Injured runners reported higher pain sensitivity, pain catastrophizing and fear-avoidance than uninjured runners, and pain catastrophizing rumination and fear-avoidance beliefs were independent predictors of pain sensitivity, supporting a biopsychosocial model in which cognitive-affective factors uniquely shape the pain experience in runners.
Fear-avoidance beliefs were measured using the Fear-Avoidance Beliefs Questionnaire (FABQ).
FABQ mean difference between injured and uninjured runners was 15.3 (p < 0.001).
This difference persisted after adjusting for demographic and training covariates in linear regression models.
Injured runners numbered 91 out of the total 235 participants.
Results
Pain catastrophizing rumination, fear-avoidance beliefs, and select training characteristics were independent predictors of pain sensitivity in runners.
Predictors of pain sensitivity (PSQ) were identified using stepwise multivariable regression adjusting for demographic and training covariates.
The final model explained 41% of the variance in pain sensitivity scores (adjusted R² = 0.41, p < 0.001).
The specific PCS subscale of rumination—not overall catastrophizing—emerged as an independent predictor.
Both fear-avoidance beliefs and select training characteristics contributed independently to the model.
Authors note these cross-sectional findings do not establish causation.
Discussion
Injury-related pain experience in runners was not explained by running load alone, as injured and uninjured runners had similar demographics and training exposure.
Despite comparable demographics and training exposure between groups, injured runners scored higher on all three psychosocial pain measures.
The authors highlight this as evidence supporting a biopsychosocial model of pain in runners.
Pain catastrophizing and fear-avoidance were described as 'potentially modifiable targets for clinical screening and rehabilitation.'
Suggested clinical interventions include pain education and graded exposure to better contextualize symptoms and guide training decisions.
What This Means
This research suggests that runners who are injured think about and experience pain differently than runners who are not injured. Specifically, injured runners reported higher pain sensitivity (how much they perceive pain from stimuli), more catastrophizing (negative, runaway thinking about pain), and stronger fear-avoidance beliefs (believing that movement or activity will cause harm) compared to uninjured runners — even though both groups had similar amounts of running training and similar backgrounds. This indicates that psychological and cognitive factors play a meaningful role in how injured runners experience pain, beyond just the physical demands of running.
The study also found that two specific psychological factors — rumination about pain (a component of catastrophizing, where a person cannot stop thinking about their pain) and fear-avoidance beliefs — independently predicted how sensitive a person was to pain. Together with some training-related factors, these variables explained about 41% of the variation in pain sensitivity scores among all runners studied. This is a relatively large proportion, suggesting these mental and emotional factors are strongly linked to pain sensitivity.
This research suggests that rehabilitation and clinical care for injured runners might benefit from addressing not just the physical injury but also the psychological side of pain. Approaches like pain education (helping people understand what pain means and how it works) and graded exposure (gradually reintroducing movement to reduce fear) are identified as potentially useful strategies. However, because this was a cross-sectional study (a snapshot in time), it cannot prove that catastrophizing or fear-avoidance actually cause greater pain sensitivity — future studies following runners over time are needed to understand the direction of these relationships.
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Pallante P, Hooyman A, Sanchez N, Sigward S, Beisheim-Ryan E, Smith J, et al.. (2026). Pain Sensitivity, Pain Catastrophizing and Fear-Avoidance in Adult Runners: Injured vs. Uninjured Comparisons and Multivariable Associations.. European journal of pain (London, England). https://doi.org/10.1002/ejp.70340