Stressed out? Your injury risk is higher, study says

According to a recent study published in the Journal of Sports Health, feeling mentally drained or stressed might be an indication you should lower your mileage or take a day off running. New research found that running-related injuries (RRI) are heavily influenced by mental fatigue and psychological stress, making you even more at risk for injury than if you have poor sleep quality.

The study evaluated the psychological profiles of 202 trail runners (55 per cent male, 45 per cent female, ages 30 to 50), assessing traits that might put them at an increased risk of injury, including psychological stress, cognitive and somatic anxiety, self-confidence, mental fatigue, sleep quality and competitiveness. Assessments were conducted four weeks before a race and again two days ahead of competition.

The study defines mental fatigue as “a psychological state of tiredness caused by prolonged periods of performing demanding, cognitive-load-inducing activities, which reduces efficiency in cognitive performance.” Pre-competitive anxiety is defined as “feelings of apprehension, tension and nervousness linked to elevated nervous system activity, generated by sporting competition,” while sleep quality was defined as “an individual’s self-satisfaction with all aspects of the sleep experience.”

The runners were divided into five “clusters” based on their psychological profiles, and the rate of RRI was determined for each cluster. RRI, in training or competition, included injuries and pain that impeded training or competition, but did not include injuries from falls or other mishaps on the trail.

The results

Surprisingly, the runners experiencing the highest levels of mental fatigue, anxiety and psychological stress were also the most likely to sustain an RRI. Three of the clusters reported injury rates of 21.2 per cent, 14.6 per cent and 8.6 per cent, respectively. Four weeks before racing, these same clusters showed elevated psychological stress, anxiety and mental fatigue. Two days before racing, those same groups reported these same traits, along with the lowest levels of self-confidence. Interestingly, these groups also reported the best perceived sleep quality.

By comparison, the remaining two groups had the lowest RRI (3.2 and 6.9 per cent, respectively) while also reporting the lowest level of psychological stress, anxiety and mental fatigue. Together, the findings indicated that anxiety, mental fatigue and stress were more closely associated with injury risk than sleep quality.

The most common injuries were muscle and tendon/bursa injuries, primarily affecting the knee and lower leg. The study found no differences in injured and non-injured groups based on demographics and sports characteristics.

What does this mean for runners?

The results of the study aligns with the Williams and Andersen model of stress and athletic injury, which suggests that impaired neuro-cognitive and perceptual processes, lower reactivity and reduced attention or concentration can increase injury susceptibility. This is especially relevant to trail running, where attention to footing and balance is critical for performance and avoiding injury.

Although centred on trail runners, the takeaway applies to road and track runners, too: mental fatigue and stress may matter as much as physical training when it comes to staying healthy and performing well. The study underscores the importance of support systems that address not only physical health–through coaches, doctors and athletic therapists–but psychological well-being as a key factor in reducing injury risk for runners.