Sport and fitness trends. 12 minute read.
Hyrox injuries: what the first prospective study found and how to train around them
By the PocketPhysio editorial team. Published 2026-10-01.
What the race actually asks of you
The format is fixed, which makes this an unusually easy sport to reason about. You run 1 km, do one station, and repeat that eight times. The stations come in a set order: 1000 m on the SkiErg, a 50 m sled push, a 50 m sled pull, 80 m of burpee broad jumps, 1000 m of rowing, a 200 m farmers carry, 100 m of sandbag lunges, and 100 wall balls (HYROX).
The loads depend on your division. In the open categories the sled push is 102 kg (225 lb) for women and 152 kg (335 lb) for men, the sled pull 78 kg (172 lb) and 103 kg (227 lb), the farmers carry 2 x 16 kg (2 x 35 lb) and 2 x 24 kg (2 x 53 lb), the sandbag 10 kg (22 lb) and 20 kg (44 lb), and the wall ball 4 kg (9 lb) and 6 kg (13 lb). The pro categories step up again: women's pro matches the men's open loads, and men's pro takes the sled push to 202 kg (445 lb), the sled pull to 153 kg (337 lb), the carry to 2 x 32 kg (2 x 71 lb), the sandbag to 30 kg (66 lb) and the wall ball to 9 kg (20 lb) (HYROX).
Add it up and two demands sit on top of each other. There is 8 km of running, a running volume in its own right, and there is heavy pushing, pulling, carrying and squatting done while your heart rate is already near the top. Neither of those is unusual on its own. Doing them alternately for an hour or more is what is new.
The first prospective data, and what it can carry
Until 2026 there was nothing here but gym blogs. The first prospective study followed 89 athletes, 56 of them women, for 12 weeks between December 2025 and March 2026, with each person completing a weekly health questionnaire alongside a record of their training hours. Entry needed at least three weeks in the sport and at least one Hyrox session a week, and recruitment leaned heavily toward UK athletes who were active online (Chittenden and colleagues, 2026).
The design matters more than any single number in it. A prospective weekly questionnaire catches the aches that never reach a clinician, exactly what an emergency department database misses, and it collects training hours, which is what turns a count into a rate. Its weaknesses are the ones the authors list: everything was self-reported, the weekly response rate averaged 62%, only 32 people answered in all 12 weeks, and 12 weeks is short for problems that take months to appear. They also say the study was underpowered for the risk factor analysis, which is why the confidence intervals are wide.
Across 4,376 hours of reported training there were 63 new injury episodes. That gives 14.4 injuries per 1,000 hours for every complaint, however minor (95% confidence interval 11.1 to 18.4), and 6.4 per 1,000 hours for the ones that cost at least one day of training (4.3 to 9.2). Two thirds of the episodes were attributed by the athletes to Hyrox training specifically, at 9.6 per 1,000 hours. In any given week, 30% of the group reported some health problem and 18% reported one substantial enough to cut their training or performance.
Where the injuries were, and how they started
The pattern is the one most clinicians would have guessed. The difference is that somebody has now counted it. Overuse accounted for 46 of the 63 episodes, 73%, against 17 sudden injuries. The knee led the regions at 14 episodes (22%), then the hip and groin at 7 (11%), the foot and the pelvis and lower back at 6 each (10%), the lower leg and Achilles at 5 (8%), the elbow at 4 (6%), and the ankle and thigh at 3 each (5%). Eight episodes, 13%, were filed as other or unspecified, and the remaining 7 were spread thinly across the head, hand and fingers, upper arm and shoulder (tables 3 and 4).
Severity is what the headlines will drop. Of the 63 injuries, 35 cost no training time at all, 25 cost between one and seven days, 3 cost between eight and 28 days, and none was recorded as severe, for 130 lost days in total. Illness cost more: 45 illness episodes accounted for 173 lost days. A sport whose reputation is built on suffering produced mostly minor, grumbling problems in this cohort, and more lost time to coughs than to injuries.
Burden, which combines how often something happens with how long it costs, puts the knee and the lower leg and Achilles together at the top, with 31 lost days each. The lower leg group did that on 5 episodes, which is the signature of a tendon: it does not happen often, and when it does it does not go away quickly. All five of those came on gradually.
