Stand Tall Don't Slouch: How Posture Feedback and the Alexander Technique Can Improve Health
Recently, I was invited by Dr. Erik Peper, professor at San Francisco State University and internationally known expert on biofeedback, to present a workshop with him at the 49th Annual Association for Applied Psychophysiology and Biofeedback (AAPB) Scientific Meeting in Orlando, Florida.
A few years ago I reached out to Dr. Peper regarding some of his research. He is the author of numerous scientific articles and books and has written extensively about posture. Of particular interest to me were his articles about "How Posture Affects Memory Recall and Mood"and "EEG Patterns Under Positive/Negative Body Postures and Emotion Recall Tasks". Dr. Peper is an expert in holistic health and stress and management and has been teaching at San Francisco State University since 1976, where he was instrumental in establishing the Institute for Holistic Health Studies, the first holistic health program at a public university in the United States.
Dr. Peper's work has been integral to the AAPB, which was founded in 1969 as the Biofeedback Research Society. He describes biofeedback as "a training and treatment approach in which you can learn awareness and control over body functions such as muscle tension, blood pressure breathing, brain waves and heart rate."
While conversing with Dr. Peper, I learned that there were many similarities in what biofeedback and the Alexander Technique could offer to promote better health. Biofeedback uses instrumentation to monitor what is occurring in the body while the Alexander Technique uses the instructor's verbal and tactile feedback to provide directional guidance.
The Alexander Technique focuses on the skeletal, muscular, and nervous systems and is based on a fundamental principle that mental & physical health are inseparable. The same concept underlies bio- and neurofeedback and is described by Elmer and Alyce Green as the psychophysiological principal which states: “Every change in the physiological state accompanied by an appropriate change in the mental- emotional state, conscious or unconscious; and conversely, every change in the mental-emotional state, conscious or unconscious is accompanied by an appropriate change in the physiological state.”
The principles of the Alexander Technique can be applied to any aspect of body use ranging from performance to rehabilitation to promoting better posture and health. The technique is non-intrusive and highly effective, leading to awareness of previously unknown habits which interfere with the body’s overall functioning in health. It is facilitated through the guidance of an Alexander Technique teacher who invites the student to learn about undesired habits and how to re-educate the body towards better usage. The technique includes a conceptual framework of optimum functioning within an individualized approach to develop lifelong skills for self-care that help people recognize and avoid repeating poor habits.
Biofeedback is an approach that records the biological signals produced by your body by attaching sensors. This information is shown back to you (feedback) so that you have the information to learn how to make changes in your body such as warming your hands, breathing slower and relaxing or tensing certain muscles so that your health and performance improves. The benefits of biofeedback are that it makes the invisible visible by demonstrating the dysfunctional patterns of the body, thus seeing is believing (Peper, Nemoto, Lin, & Harvey, R. 2015). Biofeedback is a mind-body approach that uses your thought and passive attention to improve your health. A popular culture example of the biofeedback concept would be Nintendo’s Wii Fit® device that monitors body position and balance. Biofeedback procedures have been used to effectively treat a wide variety of illnesses such as tension headaches, hypertension, anxiety, insomnia, epilepsy, attention deficit and hyperactivity. Most biofeedback procedures are highly effective in teaching awareness and reducing symptoms.
As Dr. Peper presented me to the AAPB community, he spoke highly of the Alexander Technique and said that it was one of the methods that he had found to be effective for reducing back pain and improving posture. In fact, he had taken Alexander Technique lessons years ago and had a remarkable memory of the principles that he had learned. Dr. Peper went on to suggest that the Alexander Technique and biofeedback could be used effectively together, to help individuals monitor and gauge what they were doing while carrying out activities.
The following are a few examples:
1. Posture feedback from the , UpRight™ a small wearable device that works as an app with your cellphone. After calibration, the client receives vibratory tactile feedback every time the spine slouches. This feedback helps the client in the office, at home and at work, to identify thoughts, situations and habits that evoke slouching and reminds the client to be tall.
