GUEST BLOG: Post-Treatment Stretching Techniques

Stretchingby Carol Michaels

Stretching is one of the basic components of fitness. Stretching improves your range of motion, which is the degree of movement that can be achieved without pain. Elongating the muscle and fascia by stretching improves circulation, increases elasticity of the muscle, increases oxygen to the muscles, and helps the body to repair. It increases the circulation of blood to the muscles and prevents tight muscles, which have less blood flow. The blood carries oxygen that the muscle needs for energy. Blood flow also removes lactic acid and carbon dioxide, which cause inflammation.

Stretching should be performed every day, after receiving medical clearance. The older you are, the more important daily stretching is to maintain flexibility. Commit to stretching regularly so that you gradually improve your posture, range of motion, and flexibility. It will help you manage the stress and anxiety of the disease.

First, warm up for 5-10 minutes by marching in place or use a stationary bicycle while swinging your arms. Stretching is more effective when warm. The muscles and tendons are easier to lengthen when warm. Then perform the stretching exercises daily in the beginning of your recovery if possible. Use only smooth, controlled non-bouncy movements.

All movements should be done slowly and with great concentration. Try to reach the maximum pain-free range of motion possible for you. Do the stretches slowly and allow the tissue to lengthen. Hold the stretch until you feel a little tension, but not to the point of pain. The goals are to restore joint mobility and break down residual scar tissue.

At first, you might suffer from fatigue and low endurance and might only be able to exercise for a short period of time. Every day you can lengthen the session. Patience and practice will pay off. As you get stronger, you can increase the length of your sessions.

Once you have achieved an acceptable range of motion, it is usually necessary to continue your stretching program so you can maintain that range of motion. If you have had radiation, stretching is very important to help keep your body flexible. Radiation typically causes additional tightening and can impact the affected area for a year or longer after the treatment is finished.

The Recovery Fitness® program uses a combination of active stretching and static stretching. In active or dynamic stretching, the stretch is held for 1-2 seconds and repeated 10 times. In static stretching, the stretch is maintained for approximately 10-30 seconds and can be repeated several (2-3) times. You should move in and out of each stretch slowly and smoothly.

The following is an example of shoulder flexion active stretching: Bring the arm upward and hold for 1-2 seconds and then lower it back to your starting position. Repeat 10 times. With each repetition, raise the arm higher until you feel tension, but not pain. Exhale as you bring your arm up and inhale as you bring your arm down.

Active stretching is used in the beginning of your session. You can then begin to hold the stretch longer and alternate between static and active stretching. Our muscles work in pairs: one muscle works or contracts, while the other relaxes or lengthens. As your stretching session progresses you will determine how long to hold the stretch. The amount of time one should hold a stretch depends on the individual. By listening to your body and using common sense, you will be able to determine what feels good and what works best. Stretching, especially active or dynamic stretching helps you to get ready for any physical activity. Examples of dynamic stretches are walking lunges, squats, and arm circles. Dynamic stretching acts as a warm-up to reduce injuries, get the muscles warm, and improve performance.

Some tips:

  • The brain and nervous system work together in every stretch, and every repetition causes neuromuscular education. By thinking about the movement and concentrating on the affected muscle, we rewire the injured or tight muscle. Be mindful of the movement and its purpose.
  • Slowly lengthen the muscle to a comfortable length while using relaxation breathing
  • The stretches should feel good. Hold the stretch until you feel tension. As you hold the stretch the muscle will relax and you will be able to increase the stretch. Each day it will get easier and you will see your flexibility improve.
  • Modify the stretches to take into account your day-to-day pain and fatigue levels. Do not worry if you are less flexible on a particular day. Just do your best and modify the stretch as needed. You might only be able to perform a few of the stretches on a particular day, or you may need to decrease the length of your session. You may also modify your flexibility routine by reducing the amount of time the stretch is held or changing the number of repetitions performed.
  • Stretching can be performed while standing, sitting, or lying on the floor. Most can even be done in bed.
  • Add a variety of angles to each stretch. For example, if you perform a shoulder stretch with your arm parallel to the floor, try doing the same stretch with the arm at an angle pointing toward the ceiling.
  • Stretching improves posture.
  • Each movement helps to move lymph through the body.
  • Stretching improves movement patterns and decreases the chance of developing over-use injuries.
  • Stretching with relaxation breathing reduces stress.
  • Stretching increases feelings of well-being. You are able to perform your daily activities more easily and with less pain.