Running, not the sleds, was the most reported mechanism
This is the finding most likely to change how someone trains. A mechanism was recorded for only 30 of the 63 episodes, 48%, and among those 30 the breakdown was running 43%, Hyrox station work 30% and other strength training 27% (Chittenden and colleagues, 2026). At the knee, 9 of the 14 episodes had a recorded mechanism, and running accounted for 5 of them. At the lower leg and Achilles, only 2 of the 5 episodes had a mechanism recorded and both were running. At the foot, 3 of the 6 had one, and 2 of those 3 were running.
Half the mechanisms are missing, and they are more likely to be missing for injuries the athlete did not attribute to Hyrox, so this is a lead rather than a verdict. Read as a lead, it says the running is doing more of the damage than the equipment people photograph, and that the 8 km is not a rest between stations.
Sore shins after a jump in mileage belong with shin splints, an Achilles that stiffens overnight and hurts for the first ten minutes with Achilles tendinopathy, and a knee that hurts after running with knee pain after running. None of those is caused by a sled.
The elbow, and the shoulder that barely appeared
The elbow is the odd one out in a sport this leg-dominated. It ranked third for burden on 4 episodes, two of which persisted across several weeks, with 12 days lost and 75% of them gradual in onset. The authors read it as consistent with the repeated gripping and pulling in the sled pull, farmers carry, SkiErg and rowing, and they offer that as a hypothesis for larger cohorts rather than a feature of the sport (Chittenden and colleagues, 2026). Their own caveat is the one to keep: those two persistent episodes account for 87% of the elbow's whole burden, they came from two people, and the elbow loses its third place if either one is taken out. Four episodes is a description, not a rate.
The shoulder is more interesting by its absence: a single episode in 12 weeks. The authors point out why, and the answer is in the rule book, not in physiology. There is no overhead lifting anywhere in the station set. The wall ball is thrown from a squat, the SkiErg pulls down, the row pulls in, and nothing goes above the head under load. Compare that with a sport built on snatches and jerks and the difference in the shoulder column is the expected one.
If your shoulder does complain during a training block, the cause is usually somewhere in the gym work you have added around the race, and the rotator cuff tendinopathy program is the staged version.
What the 418 athlete survey adds, and what it does not
A second piece of research exists. It is not in the same category. An international survey of 418 Hyrox athletes, posted to medRxiv in August 2026 as a preprint that has not been peer reviewed, found that 208 of them, 49.8%, reported at least one Hyrox-related injury over the previous 12 months, with the knee the most common site at 20.8%, tendon complaints the leading type at 41.6%, most problems gradual in onset, and higher Hyrox-specific training frequency the only factor independently associated with reporting an injury (Ketzer and colleagues, medRxiv preprint, not peer reviewed, 2026).
Every one of those figures needs its label kept attached. A preprint has not been through peer review, and a cross-sectional survey asks people to remember a year. The authors of that preprint, which has not been peer reviewed, describe their own exposure-adjusted figure of 1.65 injuries per 1,000 hours as a lower bound rather than an incidence rate. The reason to mention it at all is that its direction matches the peer-reviewed cohort: knee first, tendons first, gradual onset dominant. Two different designs in two different countries landing in the same order is worth more than either number.
One place the two do not agree is severity. In that preprint, which has not been peer reviewed, 20.3% of the respondents who gave severity data reported more than 28 days of interrupted training or never getting back to their previous level, while the prospective cohort recorded no severe episode at all in its 12 weeks. A survey that asks people to recall a year collects the episodes that mattered, and three winter months is too short a window to collect many of them, so neither number settles how bad a bad Hyrox injury gets.
Is the injury rate actually high?
The authors put their figures beside other activities, and then spend a paragraph explaining why the comparison is not clean. The numbers they quote are 3.2 per 1,000 hours from a meta-analysis of extreme conditioning programs, 4.2 per 1,000 hours across seventeen studies of high-intensity functional training, 7.7 per 1,000 hours in recreational runners and 17.8 per 1,000 hours in novice runners (Chittenden and colleagues, 2026).
Hyrox came out at 14.4 per 1,000 hours counting every complaint, and 6.4 counting only those that cost training time. The 3.2 figure was built on a definition that required at least three days of lost training or medical attention, so it counts a far smaller set of events than a weekly questionnaire that records any deviation from full health. None of these figures is definition-matched.
The authors call the running and resistance training comparators weaker still: the pooled running figure was assembled from studies that defined injury in different ways, so they place it at an indeterminate point between their own two rates and say it cannot be cleanly compared against either. Arithmetically the 14.4 all-complaint rate sits between the recreational and the novice running figures and the 6.4 time-loss rate sits below both, but that is a position on a number line rather than a comparison. The one comparison the authors do treat as definition-matched is their own Hyrox-attributed time-loss rate of 4.3 per 1,000 hours (2.6 to 6.8) against the 3.2 per 1,000 hours (2.06 to 4.34) for extreme conditioning program training, and those confidence intervals overlap substantially.
