68

F.M. Alexander

The origin of the Alexander Technique

Frederick Matthias Alexander was born in Tasmania in 1869. A premature

baby with some health problems, he survived thanks to the care of his
mother. During school he developed a passion for theatre and literature,
and in particular for Shakespeare.
As a young man, unfit for hard work in the fields, he went to the city of
Melbourne to work for a mining company. He grew bored with mining
and became more and more involved in dramatic recitations.
However, Alexander began to suffer a hoarse throat, and after some
performances could hardly speak. Friends also noticed audible "gasping"
during his recitations. Concerned about his throat, he consulted several
doctors, but they all claimed that there was nothing wrong and that he just
needed to rest.25
It occurred to him that if what caused his troubles was not due to a flaw
within himself, there must be a flaw with what he does. The young F.M.
began to observe himself with the aid of several mirrors, as described in his
book The Use of the Self. 26 In twelve years, he was able to overcome those
problems that had beset him. Freed of his vocal problems, Alexander gave
up his clerical jobs and embarked on a career as a professional reciter and
voice teacher.
During the early stage of his career, Alexander was called The Breathing
Man.27 He understood that the problem in speech was related to
breathing, to the fact that he was pulling his head back and stiffening the
chest, impeding the proper expansion and contraction of the ribs. But he

25 Alexander, F. M.(1932). Reprint. The Use of the Self. E. P. Dutton & Co., Inc., New York.
26 idem.

Bloch, M. (2004). F.M.The Life of Frederick Matthias Alexander, Little, Brown Book Group,
27

USA.
 69

did not know any other way to breath and speak, and he fell in the trap of
thinking that acting with more conviction was the way to be successful.
After a while, he had to give up and admit he was totally wrong. He
discovered that better speech did not depend on stronger muscles. He gave
up wanting to be right, wanting to speak and breathe correctly. 28
Dropping the presumption, dropping the attitude of wanting to fix himself
to be successful, speech begin to flow out of his mouth as firm as
articulated. In that very moment, the sudden release of tension made him
breathe! The right thing had happened by itself. He had overcome all
breathing problems and was no longer sucking the air in and gasping
during his recitations.
His friends recognized that he had changed into a different man, a good
actor. From that moment onward, he begun to say that breath is life; and
that breathing capacity is the measure of life.
Yet he was not claiming to have discovered a new method of breathing.
One of his most famous quotations was: I see at last that if I do not breathe...
I breathe. 29

Inhibition and Direction

Through observation, Alexander came to the conclusions that his speech

problem was due to the fact that he was pulling his head back and
depressing the larynx while speaking provoking general shortening in
stature and lack of breath.
Struggling to obtain a result as fast and directly as possible is commonly
seen as the only way to be successful. Alexander called such tendency end-
gaining. On the contrary, he learned, only by giving up that eagerness of
wanting to be right—which can manifest both in making too much effort
or not using enough energy—he could prevent from stiffening and

28 Alexander, F.M. (1939). Evolution of a Technique. The use of the self: its conscious direction in relation
to diagnosis, functioning and the control of reaction. Taylor & Francis, New York.
29 Alexander, F.M. (1908). Why Deep Breathing and Physical Culture Exercises do more Harm than
Good, from Articles and Lectures. F. Matthias Alexander. Mouritz, London.
70

tensing, and had more possibility to succeed. He refrained from acting

with impatience and anxiety.
Moreover, he found that pulling the head back and depressing the larynx
occurred already before he actually attempted to speak, as a response to an
intention, to a desire to speak. The more he observed himself acting, the
more he discovered that the pattern of misuse of the neck involved also
head and trunk. Also, he found that speech wasn’t the only activity
impaired by such misuse, but equally all other activities he performed
seemed to be compromised in the identical way.
By keeping eyes open, not focusing or concentrating on something but
maintaing a panoramic view, Alexander found that his neck released and
his head became lighter. Maintaing the direction the head forward and up
would naturally take the pressure off the discs of the spine. Moreover, he
discovered that, by allowing the shoulders to release, the knees to unlock,
he could sense more clearly the whole of his back lengthening and
widening. Enabling the head to balance freely on top of the spine, the
result was also a release of the erector muscles of the back and legs.
This practice he had discovered enabled him to move as a whole, to have
an overall awareness of his own body in a mindful way. He become skilled
in fluid, coordinated movement. In his words:

Once this misdirection was inhibited, my next step would be to discover what
direction would be necessary to ensure a new and improved use of the head and
neck, and, indirectly, of the larynx and breathing and other mechanisms... and in its
place employ my reasoning processes [...] to select [...] the means-whereby a more
satisfactory use could be brought about, and then, to project consciously the
directions required for putting these means into effect.30

This process of “inhibiting and directing” is the core of the Alexander

technique and it is what we deal with during Alexander lessons. Since the
main problem is that whatever we are asked to do—or we ask ourselves to
do—we act with excessive tension, waisting energies in endless tries and
repetitions which only need to frustration, we must learn to leave
ourselves alone and make sure that we inhibit harmful habits before acting.

30 Alexander, F.M. (1932). The Use of the Self. E. P. Dutton & Co., Inc., New York.
 71

As we undo tensions, we should think those “directions” in a formulation,

which Alexander himself used, as follows: let the neck be free, to let the
head go forward and up, to let the back lengthen and widen, all together,
one after the other. Directions have to be thought one after the other, in
the proper order, but also all together at the same time. The result of
directing is immediate:

Going forward and the spine lengthening, you are taking pressure off the discs, you're
taking pressure off the joints, so that the whole structure is more mobile. It's more
elastic. It's more free. Whereas, if you do the opposite, you tighten and compress and
shorten. Then everything, instead of getting mobile and free, gets fixed and stiff. 31

Primary Control

Alexander discovered that the quality of the relationship between neck,

head, and back determines the quality of coordination. When such relation
is dynamic, a person is well coordinated and has a “good use”, while when
such relation is not fluent it means that one is “mis-using” himself.
Alexander defined such a relationship primary control.
All vertebrates maintain such dynamic relationship throughout a variety of
behaviors, organizing their actions in a natural and intelligent manner to
meet needs.32 Observation led him to conclude that a sophisticated use of
the hands and the development of mental faculties in mankind had led to
a loss of co-ordination and awareness of primary control. As Gerard Foley
explains in his inspiring text about the Alexander Technique:

Normally, the inhibition of the muscles not required for a particular action takes place
automatically. But the roots of human versatility, and freedom of action, lie in the
extent to which the cortex, the thinking part of the brain, can be used to override
automatic, or reflex, functioning. It enables humans to perform actions which are
beyond the most remote bounds of animal behaviour; it equally enables them to
develop habits of behaviour that affect the individual as a whole, in uniquely self-

31Carrington, W. (1999). The Act of Living:Talks on the Alexander Technique, Mornum Time Press,
San Francisco, USA.
32 Carrington, W. (2004). Talk: What is the Alexander Technique?
72

damaging and destructive ways. 33

fino qui

In 1924 Alexander's intuition was confirmed from a theoretical perspective

when the German professor Rudolf Magnus 34 published his book about
the physiology of posture.35 Magnus stated that correct functioning was
dependent on the alignment of the head, neck and back, and on correct
sensory perception.36 Although some studies report differences between
Magnus’ approach and Alexander’s technique, the central element of
convergence of the theories is primary control.
George Coghill, a developmental biologist, heard of the Alexander
Technique in 1939 and was immediately struck by Alexander’s
conclusions. He met and worked with Alexander, over a long weekend full
of exchanges and work.37 The reason Coghill was so impressed by
Alexander discovery was that he felt that his conclusions, gained through a
practical work, were very similar to his own, obtained through years of
scientific research.
Coghill pointed out that movement in mammals involves the activation of
a total pattern, characterized by the fact that the body follows automatically
when the head moves, or, on the opposite, it involves a process of
individuation, a partial reaction of a segment that leaves the rest of the body
alone. The two processes are independent and should not interfere with

Foley, G. (2012). George Ellett Coghill and the Alexander Technique, posted on http://
33

www.geraldfoley.co.uk/012 on January 3rd, 2012.

