Sleep and Recovery in the Injured Athlete: A Comprehensive Narrative Review
DOI:
https://doi.org/10.12775/QS.2026.62.72984Keywords
Sports Injuries, Sleep Deprivation, Athletic Rehabilitation, Central Sensitization, NeuroendocrinologyAbstract
Sleep is increasingly recognized as a fundamental pillar of athletic health, yet its role in the specific context of injury rehabilitation remains under-emphasized in clinical practice. This narrative review synthesizes current literature regarding the bidirectional relationship between sleep and sports injuries. We examine how the neuro-endocrine system, specifically the GH-IGF-1 axis and cortisol-testosterone balance, dictates the speed of tissue remodeling. Furthermore, we analyze the "vicious cycle" of pain-induced sleep fragmentation and sleep-loss-induced hyperalgesia. Finally, we explore the immunological shift during sleep deprivation that promotes chronic inflammation. Our results suggest that optimizing sleep through hygiene, nutrition, and psychological support is essential for accelerating return-to-play timelines and preventing secondary injuries.References
Beersma DGM, Gordijn MCM. Circadian control of the sleep–wake cycle. Physiol Behav. 2007;90(2–3):190–5.
Le Meur Y, Duffield R, Skein M. Sleep. In: Recovery for performance in sport. Champaign: Human Kinetics; 2012.
Reilly T, Waterhouse J. Sports performance: is there evidence that the body clock plays a role? Eur J Appl Physiol. 2009;106(3):321–32.
Archer SN, Laing EE, Moller-Levet CS, et al. Mistimed sleep disrupts circadian regulation of the human transcriptome. Proc Natl Acad Sci U S A. 2014;111(6):E682–91.
Davenne D. Sleep of athletes—problems and possible solutions. Biol Rhythm Res. 2009;40(1):45–52.
Samuels C. Sleep, recovery, and performance: the new frontier in high-performance athletics. Neurol Clin. 2008;26(1):169–80.
Belenky G, Wesensten NJ, Thorne DR, et al. Patterns of performance degradation and restoration during sleep restriction and subsequent recovery: a sleep dose-response study. J Sleep Res. 2003;12(1):1–12.
Walker MP, Stickgold R. It’s practice, with sleep, that makes perfect: implications of sleep-dependent learning and plasticity for skill performance. Clin Sports Med. 2005;24(2):301–17.
Haack M, Mullington JM. Sustained sleep restriction reduces emotional and physical well-being. Pain. 2005;119(1-3):56–64.
Czeisler CA, Klerman EB. Circadian and sleep-dependent regulation of hormone release in humans. Recent Prog Horm Res. 1999;54:97–130.
Spiegel K, Leproult R, Van Cauter E. Impact of sleep debt on metabolic and endocrine function. Lancet. 1999;354(9188):1435–9.
Lange T, Perras B, Fehm HL, et al. Sleep enhances the human antibody response to hepatitis A vaccination. Psychosom Med. 2003;65(5):831–5.
Tu H, Li YL. Inflammation balance in skeletal muscle damage and repair. Front Immunol. 2023;14:1133355.
Dubois B, Esculier J. Soft-tissue injuries simply need PEACE and LOVE. Br J Sports Med. 2020;54(2):72-73.
Chennaoui M, Vanneau T, Trignol A, et al. How does sleep help recovery from exercise-induced muscle injuries? J Sci Med Sport. 2021;24(10):982-987.
Milewski MD, Skaggs DL, Bishop GA, et al. Chronic lack of sleep is associated with increased sports injuries in adolescent athletes. J Pediatr Orthop. 2014;34(2):129-133.
Roberts SSH, Teo WP, Warmington SA. Effects of training and competition on the sleep of elite athletes: a systematic review and meta-analysis. Br J Sports Med. 2019;53(8):513-522.
Grier T, Dinkeloo E, Reynolds M, Jones BH. Sleep duration and musculoskeletal injury incidence in physically active men and women: a study of U.S. Army Special Operation Forces soldiers. Sleep Health. 2020;6(3):344-349.
Nédélec M, Leduc C, Dawson B, et al. Case study: sleep and injury in elite soccer—a mixed method approach. J Strength Cond Res. 2019;33(11):3085-3091.
Smith RS, Efron B, Mah CD, Malhotra A. The impact of circadian misalignment on athletic performance in professional football players. Sleep. 2013;36(12):1999-2001.
Gupta L, Morgan K, Gilchrist S. Does elite sport degrade sleep quality? A systematic review. Sports Med. 2017;47(7):1317-1333.
Lastella M, Vincent GE, Duffield R, et al. Can sleep be used as an indicator of overreaching and overtraining in athletes? Front Physiol. 2018;9:436.
Nédélec M, Halson S, Abaidia AE, et al. Stress, sleep and recovery in elite soccer: a critical review of the literature. Sports Med. 2015;45(10):1387-400.
Kelley GA, Kelley KS. Exercise and sleep: a systematic review of previous meta-analyses. J Evid Based Med. 2017;10(1):26-36.
