I am excited about this post because it puts a TINY bit of research behind things that we inherently tend to think or feel about injuries. Most people understand the difference between an acute injury and a chronic or overuse injury, but what about those nagging aches and pains that don’t stop you from doing what you love?
There are three main types of injuries that can interfere with your activities:
An acute injury, which happens at one moment in time. You can generally pick out the moment when it happens… you twisted your ankle, you picked up a box, you tripped and fell. These injuries tend to be sprains, strains or tears. In that moment, you exceeded the strength of the tissue (ligaments, tendons or muscles). Perhaps you overstretched or tore some fibers (the more you tear, the more severe the injury) which results in pain, swelling, bruising and limited range of motion. The severity of these injuries are on a spectrum from grade 1 (give it a few days to calm down) to grade 4 (full tears, likely requiring more invasive interventions).
In contrast, a chronic or overuse injury tends to happen over time. Rather than exceeding the strength of a tissue at one moment in time, you slowly stress the tissue, exceeding its capacity over days, weeks or years. Part of the development of overuse injuries is a lack of enough recovery time. Recovery time is needed to allow tissues to get stronger. Imagine going to the gym every day and doing the same exercise, over time you will notice that body part gets more and more sore. You might even notice you’re not getting stronger, you’re actually getting weaker! Another way overuse injuries can happen is when the tissue is weak and doesn’t have enough strength to cope with what you’re asking it to do (and therefore requires more recovery time than normal). In this situation, you may be giving yourself some recovery time, but it’s not enough because the area isn’t strong enough to begin with. You may also not be doing anything to make that specific tissue stronger!
There is also a combination injury, which is called an acute on chronic injury. It is basically what it sounds like: the tissue has chronically been strained and does not have enough recovery (chronic/overuse injury). Then you do something while playing a sport or working out which shouldn’t lead to an acute injury but because of the chronic strain, it overcomes the strength of the tissue in that moment.
Now, that being said… most people who play sports or exercise have also experienced this scenario:
You’re playing or working out and you feel a tweak somewhere or a little bit bothered by a feeling in a muscle or joint
It doesn’t stop you from playing or working out and you figure it will just go away on its own
You take a few days off and the area you felt bothering you tends to get better or goes away
But if you resume playing or working out, the same area seems to continue to be a problem
This scenario can often give us a clue that our body is dealing with some type of overuse injury, but it may not have crossed the threshold into being a full-blown problem yet. That is a NIGGLE!
As an evidence-based practitioner, it can sometimes be difficult to manage situations that you encounter a lot in practice, but there isn’t a huge area of research to directly influence your decision-making. When this happens, you tend to use more basic evidence to inform your decisions. The “niggle” is one of those things. But that is also why this study is super cool…
They looked at 25 semi-professional soccer clubs in Australia and had the players fill out questionnaires about injuries that kept them from playing (time-loss injuries) and aches and pains they felt but didn’t stop them from playing. That may seem pretty normal to you, but in injury tracking research, this is quite a new development! Usually, these studies focus only on injuries that keep you from playing, and sometimes, only even injuries that keep you out for a significant amount of time.
So, what did this study have to say?
Although it may seem intuitive, it’s awesome that there is finally some research to support what we are naturally inclined to think. If an athlete reported having “no health problems”, their risk of having a time-loss injury was only 6%. That’s low! So basically, if you feel good and don’t have anything bothering you physically, you’re not likely to have a time-loss injury.
However, 68% of time-loss injuries were preceded by a physical complaint or a niggle. In fact, if you had a knee or hamstring injury, this physical complaint was in the knee 94%, and hamstring 90% of the time before having an injury that kept you from playing.
The risk of having a time-loss injury within 7 days of having a niggle was 3-7 times MORE than if there was no niggle. On top of that, the more intense the pain (that does not lead to time away from your activity), the more likely you will have an injury that leads to time loss within 7 days.
How you feel matters! And paying attention to what your body is telling you can help prevent time-loss injuries. Don’t ignore those little feelings here or there. Don’t dismiss them or ignore them. A niggle might be trying to tell you that your body is fighting an overuse injury that may lead to something bigger. It may lead to an overuse injury that stops you from playing or may be an acute on chronic injury waiting to happen. This is your opportunity to get checked out before it turns into something more!
Often times, people, players and coaches ask me how to “prevent” or reduce the risk of injury. THIS IS IT! THIS RIGHT HERE. Not letting something linger and get worse.
