Written by the Phoenix Rehab physiotherapy and hand therapy teams. Clinically reviewed by Louise Yow, Principal Physiotherapist & Director, AHPC A1300363H; hand, wrist and elbow sections by Nigel Chua, Principal Hand Occupational Therapist & Director, AHPC A1300362Z. Last reviewed 6 October 2026.
The Muay Thai and boxing injuries we see most are in the hand and wrist from punching, the shin, hip and knee from kicking and checking, and the ribs and neck from body shots and the clinch. Punching with the wrist out of line, and taking or checking kicks, sit behind many of them.
Most of the people we see from combat sports in Singapore train after work. Two or three classes a week, pads and bag rounds, a sparring night on Friday. Some are building toward a first white-collar bout or an interclub fight. If you train BJJ, judo, taekwondo or karate, the martial arts injuries guide covers the fingers, elbow, shoulder and knee from grappling and kicking.
The injuries follow the training. A hook that lands on the heavy bag with the wrist bent. A knuckle that has been puffy for a month and now shifts when you make a fist. A kick checked on the shin. A body kick that leaves you unable to laugh for a week.
In a study of Muay Thai fighters, the lower limbs were the area most often injured.1 Hands and wrists come close behind in the people who walk into our clinics, because they do the most work and get taped and ignored. Head injuries are a doctor’s job first, and they sit under “When to see a doctor first”.
The techniques, and what they load
| Technique | What it loads | What it most often irritates |
|---|---|---|
| Jab and cross on the bag and pads | Knuckles, wrist, shoulder | Knuckle injuries, metacarpal fractures, wrist sprain |
| Hooks and uppercuts | Wrist on the little-finger side, elbow | TFCC, wrist sprain |
| Punches that miss or go into the air at full speed | Elbow snapping straight | Elbow hyperextension sprain |
| Roundhouse kicks and teeps | Hip flexor, groin, hamstring, the stance knee | Hip flexor and groin strains, hamstring strain, meniscus |
| Checking kicks | The shin bone | Shin bruising, and occasionally a fracture |
| The clinch | Neck, shoulders, knees | Neck strain, shoulder instability, knee ligaments |
| Body kicks and body shots received | Ribs and the muscles between them | Rib bruising or fracture, intercostal strain |
| Pivoting on the mat | Knees and ankles | Meniscus, ankle sprain |
Every Muay Thai and boxing injury, by body part
Start from where it hurts. Each linked row goes to the page that covers that injury in full.
| Where | Injury | How Muay Thai or boxing usually causes it |
|---|---|---|
| Hand and finger | Boxer’s fracture (fifth metacarpal neck) | Punching with the wrist out of line, landing on the little-finger knuckle |
| Hand and finger | Metacarpal fracture | Punching the bag, or an opponent’s head |
| Hand and finger | Thumb-base fracture (Bennett fracture) | A punch that lands thumb first |
| Hand and finger | Boxer’s knuckle (sagittal band rupture) | Repeated punching on the same knuckle |
| Hand and finger | Thumb ligament tear (skier’s or gamekeeper’s thumb) | The thumb caught and bent back in the glove |
| Wrist | Wrist sprain or scapholunate ligament injury | Heavy bag work with the wrist bending on impact |
| Wrist | Scaphoid fracture | Punch impact, or a fall onto the hand |
| Wrist | TFCC tear, on the little-finger side | Hooks that land with the wrist bent toward the little finger |
| Elbow | Elbow hyperextension sprain | A missed punch that snaps the elbow straight |
| Shoulder | Rotator cuff tendon pain | Punch volume, round after round |
| Shoulder | Shoulder dislocation or instability | The clinch and throws |
| Neck | Neck strain or facet joint sprain | Neck wrestling in the clinch |
| Head and neck | Concussion (doctor first) | Head strikes in sparring or a fight, often with a neck injury alongside |
| Jaw | Jaw pain (TMJ) | Strikes to the jaw |
| Chest wall | Rib fracture or bruising | Body kicks and punches |
| Chest wall | Intercostal muscle strain | Body shots, and twisting hard into a punch |
| Hip and groin | Groin (adductor) strain | High kicks |
| Hip and groin | Hip flexor strain or tendon pain | Repeated kicking and knee strikes |
| Thigh | Hamstring strain | High kicks without the range to reach them |
| Knee | Inner knee ligament sprain (MCL) | A kick checked against the knee, or a knee strike in the clinch |
| Knee | Meniscus tear | Pivoting on the stance leg |
| Lower leg | Shin bruise (periosteal bruise) | Checking kicks shin to shin |
| Lower leg | Shin bone fracture (tibia or fibula) | A low kick checked by a raised knee or shin |
| Ankle | Ankle sprain | Pivoting and rolling the foot on the mat |
| Foot | Foot or toe fracture | A kick that lands on an elbow or a knee |
Not on the list, or not sure which row is yours? That is what the first visit is for.
