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The Effect of Age on Spinal Range of Motion - A brief overview of the literature

Posted By Janine Bryant on behalf of the IADMS Dance Educators’ Committee, Tuesday, July 9, 2019

The learning objectives of this article:

 

·      To share a brief overview of the literature on spinal range of motion and aging

·      To consider how aging affects dancers but also how dancers, as exercisers, can have a built-in advantage over the aging process

·      To focus on the mechanism of aging with regards to collagen and skeletal muscle

 

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In talking about aging, people always ask me to focus on the positive aspects as opposed to the negative. Although there are aspects of the aging process that can be viewed as negative, the concept of 'positive aging' is something I have recently come across in my research. How we choose to define, view, and accept the inevitable changes that come with aging is crucial to our ability to 'age gracefully'. We are living longer and this requires thought and planning. The World Health Organization (WHO) defines positive aging as: 'The process of developing and maintaining the functional ability that enables wellbeing in older age'.12

 

Because spinal mobility is important and can be viewed as a determinant in whole body function.1, understanding key aspects of spinal wellness is essential for dancers. In this next installment, we will look at some of the literature on aging and spinal range of motion and ways that dancers, who are physically very active, already have an advantage to aging well. Because there is little to no research on aging dancers' spines, it is necessary to consider the broad category with regards to other populations. For our purposes, the research included athletes, clinical, general and elderly populations.

 

The changes that occur with aging, such as loss of lumbar flexion, extension and lateral flexion, may be responsible for decreases in spinal range of motion (ROM).2,3  The literature links loss of bone density and flexibility to increased risk for postural changes and disc fractures that contribute to loss of ROM and participation in activities of daily living. Quality of life (QoL) is affected as aging populations experience decreased mobility due to age-related changes in spinal health. Information found, especially relating to collagen, points to physical and biochemical changes to collagenous frameworks with increased age resulting in decreased extensibility especially in aging skeletal muscle.

 

DANCER ADVANTAGE: The good news is that while it is understood that bone density loss may have an effect on bone strength and increased risk for osteoporosis, both women and men can help prevent bone loss with regular exercise. Exercising (and dancing), when supplemented with strength training, can also help us maintain muscle strength, coordination, and balance, which in turn helps to prevent falls and related fractures thus improving QoL.

 

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Characteristics of the Aging Spine

Important characteristics of the aging spine include damage that results in a decrease in elasticity and joint motion restriction leading to a decrease in flexibility (loss of ROM).4 Increased intramuscular connective tissue stiffness can also result in decreased ROM.2 Long-term complications associated with aging affect spinal health and can cause significant functional impairments in activities of daily living.8,9

 

The Role of Collagen

Collagen is a protein made up of amino acids that are found in the human body. There are more than 22 types, grouped according to structure and function. The word comes from the Greek word 'kolla', which means 'glue'. Common types of collagen are Type 1: Skin, tendon, vascular, organs, bone, teeth, scar tissue. Type II: Cartilage, ocular collagen, and Type III: Cells of skin, muscles, lungs.5,6 It is important to understand the role of collagen and how age-related changes to collagen matrices are linked to the declining mechanical properties of aging bone and joints.3,5  Physical and biochemical changes occur to collagen with increasing age, resulting in decreased extensibility. These changes include an increased formation of intramolecular and intermolecular cross-links that restrict the ability of the collagen fibers to move past each other as tissue length changes.2 Cross-linking involves two different mechanisms, one a precise and enzymatically controlled cross-linking during development and maturation, and the other an adventitious non-enzymatic mechanism following maturation of the tissue.  This non-enzymatic cross-linking, known as glycation, is the major cause of dysfunction of collagenous tissues in old age.  

 

The process of cross-linking and the presence of advanced glycation end products (AGEs) seem to be major determinants in the loss of ROM and strength.6 AGEs naturally form inside the body when proteins or fats combine with sugars (glycation). This non-enzymatic reaction affects the normal function of cells, making them more susceptible to damage and premature aging.

 

DANCER ADVANTAGE: There is a direct link between the quality of energy intake and the accumulation of advanced glycation end products (AGEs). Dancers may be more aware of the quality of their energy intake, and could therefore be less susceptible to the detrimental effects of AGEs that can come from consuming foods such as fried eggs, butter, cream, margarine, mayonnaise and foods cooked at extremely high temperatures.

