I thought it would be interesting to see where the Alexander Technique fits in alongside other modalities and where they converge or diverge.
With that in mind I asked local North London osteopath Alex Lubel if he'd be interested in being interviewed after we were introduced on the business networking scene.
We discussed the nature of habit, what good posture is and the myth of core strength, among other topics ...
AF: Hello this is Adrian Farrell from Alexander Technique London
My guest today is Alex Lubel, an Osteopath working in north London
AF: We are in your office here in Whetstone on a very bright sunny day. I thought I would ask
you first what drew you to Osteopathy?
AL: It’s a long story. I will cut it as short as I can. It was my Dad who had a bad back between his visits to his Osteopath. I would sit astride him, when I was a kid and massage his back and it was him saying that I seem to have good hands for it. I would find the spots that needed working. I didn’t know what I was doing but I seemed to be helping him. Then later on in life when I was at a loss of what to do. He said what about Osteopathy? I said ‘No,I couldn’t possibly’ but time drew on and eventually the penny dropped and I thought yeah, Osteopathy, that could be the place to go and I found out about it. Applied and got on the course. The rest is history.
AF: I actually looked into Osteopathy many years ago when I was still working in IT. I gave it some thought as well. So tell me about Osteopathy. What’s the underlying ethos?
AL: Osteopathy was developed by a chap called A T Still in the 1870s’/1880s when he was dissatisfied with the allopathic medicine of the day, a kind of heroic medicine and he thought there has to be a better way of treating people that doesn’t involve horrific medications that seem cause more problems than they solve.
AF: We still seem to be there though.
AL: I think in many respects, yes we are! And he thought and pondered on anatomical and physiological matters; he looked at bones a lot and started developing theories about osteopathy and developed some principles out of his thoughts and those are that the rule of the arteries supreme, so blood is all important. Getting blood through the body is no. 1. It is prime. The structure and function are mutually interrelated. So if the structure is fine, it will function effectively and vice versa, if it’s functioning well, it suggests that the structure will be sound. Another principle is that the body has its own innate capacity to heal itself. So an Osteopath’s role is to look at the structure, to take that poorly functioning structure, and address the function to make it work better so the blood circulates, so the body can heal itself
AF: Have ever you considered how people use themselves in everyday life actually affects that
AL: Well all the time. As I say to most of my patients, it’s habit. Habit is the thing that we do
that prevents us from functioning effectively; we get ourselves into situations whereby we
are stuck in a mode, our bodies conform to that mode rather than function effectively -
being fluid and dynamic, so I am always encouraging my patients to look at the things they
do regularly, to consider what they are doing and work out ways with my guidance to
address those bad habits and bring in new ideas so they can function effectively.
AF: Yes, that’s very much where the Alexander Technique comes in
AF: We are teachers. We don’t heal people but we look at how people use themselves every
day and, as you say, often those ways is what is encouraging the straw to break the camels
back further down along the line. They think ‘oh my back’s just gone’ but it’s a lifetime of..
AL: That’s it. Everyone comes in and says my back went on Saturday. I don’t know what I did. In
fact what they did was just bend down and pick something up like a rice crispy or
something totally innocuous but that rice crispy was, as you said, the straw that broke the
camel’s back. There’s been a whole history, a lifetime of things that lead up to that critical
So what type of issues do you particularly deal with? I imagine it’s quite broad actually but
more of somethings than others?
AL: Well inevitably it’s the back pain. People come in and say they I have hurt my back;
whether it is the low back in the lumbar area, mid back in the thorasics or up in the
cervicals, the neck. Nine times out of ten, that’s what people come in for but people will
come in with other musculo-skeletal issues whether it be wrist, or elbow or shoulder or hip
or knee or ankle or anything in between. Musculo-skeletal things are the common things
that people come in with but then on the other hand people come in and say I have got IBS.
Can you help me with that?
AF: That’s very forward thinking of them.