Figure 1. Illustration of a posture feedback device, UpRight™. It provides vibratory feedback to the wearer to indicate that they are beginning to slouch. Reproduced with permission from: Peper, E., Lin, I-M, & Harvey, R. (2017). Posture and mood: Implications and applications to therapy. Biofeedback.35(2), 42-48.
2. Muscle feedback monitored with electromyography (EMG) to monitor muscle activity. In many cases the client is totally unaware that they are contracting muscles in anticipation of activity, while thinking, while performing an activity and tightening unnecessary muscles or not relaxing those muscles after the activity is completed, or using excessive efforts. The EMG feedback provides documentation and instantaneous feedback to increase awareness and improve performance. This process is illustrated by the case example described by Peper, Booiman, Lin, & Shaffer, (2014).
While monitoring from the forearm extensors, the person was totally unaware that she slightly tightened her arm while listening to the instructions as shown in Figure 2.
Figure 2. EMG recording from forearm. Epoch 1 shows the muscular response to the initial explanation of forearm tension. Epoch 2 shows the SEMG activity during the actual task of minimum felt muscle tension, and Epoch 3 shows the ongoing muscle tension after the person thought she had relaxed after the minimal tension task. Reproduced with permission from Peper, E., Booiman, A., Lin, I-M., & Shaffer, F. (2014).
This was monitored without the person receiving feedback. When the therapist showed her the SEMG recording, she was surprised by the SEMG findings and what was happening in her body. She had no idea that her own thoughts during the explanation of forearm tension increased the muscle tension even higher than her deliberate efforts to produce minimum muscle tension.
This simple demonstration shifted her belief about the tension she unknowingly built up in her body. It demonstrated also that she could learn control by paying attention to her body and learning to relax. The fact that after the practice, her tension increased again without her feeling it, surprised her and caused the woman to believe that she needed to pay attention to her body for further improvement and healing. This experience became the first step in her starting to do the homework practices to relax her body.
When Dr. Peper first suggested that the Alexander Technique and biofeedback could be used effectively together, I was intrigued. The positive response from our collaborative workshop illustrated how much the participants enjoyed and benefited from learning about both. However, when Dr. Peper showed me the UpRight™ device, I didn't know what to say. Dr. Peper's work with biofeedback fascinated me, but this wearable 'posture device' seemed to go against everything that I stood for. If it weren't for my deep respect for Dr. Peper and his work, I would not have listened to the research nor taken the device seriously.
However, a few things happened since my workshop collaboration with Dr. Peper. First, I paid more attention to how many times friends reached out to me (their so-called posture expert) to ask about my thoughts on the UpRight™ device. Although I had been asked about the device in the past, I chose to refrain from elaborating on my opinion. However, Dr. Peper's perspective on the UpRight™ device made me re-think about how unfairly I had perceived this device, especially without having tried it myself. I saw this as an opportunity to do my own research. The next thing that took place was a conversation with Dr. Peper about the prospect of collaborating on an article discussing UpRight™ more extensively. Finally, I decided to reach out to UpRight™ myself.
I have devoted the past 17 years to the study, research and teaching of the Alexander Technique. While I was drawn to its sometimes enigmatic process, I acknowledge that the principles of the technique are not easy to understand at first, particularly during an initial lesson. I have often thought of the students who came to try a lesson and never returned for another, and wondered why they didn't return.
After discussing with Dr. Peper about how the Alexander Technique and biofeedback could be used effectively together, I thought about how biofeedback might be a valuable tool to use in an initial lesson. If a new student could monitor what was happening in real time, and make the invisible visible, would this not help them gain trust in this otherwise mysterious technique? True, many students stick with the technique even without understanding what it is about initially. But others don't because of the difficulty in seeing the benefits of the process in the first lesson.