So, I Have a Niggle, Now What?
As I mentioned, a niggle may be an early sign that your body is fighting an overuse injury. It’s that “tight” hamstring or calf, it’s the “tweak” in your back, it’s the soreness in your hip. Small things that don’t necessarily stop you from doing what you want to do.
The earlier you get this checked out the better, as you can start to address the reason why it is happening. As I always say, injuries happen when your demand (what you’re doing) exceeds your capacity (what your body is able to do). Seeing someone who can figure out what your weaknesses are can help you work towards a solution.
While strengthening the area is important, you should also consider what the rest of your body is doing. When you perform a movement, even though it may seem like one part of your body is working, you really have to coordinate many parts of your body to get the job done. As a simple example, when you bend down to pick something off the floor, most people think your back is the primary contributor to the movement. BUT! If you look in a mirror you will see, your hips go through almost full range of motion as well. So, if you’re limited in what your hips can do, your back will have to do more work.
You will want to see a healthcare professional who can assess not just which structures are hurting you, but also the strength of the tissues and the potential compensations that are leading to greater strain on those tissues. The idea that everything in your body is connected is true, so often looking at just the area that is hurting isn’t enough!
What You Should Expect
In recent years, there has been a push to change how these types of injuries are managed (overuse injuries, acute on chronic injuries or niggles). Previously, providers may have offered a “cure” for the injury, followed up with different types of imaging, made the person feel as though they had to be careful with how they moved or provided a quick solution for the problem. These include different types of medications, injections or surgeries.
It is sometimes tempting to do or say these things with patients because it provides an easy solution to their problem. A quick fix for reducing pain or just showing up to treatment to feel better. The truth is, when it comes to a niggle or overuse injury, there is no quick fix. We know that these types of injuries are complex, they reflect an interaction between genetics, psychosocial factors (satisfaction, support, beliefs), lifestyle (exercise, stress, sleep, nutrition), physical factors (strength, range of motion, age) and general health (other medical conditions).
If you look at this list of things that may contribute to the pain you’re feeling… how could you believe there was a simple solution like showing up to the doctor’s office to get a pill, injection or even an adjustment to fix your problem!
No matter who you see to help you deal with your injury, you should expect:
To be taught about what is going on in your body (without inducing fear)
Advice about how to live a healthy lifestyle
Recommendations on how to address physical factors (how to manage your pain, get stronger and improve mobility)
You should feel listened to, understood, supported and empowered to make changes that will lead to improvement in your pain
You should feel like you and your healthcare professional are a team tackling a problem together!
This infographic from the British Journal of Sports Medicine is a good summary of what you should expect from your health care provider.
Moral of the Story
Those aches and pains you feel may indicate that your body needs more recovery time or you need to strengthen the area, these are called niggles. You are more likely to experience an injury that will take you away from your sport or activity of choice if you try to push through niggles. Sometimes areas can experience higher levels of stress because of compensations from limitations in other areas of the body. Seeking the help of a healthcare professional who can assess your area of pain, strength and range of motion can provide the information you need to reduce the risk of time-loss injuries.
This post is intended to be informative! It in no way replaces a full assessment by a licensed healthcare professional or is intended to act as medical advice. If any of this resonates with you or if you have further questions, I strongly recommend you follow up with a professional who can give you an individualized assessment and advice regarding what you’re experiencing!
Whalan M, Lovell R, Sampson JA. Do Niggles Matter? - Increased injury risk following physical complaints in football (soccer). Sci Med Footb. 2020;4(3):216-224.
Wilke J, Vleeming A, Wearing S. Overuse injury: The result of pathologically altered myofascial force transmission? Exerc Sport Sci Rev. 2019;47(4):230-236.
About The Author
Dr. Melissa Corso has an undergraduate degree in biomedical sciences and a Masters degree in human health and nutritional sciences from the University of Guelph and was a former Varsity soccer player. She graduated from the Canadian Memorial Chiropractic College (CMCC) in 2016 and completed the Sports Science residency in 2018. In 2019 she became a fellow of the Royal College of Chiropractic Sports Sciences (Canada). Dr. Corso is in private practice at an inter-disciplinary clinic in Richmond Hill, Ontario and a research associate at the Centre for Disability Prevention and Rehabilitation at Ontario Tech and CMCC. In her spare time, she enjoys working out, playing soccer and reading