By Janine Bryant for The Dance Journal
Dancers are obedient, generous and driven people! The determination and focus required to succeed is parallel to that required of elite athletes. However, the added pressure of meeting an ever-expanding aesthetic can place additional and unique demands on dancers as athlete-artists.
In dance, there is increasing pressure to meet an aesthetic that requires extreme joint range of motion (ROM). Many dancers exert considerable physical effort to increase their ROM to produce the illusion of perfect movements or positions (Steinberg 2006). It is possible that continued demand on a joint would increase its risk of injury and disease such as osteoarthritis. The subsequent pain from this degeneration may impair ROM as well as performance. The effect of aging on skeletal muscle has possible implications for aging dancer-athletes in terms of performance, pain levels and recovery, because skeletal muscle provides the contractile element that powers sport performance.
In 2013, I had the privilege of leading a team of researchers to launch a global survey asking dancers about their activities and pain levels. The self-report survey focused on the spine and aimed to understand the link between perceived spinal pain, age and how it affects activities of daily living (ADL), including dance. Respondents to the online survey consisted of 206 student and professional dancers. The survey detailed age, anthropometrics, gender, professional status, activities, pain levels, spinal range of motion limitations, known spinal conditions, primary dance genres, and gender.
Survey participants were asked to describe their pain levels during specific activities. Results reveal correlations between age, activity and pain levels with a higher percentage of dancers reporting next day after exercise pain in comparison with other types of activities. In addition, 17.7% of dancers reported a chronic known spinal condition as opposed to a known acute condition which was reported by 6.86% in comparison. Of dancers who were aware of an acute or chronic spinal condition, 27.87% reported the condition limited their spinal ROM with 15.79% reporting they did not know why their spinal ROM was limited while 14.04% reported a known injury limiting their spinal ROM. These numbers reflect what was expected as dancers typically perform and continue activities despite pain and/or injury.
The key to aging well lies in understanding the mechanism of aging and what it does to both hard and soft tissues or, more specifically, bone, ligaments, muscles and joints.
In joints, loss of ROM is due to degeneration of connective tissue over time. The modifications of connective tissues during aging are associated with increased stiffness, resulting in brittle fibers with reduced function, ROM and injury.
For dancers the main sites of reported injury are the upper and lower (cervical, thoracic and lumbar) spines. This, accompanied by continued demands for increased ROM, could take the movement of the joints beyond normal ranges resulting in bone on bone contact causing more risk of degeneration which would in turn limit ROM due to increased pain. (Gelabert, 1986)
Collagen – a key player!
Collagen is the most abundant protein in the human body and is the substance that holds the whole body together. It is found in the bones, muscles, skin and tendons, where it forms a scaffold to provide strength and structure. The function of these tissues is primarily mechanical.
As discussed in the previous post, collagen cross-linking, via the formation of Advanced Glycation End Products (AGE’s,) can be detrimental to ROM as dancers age. This process of glycation causes collagen fibers in joints to bind together thereby preventing sliding of the molecules under load. As cross links increase in number, joint stiffness also increases causing a gradual loss of ROM.
regular vs irregular connective tissue – www.cnx.org
Pain and ROM
The presence of pain in joints may increase sufferers’ resistance to moving the extremities (Fell, 2008). Perception of pain is important because it may deter dancers from sustained effort to maintain or increase ROM creating a cycle of immobility.
Other Causes of Degeneration
For dancer-athletes, the effects of mechanical loading over time may increase stiffness, via changes in tissue properties, and therefore limit available ROM in dancers (Steinberg, 2006). Research that has addressed the effects of aging on the response of skeletal muscle tissue to physical exercise might also provide insight into age-related differences in recovery. A reference list at the end of this article might offer some additional reading.
Women vs Men
Individuals with an extra long spine may have limited hyper-extension of the low back due to the conspicuously large lumbar vertebral bodies and proportionally smaller intervertebral spaces typical with this kind of spine. The spinous processes (the ‘tail’ portion of the vertebrae that you can feel whilst running your fingers along the spine), will meet sooner as the low back hyper-extends. This creates a structural limitation of little significance in the general population, but that constitutes a serious deficit in dancers. Because of the length of this type of spine, the ligaments and tendons are shorter and thicker with less flexible muscles, causing impingement of the spinous processes during forced hyper-extension and a lateral hip lift effecting the aesthetics of the classical line. This type of spine is found more often in males than in females, in whom the lifting of the leg backward is more controllable (Gelabert, 1986).
One gender-specific survey question was asked regarding cessation of menstrual cycle or whether female respondents experienced normal menstrual cycles. Females with irregular or discontinued menstrual cycles are at an increased risk for osteoporosis and vertebral fractures (El Maqhraoui A, et al 2014). These conditions can have a direct impact on pain and spinal ROM, particularly for women.
Our survey revealed to what extent dancers are experiencing spinal pain and limited ROM and suggested that more work can be done by dance educators to implement spinal strengthening and care protocols via research-based information. Dancers could also benefit from efforts to raise awareness of the importance of medical intervention regarding spinal pain and limited ROM since almost one quarter (24.57%) of our respondents stated the presence of either an acute or chronic spinal condition with almost 68% admitting their condition sometimes or usually limits spinal ROM.
The phrase, ‘motion is lotion’, is one that I hear often from my aging colleagues, who are still dancing beautifully! We all know that, if we stop, we will loose faster what we aim to keep in terms of ROM but, how much is too much? I think the answer to this question is very different for every dancer who is experiencing age-related changes to their bodies. What is clear, though, is that the hard training of our teens and twenties is no longer possible and, more likely, less is more in terms of our activities.
The past three posts were aimed at helping to increase awareness of aging and spinal health in the dance community. Dancers can learn more by perusing the reference list at the end of this article. Knowledge is power! Please email me if you are interested in learning more about aging dancers and also if you are interested in becoming involved in my ongoing human ROM studies.
Until next time, friends, dance healthy and strong!
Assistant Professor of Dance and Kinesiology
Eastern University, St. Davids, Pa.
Fell J, Williams AD, The effect of aging on skeletal muscle recovery from exercise: possible implications for aging athletes, J Aging Phys Activ, 16, 7-115, 2008.
Ferguson SJ, Steffen T, Biomechanics of the aging spine, Eur Spine J, 12(2), S97-S103, 2003.
Gelabert R, Dancers’ spinal syndromes, JOSPT, 7(4), 180-191, 1986.
Intolo P, Milosavljevic S, Baxter DG, Carman AB, Pal P, Munn J, Effect of age on lumbar range of motion: a systematic review, Manual Therapy,14(1), 596-604, 2009.
El Maqhraoui A, Rezqi A, El Mrahi S, Sadni S, Ghozlani I, Mounach A, Osteoporosis, vertebral fractures and metabolic syndrome in postmenopausal women, BMC Endocr,14(1), 93, 2014.
Steinberg N, Hershkovitz I, Peleg S, Dar G, Masharawi Y, Heim M, Sievner I, Range of joint movement in female dancers and nondancers aged 8 to 16 years, AJSM, 34 (5), 814-823, 2006.
Wasilewski SA, Woods LC, Torgerson WL, Value of continuous passive motion in total knee arthroplasty, Orthopedics, 13(3), 291–295, 2009.