Injury epidemiology in HYROX athletes: an international cross-sectional survey

ObjectiveHYROX is a rapidly growing hybrid fitness competition combining running with functional exercise stations. Our objective was to describe the 12-month prevalence, characteristics and severity of self-reported HYROX-related injuries. MethodsWe conducted an international cross-sectional online survey of 418 HYROX athletes. The primary outcome was the self-reported 12-month period prevalence of at least one HYROX-related injury; secondary outcomes included an exposure-adjusted lower-bound rate per 1000 hours of total training exposure and the profile and severity of the most significant injury. Associated factors were examined by multivariable logistic regression. ResultsOverall, 208 of 418 participants (49.8%, 95% CI 45.0 to 54.5) reported at least one HYROX-related injury. The exposure-adjusted lower-bound rate was 1.65 reported injuries per 1000 hours of total training exposure. Injuries mainly affected the lower extremity, most commonly the knee (20.8%); tendon-related complaints were the leading type (41.6%) and most were of gradual onset. Among participants with severity data, 20.3% reported more than 28 days of training interruption or no return to their previous performance level. Higher HYROX-specific training frequency was the only factor independently associated with injury reporting (adjusted OR 1.61, 95% CI 1.20 to 2.16; p = 0.001). ConclusionApproximately half of respondents reported at least one HYROX-related injury during the preceding 12 months, predominantly involving gradual-onset lower-extremity complaints. Higher HYROX-specific training frequency was associated with injury reporting, although the cross-sectional design precludes causal interpretation. Prospective, exposure-based surveillance is needed to quantify HYROX-specific injury incidence and burden and examine whether training frequency, load distribution and recovery contribute to injury risk. What is already known on this topicHYROX has expanded rapidly as a hybrid-fitness competition format, yet sport- specific injury evidence is limited to a single small cross-sectional study and exposure-adjusted estimates are lacking. What this study addsAmong 418 athletes, self-reported HYROX-related injuries over the preceding 12 months were common (period prevalence 49.8%) and predominantly gradual-onset, lower-extremity and tendon-related. Higher HYROX-specific training frequency was the only measured factor independently associated with injury reporting. How this study might affect research, practice or policyThese hypothesis-generating benchmarks make the case for prospective, exposure- based HYROX injury surveillance; they do not support specific training prescriptions, but identify training frequency, load distribution and recovery as priorities for future study. HYROXs fixed, reproducible race structure offers a practical real-world model for such research.