Poor Sleep Quality Has a Significant Impact on Injury Risk in Runners
Key insights: 60-second read
- Poor sleep quality linked to 36% higher injury risk – A six-month study of 339 runners found that for each one-point increase in a poor sleep score, the risk of a running-related injury rose significantly.
- Fatigue and muscle soreness are early warning signs – Runners reported higher fatigue in the week before an injury and increased soreness up to two weeks prior, suggesting an imbalance between training and recovery.
- Sleep quantity may matter less than quality – The study found no strong link between hours slept and injury risk, highlighting the importance of how well you sleep, not just how long.
- Practical takeaway – Regularly monitoring your sleep quality, fatigue and muscle soreness could help you adjust training load before an injury develops.
As a physio, I see many runners who are frustrated by recurring injuries. They often track their kilometres, pace and heart rate meticulously, but when I ask about their sleep, I frequently hear: 'I'm not sleeping well, but I don't think it's related.' A recent prospective study published in the Scandinavian Journal of Medicine & Science in Sports suggests otherwise. Let's break down what the research found and what it might mean for your running and recovery.
In my Port Macquarie practice, conversations about hamstring strains, shin pain or plantar fasciitis often lead to discussions about training load, stress and recovery. While I am not a sleep specialist, understanding the role of sleep in tissue repair, inflammation regulation and motor control is essential for anyone wanting to better frame pain and injury.
The recent study investigated whether sleep quality and quantity, along with training load and recovery markers, were associated with the risk of running-related injuries (RRIs). The researchers used weekly smartphone-based questionnaires to track these factors in real time.
On this page
1. The key finding on sleep quality
Poor sleep quality was associated with a 36% higher injury risk
The analysis showed that lower sleep quality was significantly associated with an increased risk of a running-related injury at any given time (HRR 1.36, 95% CI 1.04 to 1.78; p = 0.02). In practical terms, each one-point increase in the sleep quality score (meaning poorer sleep) was associated with a 36% increase in injury risk.
2. Breaking down the study: How it worked
The researchers followed 339 adult runners from 24 countries (83.8% male, average age 43.4 years) for up to 26 weeks. Here is a snapshot of their method:
| Study component | What they did | Why it is interesting |
|---|---|---|
| The tool | Used a smartphone application (TRAINIMM) to collect weekly data | Moves beyond a one-off questionnaire to track recovery and injury in real time, in daily life |
| The tracking | Weekly reports on sleep quality, sleep quantity, sleep latency, fatigue, muscle soreness, perceived stress and training volume | Focuses on modifiable factors that runners can monitor and potentially change |
| The measurement | A running-related injury was defined as any pain affecting running practice for at least 7 days or three consecutive sessions, or requiring a healthcare consultation | Uses a clear, clinically meaningful definition of injury (time loss or medical attention) |
3. Fatigue and muscle soreness as early warning signs
The study also looked at what happened in the weeks immediately before an injury. Compared to injury-free weeks, the researchers found:
- Muscle soreness was higher both two weeks before the injury (RRI-2, p = 0.02) and one week before the injury (RRI-1, p < 0.001).
- Fatigue was elevated during the week immediately before the injury (RRI-1, p = 0.04).
This pattern suggests that perceived fatigue and muscle soreness might serve as early indicators of an imbalance between training load and recovery capacity. In other words, your body may be sending warning signs before an injury fully develops.
4. Sleep quality versus sleep quantity: What matters more?
Interestingly, the study found no significant association between sleep quantity (hours slept) and injury risk. This is worth pausing on. Many of us (myself included) have focused on getting 'enough' hours, but this research suggests that how well you sleep may be more important than how long you sleep.
Why might sleep quality matter more for injury risk?
Poor sleep quality may disrupt the training-recovery balance. It can affect tissue repair, inflammation regulation, reaction time and decision-making - all of which influence injury risk. While more research is needed, the study authors suggest that sleep quality may be a more sensitive marker of recovery status than simply tracking hours in bed.
5. A measured perspective: Limitations and context
While I find these results valuable, it is important to view them with a balanced perspective, especially when considering how they might apply to your own running.
Study design and limitations
- High dropout rate: Of the 1982 runners who initially registered, only 339 were included in the final analysis. The average follow-up was 4.2 weeks, which is shorter than the intended 26 weeks. This means the findings should be interpreted with some caution.
- Sample characteristics: The sample was predominantly male (83.8%) and competitive (92.9% competed regularly). The findings may not fully apply to recreational runners or female runners.
- Subjective measures: Sleep quality, fatigue and soreness were self-reported. While this reflects how runners perceive their own recovery, objective measures (like actigraphy or sleep staging) might provide additional insights.
- Missing data: Like many longitudinal studies, there was missing data. The researchers used statistical methods (median imputation) to address this, but some information loss is inevitable.
