Tuesday, August 26, 2008

Health: Alexander technique 'does ease back pain'

Chronic back pain, which causes probably more disability and days off work than any other health condition, can be eased through teaching better posture via the Alexander technique, doctors say.

Back pain is notoriously difficult to treat and many people suffer from it for years. It is the biggest cause of sickness absence in the UK and some people are unable to work at all. Lower back pain affects seven in 10 people at some time in their lives.

A study published online today by the British Medical Journal, referring to a trial with 500 patients, offers some hope.

The experiment, run by researchers at the universities of Southampton and Bristol, found that patients who were taught Alexander technique and combined it with exercise were significantly better at the end of a year.

The technique helps align the head, neck and back muscles. The patients reported less pain and a better quality of life after taking up the technique, and some said they were able to do things which previously had been difficult - such as walking normally, getting out and about, and doing household jobs.

Professor Paul Little of Southampton's faculty of medicine and his colleagues recruited 579 patients from 64 GP practices in the south and west of England. Each practice wrote to a random selection of patients who had seen a doctor because of recurrent back pain over the previous five years. They excluded any with serious spinal disease and those who had tried the Alexander technique before.

The patients were either given normal care, massage, six lessons of Alexander technique, or 24 lessons. Half the patients in each group were also given an exercise programme involving walking briskly for 30 minutes a day, five days a week.

Massage relieved the pain for the first three months, but the benefit did not last. But patients who had been trained in the Alexander technique reported less pain and an ability to do more by the end of the year. Those who had had six lessons and stuck to an exercise routine did almost as well as those who had 24 lessons.

Little said he was a little surprised at the result. "I had a pretty good suspicion that people who were well-motivated would do well with the technique, but you have to be committed to learning it for it to benefit you. I suspected most folks might not be that committed and so we might not show terribly much." Although most trials of back pain interventions have not had particularly good or convincing results, Little said this one was significant. "This is a good, large, trial. It is good enough evidence for people to take it seriously."

Those who combined Alexander technique with exercise improved by about 40% to 45%, he said. Generally they had been limited in eight or nine activities, but at the end of the 12 months they could do three or four of those without restriction. "It's a simple, cheap intervention," said Little. "But at the moment the Alexander technique is not available on the NHS."

The cost was about £30 a lesson, he said, which would make even a six-lesson course something of a bargain if it cut the amount of NHS time and resources taken up by back pain sufferers.

The Right Age for Drinking

COLLEGE OFFICIALS who have signed on to the provocative proposition that the legal drinking age of 21 isn't working say that they just want to start a debate. Perhaps when they get done with that, they can move on to whether Earth really orbits the sun. Any suggestion that the current drinking age hasn't saved lives runs counter to the facts.

More than 100 presidents and chancellors from such top universities as Duke and Johns Hopkins say it's time to rethink the drinking age, contending it has caused "a culture of dangerous, clandestine 'binge-drinking.' " The statement does not specifically advocate reducing the drinking age, but many who signed it say they thought legal drinking should begin at 18.

Health and safety experts have reacted with dismay, because raising the drinking age has saved many lives. In 2001, the Centers for Disease Control and Prevention reviewed 49 studies published in scientific journals and concluded that alcohol-related traffic crashes involving young people increased 10 percent when the drinking age was lowered in the 1970s and decreased 16 percent when the drinking age was raised. The retreat from a lower drinking age translates into some 900 lives saved each year among 16- to 20-year-olds. Those who would argue that other factors, such as safer cars, are responsible should take a good look at numbers posted by Mothers Against Drunk Driving showing alcohol-related traffic fatalities among 16- to 20-year-olds decreasing 60 percent between 1982 and 2006 while non-alcohol-related fatalities increased 34 percent.

The college presidents are right about binge drinking. Each year, some 1,700 college students die from causes related to alcohol use; there is also the toll of injuries and sexual assaults fueled by alcohol. But where is the logic of solving the underage drinking problem by lowering the age even more? Henry Wechsler, the Harvard expert whose studies of binge drinking popularized the phrase, put it best, comparing lowering the drinking age to "pouring gasoline to put the fire out."

Work by experts such as Mr. Wechsler, as well as the experience of college officials committed to solutions, shows that strong steps to enforce the law and change the culture can produce results. Instead of talking about lowering the drinking age (and thereby shifting the problem to high schools), colleges should be working to develop better enforcement methods, expand education and counseling, and end pricing practices that make alcohol more accessible and attractive. Then, too, college officials can stop winking at fraternity bashes that, whether they are willing to admit it or not, add to the allure of going off to college.