Welcome back to Mick's 2 cents blog!

If you missed my first one, you can read it here. In a nutshell, every 2 weeks I'm going to chime in and give my hot takes on what was discussed recently on my good mate Randall Cooper's Journal Club Podcast, and how physios & exercise professionals can easily apply the research discussed in their everyday practice.

In the latest Podcast, Randall sat down and talked with Dr Matt Whalan, an Australian Sports Physiotherapist and Exercise Physiologist who has recently completed his PhD and authored and co-authored a growing body of research in Footballers/Soccer players.

The paper that was discussed between Randall and Matt was one of Matt’s recent publications titled “Do niggles matter? Increased injury risk following physical complaints in Football (Soccer).

For those unfamiliar with the term “niggle”, it is a colloquial/slang word often used here in Australian sporting circles to describe a minor musculoskeletal complaint from an athlete that isn’t bad enough to call an “injury”, nor stop the athlete from fully participating in training or sport. Common mild complaints that are often referred to as a “niggle” would be a “tight” hamstring or “tight” calf.

There was plenty presented and discussed by Matt, but I want to focus this blog on a couple of key findings.

Firstly, amateur soccer players who reported a “mild niggle” within the 2 days after a game and the first training session of the next week had a 3x greater risk of sustaining an actual time loss injury (one that prevented the player from training and/or playing a game all together) in the next 7 days. Furthermore, players that reported a “moderate niggle” were nearly 7x more likely to sustain a time loss injury in the next 7 days.

Now it is these figures that I think are really important thing to address.

On paper, these figures are quite dramatic.

“3x-7x greater chance of becoming injured in the next 7 days after reporting either a mild or moderate “niggle”.

However, it needs to be acknowledged that players that did not report a “niggle” in the 2 days after a game and leading into the first training session of the week, all had a 10% chance of getting injured in the next 7 days.

So with this in mind, those athletes who are reporting a “mild niggle”; yes there’s a 30% chance that these athletes may go on to sustain a time-loss injury in the next 7 days, but there is also a 70% chance that they will be able to train and play fully for the remainder of the week and WON’T sustain a time loss injury in the next 7 days.

So a big take home here is that the context of the injury incidence and risk of injury needs to be taken into account here; and rather than saying to a coach “this player cant train today or he’ll need to miss this weekends game because he’s got a tight hamstring and has a 30% chance of getting injured” really needs to be tempered down with a more open conversation that takes into the account the athlete in front of you, their injury history and the stage of the season (just to name a few variables).

For example, think about a 30 year old athlete who has had a long history of recurrent hamstring strains throughout the last 3 years that usually keeps the player out of games for 4-6 weeks is complaining of tightness 2 weeks into a long 26 round competitive season. The risk vs reward conversation you have with the player, coach and support staff may land on a decision that sees this athlete modify his training and playing availability for the next 2-3 weeks. Conversely the risk vs reward conversation you have regarding an 18 year old athlete who has no hamstring injury history, has played every game this season and is complaining of hamstring tightness a week out from playing in the grand final may land on a decision that he continues training and playing as normal this week leading into the grand final.

Soccer athlete holding his knee in pain due to a 'niggle' in his knee, low back pain.

The other thing I found fascinating listening to Matt was that some “niggles” in a particular area of the body have a very high chance of evolving into a time loss injury in the next 7 days. Once again, knowing this information can help frame our thoughts on training and playing availability based on where the “niggle” is coming from.

According to Matt’s work, knee, ankle and hamstring “niggles” all have a >90% chance of evolving into a time loss injury in the next 7 days. However, “niggles” of the low back and hip/groin, did not evolve that way and were much more likely to stay a “niggle” rather than a time-loss injury.

So in wrapping up my blog – I hope you have enjoyed it by the way - here are my 2 cents regarding “niggles”:

-      “Niggles” are to be respected, but not feared. Just because a player is reporting a “niggle” doesn’t mean that they have to be shut down from training that week or forced to miss a match.

-      Get to know your athletes and build relationships and trust. Asking the questions to the athlete, “can you train/play today” and “do you think you can perform today?” can give you some great insight as to whether they can work with the “niggle” and a little discomfort, or have to modify training. Applying a blanket rule to athletes that they can't train or play because they have a “niggle” because their risk of injury is at least 3x greater than those not reporting a “niggle”, won't do you any favours with the club you’re working for.

-      Lastly, not all “niggles” are created equal. It appears from this study that knee, hamstring and ankle “niggles” will need careful consideration as to whether it's worth “rolling the dice” on a player participating in training and games this week. However, low back and hip/groin “niggles” appear to be complaints that can be treated with a little bit more tough love.

If you'd like to listen to the full 15min podcast with Randall and Matt, click on the link here.