The injuries we see most from Muay Thai and boxing
Boxer’s fracture and other hand fractures
What it feels like. Pain and swelling over the back of the hand after a punch, usually on the little-finger side. The knuckle looks flatter or sunk. When you make a fist, the little finger may cross over the ring finger.
What is usually going on. A punch that lands on the ring and little-finger knuckles, instead of the index and middle, can break the neck of the fifth metacarpal, the bone behind the little-finger knuckle. A punch that lands thumb first can break the base of the thumb (a Bennett fracture). A doctor decides whether a splint, a cast or surgery holds it.
What we measure. Finger range at each joint in degrees, any rotation of the finger when you make a fist, swelling, and grip strength against the other hand once the bone allows it. Our hand therapists make the splint, and see you through the Finger and Metacarpal Fracture Recovery Program.
This week. No punching with that hand. A knuckle that looks sunk, or a finger that crosses its neighbor in a fist, needs a doctor the same day. Pain relief and anti-inflammatory medication are a decision for your doctor or pharmacist.
Boxer’s knuckle
What it feels like. A swollen, tender knuckle, usually the middle finger, that has been puffy for weeks. Making a fist hurts. In some people, the tendon over the knuckle visibly slips off to one side as the fist closes, and the finger struggles to straighten from a fist.
What is usually going on. Repeated punching on the same knuckle tears the band of tissue that holds the finger’s straightening tendon centered on top of the knuckle (the sagittal band). Without it, the tendon slides into the groove beside the joint.
What we measure. Whether the tendon stays centered as you make and open a fist, knuckle range, swelling, and grip strength.
This week. Stop bag and pad work on that hand. A tendon that slips off the knuckle needs a doctor, and a splint is often part of the plan. Check your wraps and glove fit with your coach, and how your fist is lined up on impact.
Wrist sprains and the little-finger side of the wrist
What it feels like. Pain in the wrist on impact with the bag, worst on hooks. Pain on the little-finger side, sometimes with a click, points to the TFCC. Pain on the thumb side after a fall onto the hand, or after a hard punch, needs ruling out for a scaphoid fracture.
What is usually going on. A punch is kindest to the wrist when it lands with the wrist straight, in line with the forearm. When the wrist bends on impact, the ligaments take the force. The TFCC, a cartilage and ligament complex on the little-finger side, takes hooks that land with the wrist tilted. The scaphoid is a small bone at the base of the thumb that can break and feel like a sprain.
What we measure. Wrist range in degrees, forearm turning, grip strength, pain on loading the wrist in a push-up position, and the specific tests that separate the TFCC from other ligaments.
This week. Rest the bag and pads, and keep shadow work and footwork going. Tape and wraps support the wrist. Pain at the base of the thumb after a fall or a punch needs a doctor before training. More on wrist sprains.
Shins from checked kicks
What it feels like. A tender, swollen lump on the front of the shin after a check or a clash, sometimes with a dent you can feel under the skin. Most settle over a few weeks. A shin you cannot stand on after a kick is a different problem.
What is usually going on. The front of the shin has almost no muscle over the bone, so a check bruises the thin layer covering the bone (a periosteal bruise). A kick checked hard by a raised knee or shin can break the tibia or fibula. That is a doctor’s job first. A round kick that lands on the outer thigh bruises the muscle instead, a dead leg.
What we measure. Where the tenderness is on the bone, hopping on that leg against the other, calf strength, and kicking the pads at increasing power.
This week. Wear shin guards for any sparring. Keep the leg moving and elevated when resting. Pain that is worse with every step, or a shin you cannot put weight on, needs a doctor the same day.
Ribs from body shots
What it feels like. Sharp pain on one side of the chest when you breathe in deeply, cough, laugh or twist. Turning over in bed is the worst part of the night.
What is usually going on. A body kick or punch bruises the ribs, strains the muscles between them (intercostal strain), or cracks a rib (rib fracture). Bruised and cracked ribs feel alike, and both take several weeks to settle.
What we measure. Breathing depth, trunk rotation each way, pain on pressure over the ribs, and the techniques that still hurt.
This week. Breathe deeply a few times every hour, even though it hurts, so the lung underneath keeps opening. Rest from sparring and body conditioning. Breathlessness, coughing up blood, or pain in the belly after a body shot needs the emergency department now.
Back to full training on tests, not dates
Fight night is a date. It does not tell you whether the hand or the shin can take it. Before full training and sparring, we look for these:
- Hands and wrists. Grip strength within 10% of the other hand, a fist that closes with the tendon centered on every knuckle, and push-ups on the fists without pain. Then bag rounds built back over two to three weeks, light before heavy.