So the headline is not that Hyrox is dangerous. It is that Hyrox gives you the injury profile of a running sport with a heavy strength block attached, mostly in the form of slow-building lower limb complaints, and that the first data on it comes from 89 mostly novice athletes over three winter months.
Station by station, read as reasoning and not as data
Nothing below is a measured injury rate. The cohort did not break its station work apart, so what follows is what each station demands of the tissue, which is how a physio thinks about a complaint that arrives after a particular session.
The sled push is a long, slow, high-force effort: the ankle is driven into deep bend and the knee extends against resistance. Next-day soreness at the front of the knee and in the calf is a familiar result. The sled pull adds hand, forearm and upper back work to the same leg drive, and it is one of the four the cohort's authors name for the elbow. The farmers carry is grip plus trunk endurance, and a carry done while already tired is a common point for the lower back to start complaining. Burpee broad jumps are the one genuinely explosive station, which puts them closest to the mechanism behind a sudden calf or Achilles problem.
Sandbag lunges ask for repeated deep knee bending with load on the trunk, so they load the knee and the hip together at a point in the race when your legs are already tired. Wall balls finish the race with 100 loaded squats and 100 catches, and the front of the knee and the lower back are the usual places people feel them. The SkiErg and the row are the two stations where the arms and upper back take the largest share of the work, which is part of why an elbow turns up in the data at all.
If one of those has already left something sore, the programs that match are patellofemoral pain and patellar tendinopathy at the front of the knee, low back pain after carries and lunges, groin strain after lunging under load, and hamstring tendinopathy for pain that sits deep in the buttock when you sit or sprint. Muscle soreness after exercise or injury separates ordinary post-race stiffness from the kind that needs attention.
What is worth doing about it
Nobody has tested an injury prevention program in this sport, so anything presented as Hyrox-proofing is an opinion. It may be a good opinion. It is not a finding, and the honest version says which part is borrowed.
Strength training is the borrowed part with the best support. Pooling 6 randomized trials, 7,738 participants aged 12 to 40 and 177 injuries across several sports, strength training was associated with a relative risk of injury of 0.338 (95% confidence interval 0.238 to 0.480), and the effect grew with how much of it was done (Lauersen and colleagues, 2018). None of those trials was in Hyrox, and the age range stops at 40 while nearly half the cohort here was older than that.
The cohort's own contribution is about load. Most problems built up gradually, running was the most reported mechanism, and the one risk marker that stood out was a previous injury, which carried a rate ratio of 2.60 for cumulative severity with a confidence interval of 1.00 to 6.75, an interval the authors say is also compatible with no association at all. An old injury that keeps grumbling is the thing to deal with before race prep starts, and the week to look at when something flares is the one before it, not the session it appeared in.
Two practical habits cost nothing and have not been tested here. Add running volume and station volume in steps, not jumps, since a new program or a booked race is what usually precedes a tendon complaint. And treat the small thing while it is small, because 3 of the 63 injuries in this cohort cost more than a week and two of the four elbow problems were still there weeks later.
When to see a physio (physical therapist)
If the same complaint is still there after two weeks, book. The other trigger is pain that arrives at the same point in every session. Go sooner if you have started changing your technique to avoid something, if a knee swells after training, or if a calf or Achilles has begun hurting for the first ten minutes of every run.
Bring the training log. What sorts one diagnosis from another is which station or which run brings it on, whether it is worse the next morning, how long it has been there, and what changed in the fortnight before it started. Everything in the warning list below comes first, at the speed each line sets. For those lines, a doctor or emergency care comes before a physio.
See a doctor promptly if
- Emergency: if chest pain, pressure or tightness does not ease quickly when you rest, spreads to your arm, neck, jaw, stomach or back, or comes with sweating, feeling sick, feeling light-headed or being short of breath, call emergency services straight away, as this can be a heart attack. If it eases quickly and none of these happen, get medical advice the same day, and do not exercise again until you have been checked.
- Emergency: dark pee (brown, red or tea-colored) after exercise, or muscles that become badly swollen, extremely painful or too weak to use, are not normal soreness. Go to an emergency department straight away, as these can be signs of serious muscle damage (rhabdomyolysis).
