on tone affect both resting tone and tonic loading responses. Thus we think the postural state relevant to the Technique is a persistent underlying phenomenon that can be addressed at rest as well as in activity.

      Probably the closest we have to date on what happens with AT direction are the Lighten-up studies comparing subjects in Twister immediately before after AT-like instructions as they stood quietly. Other studies with Twister observed similar, albeit larger, effects with AT teachers and after AT lessons. In these studies, while subjects weren’t instructed specifically to direct, the changes were consistent the direction-like instruction given to AT naive subjects. Also in Neil Roberts and Malcom Williamson’s pilot study with fMRI, the subject was lying down and directing.

      Regarding hand contact our point is that AT instruction sometimes occurs without it, even in a face to face lesson lesson full of hands on, for instance when a teacher sees a student’s pattern and verbally cues them. In that regard, the AT critically differs from say osteopathy where hand contact is the sole form of interaction. We are not denying the role of hands-on nor implying anything about the efficacy of teaching without hands. Part of what the student is learning is a skill that can be performed without manual guidance.

      I hope this addresses your questions, Thanks again for getting in touch and your supportive comments.

      With best wishes,
      Tim Cacciatore

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