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 4 October 2026.
Most HYROX injuries do not arrive in one moment. They build over weeks of training. In a 2026 survey of 418 HYROX athletes, about half reported at least one HYROX-related injury in the previous 12 months. Most came on gradually, most were in the legs, the knee was the most common site, and tendon problems were the most common type. Athletes who did HYROX-specific workouts more often reported more injuries.1
That is useful to know, because an injury that builds gradually gives you warning. If you are racing at AIA HYROX Singapore on 26 to 29 November 2026, or the next race after it, this page sets out what each station loads, what is usually normal, what needs a doctor, and how the decision to race is made on measures rather than on how it feels that morning.
What the race loads
A HYROX race is eight 1 km runs, each followed by a workout station, in a fixed order: SkiErg, sled push, sled pull, burpee broad jumps, rowing, farmers carry, sandbag lunges and wall balls. You run 8 km in total, and seven of those eight kilometers start on legs the last station has just tired. That is the pattern behind most of what follows.
| Station | What it loads | What it most often irritates |
|---|---|---|
| The runs, 8 x 1 km | Calf, Achilles, knee, foot | Achilles tendon, calf, front of the knee, shin, heel |
| SkiErg | Lats, trunk, shoulders | Lower back when the hinge turns into a crunch, front of the shoulder |
| Sled push | Calf, Achilles, quadriceps | Achilles and calf, front of the knee |
| Sled pull | Grip, forearm, biceps, lower back | Inside and outside of the elbow, forearm, lower back |
| Burpee broad jumps | Wrists, shoulders, Achilles, knees | Back of the wrist from landing on a bent-back hand, Achilles |
| Rowing, 1,000 m | Lower back, hips, grip | Lower back, forearm and wrist tendons |
| Farmers carry | Grip, forearm, wrist, upper trapezius | Grip, little-finger side of the wrist, neck and upper back |
| Sandbag lunges | Knees, hips, groin | Kneecap and patellar tendon, groin and hip flexor |
| Wall balls | Shoulders, knees, wrists | Rotator cuff overhead, front of the knee, wrist on the catch |
The injuries, by body part
Achilles and calf
The Achilles that is stiff for the first few steps out of bed and for the first ten minutes of a run, then warms up. That is the usual story of an Achilles tendinopathy, a tendon that has been given more load than it is currently strong enough for. HYROX adds a specific twist: the sled push loads the calf hard on the balls of the feet, and then you run straight off it. A tendon usually tolerates continued running if the stiffness the next morning is no worse than the morning before. If it is getting worse week on week, the running and sled load come down and the calf needs strength work. Complete rest alone rarely changes it. A sudden pulling pain in the belly of the calf mid-run is more often a calf strain.
Knees
Pain at the front of the knee, around or under the kneecap, that shows up on stairs, on getting out of a low chair, and in the bottom of a lunge or a wall ball squat. Sandbag lunges and wall balls together are a lot of deep knee bending, late in the race, on tired quadriceps. The two common sources are the joint behind the kneecap (patellofemoral pain) and the tendon just below it (patellar tendinopathy). Both are load problems and both are trained, which is covered in knee pain when squatting.
Lower back
The SkiErg, the sled pull, the row and the burpees all ask the back to hold a position while the legs and arms do the work. When the trunk tires, the hinge on the SkiErg turns into a crunch and the sled pull turns into a lean back. Most of it settles in days to a few weeks. If you are not sure what kind you have, start with how to work out what kind of lower back pain you have. If your back is sore from lifting in your training, see lower back pain from deadlifts.
Shoulders
Wall balls are the last station, which means a hundred throws overhead on the most tired shoulders of the day. The SkiErg and the burpees add to it. Pain at the front or side of the shoulder that is worse reaching overhead, and worse at night lying on that side, is usually the rotator cuff.
Elbows, forearms, wrists and grip
The sled pull is a rope pulled hand over hand. The farmers carry is grip against gravity for 200 meters. Eighty meters of burpees land on bent-back wrists. Together they produce pain on the inside of the elbow (golfer’s elbow), the outside of the elbow (tennis elbow), the little-finger side of the wrist (often the TFCC), the thumb side of the wrist (De Quervain’s), and a back of wrist that aches on every burpee. Rope pulls can also strain the brachialis, felt as a deep ache at the front of the elbow. These are seen by our hand therapy team, and grip strength is measured in kilograms on both hands.