 

Aging and Loss of Bone Mass

Two parallel but independent processes characterize the aging spine: a) the development of degenerative discogenic changes and bone mass reduction, and b) osteopenia/osteoporosis, or reduced bone mineral density, which increase the risk of stress fractures.7 In focusing on the relationship between these two processes, both independent researchers and the American College of Sports Medicine underline the need for further research on osteoporosis.10 A study evaluating factors related to spinal mobility in patients with postmenopausal osteoporosis revealed that skeletal fractures are an important clinical manifestation of the disease, with older female patients the most severely affected8. Multiple vertebral fractures can result in postural deformities, which could cause functional impairments in ADLs 8,9  and have a significant impact on quality of life.

 

DANCER ADVANTAGE: Again, it is important to note that regular exercise, including activities that move against gravity whilst staying upright, help build bone.

 

The benefits of weight training are well-documented and, specifically for dancers, can help enhance strength, bone health and improve task-specific dance skills, such as lifting and partnering, jump height, balance and control, and increased ROM.11 The value of cross-training for dancers is commonly understood and loading can act as another activity toward performance enhancement.10

The overall goal of this research is to promote awareness of the importance of spinal health. Dancers have an advantage in that they are exercisers, already benefitting from moderate to high-levels of activity that includes resistance and techniques that increase ROM and strength. Awareness is key as a healthy spine is essential to whole body function.11

 

Janine Bryant, BFA, MA, SFHEA, PhD Candidate, is a Registered Provider and Quality Assessor for Safe in Dance International and International Education Advisor to The University of Wolverhampton, UK. She has presented her research on aging and range of motion in Brazil, UK, USA, and Finland. Janine is a guest speaker for The Royal Ballet School, UK and The University of the Arts, USA.

 

References

 

1. Cupon, L.N., & Jahn, W.T. (2003). Current standards for measuring spinal range of      motion for impairment. Journal of Chiropractic Medicine, 2(1), 8-12.  

2. Wallmann, H.W. (2009). Stretching and flexibility in the aging adult. Home Health      Care Management Practice, 21(5), 355-357

3. Jackson, A.R. Transport properties of cartilaginous tissues. (2009).  Current      Rheumatology Reviews, 5(1), 40

4. Charlifue, S., Post, M.W., Biering-Sorensen, F., Catz, A., Dijkers, M., Geyh, S., &        Horsewell, J. (2013). International spinal cord injury quality of life basic data set.   Spinal Cord 2013, 50, 672-675

5. Zioupos, P., Currey, J.D., & Hamer, A.J. (1999). The role of collagen in the declining   mechanical properties of aging human and cortical bone. Journal of Biomedical            Materials Research, 45(2), 108-116

6. Avery, N.C., & Bailey, A.J. (2005). Enzymic and non-enzymic cross-linking     mechanisms in relation to turnover of collagen: Relevance to aging and        exercise.  Scandanavian Journal of Medicine and Science in Sports, 15(4), 231-    240

7. Phrompaet, S., Paungmali, A., Pirunsan, U., & Sitilertpisan, P. (2011). Effects of          Pilates training on lumbo-pelvic stability and flexibility. Asian Journal of Sports          Medicine, 2(1),16-22

8. Nattrass, C.L., Nitschke, J.E., Disler, P.B., Chou, M.J., & Ooi, K.T. (1999). Lumbar     spine range of motion as a measure of physical and functional impairment: An     investigation of validity. Clinical Rehabilitation,13(3), 211-218

9. Wong, K.W., Leong, J.C., Chan, M.K., Luk, K.D., & Lu, W.W. (2004). The flexion-    extension profile of lumbar spine in 100 healthy volunteers. Spine Journal,      29(15), 1636-41

10. Sinkov, V.T.C. (2003). Osteoarthritis: Understanding the pathophysiology, genetics,   and treatments. Journal of the Natlional Medical Association, 95(6), 475-482

11. van Marken Lichtenbelt WD, Fogelholm M, Ottenheiim R, Wasterterp KR, (1995).    Physical activity, body composition and bone density in ballet dancers. Br J Nutr.        Oct:74(4), 439-51.

12.  Doan, C., World Health Organization, What is Healthy Aging?, Retrieved from URL.

 

Tags:  aging  spine 

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Aging and range of motion for dancers: An introduction to a three-part series

Posted By Janine Bryant on behalf of the IADMS Dance Educators’ Committee, Monday, April 1, 2019

The learning objectives of this article:

 

 •       To broadly understand the aging process and its impact on function and quality of life for dancers

 •       To understand how this information can help dancers age well and therefore affect career longevity

 •       To encourage dancers to create an awareness statement based on this information on how they can help themselves age well as a dancer-athlete

 •       To help dancers understand how how the very act of dancing puts them at an advantage over the aging process in some ways.

