The Recovery you cannot skip: Sleep & Injury Risk.
Trail Notes | Strength, Injury & Recovery
the recovery you cannot skip
Sleep
& Injury Risk.
If a change in one recovery signal was associated with a meaningful increase in running injury risk, you would probably want to notice it. Emerging research suggests sleep quality may be one of those signals.
In Her Trails, we spend a lot of time helping athletes refine their training, fuelling, pacing and strength work. All of those things matter. But the body still needs enough recovery capacity to absorb the work being asked of it.
Sleep supports tissue repair, immune function, nervous system recovery, learning, mood and training adaptation. Poor sleep does not automatically cause an injury. Injury is far more complex than that. But a sustained change in sleep quality may be a sign that your total load and your current capacity are moving out of balance.
Poor sleep does not automatically cause injury. But it may reduce your capacity to absorb training, and a change in sleep quality can be a useful early signal that your total load needs attention.
Running-specific research is beginning to make this relationship clearer, while also reminding us that sleep is only one part of a much larger injury picture.
Trail Note · 01
What the research actually found
A 2025 study followed 339 experienced adult runners for 26 weeks. Each week, the runners reported running-related injuries and completed a short questionnaire covering sleep quality, sleep quantity, sleep latency, fatigue, muscle soreness and perceived stress. Training load was also collected from participants' watches.
Poorer self-reported sleep quality was associated with a higher risk of running-related injury. For each one-point worsening in the weekly sleep-quality score, the relative hazard of injury was 36% higher. Sleep quantity was not significantly associated with injury risk in that particular analysis.
That result is meaningful, but it needs context. It was an observational study, so it identifies an association rather than proving that poor sleep caused the injuries. Sleep quality was self-reported, and only 16.2% of the participants were women. The finding is useful, but it cannot tell us that the same relationship applies equally across every runner, sex, life stage or training context.
A separate 2025 study by de Jonge and Taris analysed survey data from 425 recreational runners. The researchers grouped participants into four sleep profiles using sleep duration, sleep quality and sleep problems.
Runners classified as Poor Sleepers had 1.78 times the odds of reporting a sports injury compared with Steady Sleepers. The estimated probability of reporting an injury was 68% for Poor Sleepers and 55% for Steady Sleepers. Again, this was an association based on survey data, not proof that changing sleep alone would prevent injury. The statistical model explained only a small proportion of injury variation, reinforcing that running injuries are multifactorial.
What to take from the numbers
36% higher relative injury hazard was associated with each one-point worsening in weekly sleep-quality score in one prospective study.
1.78 times the odds of reporting an injury were found among Poor Sleepers compared with Steady Sleepers in a separate survey analysis.
These figures support paying attention to sleep. They do not mean that sleep is the sole cause of injury or that improving sleep guarantees prevention.
Trail Note · 02
How sleep may affect recovery capacity
The relationship between sleep and injury is unlikely to come down to one mechanism. Sleep interacts with several systems that influence how well an athlete responds to training.
Tissue repair and adaptation
Deep sleep is associated with processes involved in physical recovery, including growth hormone release. Sleep does not perform all repair work by itself, but disrupted sleep may make it harder to recover fully from repeated training stress.
Nervous system function
Sleep supports reaction time, coordination, learning and decision-making. These abilities matter when descending, navigating technical terrain or maintaining movement quality as fatigue builds.
Stress and immune regulation
Persistent sleep disruption can interact with stress regulation, inflammation, mood and immune function. These factors can affect how an athlete feels, trains and recovers across a demanding block.
Perception and behaviour
Poor sleep can change perceived effort, motivation and decision-making. A tired runner may alter her gait, make different pacing choices or have less capacity to respond to early warning signs.
Sleep may not change the kilometres on your plan. It can change the capacity you bring to them.
Trail Note · 03
Quality and quantity both matter
Sleep is often reduced to one instruction: get eight hours. Duration matters, and most adults are generally advised to aim for seven to nine hours each night. Athletes may sometimes need more, particularly during demanding training blocks.
But time in bed does not describe the whole experience. Difficulty falling asleep, frequent waking, night sweats, breathing disturbances or waking unrefreshed can all affect perceived sleep quality, even when the total number of hours appears adequate.
The practical question is therefore not only, "How long did I sleep?" It is also, "How restored do I feel, and has that changed from what is normal for me?"
Trail Note · 04
The female physiology layer
Sleep does not happen separately from hormones, life load or the stage of life you are moving through.
Sleep disruption is commonly reported during perimenopause and menopause. Hot flushes and night sweats can interrupt sleep continuity. Hormonal changes may also interact with temperature regulation, mood and anxiety, making it harder to fall asleep or return to sleep after waking.
At the same time, some women are navigating changes in tendon, muscle and bone health, alongside work, parenting, caring responsibilities and training. These factors do not sit in separate boxes. They contribute to the same total load.
