Physiotherapy in boxing

1. Dr. Siddharth Sakalle (P.T.)
Master in Sports, Musculoskeletal & Manual Therapy (IMMP) - Univer-
sity of South Australia, Senior Sports Physiotherapist Olympic Gold
Quest (OGQ), Currently working with Saina Nehwal (Olympic Medallist
2012) Former Physiotherapist of Indian Men’s Boxer, Worked with
Boxer MC Mary Kom (Olympic Medallist 2012) as Physiotherapist
PHYSIO
THERAPY
IN BOXING
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12 PHYSIOTIMES Vol. 7, Issue 5, March’ 2016

2. Boxing is a contact sport and contact sports can lead to impact
injuries. This game is a combination of Power and Endurance.
An average boxing punch delivered at a velocity of 9 meters/sec
can generate an unbelievable force of 0.2 ton. Prevention can
play a huge role in warding off injuries caused by boxing. Lack
of strength and faulty boxing techniques may be a few reasons
why injuries occur but a physiotherapist who can aid rehabilita-
tion process, can certainly prevent and treat these injuries.
Boxing is divided into two categories - one is Professional and
the other Amateur boxing. Amateur category is used in the
Olympics, Commonwealth and Asian Games. In both,
there are 10 weight categories, which ranges from 48
Kg to 90+Kg. Amateur boxing has three rounds of
three minutes in a bout, with a one-minute
interval between rounds for male players. For
female players four rounds of two minutes
with a one minute interval between
rounds.
Professional boxing ranges from
ten to twelve rounds of three
minutes with one min
interval between each
round, though four-round
�ights are common for
less experienced
�ighters.
Jab - A quick, straight punch
thrown with the lead hand
from the guard position. It is
accompanied with, clockwise
rotation of the back and hips,
while the �ist rotates 90° and
becoming horizontal upon
impact.
Cross - The rear hand is
thrown from the chin,
crossing the body and
travelling towards the target
in a straight line. For
additional power, the back
and hips are rotated
counter-clockwise as the
cross is thrown.
Hook - A semi-circular punch
thrown with the lead hand to
the side of opponent's head.
From the guard position, the
elbow is drawn back with a
horizontal �ist (knuckles
pointing forward) and the
elbow bent. The torso and
hips are rotated clockwise,
propelling the �ist through a
tight, clockwise arc across
the front of the body.
Uppercut - From the guard
position, the back shifts
slightly to the right, the rear
hand drops below the level of
the opponent's chest and the
knees are bent slightly. The
rear hand is thrust upwards
in a rising arc towards the
opponent's chin or torso,
knees push upwards quickly,
back and hips rotate anti-
clockwise.
CROSS
JAB
UNDERCUT
HOOK
BIOMECHANICS OF BOXING:
Common Punches used in Boxing:
Prevention can play a huge role in warding off injuries caused by
boxing. Lack of strength and faulty boxing techniques may be few
reasons why injuries occur but a physiotherapist who can aid
rehabilitation process, can certainly prevent and treat these injuries.
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3. Fitness Training
Components:
Strength: To produce
power in a punch and
strength endurance to
produce power over a
signi�icant period of time.
It is best to lift heavy
weights with explosive
movements (upwards),
1-3 times a week. Don’t
do weights on the same
day as you do sparring.
Core strength training is
equally important
because that also
increases power in the
punches.
Muscular endurance:
A boxer will throw
hundreds of punches
throughout a �ight, so
poor muscular endur-
ance will lead to defeat.
To improve this, add
eccentric exercises with
strength training. Also
increase number of
repetition with 50% of
1RM weight with
strength training.
Anaerobic �itness and
Aerobic �itness: A boxer
needs to �ight at high
intensity throughout a
bout (�ight) to stand any
chance of winning. The
sport has been estimated
as approx. 70-80%
anaerobic and 20-30%
aerobic.
One of the best ways to
condition the body for
boxing is through
interval running. Inter-
vals consist of intense,
sustained running for a
set distance or time.
Common intervals for
boxers consist of
distances 200, 400, 600
and 800 meters.