AL: It is very forward thinking of them. Most people wouldn’t think of osteopaths helping with
things like IBS but as an osteopath we look at how the body functions and as I said
previously we would look at the blood supply, the nerve supply to the bowel and possibly
there might be an ailment of the spine where the nerve supply to the bowel starts from and
maybe it’s that dysfunction in the spine that is actually affecting the nerve supply to the
bowel that’s causing the IBS or whatever other ailment to arise
AF: ....between blood supply and nerve flow? Because obviously, the nerves that come out of
the spine affect the entire body and that’s why a spinal issue can affect IBS, irritable bowel
syndrome, but you are mentioning nerves and most of us probably think of osteopathy in
those sort of terms anyway but you mentioned specifically blood flow. Where does the
nerve function come in? Is it part of
AL: Coming back to the point I made about the principles earlier; the rule of the artery is
supreme. Blood is...... so our aim is to always to try to improve the blood supply to the
ailing tissues by treating certain aspects of the body one can affect the nerve supply by that
supply to the smooth muscle of the blood vessels and in doing that you can conceivable
dilate the blood vessels to encourage better flow through of nutritious blood to those
tissues and one would hope that that brings in fresh blood and takes away the toxins if
Maybe a muscle has been very tight for a long time or a tissue’s being dysfunctional for a
long period of time and bringing in the fresh blood takes the waste away
AF: Do you deal with lymphatic issues then?
AL: Yes we are considering everything, so we might do a little bit of stimulate the lymphatics as
well, whether it be lymphatic drainage again considering the neurology and the vascular
system to stimulate the lymphatics as well
AF: Just to be clear to listeners. Lymphatics takes away waste from the body, yes?
AF: Ok. So what typically happens in a session when someone comes to see you?
AL: In the very first instance, I explain to them. Often people haven’t had experience of
osteopathy before and even if they have I will explain to them a little bit about the process
to expect from me, as their osteopath because I might vary from somebody else. I will go
through a process of taking a case history asking all sorts of questions from clerical
questions through to details of why that particular patient has come to see me and
...through the medical details which are often irrelevant but give me a foundation to work
from. Once I have asked all the questions to gleam as much information from patients as
possible, I then ask them to undress down to their underwear if they are happy to do so. I
have them standing up in the treatment room and take them through a few ranges of
movements to see what works and what doesn’t. In essence you could call it a postural
evaluation but it’s more of a movement evaluation. I see nuances in the patients body that
they may be unaware of and that gives me a few more clues to add to the history. Once I
have done the standing evaluation, I do a sitting evaluation as well depending on the
situation. I then ask the patient to lay on the couch where I might do a few clinical tests,
like checking reflexes and muscle power amongst other things. Once all that is done, I piece
together as much information as I can. I will then tell the patient what I believe is going on
with them and how I can go ahead and potentially help them. If they are happy for me to
carry on. I will start a treatment programme.
AF: There’s always something they forget to tell you. Its the smallest detail.. I remember you
telling me a story about an ingrowing toe nail one time but how can that be relevant?
AL: That’s true. Um the ingrowing toe nail story: a gentleman with a headache. A chap with a
headache. You want me to repeat this story?
AL: A chap came in with a headache of about six months duration. He’d been to his doctor and
to a homeopath – you name it, he went everywhere to try and resolve this headache but it
wouldn’t go away. In fact his case history was unremarkable. There was very little clue in it
but when I asked him to undress, he took his sock off and his big toe was bandaged and he
hadn’t mentioned anything about it and I said to him, so what’s wrong with your toe and he
said oh it’s just an in-growing toenail. And I said to him ‘so how long have you had that?’.
‘Seven months’. So the in-growing toe nail had preceded the headache by a month and in
fact had been causing him such discomfort that it had made him walk awkwardly so the
forces going through his adjusted knee, hip, back, up to his shoulders and into his neck had
eventually resulted in a headache. So with a little bit of treatment from me and then a visit
to the chiropodist, his toe got better and within a couple of weeks, the headaches
AF: It’s amazing how we do use ourselves as a whole..
AL: Absolutely. It blew his socks off, almost literally.