34 Althoughhe was a pharmacologist, this research made him world famous. For his work, he
was nominated for the Nobel Prize in 1927, but his sudden death in 1927 rendered this
nomination impossible.
35 Magnus, R. (1924). Körperstellung: experimentell-physiologische Untersuchungen über die einzelnen
bei der Körperstellung in Tätigkeit tretenden Reflexe, über ihr Zusammenwirken und ihre Störungen. Mit
263 Abbildungen. Julius Springer, Berlin.
36 “. . . the
experiments which led to my discovering that there is a primary control of the use
of the self, which governs the working of all the mechanisms and so renders the control of the
complex human organism comparatively simple. This primary control, called by the late
Professor Magnus of Utrecht the central control, depends upon a certain use of the head and neck
in relation to the use of the rest of the body”.
Alexander, F. M. (1932).The Use of the Self. Methuen, London.
37 As a result, Coghill wrote an appreciation for F.M. Alexander’s book, titled Constructive
conscious control of the individual, published in 1923.
76

Learning the Alexander Technique

Lessons

The Alexander technique is primarily taught one-on-one in private

lessons from a half-hour to an hour in length, and are taught in a series.
Introductory workshops or workshops for special applications of the
technique (workshops for musicians, dancers, actors) are also common.
The basic procedure in an Alexander technique lesson is getting students
in and out of a chair. Since every action we accomplish is affected by
similar patterns of misuse, the chair work is chosen among all because
almost everyone can perform it and also practice it in daily life.
When a student initiates a movement, for example when she is beginning
to sit down, she will tense her muscles in her habitual way. At that point,
the teacher asks her to put aside the intention to sit and to focus on
freeing her neck, direct her head and back. In this way the student is
focusing on the means where-by she can begin to move.
The student’s task is to consciously take time between stimulus and
response, and insert a new order in that time. As Alexander used to do, she
has to stop habitual responses: this is “inhibiting” in Alexander’s terms.
 77

Only when the old harmful patter is inhibited, will she begin to act
consciously and become able to direct herself: in the Alexander Technique
jargon that means to give oneself conscious orders by thinking
continuously to let the neck be free, to let the head go forward and up, to
let the back lengthen and widen. 46
Although repeating directions may seem similar to reciting a “mantra” their
finality of it is quite different. While the “mantra” allows to connect with
spiritual energies, the repetition of directions is a practical way of organizing
the self for moving and acting. Directing is a way to be aware of the whole
self as we move in order to accomplish concrete tasks, such as doing the
laundry or playing the piano.
Nowadays the concept of body and mind unity is widely spread among
people thanks to many oriental bodily disciplines that have become extremely
popular in the last decades. But still it is very difficult to bring that awareness
into daily—life experience. People accept the idea that body and mind are
one, but they do not know how to put this idea in practice. Only when
directions are embodied, incorporated will they affect the way we move.
During the course of a lesson the teacher guides the student through
simple movements by employing both verbal instruction and hands to help
her to identify and stop destructive patterns of tension. Tensing arises from
mental processes as well as physical, so the teacher will also tell the student
what kind of mental attitude is in the way to their full release of tension.
Alexander spoke of sitting and standing—so called chair work—as follows:

Boiled down, it all comes to inhibiting a particular reaction to a given stimulus—but

no one will see it that way. They will see it as getting in and out of a chair the right
way. It is nothing of the kind. It is that a pupil decides what he will, or will not,
consent to. 47