 

 

The process of aging affects all of the body systems. Aging causes loss in bone density, flexibility and range of motion (ROM). Women experiencing hormonal changes are especially are at risk as the loss of bone density can cause increased risk for fractures.4

 

Much of the available literature on aging includes information on quality of life (QOL) issues such as diminished mobility. 10 When mobility is limited due to an injury or medical condition, a vicious cycle ensues, resulting in increased pain, stiffness and further diminished mobility. For dancers, this process can be life altering, as age is often a determinant in participation levels. 10

 

Certain conditions are more prevalent as we age, such as osteoarthritis (OA). OA is the most common arthritis and is one of the main concerns with regards to mobility as changes in collagen could result in loss of joint function. This is usually more common in the 65+ age categories.5 With regards to low calcium and oestrogen levels, specifically on bone, there are two factors at work. A calcium-deficient diet coupled with decreased oestrogen levels can affect healthy bones in unhealthy ways, leading to osteoporotic bone. For dancers, a hard schedule coupled with fractures of built up osteophytes from OA, in addition to increased load from aesthetic demands and big ROMs, have a cumulative effect over time and can result in decreased ROM and increased pain. In terms of bone mass, females generally peak around age 30 and begin to decrease more rapidly than men, who peak around age 40 and begin to experience bone loss around age 45, although the decline is more gradual. 10

 

Dancer's Advantage: It should be noted that the activity of dancing as exercise improves bone health and can also increase muscle strength, coordination, and balance, leading to better overall health. Bone is living tissue that responds to exercise by becoming stronger. Women and men who exercise regularly generally achieve greater peak bone mass (maximum bone density and strength) than those who do not. 7,9

 

 

 

In the above photo, it is clear that the 21-year old dancer does in fact have greater ROM in the first arabesque. However, there are some problems with muscle recruitment and stabilization that the 32-year old dancer has worked out for herself. We can see the dancer on the top of the photo is more over her forefoot, is utilizing her standing quadricep muscles to stabilize, and has a more lifted and closed ribcage. As with many older elite professional dancers that I see in my studies, although they cannot make the ROMs that the younger dancers can, their shapes are more stable and less dependent on flexibility alone. All dancers have somatic challenges that they must surmount that, in the excitement and artistry of performance, is often not evident to the audience and these examples provided are no exception.

Dancer's Advantage: The photo is simply offered to encourage a dialogue that, although the aging dancer is often at a disadvantage in the youth-driven dance world, they can in fact offer a body knowledge that is oftentimes more thorough, hard-earned and worth valuing.

 

 

Aging Collagen and the Accumulation of Advanced Glycation End Products (AGEs)

 

Collagen is protein. Aside from water, collagen is the most plentiful substance in our bodies and is the building block for skin, tendons and bones. Over 90% of collagen in the body is comprised of Type 1 and 3 collagen. Collagen types that are commonly affected by the aging process likely to have an impact on dancer-athletes are collagen types 1, 2 and 3.  Collagen types contain different proteins (amino acids) and these serve separate but often parallel purposes within the body. Types 1 and 3 support structures and elements of high-tensile strength, bone, skin, tendon, muscles, cornea, and walls of blood vessels. Type 2 collagen is comprised of the fluids and function that supports cartilaginous tissues and joints, as well as intervertebral disks (IVDs), vitreous bodies, and hyaline cartilage. 6,10

 

 

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As collagen ages, skeletal muscle fibers decrease in mass (sarcopenia), tolerance for exercise decreases and there are higher rates of fatigue and decreased ability to thermoregulate. In addition, there is an impaired ability to recover from injuries. The cyclical response to this is often increased pain and a general decrease in elasticity and flexibility. 9

 

The loss of skeletal muscle elasticity can be correlated with the presence of advanced glycation end products (AGEs). Collagen becomes damaged when sugar and amino acid molecules bind together. The by-product of this process is oxidative in nature and causes AGEs to accumulate in cells. Accumulation of AGEs can wreak cellular havoc, and the increased oxidative stress results in chronic inflammation. 6,7

 

