eval set · question 7 of 22 · graded by hand
Does volume cause injury?
Evidence is mixed: some studies show higher training volume increases injury risk (e.g., >20 hrs/week in triathletes), while others show higher/lower volume alone is not significantly associated, or even protective. 1 2 3
Sudden relative or absolute changes in volume combined with pace progression were not significantly associated with increased injury risk in recreational runners. 4
In trail runners, lower training volume (along with less interval training, elevation gain, recovery, and sleep) was associated with higher injury risk, suggesting low volume rather than high volume may increase risk. 3
In marathon runners across distances, higher weekly training volume was associated with lower injury risk (protective), while previous injury and race distance were risk factors. 2
In triathletes, training volumes above 20 hours/week were associated with higher injury risk compared to lower volumes. 1
In soccer players, sudden/disproportionate increases in high-speed running relative to recent history are linked to injury risk, but absolute weekly volume within typical ranges shows negligible association. 5
In youth runners, reduced training volume during COVID restrictions was associated with fewer running-related injuries, suggesting a positive relationship between volume and injury frequency in that context. 6
In young middle/high school runners, running volume did not significantly differ between injured and uninjured groups. 7
In non-professional Brazilian runners, higher training volume was positively associated with injury in men, but not clearly in women. 8
Training volume increased right ventricular chamber enlargement (EDV/ESV) in a dose-dependent way in marathon runners, though this reflects cardiac remodeling, not injury per se. 9
A structured program with planned training volume/intensity reduced injury risk in older female half marathoners, but evidence is weak and sample size very small. 10
What we can't tell you
- No single definitive causal relationship between volume and injury risk can be established from this evidence—effects vary by sport, sex, age, and how volume changes are measured.
- see a professional
Sources
Lower sleep quantity and difficulties initiating sleep are associated with perceived performance drops in recreational triathletes; training volumes >20 hours/week are associated with higher injury risk compared to lower volumes.
pop. Recreational triathletes (n=942) · direction negative for performance (less sleep, sleep difficulties); positive dose-response for injuries (>20 hours/week higher risk than <20 hours/week) · design cross-sectional questionnaire survey · weak
Factors associated with perceived performance drops and musculoskeletal injuries in Brazilian recreational triathletes. (2022) · doi 10.26355/eurrev_202208_29498
Previous injury and race distance are main associated factors for running-related injuries, while weekly training volume, age, and previous participation are protective factors.
pop. 4380 runners across three race distances (10km n=1316, 21km n=2168, 42km n=896); median age 36 years · direction Protective effect of training volume (higher volume associated with lower injury risk); positive association with previous injury and increased race distance · design cross-sectional · weak
Training volume and previous injury as associated factors for running-related injuries by race distance: A cross-sectional study (2019) · doi 10.14198/JHSE.2019.143.06
Lower weekly training volume, less interval training, lower yearly elevation gain, lower passive recovery practice, and lower sleeping time are associated with higher injury risk in trail runners.
pop. Trail runners, 697 subjects (468 men), mixed age and experience levels · direction negative - injury risk increases with lower training volume, lower interval training, lower elevation gain, lower recovery, and lower sleep · design cross-sectional survey with causal Bayesian network analysis · moderate
Analysis of factors influencing injuries and performance in trail running. (2025) · doi 10.1016/j.injury.2025.112798
Relative weekly change >10% in running volume combined with running pace progression, and absolute weekly change >5km in running volume combined with running pace progression, are not statistically significantly associated with increased injury risk in recreational runners.
pop. 586 injury-free recreational runners in Denmark · direction No significant positive interaction effect · design Prospective cohort study with secondary analysis of randomized trial data · moderate
Interactions between running volume and running pace on injury occurrence in recreational runners: A secondary analysis. (2021) · doi 10.4085/1062-6050-0165.21
Sudden increases in high-speed running and sprint exposure are associated with injury risk in soccer, but absolute weekly volume shows negligible associations within typical exposure ranges
pop. Professional and elite soccer players · direction positive for sudden/disproportionate increases relative to recent history; negligible for absolute weekly volume within typical ranges · design Systematic review of observational studies · moderate
High-speed running and injury risk in soccer: a systematic review. (2026) · doi 10.3389/fpubh.2026.1798241
COVID-19 social distancing restrictions resulted in lower training volume, fewer running-related injuries, and reduced healthcare provider visits in youth long-distance runners.
pop. Youth long-distance runners aged 9-19 years (mean age 15.3 ± 1.7 years) participating in cross-country, track and field, road races, or recreational running (n=287; 124 male, 162 female). · direction Negative: reduced training volume and injury frequency during restrictions; reduced healthcare-seeking behavior · design Cross-sectional survey with within-subject comparison (pre vs. during COVID-19) · moderate
Impact of COVID-19 Social Distancing Restrictions on Training Habits, Injury, and Care Seeking Behavior in Youth Long-Distance Runners (2020) · doi 10.3389/fspor.2020.586141
Middle- and high-school long-distance runners with current injuries report significantly lower overall health and reduced average distance per run compared to uninjured runners, while sport specialization, quality of life, sleep habits, and running volume show no significant differences by injury status.
pop. Middle- and high-school long-distance runners (n=306; mean age 15.7±1.1 years; 107 male, 176 female, 23 unspecified) · direction Negative for current injury group (lower overall health and reduced average distance per run) · design Retrospective cross-sectional survey · weak
Sport Specialization and Quality of Life among Middle- and High-School Long-Distance Runners of Different Injury Status: A Retrospective Study (2021) · doi 10.1080/02640414.2021.1954350
Training characteristics (frequency, volume, and competition number) have stronger influence on running-related injuries than anthropometric factors in non-professional runners, with sex-specific associations.
pop. 97 Brazilian runners of both sexes, mean age 39.1±11.5 years, BMI 24.2±4.2 kg/m², non-professional · direction Positive for women (training frequency r=0.57, competitions r=0.64); positive for men (BMI r=0.89, training volume r=0.82); negative for men (age r=-0.69) · design cross-sectional · weak
Using complex systems to understand running-related injuries. (2025) · doi 10.1080/15438627.2024.2428597
Prolonged high-intensity endurance exercise in amateur marathon runners causes acute reductions in right ventricular global longitudinal strain within 1 hour post-marathon, with training volume positively correlating to right ventricular chamber enlargement.
pop. 30 amateur marathon runners (marathon group) and 27 healthy volunteers (control group) · direction negative for RV GLS acutely post-marathon (26.2% to 23.0% reduction); positive dose-dependent relationship between training volume and RV EDV/ESV · design prospective observational cohort with repeated measures · moderate
Assessment of right ventricular structure and systolic function in amateur marathon runners using three-dimensional speckle tracking echocardiography. (2023) · doi 10.1007/s10554-023-02869-z
An annual structured physical training program (PASm-12) with planned training volume and intensity improves performance in masters +45 female half marathon runners and reduces injury risk.
pop. 6 female half marathon runners, masters +45 years old, with over 10 years of running experience · direction positive · design quasi-experimental / small cohort study · weak
Evaluating the Effectiveness of the Annual Physical Training Plan for Masters +45 Women Half Marathon Athletes: A Guideline Model for Good Practices for Programming Effort Volume and Intensity (2024) · doi 10.3390/sports12090256