Sleep and Running Injuries: What the Evidence Is Telling Us

If there’s one thing runners are good at, it’s focusing on training. Mileage, intensity, strength work, shoes, biomechanics, we obsess over the mechanical side of performance and injury.

But one area still tends to sit in the background: sleep.

Not sleep as a vague wellness concept, but sleep as a measurable, clinically relevant factor in injury risk. Over the past few years, the evidence linking poor sleep to running-related injuries has been growing. Two recent studies in particular add important weight to this conversation.

The key message is simple, but important: sleep quality and sleep patterns appear to meaningfully influence injury risk in runners.

Study 1: Sleep Quality and Injury Risk Over Time

A recent prospective study by Goldberg et al. (2025) followed 339 runners over six months and looked specifically at the relationship between sleep quality and running-related injuries.

The standout finding was this:

Each one-point worsening in sleep quality was associated with a 36% increase in running-related injury risk.

Importantly, this wasn’t just a snapshot in time. This was prospective data, meaning sleep quality was assessed first, and injuries were tracked forward. That strengthens the argument that sleep quality is not just something that suffers after injury, but may play a role before injury occurs.

Another key takeaway from this study was that sleep quality mattered more than sleep duration alone. In other words, simply counting hours in bed may miss part of the picture if the sleep itself is fragmented or unrefreshing.

Study 2: Sleep Profiles and Injury Risk

The second study, by de Jonge and Taris (2025), took a slightly different and arguably more clinically useful approach.

Rather than looking at sleep as a single variable, they assessed 425 recreational runners using a multidimensional sleep profile, incorporating:

• Sleep duration

• Sleep quality

• Sleep problems (such as night-time awakenings and non-restorative sleep)

Using this approach, they identified four distinct sleep profiles:

• Steady Sleepers

• Poor Sleepers

• Efficient Sleepers

• Fragmented Sleepers

The group that stood out was the Poor Sleepers: runners who combined shorter sleep duration, poorer sleep quality, and more sleep disturbances.

Compared with Steady Sleepers, this group had:

• 1.78× higher odds of reporting a running-related injury

• An injury probability of 68%

Notably, the other sleep profiles did not show significantly higher injury risk. This reinforces the idea that it’s not one single sleep variable in isolation, but the overall sleep picture that matters.

How This Fits With the Broader Evidence

These findings don’t exist in isolation. They align well with earlier research across endurance and youth athletes:

• Endurance athletes sleeping <7 hours per night have been shown to have a ~50% higher risk of new injury (Johnston et al., 2020).

• In student-athletes, each unit increase in sleep disturbance is associated with a progressive increase in injury odds (Messman et al., 2024).

• Youth and adolescent athletes sleeping <8 hours per night show ~1.7× higher injury risk, with similar findings in middle-school cross-country runners (Milewski et al., 2014; Wu et al., 2021).

Across age groups and sporting levels, the pattern is remarkably consistent: poorer sleep is associated with higher injury risk.

What Does This Mean for Runners?

If you’re a runner dealing with recurrent injuries, slow recovery, or the sense that your body just isn’t tolerating training the way it used to, sleep quality deserves attention.

This isn’t about perfection or chasing an idealised eight hours every night. It’s about recognising that:

• Fragmented or non-restorative sleep increases physiological stress

• Recovery capacity is reduced when sleep quality is poor

• Tissues may be less tolerant of training load under these conditions

Sleep doesn’t replace sensible training, strength work, or load management, but it clearly interacts with all of them.

What Does This Mean for Clinicians?

From a clinical perspective, these studies support something many of us already suspect:

Sleep quality should be considered part of injury risk assessment and rehabilitation, not an afterthought.

Simple screening questions around sleep quality, night-time awakenings, and daytime fatigue can provide valuable context, particularly in athletes with persistent or unexplained injury patterns.

Sleep is also a modifiable factor. Addressing sleep hygiene, timing, and consistency may not only improve recovery but also potentially reduce injury risk when combined with appropriate load management and strength work.

The Takeaway

Sleep is not just passive recovery time. It’s an active contributor to how well runners tolerate training stress.

The emerging evidence suggests that poor sleep quality and poor sleep profiles are consistently associated with higher running-related injury risk. For runners and clinicians alike, sleep deserves a seat at the injury-prevention table.

References

• Goldberg, A. et al. (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.

• de Jonge, J. and Taris, T.W. (2025) Sleep matters: Profiling sleep patterns to predict sports injuries in recreational runners. Applied Sciences, 15(19), 10814.