AL: And it really showed me, because that was shortly after graduating, really proved to me
how everything was interlinked. There are no two bits of the body that don’t influence the
rest of the body. Everything, everything, everything has an influence on everything else in
AF: Yeah.. and it’s not only that, the mind is equally part of that equation
AL: Indeed. Couldn’t agree more.
AF: Excellent. So are there any specific conditions you specialise in? You have found a market
niche that you are known for, to people?
AL: No. I am a very general osteopath. I like to treat a broad variety of people.. I enjoy working
with a variety of people with a variety of problems to keep things interesting. Having said
that, I do find, maybe because I am possibly slightly biased to it, I do find a lot of people
have respiratory problems without even realising they have respiratory problems. So many
of us don’t breathe very well. The muscles and mechanics of breathing I often find are
dysfunctional and by working on to those, I seem to have quite a lot of positive results with
patients. Whether they are realising they are breathing badly or not. Laughs.
AF: I usually find the same people come usually about back pain issues when we look at them
we find that rib cage isn’t moving much.
So are there any situations you don’t deal with? And why?
AL: I’ll always look at...er..red flags maybe. Well if someone comes to see me and says ‘I have
cancer can you cure me?’ There are a lot of things. I wouldn’t say to someone ‘I can cure
IBS’. I wouldn’t say to someone ‘I can cure your migraines’. But I will say to people,
alongside your other things, I may be able to help you manage what you have got going on.
I have to, obviously, take precaution with these things. I can’t make claims, even as far as
whiplash is concerned. I do treat people who say they have whiplash but some authorities
suggest that whiplash isn’t necessarily something that manual therapy can treat.
AL: It’s a sticky conversation. Laughs. I won’t treat people who say they have mainline illnesses
and diseases that clearly a few treatments of osteopathy isn’t going to have any inroads
into. If I believe that the patient can benefit from a little bit of osteopathic help with their,
to help them manage and they are happy for me to continue and it is ethical, then I will
AF: Yeah, I have found myself in many situations where it is a case of managing to the best of
people’s abilities, not cure it.
We don’t cure. We don’t claim to cure. In many cases I wouldn’t expect to see one. If I have
a client with cerebral palsy, you know, I am not going to be trying to cure cerebral palsy but
we can see how we can improve her lifestyle. Quality of life, shall I say?
AL: There have been situations..there was a lady I was treating earlier this year who is
wheelchair bound. She’s got all sorts of mobility issues and she came in with no expectation
of being able to cure her, of course but she was in discomfort. She wanted improvement in
the way she could operate and after a couple of treatments she was noticing the benefit
and wanted a little bit more and she reached a point whereby she felt great. She said she
will come back to you as and when for maintenance. No red flags there particularly and she
AF: Yeah. Right next question; most people do perceive me as the posture police. I don’t think I
am. What is your view on posture?
AL: Well just this morning, three patients said to me ‘ I have dreadful posture and I said ‘ no
you don’t’. I have been there.
AL: There’s no such thing as good posture in terms of the perception of posture that people
have. Everyone thinks of that Victorian ethic of book on the head, shoulders back, tummy
in, bottom in. Standing bolt upright like a soldier at Buckingham Palace. That isn’t good
AF: I totally agree
AL: From my point of view that is as bad as being a constant sloucher. It’s coming back to that
habit again. If you slouch or are habitually sloucher or stiff as a board upright, it is going to
be detrimental. Posture is coming back to the osteopathic principle of function again. If you
are structurally functional and able to use your body in any scenario you put it in then you
can say you have got good posture. It is about your body being versatile, dynamic and able
to cope with what you throw at it, or throw it at..
AF: Laughs....yes, yes I totally agree with all of that. I like to think of good posture as a lack
of things, actually. We have postural reflexes which work just fine, we are born with
them, millions of years of evolution, we just need to get out of its way of doing its own thing. But for me, you don’t do good posture, you can only do bad posture.
AL: Of course. There’s John Merrick. The Elephant Man. I saw his skeleton in the Royal London
Hospital. There’s a museum for medics there. And I saw his posture, and his skeleton, and I
was thinking his posture might be deemed to be bloody awful but he could on the other
hand function perfectly effectively, perfectly within his limits but in comfort. Probably
didn’t but conceivably, he could have done. You might deem him to have bad posture but
in function, it could have been good posture if that makes any sense.