46 A mantra is a sound, syllable, word, or group of words that is considered capable of "creating
transformation". Its use and type varies according to the school and philosophy associated with
the mantra. Mantras originated in the Vedic tradition of India, becoming an essential part of the
Hindu tradition and a customary practice within Buddhism, Sikhism, and Jainism.The Sanskrit
word mantra (m.; also n. mantram) consists of the root man- "to think" and the suffix -tra,
designating tools or instruments, hence a literal translation would be "instrument of thought".
47 Alexander, F.M. (1995). Teaching Aphorisms in Articles and Lectures. Mouritz, London.
78

Thinking up

Alexander found that coordination and uprightness have to do with a wish

that involves the whole self.48 As it is explained by the curators of the
STAT web-site:

If a small child asks to be picked up and carried or cuddled, there will be a willingness
and a lightness throughout her body, despite the fact that, in allowing you to lift her
off the ground, she cannot possibly be helping you to take her weight. Conversely of
course, if the child wishes not to be lifted, or is perhaps very sleepy, she may feel
almost impossibly heavy and tiring to carry. Clearly, the difference between these two
situations is not in what the child does so much as in what she wishes. In the language
of the Alexander Technique we would describe this difference of intention by saying
that in making herself "heavy" or "light" the child's Direction of herself is different.49

Coordination depends on her wish, and not on voluntary muscle

contraction. The clarity in what she wants, either resting or being lifted,
determines the movement pattern she adopts. Such clarity is made possible
thanks to a clarity within herself. We may say that a child “aims up” or
“goes up” because she adopts instinctively the “manner of use” that allows
her to move according to her wish, ensuring the ability of coordinating
not only the body in specific actions, but the whole self with its luggage of
wishes.
Thinking up and going up are common encouragements that an Alexander
teacher will express to enhance a wish of uprightness, rather than a
mechanical replacement of our head and back. If we tense or stretch the
muscles voluntarily we will not get any significative improvement in
posture.
Being a natural reflex, uprightness occurs involuntarily when the weight of
the body is supported by the ground and the self aims up, undoing all
tensions that impede the proper release of the reflex.
When animals first evolved to survive on land, a form of skeleton would
have been developed to cope with the increase in the force of gravity.

48Alexander, F.M. (1932). The Use of the Self, Integral Press, Bexley, Kent, Third Edition
Reprinted.
49 STAT website: http://www.stat.org.uk/pages/principles.htm
 79

Later, there has been a pattern in primate evolution of an upright body

position. That change was probably due to an immense wish, and for sure
not to a voluntary replacement of the body.

Touch

The contact of the hands of an Alexander technique teacher is particularly

refined. They will be able to feel whether the student is inhibiting her
habitual pattern of reaction, releasing tension and breathing better. The
hands of the teacher will also indicate the proper direction to the neck,
head and trunk. All basic movements are explored and defects and parasitic
movements are eradicated. Apparently simple actions such as lifting the
arms to the front or to the side, turning the head and the torso, squatting,
walking and changing direction consciously while walking, whispering
and speaking, are the basis for almost all human movements. Once basic
coordination is established, more complex actions such as playing an
instrument, running, swimming, dancing and so on can be examined.
Improving general coordination, students will be able to solve also
particular or localized tensions.

Table work

During an Alexander Technique lesson, students will experience the so

called table work. Teachers ask the student to lie on a slightly cushioned
table, dressed in comfortable clothes, without shoes. The head will lie on a
number of books, so that it will be suspended forward and up, releasing the
neck, in much the same way a pillow does. Note that in Africa and
Oceania, tribes have always created objects out of wood on which to rest
their heads.
Knees up, soles of the feet in contact with the table, elbows will also be
bent, and the palms of the hand will rest on her chest. The student is
facilitated in giving directions by the fact that the table fully supports the
80

back. In this position, the teacher will move the student’s limbs without
interfering with the peaceful rest of her head, neck, and chest, and
improving release by relieving some of the pressure that the limbs have
produced in the trunk.The student will become more aligned and breathe
better.
Lying down allows the release of fixed postural twists that interfere with
spiralling movement and erect posture. Lying down, we need not fear
falling. So if in the student’s habitual way, lifting an arm could not be easily
dissociated from twisting the back, thanks to the support provided by the
floor a new way of moving can be carried out and acknowledged.

