feature
football medicine & performance
DO NIGGLES MATTER? INJURY SURVEILLANCE IS A KEY STEP IN THE PREVENTION OF INJURIES FEATURE / DR MATT WHALAN It has long been acknowledged that injury surveillance is the cornerstone for the development of effective injury prevention programs and systems (Van Mechelen et al, 1992). Without injury surveillance it is difficult to not only determine what injuries you need to target but also, surveillance ensures that your intervention is effective. Most commonly in football injury research, however, only time-loss injuries which result in a failure to fully participate in training or matches are used to determine injury incidence and severity, based on the football injury recording consensus statement (Fuller et al, 2006). As such, injuries or physical complaints that do not stop a player training or playing, non-time loss injuries or “niggles”, are not routinely reported in the literature or if they are, it is only when the injury is significant enough to impact on participation. Clarsen and Bahr (2014a) produced an excellent figure which outlines the different definitions applied to injury classification (Figure 1). As seen in this figure,
the time loss definition captures many but not all injuries that can occur to a player with the “niggle zone” previously not addressed in football injury research. The Oslo Sport Trauma Research Centre (OSTRC) Questionnaire on Health Problems for Self-Reporting Injuries. Developed in 2014 by Assoc Prof Ben Clarsen and colleagues, the OSTRC Questionnaire on Health Problems was developed to try and improve injury data collection methods across a number of sports. The survey was sent out once a week and explored the impact of any physical issue during the week on participation, performance, pain perception and training volume (Figure 2). More recently, other versions of the survey have been used to capture locationspecific (e.g. hip/groin) non-time loss injury information with much larger capture of physical issues compared with the traditional time loss method (Harøy et al 2017).
The Research Our research questions – how many niggles occur in football & can a niggle help identify a player at an increased risk of a time-loss injury? Based on the emerging research and from most practitioners’ own experience, it is likely that time loss injury rates significantly underestimate the prevalence of physical complaints in football. Furthermore, little was also known about the prevalence and impact niggles in football may have on more serious time loss injury risk. As such, we looked to capture both time loss and non-time loss (niggles) injuries over an entire season and explore the concept of injury risk. What Did We Do? Players from semi-professional football clubs in Australia agreed to participate in an injury study during the 2016 season (35 weeks). All players participated in football exposures 3-4 times per week and had any time loss (medical staff recorded via the Football Consensus injury
Figure 1 - Adapted figure from Clarsen and Bahr (2014a) highlighting different classifications of injury. The consensus for injury recording in football (Fuller et al, 2006) covers the time loss injury portion, while the OSTRC Questionnaire on Health Problems (Clarsen et al, 2014b) endeavours for a much larger injury capture. The Niggle Zone is the missing piece in football injury surveillance.
Figure 2 - The OSTRC Questionnaire on Health Problems (Clarsen et al, 2014b) explores the impact of physical complaints on 4 categories – participation, volume, performance and perception of severity.
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