AF: It does. We have an example within the Alexander community; a guy called Alexander
McDonald who was trained by Alexander himself. One of the first to be trained by him, he
had congenital curvature of the spine. He was never going to have a straight spine, he was
born that way. Does that mean he had bad posture. That is a hell of a judgement but you
know he used himself fantastically with what he had, and that is what matters.
AF: So I have kind of sprung this one on you. I know I sent you a list of questions earlier but I
have added this one this morning and that is how do emotional states affect physical
AL: Well, the mind and the body are two things that are combined. They are not separate. They
are not even two things. I was coming to that.
When one is happy you tend to feel open,
your shoulders open up, your face opens up, everything opens up. Ha ha its all good. When
you are feeling sad, low depressed, you tend to sort of internalise, curl in, compress down,
drop your shoulders . So whatever is going on in the little box on top of your neck is
expressed through your musculature. You show your emotions through your
posture...so..um there is a lovely Charlie Brown cartoon whereby Charlie Brown is hunched
over looking down at the ground and one of his friends says ‘hey Charlie what are you
looking like that for?’ and he replies ‘If you want to get the most out of being depressed
there is no point standing like this’ and as he says this, he stands upright, open and then he
curls back down, depressed stance again. So Charles Schulz was saying mind and body are
totally intertwined. There is no separateness in mind and body, in the emotion and physical
AF: In our jargon, psychophysical unity. Now people do come to me thinking I am
posture police and come with their physical issues but you kind of phrased it the right way
AL: I kind of get to people’s minds through their body. Its round training because I have my
patients for maybe a session, maybe for half a dozen sessions but to try and help people
really and truly understand these points and take them on board and go away with them
and actually interject them into their daily routines is so tricky. It is a really hard thing to do
to help someone suddenly go ‘yeah, wow, I see what you mean, I am going to use that’.
Some people do get it but the majority of people that come in and say that’s really
interesting and as soon as the door shuts behind them they are back to the old habits
AF: Laughs. I am going to jump a question because you have led so perfectly into it and that is,
is telling people what they should do, psychologically effective?
AL: Evidently not. Telling people what they should do, isn’t, well I suppose it has some
psychological effectiveness. Advising people how they might do better, is better. Giving
people a large branch to hold onto is difficult. Giving them something small that they can
grasp onto, that they can develop and build on is much easier. I try to encourage them to
build these new habits, whether physical or psychological, in small bites size pieces so when
they leave the room, they can say Alex told me to do this and because it is such a small
thing, I think I can manage that and hopefully after a few treatments, it builds. But once
again, it’s down to the patient actually taking on board the information and going forward
AF: Patients are forever asking for advice. I hate to disappoint but I try not to give advice
because would you do what I suggest anyway. I then ask the question, are you capable of
doing what I suggest, interpret it correctly? On the errors, we try to circumvent that. In the
Alexander Technique, we try to give people the experience of doing things a different way
and then they get to choose. It’s still their choice.
AL: At least you give them the choice
AF: So what do you think people can do to be more responsible for their own health and well
being? And you actually gave me a few tips, when we were talking a few weeks back, you
gave me a little metaphor using grammar. Do you remember?
AL: Well, I often talk about these little of things that patients could do and going back to the
small bite size pieces again; if I gave them a great big chunk of something to do, they won’t
do it. If I give them small bite size pieces they are more inclined and I say to people ‘ do you
read?’ and they say ‘yes’ and I say ‘imagine taking that passage of your book and taking out
all the punctuation; the passage that your reading no longer makes as much sense. You
can’t breathe through it, there are no commas, no full stops, no punctuation marks. There’s
nothing in there – it makes no sense any more. Put the punctuation back and hey presto
the passage works again. We sit down at our desks, we do our jobs, routinely, and we sit
there breathless until the very end. Why not punctuate your day; take a few breaks. At the
end of doing a report, at the end of whatever little task that you are doing. Push yourself away from the desk and punctuate your day with a small exercise, might be something tiny,
for example, a ham string stretch, a tricep stretch. Just stretch this, or stretch that. Walk to
the water machine or the coffee machine, go to the loo, go and have a fag break. Whatever
it is you do, just change the attitude of your day a little bit, but regularly. A little bit of
punctuation is a very easy way for a patient to interject some useful movements into the
day, to break up the monotony of the normal working posture
AF: I wrote a blog, not long ago, about how to build natural breaks into your working day. I quite like your punctuation analogy . I might go back and edit it.