- Shins. No tenderness on pressing the bone, single-leg hops matching the other side, and kicking pads at full power before checks and sparring.
- Hips and groin. Strength against the other side, and full-height kicks on pads without pain that day or the next.
- Ribs. Deep breaths, twisting and pad work without pain, before any body contact.
- After a concussion. Your doctor’s clearance, through a graded return that ends with contact last.
Sparring comes back last, after every other part of training is tolerated. Pain is the first thing to leave. Strength is the last to train and recover.
Is this normal?
Usually expected: sore knuckles, bruised shins and aching muscles a day or two after a hard class or sparring, that ease with light movement and are better each day.
Worth getting checked: a knuckle that stays swollen for more than a week or two, a tendon that slips on making a fist, wrist pain on every impact, a shin that hurts more with each step, or rib pain that is not easing after a few weeks.
When to see a doctor first
- Call 995 after any head strike followed by loss of consciousness, a seizure, repeated vomiting, a worsening headache, confusion, slurred speech or drowsiness, or any neck injury with numbness, tingling or weakness in the arms or legs. Do not move someone with a suspected neck injury.
- Go to the emergency department now for breathlessness or coughing up blood after a body shot, pain in the belly after a body kick, a shin or forearm that looks out of shape, a leg you cannot stand on after a kick, or a shoulder that is still out of the joint.
- See a doctor the same day for any suspected concussion, even if the symptoms are mild: headache, feeling foggy, dizziness or blurred vision after a strike. Stop training for the day and do not spar again until a doctor clears you. The same applies to a knuckle that looks sunk, a finger that crosses its neighbor in a fist, or pain at the base of the thumb after a punch or a fall.
- See a doctor soon for a tendon that slips off a knuckle, a jaw that clicks, locks or will not open fully after a strike, a thumb that feels loose when you pinch, or tingling down an arm after a clinch.
Questions people ask
What is a boxer’s fracture?
A boxer’s fracture is a break in the neck of the fifth metacarpal, the bone behind the little-finger knuckle. It usually happens when a punch lands on the ring and little-finger knuckles. The knuckle can look flat or sunk, and the little finger may cross the ring finger in a fist. It needs a doctor the same day.
What our patients say
Google reviews from our clinics in Singapore.
What is boxer’s knuckle?
Boxer’s knuckle is a tear of the sagittal band, the tissue that keeps the finger’s straightening tendon centered on top of the knuckle. Repeated punching on the same knuckle causes it. The knuckle stays swollen and sore, and the tendon can slip off to one side as the fist closes. A slipping tendon needs a doctor.
Is it a bruised shin or a fracture after checking a kick?
Most checked kicks bruise the thin layer covering the shin bone, leaving a tender, swollen lump. A kick checked hard by a raised knee or shin can break the tibia or fibula. A shin you cannot stand on, or that looks out of shape, needs the emergency department now.
When can I spar again after a concussion?
After a suspected concussion, stop training for the day and see a doctor the same day, even if the symptoms are mild. Do not spar again until a doctor clears you. The return follows a graded plan that brings contact back last. Loss of consciousness, a seizure or repeated vomiting means calling 995.
Where are you with this right now?
1. It is settling on its own
If it eases week by week while you take that limb off the bag or out of sparring, you are on the right road. Bring the work back light before heavy. You do not need us for this, and we would rather say so.
2. It has stopped improving
It settles in the week and flares on the first bag round. You have started punching with only one hand on the heavy bag, kicking off the other leg, or sitting out sparring with an excuse. That pattern is usually a strength and load problem, and rest alone rarely changes it. It is worth measuring. If it has been months, the Stalled Recovery Review runs over three weeks with the same therapist.
3. You have had surgery, or you have a date
A metacarpal fixation, a knuckle tendon repair, a scaphoid fixation or a shoulder stabilization each has a shape, with protected weeks before the gloves go back on. See hand therapy after surgery, physiotherapy after surgery and the recovery programs. All of it runs on the four stages of the Phoenix Recovery Protocol: Calm & Protect, Move & Mobilize, Rebuild & Strengthen, and Return & Perform.
Next step
Find out which stage you are in
Pain is the first thing to leave. Movement and strength are the last things trained back, and most people stop before that part is done. One Assessment and Treatment is a single 45-minute appointment at $230, nett, no GST. Your therapist finds what is actually limiting you, treats it in the same appointment, and you leave with your current stage and a written plan.
Prefer to phone? Each of our five clinics has its own number on the clinics page. No referral needed to book.
Related reading
Sources
- Gartland S, Malik MH, Lovell ME. Injury and injury rates in Muay Thai kick boxing. Br J Sports Med. 2001;35(5):308-313.
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