Radiation treatment can cause additional tightening. Ongoing flexibility exercises are always recommended to those who have had radiation so that they are able to maintain their range of motion and all of the benefits that good flexibility brings.

Learn more about fitness for cancer patients in our previous articles by Carol Michaels: First Steps to Starting an Exercise Program and Relaxation Breathing, Stretching, and Initial Exercise Precautions.


Carol Michaels FitnessCarol Michaels is a cancer exercise specialist and creator of the Recovery Fitness cancer exercise program. Recovery Fitness is taking place at Morristown Medical Center and several other facilities in New Jersey. Michaels also wrote “Exercise for Cancer Survivors,” a resource for cancer patients going through surgery and treatment.

Meso Foundation Recognizes Workers Memorial Day

Asbestos WorkerWorkers Memorial Day is held annually on April 28, and it consists of dozens of local events held all over the United States. More details about this event can be found in this this post. This year, the Meso Foundation will participate in the Workers Memorial Day Ceremony that will be held tomorrow in Pittsburgh, Pennsylvania.

Diane Blackburn-Zambetti, Director of Policy and Prevention Education at the Meso Foundation, will be speaking at the ceremony in memory of her father, Dale Blackburn, a UA Pipefitter and pleural mesothelioma victim.

Diane will focus her presentation on workplace asbestos exposure and the subsequent risk of developing mesothelioma. This type of occupational exposure can, and does, cause workplace fatalities for many years after the initial exposure. The latency period between exposure and mesothelioma diagnosis can range from 20-50 years. Because of this, workers who were exposed decades ago are now developing this cancer.

Workers Memorial Day is a time to honor those who have lost their lives on the job. According to AFL-CIO, 4,628 individuals were killed on the job and an estimated 50,000 died from occupational diseases in 2012 alone. In the same year, nearly 3.8 million work-related injuries and illnesses were reported, and research suggests these numbers may actually be two or three times higher.

Held on April 28, Workers Memorial Day is the anniversary of the establishment of the Occupational Safety and Health Administration (OSHA) in 1970. Additionally, Congress enacted the Occupational Safety and Health Act in December of 1970. This act holds employers responsible for providing employees with a safe and healthy work environment.

Examining Current Clinical Trials and Mesothelioma Treatment Trends

Watch Mary Hesdorffer, the Meso Foundation’s executive director and mesothelioma expert, in this opening presentation at the 2015 International Symposium on Malignant Mesothelioma. In this video, she discusses the state of mesothelioma research and treatment options. Her discussion begins with a focus on clinical trials. With 92 open clinical trials for mesothelioma, of which 55 include some form of pharmacologic or radiotherapy intervention, mesothelioma research has never looked more hopeful.

Currently, research is focusing beyond chemotherapy, taking a look at how manipulation of the immune system can advance treatment options. SS1P, an immunotoxin, illustrates this new area of research. Other trials are looking at modulating the immune system with t-cells in hopes of starting immune system surveillance that will destroy the bad cells.

Available clinical trials now include vaccine treatments, chemotherapy, and, sometimes, a combination of both. For example, the CRS-207 trial combines a mesothelin-targeting vaccine with traditional chemotherapy.

Various new trials are also in the works. Verastem, a pharmaceutical company, is beginning a trial that uses an agent to target cancer stem cells to delay the time to progression after having a response or stabilization with first-line therapy.

Another focus in mesothelioma research is targeting angiogenesis. Angiogenesis is the ability for cancer cells to find new blood supplies so they can continue growing. This type of research is working on ways to cut off this blood supply.

Mary notes that the face of cancer treatment is changing, and it is important that patients are healthy enough to receive new treatments. When considering a new clinical trial or treatment, a patient must consider the impact it can have on their health, how it will impact their cancer, and whether or not the new drugs will prevent them from being able to try other treatments in the future.

