579 patients with chronic or recurrent back pain were enrolled in this randomized controlled trial to determine the effectiveness of the Alexander technique, massage therapy, and normal care. Patients were randomized to receive an intervention of massage (n=147), six Alexander technique lessons (n=144), 24 Alexander technique lessons (n=144) or normal care (n=144); half of patients in each group were randomized to receive exercise. The results from this trial demonstrated that lessons in the Alexander technique were beneficial in reducing disability and the number of days pain was reported at one year. Massage therapy was effective in the short term; however, the positive effects were not retained at 1 year.