A biofeedback tool, such as the SEMG recording in Figure 2, could add credibility to an individual's experience with learning about previously unknown habits and tension. Having such tangible feedback during an Alexander Technique lesson, particularly when the individual might be uncomfortable, uncertain, or skeptical, allows us teachers to be more inclusive of prospective students and more importantly, open ourselves up to new resources for them.
Biofeedback cannot and should not replace the role of the teacher or practitioner, but it can offer palpable information to their students. If I ask a student to 'think up' as they are getting out of a chair, they may have no idea what I am talking about. Furthermore, if I say, "good" as they are 'thinking up' they may not 'feel' any differently than before I invited them to them to 'think up'. However, if a biofeedback tool were able to gauge their thinking with corresponding tension, such as in the aforementioned SEMG recording, the individual would find the process less mysterious and more tangible.
Using biofeedback tools during Alexander Technique lessons is something worth exploring within the Alexander Technique community. It is not a replacement for the teacher, but rather a resource for students that need more 'proof' of the process. It would be amiss to rule out opportunities that might help us grow as a community and reach more individuals.
In that same vein, my initial reluctance to be open-minded about biofeedback devices such as UpRight™, stemmed from my own fixed-thinking. As I received more inquiries from friends about the efficacy of posture devices like UpRight™, I realized that it wasn't fair to dismiss it without doing my own research.
When I contacted UpRight™, I was put in touch with Alex Gomberg, a physical therapist who works for the company. We spoke on the phone and I expressed my main concern with the device. Namely, how would an individual who is unaware of how they use their body be able to use the device effectively? More specifically, if the device requires the individual to calibrate the device, wouldn't their own assessment of what is upright likely to be faulty? The reason being that when most people think of upright, they think of sitting up 'straight' and the habits associated with 'straight' often include sitting or standing in a military like position with an arched back, raised chest, and tight neck.
I described to Alex the faulty sensory awareness that most individuals experience, particularly with the notion regarding sitting or standing 'straight' and the dangers of unknowingly arching the back every time the device vibrates. I proposed that the device would be more effective if initially calibrated with a trained professional, like an Alexander Technique teacher. In this way, the teacher would guide the student into a starting point that reduced tension in the body and if calibrated properly, the device would not vibrate if the student's habitual posture drastically differed from the teacher's calibration. As the student and teacher would work together in lessons, the association with the device would not be to sit up 'straight' but rather to sit free of tension, thus using the device as a biofeedback tool that is in-line with the principles of the Alexander Technique. Just as a mirror provides feedback during a lesson, the device could offer additional information about use.
It is also worth noting that during my training to become an Alexander Technique teacher we sat on stools, in a circle, every day, as we read F.M Alexander's books. During that time, I doubt all of us were sitting without tension. We may have tried to sit up as best as we could. However, the mere act of sitting helped us gain strength in our torsos. If a device like UpRight™ encourages consciousness while sitting, and promotes core strength, it is worth exploring.
Alex, from UpRight™, graciously offered to send me an UpRight Go™ device to try for myself. In our next collaboration, Dr. Peper and I will discuss the use and efficacy of this device with his trials and my own experience.
Peper, E., Booiman, A., Lin, I-M., & Shaffer, F. (2014). Making the Unaware Aware-Surface Electromyography to Unmask Tension and Teach Awareness. Biofeedback.42(1), 16-23. https://biofeedbackhealth.files.wordpress.com/2013/09/making-the-unaware-aware-2013-07-04.pdf
Peper, E., Lin, I-M, & Harvey, R. (2017). Posture and mood: Implications and applications to therapy. Biofeedback.35(2), 42-48. https://biofeedbackhealth.files.wordpress.com/2017/11/a-article-biof-45-02-42-48.pdf
Peper, E., Nemoto, S., Lin, I-M., & Harvey, R. (2015). Seeing is believing: Biofeedback a tool to enhance motivation for cognitive therapy. Biofeedback, 43(4), 168-172. DOI: 10.5298/1081-5937-43.4.03 https://biofeedbackhealth.files.wordpress.com/2011/01/a-seeing-is-believing-published.pdf