The whispered “Ah”

F.M. Alexander used to practice the so-called whispered “Ah” procedure,

and encouraged his pupils to experience it daily to improve their
consciousness of breathing. The whispered “Ah” as we know it, passed on
by four generations of teachers, works like this: allow your neck to be free
so that your head can go forward and up, think of something funny,
allowing the face to soften and the eyes to smile. The soft palate will lift
smoothly. Pressure on the throat will decrease as you lengthen. The tip of
the tongue is directed to the back of the lower teeth, and you allow the
jaw to move forward and down. The mouth opens and the sound “Ah” is
whispered. If you consciously direct the air out, the in-breath will happen
automatically. The air will flow in softly through the nostrils, reaching the
lungs, allowing more expansion in the ribcage at every whisper.
98

The axial skeleton

The axial skeleton is made up of the skull, the spine

and the ribcage while the appendicular skeleton is
made up of the pelvis and the limbs. Except for the
mandible, all of the bones of the skull are joined
together by sultures, synarthroidal (immovable) joints.
The atlanto-occipital joint (the atlas) is made by the
top cervical vertebra in our spine. Alexander
discovered that a freely mobile atlas joint is prerequisite
to the dynamic motion of the head, neck and back and
the natural flexibility of the entire organism. If the atlas
is held in tension, this diminishes the balance and
coordination of the entire body.
The spine (the vertebral column) consists of 24
articulating vertebras and 9 fused vertebras in the
sacrum and the coccyx. It houses and protects the
spinal cord in its spinal canal.
The articulating vertebras are divided into the 7
cervical, 12 thoracic, and 5 lumbar vertebras.
A lateral view of the vertebral column presents
several curves, which correspond to the different
regions of the column: cervical, thoracic, lumbar,
and pelvic.
The cervical curve, convex forward, begins at the
apex of the odontoid (tooth-like) process, and ends
at the middle of the second thoracic vertebra; it is
the least marked of all the curves. 71
The thoracic curve, concave forward, begins at the
middle of the second and ends at the middle of the
twelfth thoracic vertebra. The lumbar curve is more
marked in the female than in the male; it begins at
the middle of the last thoracic vertebra, and ends at
the sacrovertebral angle. The pelvic curve begins at

71 Dorland's Medical Dictionary.

 99

the sacrovertebral articulation, and ends at the point of the coccyx.

The thoracic and pelvic curves are termed primary curves because they
alone are present during fetal life. The cervical and lumbar curves are
compensatory or secondary and develop after birth, the former when the
child is able to hold up its head (at three or four months) and to sit
upright (at nine months), the latter at twelve or eighteen months, when
the child begins to walk.72
Babies begin to explore the world around them and to differentiate their
own body from the other bodies by experiencing differences through the
senses. At 8 months, they throw objects around, exploring the depth of
space and gravity; around 12-15 months, they begin to move in space and
motor activity is the way to discover the environment. In this period,
babies acquire basic postures: sitting, standing, crawling, supine and prone.
The self begins to have an autonomous configuration, which will expand
throughout the entire life.73
As they grow, some people tend to stiffen up, to push themselves up,
flattening or exaggerating the back’s curves, impeding the full range of
movements of the back.
The improper displacement of the head in relation to the back is the cause
of occurring compensation by arms and legs.
The misalignment of part of the musculoskeletal structure makes it unable
to absorb weight. In response, other muscles tighten up in order to protect
the joint. Over time, too much compression on joints can cause serious
structural damage.