If the training load you previously handled now feels harder to absorb, that does not automatically mean you have lost discipline or resilience. Your recovery context may have changed. That information deserves a response, not self-criticism.
Her Trails coaching cue
Sleep disruption during perimenopause is not something you simply have to tolerate. If it is persistent or affecting your quality of life, speak with a GP who is experienced in menopause care about appropriate hormonal and non-hormonal options.
Trail Note · 05
Sleep belongs in the total load picture
Training load is easy to count. We can see kilometres, elevation, duration and intensity. Recovery capacity is less visible, but it still shapes the outcome of the week.
The same training week can land differently when it sits beside good sleep, adequate fuelling and manageable life stress than when it sits beside interrupted nights, illness, emotional stress or a large caregiving load.
Running injuries rarely have one cause. They tend to emerge through an interaction between training exposure, previous injury, tissue capacity, health, recovery, biomechanics and life context. Sleep is one part of that equation. It is not the whole explanation, but it should not be left out.
You do not have to be training more for the same training to become harder to absorb.
Trail Note · 06
What can influence sleep quality
Not every barrier to sleep can be solved with a better bedtime routine. Young children, shift work, chronic pain, perimenopausal symptoms, medical conditions and periods of intense stress can all disrupt sleep. The goal is not to make poor sleep feel like another personal failure. It is to identify what is happening and respond where you can.
Timing
A reasonably consistent sleep and wake time can support circadian rhythm. It does not need to be perfect, but large swings in timing may make sleep less predictable.
Temperature
A cool room and breathable sleepwear may help some people, particularly women experiencing hot flushes or night sweats. Persistent vasomotor symptoms deserve clinical support.
Alcohol
Alcohol can make sleep onset feel easier while contributing to more fragmented sleep later in the night. Reducing alcohol can be a useful experiment during demanding training or recovery periods.
Training timing
Evening exercise does not disrupt sleep for everyone. If hard late sessions consistently leave you alert, hot or restless, experiment with finishing earlier or extending your cool-down.
Total stress
Work, parenting, relationships, uncertainty and emotional strain are real loads. Sleep quality often reflects the whole life context, not simply the quality of your bedtime routine.
Trail Note · 07
Signals worth noticing
These signs are not diagnostic and none proves that sleep is causing an injury. They are patterns worth noticing, particularly when several appear together or represent a clear change from your normal.
Your recovery capacity may need attention if you are:
Waking regularly and struggling to return to sleep.
Waking unrefreshed despite allowing adequate time for sleep.
Experiencing persistent heaviness, fatigue or a rise in perceived effort.
Becoming more irritable, emotionally reactive or unable to concentrate.
Developing recurrent niggles during a period when your training has not obviously increased.
Feeling that your body is no longer absorbing training in the way it normally does.
When to seek support
Speak with your GP if sleep disruption is persistent, significantly affects daytime function or is not improving with practical changes.
Insomnia, obstructive sleep apnoea and restless legs can affect women and may be missed when tiredness is attributed only to training, parenting or hormones.
If hot flushes, night sweats or other perimenopausal symptoms are disturbing your sleep, seek individual medical advice. Effective treatment options may be available.
Trail Note · 08
What to do after a poor night
One poor night does not mean you must cancel every session. Look at the pattern, the session ahead and how you feel.
One disrupted night: consider keeping the session easy, reducing technical risk and reassessing during the warm-up.
Several poor nights: reduce intensity or volume and prioritise fuelling, hydration and an earlier recovery opportunity.
Poor sleep with pain, illness or unusual fatigue: pause and seek appropriate coaching or health support rather than forcing the planned session.
A persistent pattern: investigate the underlying reason. More discipline is not always the answer.
Sleep does not look like a training intervention. It is quiet. It does not appear on Strava, add kilometres to the week or provide the visible satisfaction of completing a hard session.
But it remains part of the environment in which training is absorbed. The most resilient athlete is not simply the one who tolerates the most work. She is the one who can notice when her capacity has changed and adjust before the body has to make the decision for her.
Protecting sleep will not remove every injury risk. It gives your training a better recovery context, and it gives you another signal worth listening to.
train with intention. recover with the same.
Research behind this Trail Note
Goldberg M, Le Mat Y, Metra M, et al. 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. 2025. Read the study.
de Jonge J, Taris TW. Sleep Matters: Profiling Sleep Patterns to Predict Sports Injuries in Recreational Runners. Applied Sciences. 2025;15(19):10814. Read the study.
Walsh NP, Halson SL, Sargent C, et al. Sleep and the Athlete: Narrative Review and 2021 Expert Consensus Recommendations. British Journal of Sports Medicine. 2021;55:356-368. Read the consensus statement.
Written by the Her Trails coaching team
Trail Notes are evidence-informed field notes for women who run, train, race and explore. We translate research into useful information without pretending one study can explain the whole woman.
This article provides general educational information and is not a substitute for individual medical advice, diagnosis or treatment.
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