To watch Mary Hesdorffer’s full presentation, click here.

Preliminary Results of Immunotherapy Drug Show Promise for Mesothelioma Patients

VaccineThe Meso Foundation is optimistic about the results of the Phase 1b trial of pembrolizumab for PD-L1-positive advanced solid tumors, which were announced at the most recent meeting of the American Association for Cancer Research (AACR).

Dr. Evan W. Alley, MD, PhD, co-director of the Penn Mesothelioma and Pleural Program, reported the results of a Phase 1b trial of pembrolizumab for PD-L1-positive advanced solid tumors at the AACR Annual Meeting on Sunday. Of the twenty-five patients with mesothelioma who were treated as part of the study, 28% experienced tumor shrinkage and another 48% had prolonged stabilization of their disease. The drug was also demonstrated to be safe, with no patients discontinuing treatment as a result of side-effects.

”These results are quite exciting, and provide further proof of principal that this class of drugs, known as checkpoint inhibitors, are effective for mesothelioma,” noted Dr. Lee M. Krug, Chair of the Board of Directors for the Meso Foundation. “Hopefully this study will encourage much larger trials in this disease.”

Pembolizumab is an antibody that blocks the inhibitory effects of PD-1, thereby boosting the immune system’s activity. In cancer, high tumor expression of PD-L1 is linked with more aggressive disease and a poorer prognosis, and PD-L1 expression was used to select patients for this study. PD-1 inhibitors have already shown great promise in melanoma, renal cell carcinoma and lung cancer, demonstrating both tumor shrinkage and durable responses. Pembrolizumab (KeytrudaTM) is FDA approved for the treatment of advanced melanoma.

In May, the Meso Foundation will be hosting Dr. Alley in an interview, as part of the Meet the Mesothelioma Experts series. More information about the series is available at curemeso.org/experts.

How Past Asbestos Use Still Affects Life Today

Asbestos in AmblerIn 1875, Ambler, Pennsylvania was the largest manufacturer of asbestos insulation and asbestos-containing products in the United States. Asbestos manufacturing brought economic growth to Ambler. With the growth came the knowledge that exposure to this  “miracle fiber” caused horrible disease, such as mesothelioma. Over the next 140 years, asbestos continued to contaminate the grounds, creeks, and playgrounds of Ambler.

Ambler, PA has over 3 million tons of asbestos waste left over from past manufacturing. The “Ambler Piles” (literally piles of asbestos) were the playground of many until the 1980s, and the area later became a superfund site.

In 2009, another Ambler asbestos waste site became the BoRit Superfund site. Despite this designation, this parcel of land has been proposed to become the home of a multi-story housing complex.

In 2015, the BoRit Citizen Advisory Group is still organizing efforts to properly clean up the town and keep the citizens of Ambler safe and informed. The Meso Foundation had the opportunity to organize an educational presentation on April 1, 2015. Diane Blackburn-Zambetti of the Meso Foundation was joined by Dr. Keith Cengel, and Richard Pepino to meet with community members to discuss prevention, research, treatment and more regarding asbestos and asbestos-related diseases. Diane helped residents learn about their resources and meet others whose lives have been impacted by asbestos. This meeting was well attended.

The EPA estimates that asbestos is still present in tens of millions of homes, government buildings, schools, and has also been found naturally-occurring in the soil in several locations in the United States, sometimes in very close proximity to inhabited areas. According to the US Department of Labor’s Occupational Safety and Health Administration (OSHA), an estimated 1.3 million construction employees continue to be occupationally exposed to asbestos. When disturbed, asbestos particles become airborne and are easily inhaled. No amount of exposure is deemed safe.

Contrary to popular belief, asbestos has not yet been fully banned by the U.S. government, but even if it were, the problem of exposures occurring as a result of past use continues. All individuals who have already been exposed and those who will continue to be exposed to the asbestos already present in our environment will remain at risk of mesothelioma. It is important to learn about the dangers of asbestos and where it is present in order to prevent exposure. This information and more is available at curemeso.org/asbestos.