72 idem.
73 Camaioni, L. (1996). La prima infanzia. Il Mulino, Bologna.
100

The ribcage

The ribcage consists of 24 ribs, the

sternum—also called the breastbone—
costal cartilages and the 12 thoracic
vertebras. The last two pairs of ribs are
called “floating ribs” because they are
attached to the vertebrae only, and not to
the sternum or cartilage coming off the
sternum.
When it reaches its full extension, the
ribcage forms a very wide ellipse that
contains vital organs such as the lungs and
heart. These provide the rhythm and the fuel for the flow of energy in all
our body. On the ribcage rests the shoulder-girdle, the part of the
skeleton that comprises clavicles and scapulae, which connect the arm to
the torso through tendons and muscles alone (there is no bony attachment
between arms and trunk).74
Excessive contracting of the muscles around armpit and shoulders will pull
down the pectoral region, impeding full breath. The width of the trunk is
diminished and the figure results “narrow”. Whenever the musculature
around the ribcage is too tensed proper breathing is impeded.
Undoing those tensions by rebalancing the extensors and flexors
(musculature in the back and front of the trunk) is very important in order
to avoid severe breathing and circulatory problems.

The diaphragm

Anatomically speaking, the diaphragm is a dome-shaped, muscolo-fibrous

septum that separates the thoracic from the abdominal cavity, its convex
upper surface forming the floor of the former, and its concave

74 The space created by the junction of the clavicle to the scapula allows the upper arm bone to
rotate. It is actually the joint with the widest range of movement in the body.
 101

lower   surface forming the roof of the latter. Its peripheral part consists of
muscular fibers that originate at the circumference of the inferior thoracic
aperture and converge into a central tendon. The diaphragm is primarily
innervated by the phrenic nerve, which stems from the cervical nerves
C3, C4 and C5.
Inhibiting the tension in the neck and getting the full length and width
in the chest is this condition for letting the diaphragm work naturally. 
When you breathe in, the diaphragm
moves downward. This increases the space
in your chest cavity, into which your
lungs expand. The intercostal muscles
between your ribs also help enlarge the
chest cavity. They contract to pull your
rib cage both upward and outward when
you inhale.   As your lungs expand, air is
sucked in through your nose or mouth.
The air travels down your windpipe and
after passing through your bronchial tubes, the air finally reaches and
enters the alveoli.Through the very thin walls of the alveoli, oxygen from
the air passes to the surrounding capillaries.
At the same time, carbon dioxide moves from the capillaries into the air
sacs. The gas has traveled in the bloodstream from the right side of the
heart through the pulmonary artery.When you breathe out, your
diaphragm relaxes and moves upward into the chest cavity. The intercostal
muscles between the ribs also relax to reduce the space in the chest
cavity.As the space in the chest cavity gets smaller, air rich in carbon
dioxide is forced out of your lungs and windpipe, and then out of your
nose or mouth.
Breathing out requires no effort from your body unless you have a lung
disease or are doing physical activity. When you're physically active, your
abdominal muscles contract and push your diaphragm against your lungs
even more than usual. This rapidly pushes air out of your lungs.
 103

When I practiced martial-arts I had been taught to focus a lot on

stepping, always by paying attention and being alert. Complementary
stepping, as it is called in the Book of Five Rings, or the Art of the Japanese
Sword, 77 is essential to both executing an attack efficiently and surviving
one.
All martial artists have figured out a special way of stepping, a certain
rhythm and coordination to trap the enemy. Indeed, you can only find a
way in or out of an attack when you know where your feet are. Being able
to shift in space without losing balance and knowing where in the enemy’s
stance your stance can quickly enter is the most important part of the art.

The vestibular system

Our sense of balance is

pr imar ily controlled by a
maze-like structure in our
inner ear called the labyrinth,
which is made of bone and soft
tissue. At one end of the
labyrinth is an intricate system
of loops and pouches called the
semicircular canals and the
otolithic organs, which help us
maintain our balance. At the
other end is a snail-shaped organ called the cochlea, which enables us to
hear. The medical term for all of the parts of the inner ear involved with
balance is the vestibular system.
The vestibular system is responsible for movement. Stimuli are detected by
nerves within the body itself, as well as by the semicircular canals of the
inner ear. The inner ear registers the position of the body in space and the
position of the head in relation to the horizon, to the ground. The message

