# Alexander Technique vs. Targeted Exercise for Neck Pain--A Preliminary Comparison
## 4 Discussion  
### Summary of Results  
This study used a two-group pre-test-post-test design to compare the effects of two different interventions ([PERSON] technique and targeted exercise) on neck pain, pain self-efficacy, postural alignment, and neck muscle activity. The results indicated that 10 Alexander classes were at least as effective as 10 exercise classes at attenuating neck pain. Both groups reported significantly decreased neck pain immediately after the intervention, with no significant increase in pain 5 weeks after the intervention ended.  
Self-efficacy has been considered a plausible mediator of neck pain [36]. We found no effect of either intervention on self-efficacy. However, this could have been a type II error due to small sample size. We saw no relation between self-efficacy and neck pain at baseline, but 5 weeks after the intervention ended, self-efficacy was strongly correlated with neck pain, and the relationship between increased self-efficacy and decreased neck pain after the intervention approached significance. There was no difference in self-efficacy between the groups, but participants in the Alexander group were more likely than those in the exercise group to report that they learned how their movement habits contributed to their neck pain and that they were able to choose different ways to carry themselves. This suggests that [PERSON] technique teaches generalizable skills that can be applied in everyday motor tasks and thus may be a viable long-term approach to neck pain.  
Contrary to our prediction, head-torso angle during the video game decreased after the intervention in both groups. We therefore also examined neck and head angles separately with respect to the horizontal plane. The fact that neck angle _increased_ indicates that the decreased head-torso angle was not due to a more forward neck. Instead, it appears that the upper torso became more vertical after the interventions. Unfortunately, we did not record landmarks that allow us to confirm this conclusion. Unofficial post hoc tests (not driven by a significant interaction) comparing baseline to second post-test in each group suggest that the increase in neck uprightness was driven by the [PERSON] group (\(p\) = 0.03), while the increase in head extension was driven by the exercise group (\(p\) < 0.0001). This provides a clue that the two interventions may have quite different mechanisms. However, none of the posture angles were significantly correlated with neck pain or change in pain. This absence of relationship is consistent with our previous work [25], and with a growing body of literature suggesting that the alignment aspect of posture may not be the most important determinant of pain [37].  
After the intervention, the [PERSON] group showed significantly decreased activity in surface neck muscles during the neck flexion task, while the exercise group showed a tendency toward _increased_ activity in the same muscles. These changes in SCM activation were still present 5 weeks after the intervention. In addition, 5 weeks after the intervention ended, lower SCM activation was associated with lower neck pain. This result is in line with the emphasis in [PERSON] technique on learning to observe and inhibit habitual patterns of reaction in daily life [28; 32; 38].  
Both groups showed an increase in muscle firing frequency after the intervention, thought to reflect decreased muscle fatigue. The effect was strongest at the last testing session and at the most difficult level of the neck flexion task. However, EMG frequency did not correlate with neck pain.