Generalisability to everyday runners
The principle - that poor sleep quality and elevated fatigue may increase injury risk - seems broadly relevant. However, the specific numbers (like the 36% increased risk) come from a specific group with a specific training background. Your own risk will depend on your unique combination of training load, recovery, life stress, nutrition and injury history. The empowering idea is that you can monitor these factors and adjust accordingly, not that a specific percentage applies to everyone.
Key takeaway for managing injury risk
The study does not prove that poor sleep causes injuries. But it does suggest that regularly monitoring your sleep quality, fatigue and muscle soreness could help you identify when you might be at increased risk. This shifts you from a reactive approach (treating injuries after they happen) to a more proactive one (adjusting training before an injury develops).
6. From research to your running: Practical applications
So, what might we gently take from this as runners and as a physio? If you are currently training or rehabbing an injury, consider these ideas:
- Monitor your sleep quality, not just hours. A simple daily rating (1 = terrible, 5 = excellent) can help you spot patterns. If you notice several days of poor sleep quality, it may be a sign to ease back on intensity or volume.
- Track your morning fatigue and muscle soreness. If you wake up feeling more fatigued or sore than usual for your training load, that could be an early warning sign. Consider an extra rest day or a lighter session.
- Look for patterns over time. The study found that muscle soreness was elevated two weeks before an injury. By keeping a simple log, you might notice your own patterns and intervene earlier.
- Prioritise sleep hygiene. Simple strategies like a consistent bedtime, reducing screen use before sleep, and keeping your bedroom cool and dark may improve sleep quality. These are low-cost, low-risk interventions that might reduce injury risk.
- Start small. You do not need a full research protocol. Try tracking just two things for two weeks: your sleep quality (1-5) and your morning muscle soreness (1-7). See if you notice any patterns.
A crucial note: This approach is about modifying training load and recovery habits to reduce injury risk. It is not a substitute for professional medical advice. If you have an acute injury, persistent pain, or concerns about your sleep (such as suspected sleep apnoea or insomnia), please consult an appropriate healthcare professional.
Final thoughts
This study offers a useful, data-driven glimpse into the relationship between sleep quality, recovery and running injuries. It suggests that how well you sleep may be as important as how much you train, and that paying attention to fatigue and muscle soreness could help you avoid time on the sidelines.
As a physio, I see the frustration of runners who keep getting injured despite doing 'everything right'. While I treat the body's tissues, understanding the role of sleep and recovery - factors that are often overlooked - can be a valuable part of a comprehensive approach to staying healthy and running well. It is not about adding more stress or tracking everything perfectly. It is about learning to listen to what your body is telling you, and responding with kindness and wisdom.
I hope this article offers a fresh perspective on injury prevention. If you have a different issue, or simply want to learn more about how your body moves, head over to the Your Wellness Nerd YouTube channel. Subscribe if you feel inclined, and let me know in the comments what you would like me to cover next.
– Grant
Frequently asked questions
What is the link between sleep quality and running injuries?
A 2025 prospective study of 339 runners found that lower sleep quality was associated with a 36% higher risk of a running-related injury. Poor sleep may disrupt the training-recovery balance, affecting tissue repair and inflammation regulation.
Does sleep quantity (hours slept) affect injury risk?
The study found no significant association between sleep quantity and injury risk. Sleep quality appears to be a more important factor than simply the number of hours slept.
Can monitoring fatigue and muscle soreness help prevent injuries?
Yes. The study found that muscle soreness was higher two weeks before an injury and fatigue was higher one week before an injury. Regularly tracking these markers may help you identify when you are at increased risk and adjust your training load accordingly.
What is the best way to monitor sleep quality for injury prevention?
A simple daily rating (for example, 1 = very poor, 5 = excellent) can help you spot patterns. Consistency matters more than complexity. If you notice several days of poor sleep quality, consider easing back on training intensity or volume.
Can improving sleep quality reduce my injury risk as a runner?
While this study shows an association, not causation, improving sleep quality is a low-risk intervention that may help. Good sleep hygiene (consistent bedtime, reducing screen use before bed, a cool dark room) is worth prioritising as part of a comprehensive injury prevention strategy.
One profound insight from this post
"Poor sleep quality was associated with a 36% higher risk of running-related injury. Fatigue and muscle soreness were elevated in the weeks before an injury occurred. Monitoring your recovery may be as important as tracking your training."
Reference:
Goldberg, M., Le Mat, Y., Metra, M., de Sousa, T., Edouard, P., Millet, G. Y., Pairot de Fontenay, B., & Debarnot, U. (2025). Poor sleep quality is associated with an increased risk of running-related injuries: A prospective study of 339 runners over six months. Scandinavian Journal of Medicine & Science in Sports, 35, e70164. https://doi.org/10.1111/sms.70164
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