77 Miyamoto, M. (2005). The Book of Five Rings: A Classic Text on the Japanese Way of the Sword,
(translator Thomas Cleary), Shambhala Publications, Boston.
104

travels through the central system, through the spinal cord to the spindles
in each and every muscle of the body.
As our movements consist of rotations and translations, the vestibular
system comprises two components: the semicircular canal system, which
indicates rotational movements; and the otoliths, which indicate linear
translations.
The vestibular system sends signals primarily to the neural structures that
control our eye movements, and to the muscles that control our posture.
The projections to the former provide the anatomical basis of the
vestibulo-ocular reflex, which is required for clear vision; and the
projections to the latter are necessary to keep us upright.
In other words, the primary role of the semicircular canals with their
associated sensory cells is to permit us to sense angular acceleration and
deceleration while the utricle and saccule enable us to sense linear
acceleration or deceleration and to sense head position relative to gravity.
Another critical role of the semicircular canals is to make possible the
maintenance of visual fixation while our body is in motion. There is a
reflexive connection between the semicircular canals and the muscles
controlling eye movement.

The righting reflex

Initiated by the vestibular system, the righting reflex is a reflex that corrects
the orientation of the body when it is taken out of its normal upright
position. It detects that the body is not erect and causes the head to move
back into position as the rest of the body follows.
In malposture the muscles that are meant to contract and release for
short-duration effort become constantly engaged in order to maintain
posture. The main consequence of fixing the head is interfering with the
righting reflex. Malposture is maintained by a tightening of all superficial
muscles that impede rather than facilitate movement of the body,
shortening the neck and holding the head in a fixed position for long
time, reading for example, focussing the eyes for too long on the computer
screen or music sheet.
 105

Alexander Technique and musicians’ health

Musicians’ pain and injury

Playing a specific instrument requires an appropriate playing posture and a

know-how of the way the instrument must be supported while it is
played. Qualities like coordination, lightness, refinement, poise, and clarity
in learning and in communicating intentions are essential for every
performer. So often the work is complicated by excessive tension, difficult
breathing, stage-fright. A musician’s technique and posture are important
factors in determining predisposition to injury.
Being in balance, having a good postural tone, does not mean sitting up
straight in a fixed position. Good posture is dynamic, in the sense that it
registers moment by moment the state of the body in motion or stillness.
When we are more conscious of our structure and functioning, we can be
mindful of movement and action, avoiding the stress of unconscious
guidance of the force of habit. Any action and movement without
awareness is stressful for our system. Habits are the pivot of choices that, in
most cases, lead to physiological and neurological problems.
In order to stay competitive, many performers keep struggling with their
injury, but those injuries need to heal and pain should never be
underestimated. As we have already explained, repetitive motions can cause
compensation patterns.

When muscles continually hold the body in place or are continually used to perform
the same movement, they are actively contracted on regular base without being
lengthened regularly by their antagonists. As a result, the muscles that repeatedly
contract or hold contractions for extended periods of time adopt a shorter resting
length (they are posturally shortened) and their antagonists develop longer resting
lengths (they are overstretched). [...] The body’s compensation is registered not only
in the muscles, but also in the nervous system via nerve tracks.78

78Brown, M.B.; Simonson, J.; Howard, D.C. (2008). Introduction to Massage Therapy, 2e,
Limpincott Williams & Wilkins, USA.
106

Discomfort and disturbance (permanent pains at the shoulders, neck, back,

wrists, elbows, knees, ankles) turn quickly into pathology: Tendonitis, Carpal
Tunnel Syndrome,Thoracic Outlet Syndrome, Focal Dystonia, to name a few.

