Column: The Versus Debate

by Lori Shupak, Physical Therapist
Morinville Physical Therapy & Sports Injury Clinic

Frequently patients ask questions regarding the following:

Ice versus Heat: Both of these agents can be helpful in decreasing inflammation, however the timing of their application is very different. Ice is best used within 72 hours of an injury, whereas heat is best applied after 72 hours of an injury. When an injury is chronic (meaning it has existed for more than three weeks) and there is a new irritation or re-aggravation of the existing condition, the body experiences an ‘acute on chronic injury’, where we resort back to icing for the first 72 hours then change to heat application after this amount of time has elapsed.

Hurt versus Harm: Often times people are apprehensive to return to activity following injury as they are not sure whether returning will lead to further damage or worsen the existing injury. Working through minor discomfort can be a healthy and necessary progression toward healing. A general rule of thumb is: if you are saying (or thinking) “ouch”, you are pushing too far. However, if you are saying (or thinking) “this is uncomfortable”, you are likely okay. The body has a remarkable way of healing itself. When tissue is stressed to a level within the body’s tolerance (hurt) it will lead to the body repairing itself in a stronger state. If you push the body past the acceptable “hurt” limits, you enter the “harm” stage where the tissue has been pushed past its easily repairable state, and you will now have to battle with potential long term consequences. We generally say that when returning from an injury, discomfort is acceptable, but pain is not.

Stretch versus Strength: Many people seek home exercise programs to assist with their recovery. Before any exercise is done at home, it is important to properly identify the exact cause of the injury in order to ensure that the exercises being done are appropriate. A common misconception is that people are injured due to weakness, however the majority of the time, it is actually due to tightness. When a muscle is tight, it is no longer working under ideal conditions, therefore it pulls and creates friction which leads to inflammation and then weakness. Without properly correcting the underlying problem (tightness or muscle shortening), there is little benefit to strengthening the muscle. Therefore, most home exercise programs should start with stretching in order to restore the muscle to its optimal working length, then strengthening can be brought in under ideal conditions to prevent future problems in the area.

Stretch before versus after activity: Generally, stretching of any kind before or after activity will help more than harm, although certain types of stretching have been proven more beneficial than others. As mentioned above, the majority of soft tissue injuries are caused by tight, shortened muscles, so any stretching is better than no stretching. However, if you are looking for the best performance gains through pre- and post-workout stretches, it is recommended you participate in a dynamic stretching routine (stretching through mimicking sport-specific movements) pre-event, and a more static stretching (get into a position and hold for 30 seconds) routine post-event. Stretches should never result in pain being felt. The ideal outcome is a “pull” of medium intensity.

If you have any topics that you would like discussed or questions you are seeking answers to, please email We hope to provide a routine column based on the community’s specific questions or concerns.

Print Friendly, PDF & Email