Introducing a lasting injury system in Dungeons and Dragons 5th edition can greatly enhance the depth and realism of your adventures. Combat, a cornerstone of the game, gains significant weight as each encounter carries potential long-term consequences. This system not only makes every decision in battle consequential but also turns health into a crucial resource that demands thoughtful management, adding a layer of strategic complexity.

The lasting injury mechanic fosters a sense of camaraderie among players as they must now invest in each other’s well-being, reinforcing the bonds of their adventuring party. By raising the stakes in this way, victories become even more rewarding, and surviving against the odds offers an unparalleled sense of accomplishment. In essence, this system deepens player engagement, making every encounter, decision, and dice roll truly matter in their shared story.

Below is a revised version of the original Injury Rules I created based on the OneDnD playtest changes to Exhaustion.

A man in armor kneeling next to a young woman who is holding her arm out to receive healing.

Injured [Condition]

While you are subject to the Injured Condition, you experience the following effects:

  • Levels of Injury. This Condition is cumulative. Each time you receive it, you gain 1 level of injury. You die if your injury level exceeds 10.

  • d20 Rolls Affected. When you make a d20 Test, you subtract your injury level from your d20 roll.

  • Spell Save DCs Affected. Subtract your injury level from the Spell save DC of any Spell you cast.

  • Gaining the Condition. A character gains 1 level of Injury whenever they fail a death save or if they are damaged by more than half their max hit points from a single source of damage. Characters killed through the Massive Damage rules gain 10 levels of Injury.

  • Recovering. Immediately after finishing a Long Rest, the character may make a DC 10 Constitution Test, removing 1 level of injury on a success. Characters who fail by rolling a 1 gain an additional injury level. A character may gain advantage on a recovery roll if they are being provided medical care, provided hot meals, and in a restful environment, or other conditions as determined by the DM. Characters without adequate shelter or in a very stressful environment roll recovery at disadvantage. When their injury level reaches 0, the character is no longer injured.

Class Ability

Shake it Off. Fighters, Paladins, and Rangers gain the ‘Shake it off’ ability at 1st level. As a free action, the character can choose to tap their deep reserves of fortitude to prevent taking one level of Injury. They can use this ability once and regain the ability to do so after a Long Rest.


  • Healing Injury with Magic. One level of Injury may be removed by casting Lesser Restoration. Greater Restoration removes all levels of injury.

  • Bring Out Your Dead. Any injury remains with a character brought back to life through Revivify, or Raise Dead, with a maximum of Injury level 9. Resurrection, True Resurrection, and Wish bring characters back to life with 0 levels of injury.


In conclusion, incorporating the Injury rules in a Dungeons and Dragons game adds a whole new layer of strategic depth and emotional engagement. It elevates the stakes of every combat encounter, pushing players to think more critically about their actions and encouraging a greater sense of camaraderie within the party. This not only enhances the realism of the game but also enriches the storytelling, creating a more immersive and memorable experience. While it’s a more challenging way to play, the rewards are substantial, making each victory a testament to the players’ resilience and teamwork.