AL: Yeah go ahead and add it in there
AF: So what’s your view on core strength
AL: My view on core strength? It’s very common to talk about it. You see it written a lot
about in the media: a lot of people comment on core strength. In fact one of my students
yesterday had a gentleman in with a rather portly stature
AF: One of your students?
AL: Yes, I teach at the London School of Osteopathy. One of my students had a rather portly
gentleman who said I may have a large tummy but I have excellent core strength and
maybe he did. There’s a lot of talk about core strength but I think there is a bit of a
misnomer. I think good strength of musculature throughout broadly is what we need.
Holding in certain muscles and missing others out is not necessarily the right way to go
about things. I think we need to look at the whole body in unison rather than focussing
specifically on the core.
AL: Having said that, some of those core muscles are really quite vital in supporting an ailing
lower back, for example, and I might suggest to patients considering doing some
strengthening exercises with the guidance for those muscles but I wouldn’t say it to the
exclusion of other things. People who sort of solely go out to strengthen their core are
missing a trick
AF: Firstly I think the idea of the core is not very well defined, and I have to say that I have
never met someone so weak that there core cannot provide perfect posture
AF: Yes, if you can make it into my clinic you have a good enough core. The act of walking
provides all the work out that area would need to keep you upright. You certainly wouldn’t
want a weak core. I have no idea how it becomes so weak you can’t walk.
AL: And like I say overall coordination is far more important
AF: Core strength has kind of become the buzz words within the Pilates culture. Not that I have
anything against pilates at all. It serves a lot of people very well
AL: There’s nothing wrong with being strong fit and healthy, generally. It just may not be a
clinical solution to a particular problem.
AF: And even Pilates, they talk about, the Pilates teacher will talk about core but doesn’t bang
on about core strength. I think it has been one of those phrases that has been taken out of
context and bandied around by everybody left, right and centre and of course, Joe Bloggs
does love a label and talk about core strength, core strength, core strength without
realising what it actually is, or isn’t
AL: I may have been guilty of that myself in the past. I talked to a Pilates teacher, not long ago,
and I had this view that their work was somewhat rigid. Actually Pilates teaching is very
much about fluidity of movement and coordination. And as I say, it is not only Pilates itself
that is taken by others how it is heard and run away with...
AF: like in many walks of life, there is the good, the bad and the ugly and there are very many
excellent Pilates teachers out there who are, unfortunately, sullied by the occasional not so
good one, who has been on a weekend Pilates course and come away saying they can teach
Pilates and then bandying around this core strength idea.
I am sure all our professions would find a few guilty of that
AL: Indeed, but let’s not go down that route.
AF: So a final question, your wife’s Grandfather is Colin Colahan. Now why do I mention that?
AL: Yes, my wife’s late grandfather is, was, an artist by the name of Colin Colahan and he was a
prolific artist and yes, he painted Alexander
AF: He did indeed
AL: Of the Alexander technique
AF: Where did it end up?
AL: It ended up on the Antique’s Roadshow. It was valued at a mere £5000. We thought it was
worth a lot more. In fact recently there has been a sale of quite a few of his pictures, so in
fact, Colin Colahan’s name is a little more known in the art world now, parts of Alexander’s
portrait may be worth £5500.
AF: Every £500 helps. Well, thank you very much Alex, it’s been lovely to talk to you today.
AL: It’s a pleasure
AF: We're here in Whetsone, North London. I will put a link to Alex’s website and good to talk to you.
AL: Wonderful. Thank you very much.