Strain and Injury

Note: These rules are taken from the Strain and Injury rules on the Paizo forums. The document linked there has much more meta-game analysis and advice than is described here.

Instead of taking simple hit point damage, creatures now sustain either strain or injuries. However, strain is easily healed, while injuries persist until healed.


Strain damage represents a tiring parry or dodge, armor or shield wear and tear, superficial cuts, bruises and pricks, divided attention, dwindling morale, and dumb luck. A creature’s various defenses get worn down after many intercepted attacks, and this leaves them vulnerable to a more devastating hit.

Most hit point damage a creature takes will be strain. It results from any hit point damage that does not qualify as an injury (see below).

Strain damage recovers completely with a few minutes’ rest and refit (see below). This takes about five minutes without an encounter, dangerous conditions, or further strain being sustained.


Injury damage represents real physical harm, such as burnt skin, broken bones, and cut flesh. An injury results from any confirmed critical hit, any failed saving throw, or the “final blow” that sends a creature below zero hit points.

An injury does not recover without mundane or madical treatment. Injuries are healed by magic at the normal rate for healing hit points, and can be treated through use of the Heal skill’s Treat Deadly Wounds option. Mundane or magical treatment cures injuries and strain at the same rate, but injuries are always healed first.

When a creature sustains an injury, subtract the damage amount from its current hit points as you would normally. Note the amount of injury damage separately; this damage will remain until it is treated.

Rest and Refit

If a character has sustained strain damage during an encounter, this damage can be recovered with a rest and refit. The character must have about five minutes where they are neither threatened by further encounters nor suffering additional ongoing strain (e.g. thirst, starvation, extreme heat or cold, Constitution checks from stabilization without treatment, etc.). During this time, characters regain their composure, perform minor armor and weapon repairs, and catch their breath.

A character may tend to another’s injuries through use of magic or the Heal skill during the rest and refit without compromising their own recovery.

An unconscious, stable character may rest and refit if they are being tended to. Unattended characters that are unconscious and stable cannot gain the benefits of a rest and refit, and if they ever wake they will retain their strain until they can rest and refit.

Strain and Injury

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