With the good weather there is much more people out exercising. We are just over 3 months away from the London Marathon, there are Ironman and triathlon events alongside all the summer sports. We are seeing many people come to the clinic complaining of a “niggle” that is not quite painful or an injury but is very frustrating.
What is a ‘niggle’?
Typically people refer to niggles as an ache/tightness that they don’t consider to be relevant enough to categorise as an injury. People are aware of them but they are usually still able to perform their day to day activity or training. They are any physical complaint that is different from a persons ‘normal’ but that does not prevent them from doing something.
Examples are:
- Having a tight calf or hamstring
- A sore toe
- Having an ache but not what you would consider pain in your groin or adductors
- Having soreness in a part of your shoulder or forearm
- Discomfort in your low back
What can cause a niggle?
- Previous injury
- Decreased strength
- Poor running technique
- Inaccurate Bike set up
- Poor recovery – sleep, diet, hydration, stress
- Low energy availability
- Too much loading too soon
The prevalence of niggles is about 20-40% in most sports 1,3,4
Evidence:
A paper published in 2019 titled “Do niggles matter? Increased injury risk following physical complaints in Football (Soccer)” looks at how likely a niggle is to develop into an injury. 1, 2
The study looked at 218 semi professional football players in Australia (age: 24.1 ± 4.3 years). The study looked at the prevalence of time loss (TL) and non-time loss (non-TL) injuries and the relationship between non-TL injuries (niggles) developing into TL injuries. (For context a TL injury can mean just missing one training session)
Results:
- Players who reported a “mild niggle” within the 2 days after a game and the first training session of the next week had a 30% greater risk of sustaining a TL injury.
- The players that reported a “moderate niggle” were nearly 70% more likely to sustain a TL injury.
- The players that did not report a niggle in the 2 days after a game had a 10% chance of getting a TL injury in the next 7 days.
- According to the study, knee, ankle and hamstring niggles all have a >90% chance of evolving into a TL injury in the next 7 days.
- Niggles of the low back and hip/groin were more likely to stay a niggle rather than a TL injury.
Conclusion:
“Over a quarter of players on average, report a physical complaint each week that does not prevent them from participating in training or match play. A non-TL injury was shown to be useful in identifying individual players at an increased risk of a TL injury.” 1
Whalan et al, 2019
Does this mean I shouldn’t train if I have a niggle?
Not necessarily. If you have a mild niggle and therefore a 30% increased injury risk, that also means there is 70% where you do not have an increased injury risk. Other things need to be taken into consideration – injury history, current/external stressors – periods of being unwell/reduced training, stage of marathon prep or in this study stage of the season, baseline strength, have they slept well and been optimising recovery etc.
If you feel you can train without your performance being affected, you are optimising recovery and the niggle is not getting worse – you are usually fine to do so.
What should I do if I have a niggle?
- Ensure proper recovery – good sleep, good nutrition and hydration
- Speak openly with your coach or physiotherapist about it – there are ways to reduce niggles such as exercise prescription, manual therapy and taping
- Adapt training sessions if required to a lower intensity, particularly over the next 7 days
- Pay attention to if it worsens during or after a certain activity
How do I prevent getting injured or getting a niggle?
- Addressing problematic areas – lack of mobility/strength etc
- Maintain a strength program throughout your training
- Gradual increase in loading
- Good recovery
Sources / References:
- Matthew Whalan, Ric Lovell & John A Sampson (2020) Do Niggles Matter? – Increased injury risk following physical complaints in football (soccer), Science and Medicine in Football, 4:3, 216-224, https://doi.org/10.1080/24733938.2019.1705996
- Mick Hughes, APA Titled Sports & Exercise Physiotherapist. Learned Physio
- Docking SI, Rio E, Cook J, Orchard JW, Fortington LV. The prevalence of Achilles and patellar tendon injuries in Australian football players beyond a time-loss definition. Scand J Med Sci Sports. 2018 Sep;28(9):2016-2022. doi: 10.1111/sms.13086. Epub 2018 Apr 18. PMID: 29572969
- Bahr, R. No injuries, but plenty of pain? On the methodology for recording overuse symptoms in sportsBritish Journal of Sports Medicine 2009;43:966-972.
- Journal Club with Randall Cooper – Matt Whalan. https://www.youtube.com/watch?v=Tx6RD54FH-g