We consume AGEs mostly from food (specifically high-fat meats) cooked at high temperatures via dry heat, or processed foods, and absorb AGEs from tobacco smoke. Declined kidney function has also been implicated in the formation of AGEs and dancers with high blood sugar, familial history of such, or insulin resistance, could be at risk for an increased presence of AGEs. However, high levels of AGEs are found in many healthy older people as well as in those with chronic diseases. It is therefore unclear the degree this plays in human health and aging and so the current research remains inconclusive. The research does support the idea that a diet low in AGEs (one that avoids baking, grilling or frying food for long periods of time and at high temperatures) can in fact lower blood levels of AGEs, reduce insulin resistance and decrease markers for inflammation and oxidative stress. However, more research is needed to fully understand the effects of AGEs on the human body. 11

 

Dancer's Advantage: Aside from the mood and mind benefits, dancing can increase muscle fiber growth, and improve flexibility and balance, especially in populations over the age of 35, 7 possibly offering dancers some leverage over the aging process.

 

What should dancers think about with regards to aging well?

 

Intrinsic Factors: Dancers would benefit from knowing their genetics and family history, especially with regard to conditions such as diabetes, insulin resistance, arthritis, and other inflammatory responses. As well, dancers can think about their current hormonal status and age as fair markers to providing clues to their overall health status picture.

 

Extrinsic Factors: Dancers would benefit from safer training protocols from young ages and safer techniques to big ROMs. Factors such as quality of nutrition, amount of sleep, stress levels, and smoking can have a direct effect on how dancers age and can be controlled. Social support and networks have been found to have a positive effect on aging, as populations live longer, having and maintaining social connections is associated with mental wellbeing and a feeling of connectedness.

 

Above all, dancers should keep moving! The research supports that negative health outcomes are associated with impaired mobility and that health and wellbeing are enhanced through strategies that optimize mobility. 7,10

 

Based on the information provided in this article, dancers are encouraged to create an awareness statement supporting the idea of healthy aging and career longevity.

 

In the next article, we will discuss what the published literature says about aging and range of motion.

 

Janine Bryant, BFA, MA, SFHEA, PhD Candidate, is a Registered Provider and Quality Assessor for Safe in Dance International and International Education Advisor to The University of Wolverhampton, UK. She has presented her research on aging and range of motion in Brazil, UK, USA, and Finland. Janine is a guest speaker for The Royal Ballet School, UK and The University of the Arts, USA.

 

References

 

1. Wong KW, Leong JC, Chan MK, Luk KD, Lu WW. The flexion-extension profile of lumbar spine in 100 healthy volunteers. Spine. 2004; 29(15):1636-41.

 

2. Benjamin M, Toumi H, Ralphs JR, Bydder G, Best TM, Milz S. Where tendons and ligaments meet bone: attachment sites (‘entheses’) in relation to exercise and/or mechanical load. J Anat. 2006; 208(4):471–490.

 

3. Jackson AR, Gu WY. Transport properties of cartilaginous tissues. Curr Rheumatol Rev. 2009;5(1):40.

 

4. Papadakis M, Sapkas G, Papadopoulos EC, Katonis P. Pathophysiology and biomechanics of the aging spine. Open Orthop J. 2011; 5:335–342.

 

5. Ferguson SJ, Steffen T. Biomechanics of the aging spine. Eur Spine J. 2003; (Suppl 2):S97–S103.

 

6. Jaskelioff M, Muller FL, Paik JH, et al. Telomerase reactivation reverses tissue degeneration in aged telomerase-deficient mice. Nature. 2010;469(7328):102-6.

 

7. Hamerman D. Aging and the musculoskeletal system. Ann Rheum Dis. 1997; 56(10):578–585.

 

8. Rajasekaran S, Venkatadass K, Babu J, Ganesh K, Shetty AP. Pharmacological enhancement of disc diffusion and differentiation of healthy, ageing and degenerated discs: Results from in-vivo serial post-contrast MRI studies in 365 human lumbar discs. Eur Sp J. 2008;17(5):626-43.

 

9. Singh K, Masuda K, Thonar E, An H, Cs-Szabo G. Age-related changes in the extracellular matrix of nucleus pulposus and annulus fibrosus of human intervertebral disc. Spine. 2009;Vol. 34 (1):10-16.

 

10. Loeser RF. Age-Related Changes in the musculoskeletal system and the development of osteoarthritis. Clin Geriatr Med. 2010;26(3):371–386.

 

11. Chen, JH, Lin, X, Bu, C, & Zhang X. Role of advanced glycation end products in mobility and considerations in possible dietary and nutritional intervention strategies. Nutrition & metabolism. 2018;15:72.

Tags:  aging  dancers 

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