Interval training should bring heart rate to anaerobic levels. Over the time,
gradually lower player’s heart rate and improve recovery time between
intervals. It is best to run intervals 2 or 3 days per week. To improve
aerobic �itness TABATA technique is effective, that I have mentioned in my
revious article. Most common technique is long distance running to
increase aerobic �itness.
“Arjun Award Manoj Kumar Olympian, Boxer”
Balance: If you have
bad balance then you
have a greater chance
of being knocked
down. It is also
required to deliver a
solid punch. One of
the ways is to stand
on one leg & try all
punches. I found
boxer’s balance also
deteriorates due to
excessive weight
reduction. As a
Physiotherapist we
should keep an eye
on their weight.
Weight shouldn’t go
higher than 2.5Kgs in
their respective
weight category.
Skipping is a
common practice in
boxing to improve
balance.
Agility & Reaction:
A boxer will need to
constantly change
direction during a
�ight i.e. agility.
Boxer needs to be
able to block
punches and duck
in time i.e. reaction.
This can be
achieved by
Plyometric training.
It improves explo-
sive power and is
good for anaerobic
�itness.
“Padma Bhushan Mary Kom Olympic Medalist 2012, Boxer”
“Sumit Sangwan Olympian, Boxer”
“Devendro Singh Olympian, Boxer”
Shiva Thapa (World No. 2)
1 Km
4 × 200 meters
4 × 200 meters
4 × 600 meters
4 × 800 meters
800 meter
Warm up
30 second (sec) rest period between each interval
30- 45 sec rest period between each interval
1 min rest period between each interval
1min rest period between each interval
cool down - light jog
A Sample Routine:
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4. Start with 4 sets and then add 1 set to the workout every week.
Speed: Hand and feet speed
is essential in boxing, so
they are able to punch and
move ef�iciently. We can add
hand movements with the
plyometric exercise; this
will help to increase hand &
feet coordination. Boxers
are doing a drill in boxing
training, in that they place a
rope between two pillars.
They move around the rope
& do punching practice. It
helps to improve reaction as
well as hand feet speed.
Skipping also helps to
improve speed.
Flexibility: This will
increase with stretching.
Dynamic stretching is used
during warm up and static
stretching during cool down
of upper, lower extremity as
well as back stretching.
Common Boxing Injuries
and its Management:
Poor training methods,
inadequate warm-up, and
lack of conditioning are a
few causes of injuries.
Injuries can be caused by a
combination of those things
without necessarily being
the only reasons. Fatigue
and overuse are also
signi�icant contributors to
an injury and not excluding
also the psychosocial
aspects and dehydration
that cause athletes to be
prone to injuries (which is
very common in boxing).
Head or Brain Injuries: The
most concerning boxing injury
is a head impact resulting in a
potential brain injury. The
punch impact shakes the brain
within the skull and causes the
brain to act abnormally for a
brief period of time. This is
known as concussion. Wearing
head gear can reduce the
impact stress and shock that
could reverberate through your
brain. This can also be
prevented with good skill of
defence boxing.
Jaw & Facial Injuries: Punch-
ing impact to jaw can cause jaw,
nose or facial fractures. Jaw
injury leads TMJ dysfunction
due to fracture, subluxations or
dislocation. TMJ strain is also
possible due to punches. Cold
pack for 20 mins for next 2-3
days is helpful. After pain
reduction putting thumb on
both sides of joint and trying to
open and close the jaw would
help to come out from strain.
Shoulder Injuries: Shoulder
injuries can occur through
repetition of impact. Injuries
include rotator cuff injuries or
shoulder dislocation. In rotator
cuff speci�ically supera & infra
spinatus muscles are commonly
involved because of punches
like upper cut & hooks. This is
most likely an over use injury.
Cold pack is for pain and
K-tapes for muscle support. To
treat trigger points, dry
needling technique as well as
soft tissue release is effective.
Prevention measures include
rotator cuff strengthening,
which also reduce chances of
shoulder dislocation/ sublux-
ation .