Shins and feet
Diffuse ache along the inside of the shin that eases as you warm up is usually shin splints. Pain at one spot on the shin or the top of the foot that you can press with a fingertip, and that gets worse with every run, can be a bone stress injury and needs a doctor before you run again. Heel pain on the first steps out of bed is covered in heel pain.
Is this normal?
Usually expected: muscle soreness 24 to 72 hours after a hard workout, on both sides, that eases once you are moving. Tendon stiffness in the morning that loosens in a few minutes and is not getting worse week on week.
Worth getting checked: pain on one side only, at one spot, that is worse each week, that changes how you run, lunge or grip, or that is still there after a week of lighter training.
When to see a doctor first
- Call 995 for chest pain, collapse or fainting, breathlessness out of proportion to the effort, or confusion or slurred speech after training in the heat.
- Go to the emergency department now if your urine turns dark brown or cola-colored with severe muscle pain or swelling after a hard workout, which can be exertional rhabdomyolysis. Also if back pain comes with numbness between the legs or new problems passing urine or stool, or a joint looks out of place.
- See a doctor the same day if you felt a sudden kick or snap at the back of the ankle and cannot push off on that foot, which can be an Achilles rupture. The same for a pop at the chest or the front of the elbow with bruising.
- See a doctor soon for pain at one spot on a shin or foot that is worse with every run, night pain that does not change with position, or pins and needles running down an arm or a leg.
Injured, and the race is weeks away
The question is usually not whether you can race. It is what the injured part can tolerate between now and then, and what you change so the rest of your training keeps going.
- Keep what the injury tolerates. A sore Achilles can often keep running if it settles by the next morning, while the sled push and the burpee jumps are cut back. A sore wrist can keep running and lunging while the burpees and the farmers carry are modified.
- Change the format. In HYROX Doubles, both partners run every kilometer together and split the station work between them. In the relay, each of four athletes runs 2 km and does two stations. If one station is the problem, a format that lets someone else do it is a real option.
- Do not add volume in the last two weeks. The last 10 to 14 days before a race is not the time to make up for training you missed.
HYROX: what we focus on
Fine on the first run. Not by the lunges.
The Achilles that needs ten minutes of jogging before it lets go. The wall balls you now break into sets of five. The sled you push with one leg doing most of the work. You took a week off, it settled, and the first full simulation brought it straight back.
- Calf and Achilles. Single-leg calf raises counted against the other side, and how the tendon responds the morning after load.
- Knee. Quadriceps strength and single-leg squat control, tested on both sides.
- Back. Trunk endurance and the hinge, tested tired as well as fresh, because that is when the race asks for it.
- Grip, wrist and elbow. Grip strength in kilograms on both hands, by our hand therapy team.
Tested, not dated. Full race simulations come back when the measures say so, not when the race gets close. Pain is the first thing to leave. Strength is the last to train and recover.
WhatsApp us · Get Assessed & Treated · One 45-minute appointment, $230, nett, no GST.
Where are you with this right now?
1. It is settling on its own
If the pain is easing week by week while you train at a lower load, and the morning stiffness is getting shorter, you are on the right road. Hold the load where it is until the improvement stops, then build. You do not need us for this, and we would rather say so.
2. It has stopped improving
It settles when you back off and comes back with every full simulation. You have started breaking the wall balls into smaller sets, shortening the lunge, or pushing the sled off your good leg. 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 is three appointments over three weeks with the same therapist, $690.
3. You have had surgery, or you have a date
An ACL reconstruction, an Achilles repair or a shoulder stabilization has a shape, with protected weeks before racing comes back. See physiotherapy after surgery and the recovery programs. All of it runs on the four stages of the Phoenix Recovery Protocol.
Related reading
Sources
- Ketzer C, Kirstein L, Bonleitner M, et al. Injury epidemiology in HYROX athletes: an international cross-sectional survey. medRxiv, posted 11 August 2026. doi:10.64898/2026.08.09.26359590. A preprint, not yet peer reviewed, based on self-reported injuries.
- Race dates: AIA HYROX Singapore event page, checked 4 October 2026.
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