- Emergency: the knee became very swollen very quickly, within a few hours of a twist, fall or blow, or you felt a pop or snap. Go to an emergency department straight away. Do not drive yourself: ask someone to drive you or call an ambulance. A knee that fills up that fast has usually bled inside the joint, which can come from a torn ligament, a kneecap that slipped out or a break, so it needs checking before you train again.
- Emergency: pain, tingling, numbness or weakness in both legs, numbness or altered feeling around your genitals or bottom, or new trouble peeing or controlling your bladder or bowels. The same applies if you lose feeling in one leg. Call emergency services or go to an emergency department straight away. These can be signs of pressure on the nerves at the base of the spine (cauda equina syndrome).
- Same day: a sudden pop or snap at the back of your ankle or heel, a feeling that someone kicked you there, or sudden pain there after which you cannot push off or rise onto your toes on that leg. Stop, take the weight off that leg carefully and go to an urgent care center or emergency department the same day, even if you can still walk, as this can be a torn Achilles tendon.
- Same day: back pain that comes on suddenly after lifting, bending, a cough or a sneeze, even without a fall, if you have low bone density (osteoporosis). Get medical advice the same day. This can be a sign of a broken bone in the spine (vertebral fracture). Stop the exercises until you have been checked.
- Same day: back pain after a minor fall or strain if you are older, have low bone density (osteoporosis) or have taken steroid tablets for a long time. Get medical advice the same day.
- Same day: a joint is hot, red and swollen, or you have joint pain with a high temperature or feel hot, cold or shivery. Get medical advice the same day, and go to an emergency department if you feel very unwell. This can be a sign of infection in the joint, which needs treatment quickly.
- Same day: a calf or thigh that is newly swollen, warm, tender, red or darker than usual, has swollen veins that are sore to touch, or has a throbbing or cramping pain that does not fit your injury or condition, or that feels different from normal muscle soreness after exercise. This can be a sign of a blood clot (deep vein thrombosis), especially after surgery, an injury, time in a cast or boot, a long trip or a spell of being much less mobile than usual. Get medical advice the same day. If you are also short of breath or have chest pain, call emergency services.
- Within a few days: the pain is there at night or at rest and keeps getting worse. See your doctor within a few days. If you have had cancer, now or in the past, or are losing weight without trying, see your doctor sooner, within a day or two, and mention it. This applies even if the pain is not getting worse. If you are being treated for cancer now, contact your cancer team the same day.
Common questions
What are the most common Hyrox injuries?
In the only prospective study of the sport, the knee led at 14 of 63 injury episodes, or 22%, followed by the hip and groin at 7 (11%), the foot and the pelvis and lower back at 6 each (10%), the lower leg and Achilles at 5 (8%), and the elbow at 4 (6%); 8 episodes (13%) were filed as other or unspecified, and the last 13 were scattered across the ankle, the thigh, the head, the hand, the upper arm and the shoulder (Chittenden and colleagues, 2026, tables 3 and 4). Those are shares of the injuries 89 athletes reported over 12 weeks, not your odds of anything. The more useful number is how they began: 46 of the 63, 73%, were overuse and not one sudden moment, and every one of the five lower leg and Achilles episodes came on gradually. Most were also minor, with 35 of the 63 costing no training time at all and only 3 costing more than a week. That is what a 12-week window catches; in a separate recall survey of 418 athletes, posted as a preprint that has not been peer reviewed, 20.3% of the respondents who gave severity data reported more than 28 days of interrupted training or never getting back to their previous level.
Is Hyrox bad for your knees?
The knee is the most affected region in the research, and the surprise is where the load was coming from. Of the 14 knee episodes in the prospective cohort, a mechanism was recorded for 9, and running accounted for 5 of those, with strength training and station work two each; 71% of the knee episodes came on gradually (Chittenden and colleagues, 2026, table 4). So the 8 km of running spread through the event looks like more of the knee story than the sandbag lunges, at least in this group, 62% of whom had less than a year in the sport. A knee that aches on stairs and after sitting is usually a loading problem and belongs with patellofemoral pain or, where the pain sits on the tendon below the kneecap, patellar tendinopathy.
Which Hyrox station causes the most injuries?
Nobody has measured that. Every gym blog has an answer, so it is worth saying plainly. The prospective cohort recorded a mechanism for only 30 of its 63 injury episodes, and grouped them as running (43%), Hyrox station work (30%) and strength training (27%), without breaking the stations apart (Chittenden and colleagues, 2026). The one station-level comment the authors make is about the elbow, which they link to the repeated gripping and pulling of the sled pull, farmers carry, SkiErg and rowing, on the basis of 4 episodes. Anything more specific than that, including any station-by-station list, is reasoning from what the movements demand rather than a finding.
