Physical Therapy for Boxing Injuries
Boxing is a high-impact sport requiring full-body movement, coordination, agility, endurance, and power, combining upper-body power punching with lower-body footwork. Due to the high intensity of the sport, upper body injuries are common, including concussions, wrist and elbow strains, boxer’s fracture, or shoulder rotator cuff or labrum tears. Physical therapists can help boxers prevent injury through a customized strength and conditioning program and recover from and return to the boxing ring safely after injury.
Common Boxing Injuries
Boxing is a high-impact sport that requires significant power, agility, endurance, coordination, and cardiovascular conditioning of the entire body. Boxing requires full-body movement, combining upper-body power punching with lower-body footwork, with short intervals of high-intensity activity over an extended period of time (in professional boxing, there are 3-minute boxing bouts over a max of 12 rounds).
Due to the intensity of boxing, amateur and professional boxers are at risk for injuries, particularly to the head and upper extremities, such as the hand, wrist, arm, and shoulder. Long, high-intensity boxing workouts can place a tremendous strain on a boxer’s joints and muscles. Once certain muscles become fatigued, such as the shoulder muscles, the body compensates by transferring the stress of the workout to other structures of the shoulder like the labrum or rotator cuff tendons, which can lead to injury. Fatigue can also lead to overextending, altering the biomechanical chain of the swing and punch, negatively affecting the ligaments and tendons of the arm, wrist, hand, and shoulder.
Common boxing injuries include:
A concussion is a mild traumatic brain injury due to a direct blow to the head during a boxing match. Concussions can cause cognitive, behavioral, and physical symptoms and must be carefully managed.
Bruises and contusions to the face and upper body due to the impact of the punching fist on the upper body.
Nose bleeds occur due to a direct blow to the nose or from dehydration.
Wrist sprains and strains can result from poor punching technique or improper hand and wrist wrapping and gloves.
Rib or jaw fractures happen from a direct punch to the rib or jaw that causes a breakage in the bone.
Boxer’s elbow, or posterolateral elbow impingement, is caused by repetitive hyperextension trauma during missed punches due to hyperextension and pronation of the arm.
Rotator cuff tendonitis occurs when the rotator cuff muscles are strained from repetitive use and the tendons develop microtears due to overexertion of the shoulder joint. This can lead to a rotator cuff tear.
Rotator cuff tears can occur over time or due to a sudden traumatic incident. For most boxers, a rotator cuff tear tends to occur because of small micro-tears in the rotator cuff muscles and tendons that get larger and worse over time. If the shoulder is not given time to rest, these tears in the tendons cannot repair themselves which weakens the shoulder. It can also tear due to a missed punch or from over-rotating the shoulder.
Subacromial bursitis involves inflammation of the bursa, or small sac, that cushions the shoulder joint and allows shoulder bones to slide smoothly over one another due to overexertion and lack of proper rest of the shoulder joint from punching motions.
Torn shoulder labrums typically occur in the back of the shoulder at the posterior labrum due to the shoulder being repetitively loaded with each punch. The labrum plays a key role in maintaining shoulder stability as it holds the head of the humerus in the shoulder socket. A tear in the labrum leads to shoulder instability and causes a serious issue for boxers as the movement of the arm can cause the shoulder to dislocate when the labrum is torn.
“Boxer’s Fracture” is a fracture of the bone in the pinky finger that connects the wrist to the finger bones due to punching with a clenched finger, leading to hand pain and swelling, difficulty straightening the finger, and inability to move the finger.
Physical Therapy for Boxing Injuries
Physical therapists can help boxers prevent injury through a customized strength and conditioning program and recover from and return to the boxing ring safely after injury. For many of the most common boxing injuries, physical therapists incorporate manual therapy, therapeutic and strengthening exercise, and functional sport-specific training to optimize the boxer’s recovery.
Manual therapy involves soft tissue and joint mobilizations to restore mobility and range of motion in the injured area as well as relieve pain. Aerobic conditioning helps the boxer regain cardiovascular fitness, endurance, and stamina while strengthening targets specific muscle groups around the injured area to rebuild strength and reduce stress on the injured joint or muscle. Functional sport-specific training is generally the last step in the rehabilitation program, focused on agility, coordination, and power drills to help the boxer regain competition-level upper body movement.
Physical therapy treatment for boxing injuries can include:
Concussion management: It is essential to receive effective, timely, and well-monitored treatment after a concussion. A physical therapist manages concussion recovery with evidence-based protocols, using vestibular rehabilitation, balance training, manual therapy, and a graded, progressive exercise program to help the boxer adapt to the increased physiological demands of activity over time with careful monitoring.
Hand & wrist treatment: Following an injury to the hand or wrist and subsequent immobilization while the bones heal, it is critical to work with a physical therapist to regain strength, function, and mobility in the hand and wrist. This can involve grip and finger strength exercises, range of motion exercises of the wrist, and targeted strengthening of the forearm, arm, and hand.
Shoulder injury rehabilitation: Shoulder injury treatment focuses on regaining strength and mobility in the shoulder joint. This is done through manual therapy and dry needling to relieve tension in shoulder muscles, shoulder muscle stretching and targeted strengthening of the shoulder and upper back muscles, core stabilization for a strong trunk from which to transmit power to the arm, and postural training.
To prevent injury and stay safe in the boxing ring, work with a qualified boxing coach to master the proper boxing fundamentals in punch technique and footwork as well as use proper equipment, like gloves, groin and mouth guards, and hand wraps and guards. Maintain a balanced nutrient-dense eating plan and stay properly hydrated. Work with a physical therapist to build sport-specific strength, endurance, and stamina, and pace your training to avoid overuse injuries, allowing for enough rest days to recover from training and competition.
Have you experienced a boxing-related injury? Work with a physical therapist today!
