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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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The Spine: The impact of head position

Posted By Elsa Urmston on behalf of the IADMS Education Committee, Monday, April 6, 2015

This blog post from the IADMS Education Committee brings focus to the importance of spinal alignment and its role in aiding the efficient and effective mobilization of the body in dance.  Specifically this week, we will look at the cervical spine and the all too common problem of the forward head posture.


In recent weeks I’ve been aware of the images on social media about the impact of smartphone and tablet use on the alignment of the upper body in everyday life, bringing about the forward head posture which drops the shoulder girdle down and forwards, bringing with it the cervical spine and skull.  The middle back or thoracic spine area has a tendency to drift backwards and, to accommodate the upper back shift, the hips tip forwards, creating a domino effect of increased force on the central line of the body.  Herein lies muscular and skeletal imbalance as the center of gravity is pulled anteriorly and posteriorly off the midline – the result – pain, discomfort and inhibited movement range.  Here we see the resulting force placed on the spinal column, relative to degrees of anterior cervical spine flexion.

 



In my own classes I often see this forward head posture - whether it is a result of increased screen use is up for debate!  I’d like to think it is the students’ eagerness to learn but this forward head posture may come about because of students looking down, lack of confidence, concentration or any multitude of reasons.  But balancing the skull on the spine is critical in helping young dancers to find efficiency in their whole body movement, and tackling it early on in the training journey seems a prudent step in finding fluency of movement and avoiding injury risk. 


Ideal spinal alignment requires the skull to be balanced on the occiput, creating a central line through the spine which minimizes stress on the body.  And once the skull is balanced on the spine we can ensure that the natural curves of the spine are supported for maximum shock absorbancy in jumping and support for the dancing body in motion.  As soon as the head moves off this central line, forces impact on the joints of the body; of course sometimes we want that to happen as this initiates movement, or balances movement in other parts of the body.  But equally, we need to ensure the efficient balance of the skull on the spine to enable safe and effective practice.  Any distortion in the spine because of head position can impact balance and how we move – pirouetting with a forward head stance is nigh on impossible!  


The impact of the forward head posture on the spine is varied, but as I mentioned earlier there is always a domino effect on the spine and indeed the joints of the lower limbs.  This image below really illustrates this clearly – with the arrows indicating the stress points rippling down the body from poor head position.



So what can educators do to enable efficient head position amongst our youngsters and avoid the impacts on the spine we see above.  We have probably all experienced the image of the string coming from the top of the head, to ‘lighten’ the skull on the spine and allow length in the spinal column.  This can be helpful but I think can sometimes result in the chin being pulled inwards towards the throat, the head falling slightly back and in turn, creating the flat back posture, also often associated with young dancers as they try to find that length we all seek.  Those vital spinal curves disappear. 


Multidimensional images of the head-spine relationship seem to create a better balance amongst the students I work with.  For example, whilst standing we consider the string from the crown of the head, alongside marionette strings which cluster above the ears and draw upwards to help students understand the volume of the skull balanced on the spine.  Often I will have students working in trios, one partner clustering their fingertips firmly on the sides of the skull just above the ears.  They press gently on the flesh for 30 seconds or so, so that the dancer can feel the touch of their partner, the partner then draws the fingertips up to the crown of the head to unite and lengthen up into the space above, often drawing the hair with the fingers.  The other partner lightly cups one hand on the forehead and the other on the posterior curve of the skull and remains there whilst the marionette strings are drawn upwards.  Students’ reactions to this tactile task are always positive and they observe in their partners the lengthened spine and ideal head placement we seek but also the spinal curves remain intact.  They are able to recall the tactile memories of the hands-on work in their dancing as a reminder. 


For me, I have learnt a lot from Alexander Technique (AT).  The verbal directions, “to let the neck be free, to allow the head to go forward and up, so that the back can lengthen and widen”, alongside hands-on work in class as shown below, reiterate the balance of the head whilst dancing.  Examples of AT in practice are widely available on the web; these short films are a great visual introduction to the basic principles of AT, and their specific application in dance. 
Video 1
Video 2

I have also found these dance-specific AT podcasts helpful in developing my own understanding and taking these ideas into the classroom to help my students.  I strongly recommend a listen!
BodyLearningCast

IMAGE WILL RETURN SOON


At the DanceEast Centre for Advanced Training we spend a lot of time team-teaching in technique classes – a luxury I know.  I will work within ballet and contemporary classes, the class teacher leading the class in the normal way, whilst I circulate to work with students individually, reminding them quietly of teaching points covered in dance health classes, using tactile feedback from the examples above as well as many others, to try to support the transfer of learning of principles from our health classes to their application in technique and performance.  So in fact we are trying to overcome habitual movement patterns such as the forward head posture through re-education.  We find a sustained deepening of the students’ understanding when we work in this way, which enables an enquiring learning approach from the students in which they ask questions and interrogate their own practice.


There are numerous videos including stretches for forward head posture available on the web.  In my experience some people, sometimes find these useful, but the focus is on treating the pain caused by poor alignment rather than tackling the root cause.


For further resources, take a look at the following:


A great collection of Alexander’s writings:
Alexander, F. M.
The Alexander Technique: The Essential Writings of F. Matthias Alexander. Lyle Stuart. 1990.


Batson, G. Somatics Studies and Dance.  IADMS Resource Paper. 2009.


The Complete Guide to the Alexander Technique

  


Elsa Urmston MSc PGCAP AFHEA is the DanceEast Centre for Advanced Training Manager, Ipswich, UK and a member of the IADMS Education Committee.

Email: elsa.urmston@danceeast.co.uk

 

Tags:  dancers  ergonomics  neck  spine  teachers 

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