Alexander Technique Lessons or Acupuncture Sessions for Persons With Chronic Neck Pain

MacPherson, Hugh; Tilbrook, Helen; Richmond, Stewart; Woodman, Julia; Ballard, Kathleen; Atkin, Karl; Bland, Martin; Eldred, Janet; Essex, Holly; Hewitt, Catherine; Hopton, Ann; Keding, Ada; Lansdown, Harriet; Parrott, Steve; Torgerson, David; Wenham, Aniela; Watt, Ian

doi:10.7326/m15-0667

Cited by 131 publications

(72 citation statements)

References 34 publications

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“…The lessons were delivered over a 12 week period, twice a week for the first 8 weeks and weekly for the final 4 weeks. This rate of delivery was chosen to ensure similarity with other clinical trials investigating the AT, as well as with routine practice [31, 32]. …”

Section: Methodsmentioning

confidence: 99%

“…For example AT lessons have been shown to improve clinical outcomes in people with chronic low back [31], reduce pain in individuals suffering with neck pain [32] and also to improve self-reported disability and depression in people diagnosed with Parkinson’s disease [33]. Research has also demonstrated that training in the AT can improve neuromuscular coordination and enhance the dynamic regulation of postural tone [34, 35].…”

Section: Introductionmentioning

confidence: 99%

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Reductions in co-contraction following neuromuscular re-education in people with knee osteoarthritis

Preece

Jones

Brown

et al. 2016

BMC Musculoskelet Disord

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BackgroundBoth increased knee muscle co-contraction and alterations in central pain processing have been suggested to play a role in knee osteoarthritis pain. However, current interventions do not target either of these mechanisms. The Alexander Technique provides neuromuscular re-education and may also influence anticipation of pain. This study therefore sought to investigate the potential clinical effectiveness of the AT intervention in the management of knee osteoarthritis and also to identify a possible mechanism of action.MethodsA cohort of 21 participants with confirmed knee osteoarthritis were given 20 lessons of instruction in the Alexander Technique. In addition to clinical outcomes EMG data, quantifying knee muscle co-contraction and EEG data, characterising brain activity during anticipation of pain, were collected. All data were compared between baseline and post-intervention time points with a further 15-month clinical follow up. In addition, biomechanical data were collected from a healthy control group and compared with the data from the osteoarthritis subjects.ResultsFollowing AT instruction the mean WOMAC pain score reduced by 56 % from 9.6 to 4.2 (P < 0.01) and this reduction was maintained at 15 month follow up. There was a clear decrease in medial co-contraction at the end of the intervention, towards the levels observed in the healthy control group, both during a pre-contact phase of gait (p < 0.05) and during early stance (p < 0.01). However, no changes in pain-anticipatory brain activity were observed. Interestingly, decreases in WOMAC pain were associated with reductions in medial co-contraction during the pre-contact phase of gait.ConclusionsThis is the first study to investigate the potential effectiveness of an intervention aimed at increasing awareness of muscle behaviour in the clinical management of knee osteoarthritis. These data suggest a complex relationship between muscle contraction, joint loading and pain and support the idea that excessive muscle co-contraction may be a maladaptive response in this patient group. Furthermore, these data provide evidence that, if the activation of certain muscles can be reduced during gait, this may lead to positive long-term clinical outcomes. This finding challenges clinical management models of knee osteoarthritis which focus primarily on muscle strengthening.Trial registrationISRCTN74086288, 4th January 2016, retrospectively registered.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Reductions in co-contraction following neuromuscular re-education in people with knee osteoarthritis

Preece

Jones

Brown

et al. 2016

BMC Musculoskelet Disord

View full text Add to dashboard Cite

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“…15 In an interview, Laine pointed to a trial her journal and the COMPare team had tussled over for months (box 1).…”

Section: Journal Dissentmentioning

confidence: 99%

“…The journal's editor, Jeffrey Drazen, has been a longtime supporter of trial registration, [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] and NEJM was the first of its peers to publish trial protocols alongside trial publications, a practice now followed by JAMA, The BMJ, and most recently-in part thanks to COMPare 27 -Annals.…”

Section: Journal Dissentmentioning

confidence: 99%

“…COMPare says it found evidence of incorrectly reported outcomes 16 17 in a trial of the Alexander technique and acupuncture for chronic neck pain 15 : "There were 3 pre-specified primary outcomes (one score at 3 timepoints). Although data for all 3 time points is reported in the paper, it is also incorrectly stated that the primary endpoint was at 12 months, when no such ranking is given in the registry entry," COMPare wrote to Annals last November.…”

Section: Box 1: Compare Versus Annals Of Internal Medicinementioning

confidence: 99%

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Is this trial misreported? Truth seeking in the burgeoning age of trial transparency

Doshi¹

2016

BMJ

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Acupuncture for neuropathic pain in adults

Wang

Cui

et al. 2017

Cochrane Database of Systematic Reviews

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Due to the limited data available, there is insufficient evidence to support or refute the use of acupuncture for neuropathic pain in general, or for any specific neuropathic pain condition when compared with sham acupuncture or other active therapies. Five studies are still ongoing and seven studies are awaiting classification due to the unclear treatment duration, and the results of these studies may influence the current findings.

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Alexander Technique Lessons or Acupuncture Sessions for Persons With Chronic Neck Pain

Abstract: Arthritis Research UK.

Cited by 131 publications

References 34 publications

Reductions in co-contraction following neuromuscular re-education in people with knee osteoarthritis

Reductions in co-contraction following neuromuscular re-education in people with knee osteoarthritis

Is this trial misreported? Truth seeking in the burgeoning age of trial transparency

Acupuncture for neuropathic pain in adults

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