Effects of the Alexander technique on pain and adverse events in chronic non-specific neck pain: A systematic review and meta-analysis

Objective: Self-care-oriented positive approach are very important for the management of chronic neck pain. To evaluate the clinical efficacy of the Alexander Technique (AT) courses on pain and adverse events in chronic non-specific neck pain (CNSNP), compared to the conventional therapy. Methods: We evaluated the effects of the AT in the treatment of the CNSNP according to PICO (participant, intervention, comparison, outcome) elements. In this paper, we have utilized some English databases. Totally 140 records are included in the Cochrane Library (43), PubMed (18), Web of Science (27), EBSCO (21), EMBESE (31). The search dated from the day of the database’s inception to June, 2024. Those parameters like Weighted mean differences (WMD), Standardized mean difference (SMD) and 95% confidence intervals (Cis) are calculated. A random-effects model is applied to minimize the heterogeneity, and I2 test is used to assess heterogeneity, the risk of bias of RCTs studies included are assessed by the PEDro tools. Results: A total of three studies (Two RCTs and a quasi-randomized trial) are included in this paper based on the predetermined eligibility criteria. Compared with the conventional therapy group, the included studies collectively show that the AT can provide a significant pain relief in CNSNP, whose effects can last for 2 months with a very low heterogeneity (immediate term pain score: SMD: -0.34, 95%CI: -0.87–0.19, P = 0.208, I2 = 0.0%; short term pain score: SMD: -0.33, 95%CI: -0.55–0.10, P = 0.005, I2 = 0%). In addition, compared with the conventional therapy group, the AT does not significantly increase the incidence of adverse events (AE: RR = 1.690, 95% CI: 0.67–4.27, P = 0.267, I2 = 44.3%). Conclusion: This meta-analysis preliminarily indicated that the Alexander Technique courses may not have a significant pain relief effective in patients with chronic Non-specific neck pain, which is related to the follow-up time of the post-intervention. However, it’s necessary to interpret and apply the outcome of this research cautiously. Systematic review registration: PROSPERO, CRD420222361001.