Hand and Wrist Injuries:
Hand and wrist are vulner-
able to impact injuries. It
includes soft tissue bruising
or joint sprains, �inger, thumb
and hand fractures & thumb
dislocation/subluxation etc..
Commonly �irst & second
knuckles are sprained. Icing is
used in acute condition and
contrast bath in chronic for
pain. Rigid tapes are used to
reduce impact on knuckle at
the time of training. In
chronic cases dry
needling is useful to
reduce pain & improve
blood supply to
cartilage as well as soft
tissue.
Ankle, Knee & Leg
Injuries: Lower limb
injuries can occur with
overuse (e.g. stress
fractures, tendonitis)
or with trauma (e.g.
ankle or knee sprain).
Treat ankle & knee
sprain or tendonitis as
per regular orthopae-
dic treatment.
Jumps
Box Jumps 1
(12-15 inch box)
Box Jumps 2 (as
tall as possible)
Drop Jump
Sets×Reps
4×10
4×6
4×6
Rest
15 sec
60 sec
60 sec
Progression
Add 4 reps every
week
Add height to the
box every week
A
B
C
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5. Neck, Back & Rib Injuries:
Spine or ribs can be injured
through impact or
overstraining. Core stability
muscles strength will not
only protect your spine from
injury, but also improve
your punching power and
ability to absorb the impact
of a punch. Neck strain is
quite common due to
punches on the head leading
to jerk on the neck. To
manage the injury ice packs,
K-tapes and dry needling is
prescribed. Neck strength-
ening is equally important
as core strengthening.
Cuts & Bruises: Cuts and
bruises are the most
common boxing injuries.
These injuries occur from
contact with an opponent’s
gloves or head. Since last
Olympics, amateur male
boxers can’t use head guard
during �ights. Due to this
rule boxers are more prone
to cuts around eyes & head.
Now international body of
boxing allows a cut master
(may be a physiotherapist)
during the �ight. He has to
soak a Q-tip with adrenaline
(1/1000) from an ampoule.
After the bell, applies direct
pressure with the gauze
from one hand, for at least
20 sec. The other hand can
be wiping the oozing blood.
After 20 sec the gauze is
removed. The cut is parted
and adrenaline Q-tip is
reapplied into the cut with
pressure for another 20 sec.
Vaseline can be applied to
the surface of the cut.
Kidney Damage: Punches
to the kidneys are illegal at
all levels of boxing. A heavy
blow to the kidney can
cause kidney failure.
General Preventive
Measures:
Boxers can use preventative
measures to limit the
possibility of potential
injury, such as:
• Protective Equipment:
Headgear, no-foul protector
cup, mouthpiece, hand
wraps and gloves weighing
at least 16 ounces should be
worn during all sparring
sessions.
• Petroleum Jelly: Covers a
boxer’s face so that punches
slide off upon contact.
• Sparring: Sparring should
always involve use of a gum
shield, head guard and
groin-guard. Sparring gloves
are often more padded than
gloves used in actual bouts.
• Rest: The number one
recovery tool for healing.
• Stretching: Should be
incorporated at the begin-
ning and end of workouts.
• Conditioning: Fatigue and
injury have a strong
relationship. A well-
conditioned boxer is less
likely to suffer an injury.
• Defence: From an injury
standpoint, boxers must be
able to protect themselves
in the ring.
Each sport carries its own
risk of injury for the athlete.
Physical therapists can help
in preventing and diagnos-
ing injuries in a better way
by understanding the
biomechanics and common
injuries of boxing/game.
Although some treatment
procedure would remain the
standards of care, the means
to address the injuries could
change.
Physical
therapy helps
boxers to
rebuild
strength and
movement of
their body
after an injury.
Therapy can
also help
someone
manage pain
and prevent
permanent
damage and
recurring
problems.
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6. “Last year was
crucial, I had a
thumb surgery
and Olympic in
line. Physiotherapy
helped me to
recover fast and
back in action
again. Now I am
looking forward
for Rio Olympic
2016.”
Sumit Sangwan
(Indian Boxer,
Olympian 2012)
Sangwan’s
statement
regarding
physiotherapy:
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