Why do Hyrox athletes get elbow pain?
Four episodes is a small number to build anything on, and it is what exists. The elbow came third for burden in the prospective cohort on the strength of those 4 episodes, two of which persisted, and 75% of them came on gradually; the authors attribute the pattern to the repeated gripping and pulling demands of the sled pull, farmers carry, SkiErg and rowing (Chittenden and colleagues, 2026). That fits what clinics see after a block of carry and pull work: pain on the bony bump on the outside of the elbow, worse when you grip. The program for that is tennis elbow, with golfer's elbow covering the inner side, and elbow pain when lifting if you are not sure which you have.
How many hours a week do Hyrox athletes train?
In the prospective cohort the middle of the group was 7.0 hours of training a week in total, of which 3.0 hours were Hyrox-specific; both are medians, with half the group between 6 and 10 hours in total and between 2 and 4 hours of Hyrox work (Chittenden and colleagues, 2026). That is the middle of a mixed field: 28% were aged 16 to 29, 27% were 30 to 39, 27% were 40 to 49 and 18% were 50 or over, and 62% had less than a year in the sport. It is a description of who volunteered for a study, not a target. The one hint about volume comes from the preprint survey described on this page, which found higher Hyrox-specific training frequency to be the only factor independently linked to reporting an injury, and which has not been peer reviewed.
How do I avoid getting injured training for Hyrox?
Nothing has been tested in this sport, so the honest answer borrows from elsewhere and says so. Across 6 randomized trials, 7,738 participants aged 12 to 40 and 177 injuries in other sports, strength training was associated with a relative risk of injury of 0.338 (95% confidence interval 0.238 to 0.480), and the effect grew with the amount of strength training done (Lauersen and colleagues, 2018); none of those trials involved Hyrox. The second thing is specific to what the cohort found: since running was the most reported mechanism and most problems built up gradually, the running mileage and how quickly you add it deserve the same attention as the stations. Build the week in steps rather than jumps, and treat a complaint in the fortnight it appears instead of the month it settles into.
References
- Chittenden E, Bell A, Forbes G, Tooth P, Porter R, Van Der Vliet R, Shouman K, Williams S. Prevalence, burden and risk markers of health problems in HYROX athletes: a 12-week prospective cohort study. Frontiers in Sports and Active Living. 2026;8:1937574. https://doi.org/10.3389/fspor.2026.1937574
- Ketzer CE, Kirstein L, Bonleitner M, Beyerle P, Zehnder P, Schwarz M, Biberthaler P, Zyskowski M. Injury epidemiology in HYROX athletes: an international cross-sectional survey. medRxiv preprint, posted 11 August 2026. Not peer reviewed. https://doi.org/10.64898/2026.08.09.26359590
- HYROX. The Fitness Race. Accessed 1 October 2026. https://hyrox.com/the-fitness-race/
- Lauersen JB, Andersen TE, Andersen LB. Strength training as superior, dose-dependent and safe prevention of acute and overuse sports injuries: a systematic review, qualitative analysis and meta-analysis. British Journal of Sports Medicine. 2018;52(24):1557-1563. https://doi.org/10.1136/bjsports-2018-099078
- NHS. Chest pain. Page last reviewed 8 August 2023. https://www.nhs.uk/symptoms/chest-pain/
- NHS. Knee pain. Page last reviewed 21 December 2023. https://www.nhs.uk/symptoms/knee-pain/
- NHS. Sciatica. Page last reviewed 3 December 2024. https://www.nhs.uk/conditions/sciatica/
- NHS. Septic arthritis. Page last reviewed 3 September 2026. https://www.nhs.uk/conditions/septic-arthritis/
- NHS. DVT (deep vein thrombosis). Page last reviewed 30 April 2026. https://www.nhs.uk/conditions/deep-vein-thrombosis-dvt/
- Cleveland Clinic. Rhabdomyolysis. Last updated 24 February 2023. https://my.clevelandclinic.org/health/diseases/21184-rhabdomyolysis
- Cambridge University Hospitals NHS Foundation Trust. Achilles tendon rupture. Patient information. Approved 14 January 2025. https://www.cuh.nhs.uk/patient-information/achilles-tendon-rupture/
Written and checked by the PocketPhysio editorial team. Last updated 2026-10-01.
This page is general education, not a diagnosis or a personal treatment plan. See a physiotherapist or doctor for advice about your own situation.