Author: Janine Bryant on behalf of the IADMS Dance Educators’ Committee

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.

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 affected.⁸ 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

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: https://www.who.int/ageing/healthy-ageing/en/