Find out HYROX’s blind spot and why the real risk isn’t in your legs.

While HYROX is commonly treated as a leg-endurance race, stations like Wall Balls and the SkiErg expose an overlooked blind spot: severe upper-body strain.

As Singapore athletes preparing for HYROX Singapore from November 26 to 29, peak pre-race fatigue sets in. Bad habits may shape race-day performance and future joint health.

Dr Lester Tan, senior consultant orthopaedic surgeon at Oxford Orthopaedics, provides critical clinical expertise on the biomechanics of shoulder and elbow injuries from daily wear-and-tear to sports, their prevention and treatments, and how to care for upper-body mobility and health before, during and after any sports or activities:

Part 1 – The overlooked risk

While most athletes train for running and leg endurance, why are shoulder and elbow injuries often overlooked by HYROX athletes?

Dr Tan: Many people see HYROX as a running race, but it pushes the entire body to its limit, shoulders and elbows included. Beginners who share this view that it’s just a race might leave their upper body underprepared, which can lead to injuries. As with any sport you’re new to, training needs to be gradual and progressive, and proper coaching and preparation are highly recommended.

A coach can also correct technique, which matters at stations like Wall Balls. These might look shoulder-focused, but the drive needs to come from the legs and core as well. When injuries do happen, they can come from a fall or sudden trauma, or from repetitive strain. Strain injuries tend to build gradually, which makes them easy to overlook, and they can turn into long-term problems if not treated appropriately.

Which HYROX stations put the most strain on the shoulders and elbows?

Dr Tan: The Wall Balls and SkiErg are quite upper-body heavy. With 100 overhead throws, Wall Balls put a lot of strain on the shoulders, and they can be especially difficult for anyone with a labral tear or a history of shoulder instability. The SkiErg’s repetitive pulling can also place considerable strain on the arms if the technique isn’t right.

 

What shoulder and elbow conditions, or biomechanical mistakes, might HYROX athletes be missing during training and competition?

Dr Tan: Together, the eight stations test the whole body, and even the upper-body-heavy ones draw on the legs and core. This is why getting familiar with each station is essential when starting HYROX. Wall Balls need the legs and core to power the throw, not just the shoulders. On the SkiErg, engaging the core maximises efficiency and reduces the risk of injury. The Sled Pull should be driven by the legs and hips with the back braced, almost like a horizontal deadlift, rather than pulling with the arms alone. HYROX is also a test of endurance, so pace yourself to last rather than going too hard in the first two stations and struggling towards the end. As fatigue sets in, technique tends to slip, and the shoulders and arms end up taking on more of the work.

 

Part 2 – Why it matters long term

Why do shoulder and elbow injuries in functional fitness often take a long time to heal if left unaddressed?

Dr Tan: It’s hard to rest the shoulders and elbows properly, because we use our arms in almost everything we do, and busy schedules make it difficult to take time off or attend physiotherapy. This matters because even minor strains can take a few days to two weeks to settle, while more serious muscle strains can take six to 12 weeks to recover fully. A significant injury should also be checked by a trained medical professional to rule out a tear.

 

What are the long-term consequences of untreated shoulder and elbow injuries as athletes get older?

Dr Tan: It really depends on the severity of the injury. Major injuries to the rotator cuff or labrum in the shoulder might lead to joint problems later in life. At the elbow, athletes can develop tendinitis of the biceps or triceps, or lateral epicondylitis, better known as tennis elbow. Tendinitis, which is inflammation of the tendon, can progress to a tear if it isn’t adequately rested before returning to full training. Pushing through the pain adds to this risk and can make any of these injuries worse.

 

Part 3 – Spotting the warning signs

How can athletes tell the difference between routine delayed-onset muscle soreness (DOMS) and a genuine shoulder or elbow injury?

Dr Tan: DOMS usually peaks a day or two after training and then fades. A genuine injury tends to last longer, so if the pain persists after a few days of rest with little or no improvement, consider getting it checked.

 

What specific symptoms should athletes never ignore, such as night pain, weakness, painful clicking/catching or numbness?

Dr Tan: Persistent pain and an inability to use the arm are worrying signs, and painful clicking also needs investigating. Weakness or numbness should be looked at too, as they might indicate nerve irritation or injury.

 

If an athlete suspects an injury close to race day, should they rest, modify training or withdraw, and when should they see a specialist?

Dr Tan: It’s never easy to pull out of a race after all the training and preparation, perhaps even more so in a team event. Listen to your body and adjust accordingly, bearing in mind that missing one race is better than a serious injury. If race day is still some time away, get a specialist review and clearance to take part.

 

Part 4 – Prevention, recovery and treatment

What steps can HYROX athletes take to prevent these injuries?

Dr Tan: Preparation is key. Know the stations and how to maximise efficiency at each one, train for what each station demands, and consider getting a coach to help. Don’t neglect cardiovascular fitness either. By race day, you should already have completed a full HYROX in training.

 

How should athletes recover after the race to protect their shoulders and elbows?

Dr Tan: Warm-ups and cool-downs are a must for all strenuous exercise. A proper warm-up prepares the body for the effort ahead and lowers the chance of injury, while a cool-down with gentle stretching helps the body wind down afterwards. In the days after the race, give your shoulders and elbows time to rest before returning to full training, and get any pain that hasn’t eased after a few days checked.

 

What are the treatment options for these injuries, and when is surgery considered?

Dr Tan: Treatment depends on the individual patient and the severity of the injury, so it starts with a thorough assessment, including a physical examination and scans where needed. Torn tendons and ligaments might need physiotherapy or, in some cases, surgery. Either way, getting it checked is the first step to recovery.

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