Analysis: What runners tell us about their experiences with the infamous niggles can enhance our understanding of injury
Running is one of the most popular forms of physical activity in Ireland, with over 140 Park Runs occurring every week. While running has many physical, mental, and social benefits, injuries pose a big problem. Over half of Irish runners sustain an injury every year and the impact these injuries have on their lives can be significant; causing physical pain, long and frustrating disruptions to training, and high costs with medical treatments.
Most research has focused only on injuries which are severe enough to cause significant disruptions to training, and typically consider pain and time lost from running as the main consequences of injury. However, with extensive focus group data collection and over 150 hours of data analysis, we explored runners' lived experience of injury, allowing us to develop the Running Injury Continuum which depicts the progressive and fluctuating process of injury development.
We were able to identify 9 levels of injury that represent the typical insidious onset of running injuries. These reflect the physical symptoms experienced (such as discomfort and low pain), the negative outcomes (such as forced reductions in mileage and difficulties with daily tasks), the psychological consequences (such as anxiety and frustration), and the management strategies required with injury.
Importantly, while runners acknowledged the high-level, more well understood aspects of injury (those which usually result in more severe pain and can prevent a runner from being able to run), they also identified lower-level injuries, where they experience pain, yet continue to run. In addition, they characterised the psychological and social effects of injury that have largely been undocumented in research. The most frequently used term to describe these lower-level injuries, and which took up the majority of discussion, was the infamous 'niggle'.
From Insight SFI Research Centre for Data Analytics' Science of Running symposium, Aisling Lacey on runners' perspectives on injuries
What is a niggle?
A niggle is typically a mild physical sensation, such as discomfort or low pain, that is felt on repeated occasions but with which a runner can continue to run. Some runners describe it as "background noise" or "something that lingers", but it is typically something that they "can ignore".
Is a niggle an injury?
From a current research perspective, a niggle is not considered an injury as injuries are typically only registered when they cause significant disruptions to training, a complete stop to running, or a need for medical attention. However, this strict definition is a possible limitation to research, and our findings show that niggles are a part of the injury continuum, and therefore can be considered as ‘injuries’.
Do niggles lead to injuries?
Runners describe niggles as the "root" to an injury, often preceding the onset of more significant injuries. There is a clear progression from no injury, through various niggles (and discomfort and/or twinges), to significant higher-level injuries; so, it is likely that these niggles act as precursors to more severe injuries. Unfortunately, research has been slow in recognising the importance of these niggles, with no studies investigating their possible causative relationship with higher-level running injuries.
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From RTÉ Brainstorm, why some runners get injured and how to stop it happening
Can you run with a niggle?
Because the symptoms of a niggle are typically mild, runners often feel they can be ignored and will continue to run with them. While some discomfort can be a 'normal' response to training and is necessary to increase muscle strength through progressive overload, these ‘milder’ symptoms can indicate physiological tissue damage, indicative of injury.
There is a fine balancing act between achieving this ‘progressive overload’ and tipping the scales too far. It's in this case, when niggles are ignored and training continues, that higher-level-injuries can occur. Runners should therefore learn to listen to their bodies properly, recognising the importance of niggles as part of the Running Injury Continuum, and not ignore them. One major challenge however is that runners’ either convince themselves that niggles are "not bad enough", or their personal desire to run through them is too great as they are"chasing the running high".
How common are niggles?
Many runners see niggles as "an inevitability of running", with some runners describing how they "constantly have niggles" and live in "Niggle City". If this is the case, it is likely that research is vastly underestimating the frequency of injury among runners.
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From RTÉ Radio 1's Today With Claire Byrne, chartered physio Jenny Branigan on how to avoid exercise-related injuries for adults and children
A surprising finding of this study was that runners describe significant psychological responses to injury much earlier than we had thought, describing how niggles and injuries "mess with your head". Our findings highlight that this aspect of injury cannot be overlooked by runners, coaches, clinicians, or researchers.
How should you manage niggles?
For most runners, niggles are self-managed with strategies such as stretching more regularly, taking rest days, or altering their training with reductions in mileage, intensity, or frequency. Sometimes, when niggles start to become more severe or persistent, runners turn to external sources for advice, from friends, a coach, or the Internet.
Runners don't seem to look for medical advice from an Athletic Therapist or physiotherapist without having attempted these management strategies first. However, this can sometimes be too late; to reduce loading and further damage to injured tissues, there is a need for more significant training restrictions and treatment modalities.
Runners should focus on information from reputable sources (especially online) and use evidence-based advice with regard to injury management and prevention.
Put simply, injuries occur when an excessive load is applied to a tissue beyond its strength. Therefore, by reducing the loading placed on the tissues (by altering their training) and/or increasing tissue strength (by performing appropriate strengthening exercises), runners may be able to better manage niggles before the need for significant training disruption. This does not necessarily mean attending a medical professional with each niggle.
However, medical professionals can provide runners with appropriate evidence-based strategies for reducing the loading and increasing the strength of tissues, which runners can then utilise as self-management strategies. It’s important to emphasise that runners should focus on information from reputable sources (especially online) and use evidence-based advice with regard to injury management and prevention.
How do I prevent niggles?
Unfortunately, there is very limited evidence for effective injury prevention programmes and therefore, we cannot suggest explicit strategies for preventing running injuries. This limited evidence is possibly because research has failed to appropriately consider niggles as part of the injury continuum. By explicitly identifying multiple levels of injury (including niggles) and capturing the full process of injury development with the Running Injury Continuum, we could possibly gain significant insights into the risk factors for injury and make advances in injury prevention.
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The views expressed here are those of the author and do not represent or reflect the views of RTÉ