Tendonitis is the the inflammation of a tendon. A tendon is a tough yet

flexible band of fibrous tissue. It is the structure in your body that connects
a muscle to bones. Tendonitis is most often an injury of overuse and
misuse. If the normal smooth gliding motion of your tendon is impaired,
the tendon will become inflamed and movement will become painful.79

79 http://orthopedics.about.com/cs/sportsmedicine/a/tendonitis.htm
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People with Carpal Tunnel Syndrome experience numbness, tingling, or

burning sensations in the thumb and fingers, in particular the index,
middle fingers, and radial half of the ring fingers, which are innervated by
the median nerve. Less-specific symptoms may include pain in the wrists
and hand and loss of grip.80

The Thoracic Outlet Syndrome is a group of symptoms arising not only from
the upper extremities, but also from the chest, neck and shoulders. The
symptoms are produced by a positional, intermittent compression of the
brachial plexus and subclavian artery and vein. 81

80 Atroshi, I.; Gummesson, C; Johnsson, R; Ornstein, E; Ranstam, J; Rosn, I (1999). Prevalence of

Carpal Tunnel Syndrome in a General Population. JAMA 282 (2): 153–158.

Liveson, J.A. (25 September 2000). Peripheral neurology: case studies. Oxford University Press,
81

New York.
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Tennis elbow is an overuse injury occurring in the lateral side of the

elbow region, but more specifically it occurs at the common extensor
tendon that originates from the lateral epicondyle. The acute pain that a
person might feel occurs when they fully extend their arm.

Focal Dystonia, such as musician’s dystonia is characterized by excessive

muscular activation during manipulative tasks and is a form of ataxia.
When the brain tells a given muscle to contract, it simultaneously silences
muscles that would oppose the intended movement. In dystonia, it appears
that the ability of the brain to inhibit the surrounding muscles is impaired
leading to loss of selectivity. 82
Each part of the body has a separate area of the brain dedicated to moving
and sensing that body part. So, we have hands, and we have virtual hands
in the brain – parts of the brain that represent the size, shape and position
of the hands. 83
The part of a musician’s brain that senses and controls the fingers is
actually observably larger than the counterpart of a person who does not
use his or her hands as much. In dystonia, these maps lose their distinct
borders and overlap occurs.84 It is thought that the excessive motor

82Hallet, M. (2011). Neurophysiology of dystonia:The role of inhibition. Neurobiology of Disease 42:

177–184.
83Murray, J. (2007). Penfield Wilder Graves in Dictionary of Medical Biography, volume 4 (M-R),
Bynum W.F.; Bynum H., Greenwood Press, Westport-London.
84 Byl, N.N.; Merzenich, M.M.; Jenkins, W.M. (1996). A primate genesis model of focal dystonia and
repetitive strain injury: I. Learning-induced dedifferentiation of the representation of the hand in the
primary somatosensory cortex in adult monkeys. Neurology 47 (2): 508–20.
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training in musicians may contribute to the development of dystonia as

their cortical maps become enlarged and begin to overlap. 85 Lack of
movement will reverse this process. If you fail to move in a certain way for
a period of time, you lose the ability to accurately sense and control that
movement. This is called sensory motor amnesia. 86
Since the root of the problem is neurological, it is thought that
sensorimotor retraining of activities can enable the brain to "rewire" itself
in a manner that can ultimately eliminate dystonic movements. The work
of several doctors has shown that sensorimotor retraining (including
Alexander Technique) and proprioceptive stimulation can induce
neuroplasticity, making it possible to recover substantial function that was
lost from focal dystonia.87

85Rosenkranz, Karin; Katherine Butler, Aaron Williamon, and John C. Rothwell (November
18, 2009). Regaining Motor Control in Musician’s Dystonia by Restoring Sensorimotor Organization.
The Journal of Neuroscience 29 (46): 14627–14636.
86 Hanna, T. (1979). The Body of Life. Alfred A. Knopf, New York.
87 Farias J., Sarti-Martínez M.A., Elite musicians treated by specific fingers motion program to stimulate
propiceptive sense. Congreso Nacional De La Sociedad Anatómica Española. Alicante, Spain.
European Journal of Anatomy, p. 110.