Besedovsky L, Lange T, Haack M. The sleep-immune crosstalk in health and disease. Physiol Rev. 2019;99(3):1325-1380.
Leeder J, Glaister M, Pizzoferro K, Dawson J, Pedlar C. Sleep duration and quality in elite athletes measured using wristwatch actigraphy. J Sports Sci. 2012;30(6):541-5. doi: 10.1080/02640414.2012.660188. Epub 2012 Feb 14. PMID: 22329779.
Lastella M, Roach GD, Halson SL, Sargent C. Sleep/wake behaviours of elite athletes from individual and team sports. Eur J Sport Sci. 2015;15(2):94-100. doi: 10.1080/17461391.2014.932016. Epub 2014 Jul 4. PMID: 24993935.
Lastella M, Roach GD, Halson SL, Martin DT, West NP, Sargent C. The impact of a simulated grand tour on sleep, mood, and well-being of competitive cyclists. J Sports Med Phys Fitness. 2015 Dec;55(12):1555-64. Epub 2014 Oct 6. PMID: 25286890.
Taylor SR, Rogers GG, Driver HS. Effects of training volume on sleep, psychological, and selected physiological profiles of elite female swimmers. Med Sci Sports Exerc. 1997 May;29(5):688-93. doi: 10.1097/00005768-199705000-00016. PMID: 9140908.
Richmond LK, Dawson B, Stewart G, Cormack S, Hillman DR, Eastwood PR. The effect of interstate travel on the sleep patterns and performance of elite Australian Rules footballers. J Sci Med Sport. 2007 Aug;10(4):252-8. doi: 10.1016/j.jsams.2007.03.002. Epub 2007 May 23. PMID: 17524795.
Melone MA, Tourny C, Gehlbach BK, Schmidt EL, Lalevée M, L'Hermette M. Prevalence and Risk Factors of Poor Sleep Quality in Collegiate Athletes during COVID-19 Pandemic: A Cross-Sectional Study. Int J Environ Res Public Health. 2022 Mar 6;19(5):3098. doi: 10.3390/ijerph19053098. PMID: 35270790; PMCID: PMC8910097.
Juliff LE, Halson SL, Peiffer JJ. Understanding sleep disturbance in athletes prior to important competitions. J Sci Med Sport. 2015 Jan;18(1):13-8. doi: 10.1016/j.jsams.2014.02.007. Epub 2014 Feb 13. PMID: 24629327.
Buckley TM, Schatzberg AF. On the interactions of the hypothalamic-pituitary-adrenal (HPA) axis and sleep: normal HPA axis activity and circadian rhythm, exemplary sleep disorders. J Clin Endocrinol Metab. 2005 May;90(5):3106-14. doi: 10.1210/jc.2004-1056. Epub 2005 Feb 22. PMID: 15728214.
Rice TB, Dunn RE, Lincoln AE, Tucker AM, Vogel RA, Heyer RA, Yates AP, Wilson PW, Pellmen EJ, Allen TW, Newman AB, Strollo PJ Jr; National Football League Subcommittee on Cardiovascular Health. Sleep-disordered breathing in the National Football League. Sleep. 2010 Jun;33(6):819-24. doi: 10.1093/sleep/33.6.819. PMID: 20550023; PMCID: PMC2881715.
Dumortier J, Mariman A, Boone J, Delesie L, Tobback E, Vogelaers D, Bourgois JG. Sleep, training load and performance in elite female gymnasts. Eur J Sport Sci. 2018 Mar;18(2):151-161. doi: 10.1080/17461391.2017.1389992. Epub 2017 Oct 26. PMID: 29072537.
Besedovsky, L., Lange, T. & Born, J. Sleep and immune function. Pflugers Arch - Eur J Physiol 463, 121–137 (2012). https://doi.org/10.1007/s00424-011-1044-0
Venter, R.E. (2014), Perceptions of team athletes on the importance of recovery modalities. European Journal of Sport Science, 14: S69-S76. https://doi.org/10.1080/17461391.2011.643924
Bonnar, D., Bartel, K., Kakoschke, N. et al. Sleep Interventions Designed to Improve Athletic Performance and Recovery: A Systematic Review of Current Approaches. Sports Med 48, 683–703 (2018). https://doi.org/10.1007/s40279-017-0832-x
Gosselin N, Lassonde M, Petit D, Leclerc S, Mongrain V, Collie A, Montplaisir J. Sleep following sport-related concussions. Sleep Med. 2009 Jan;10(1):35-46. doi: 10.1016/j.sleep.2007.11.023. Epub 2008 Jan 28. PMID: 18226956.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Katarzyna Oszast, Jakub Koszewski, Wiktoria Pielak, Anna Janiszewska, Wiktor Kołkowski, Jan Jakubczyk, Monika Wądołowska, Magdalena Antoszewska, Maria Grabowska, Katarzyna Gozdera
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 89
Number of citations: 0
