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Muay Thai

Being a health professional working in the field of sports with studies in orthopaedics and oriental medicine I have been privileged to work with combat fighters, instructors, coaches, authors and athletes from all around the world. This health news article will briefly discuss the following:


  1. Brief History

  2. Injury Risks

  3. Head, Neck, Face Injuries

  4. Leg Injuries    

  5. Injuries in other regions    

  6. Health Benefits

  7. Muay Thai Conditioning and Training

  8. Injury Prevention

  9. The Ideal Fighting Position

  10. Tissue Healing Process 

  11. Ailments and Remedies

  12. Final Thoughts


1. Brief history

Muay Thai formerly called Siam has been developed over the centuries mainly in Southeast Asia as one of the several Thai martial arts such as Krabi-krabong (staff and sword fighting by means of planned sets), Lerdit (empty-hand battleground art), Kemier (ninjutsu-resembling stealth and survival arts), Thaiplum (grappling), Chuparsp (weaponry) and Thaiyuth (Thai combat skills including Muay Thai). However to date the exact origins is still unknown due to the Siamese records being destroyed during the Siamese and Burmese war [1,2]. 


During the Siamese and Burmese war it has been suggested that a Siam soldier (called Nai Khanom Tom) achieved freedom from his captives by fighting the greatest Burmese fighters with outstanding fighting abilities. Upon his freedom and in honour of his name, a yearly tournament is organised in Bangkok currently held at the Lumpini stadium [1,2]. 


Today, since its early origins, Muay Thai is still taught as a combat technique for warfare and at the same time practiced as a sport world-wide in which Muay Thai fighters combat each other to entertain spectators. It is still an integral part of Southeast Asia society in which festivals are held in Muay Boran temples.


Over the last twenty years Muay Thai popularity has grown particularly in the western world. It has become recognised by the Olympic Council of Asia, multiple combat competitions such as the Asian Indoor and Martial Arts Games, the Sport Accord World Combat Games. The sport has grown popular with the general public outside the professional arena and fight clubs and has been adapted to accommodate studio gym fitness classes for workouts for all ages and levels of abilities [3].  


2. Injury risks

The increasing popularity of Muay Thai for general fitness to professional competition bouts has both its health benefits and potential risks of injury occurrence. At the professional competition level Muay Thai boxers use fairly aggressive attacking techniques similar to other martial arts sports. In comparison with other combat sports Muay Thai injury rates are similar to Karate-do and Taekwondo. However epidemiology studies suggest Muay Thai boxers with less experience and younger age were potentially susceptible to higher risks of injury occurrence similarly to that of other martial arts sports [7-17]. Reports of sparring tournaments and competitions were suggested to have fewer injuries but those that did occur were more severe [7-25].


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3. Head, Neck, Face injuries

Soft tissue trauma to the head, neck and face region such as haematomas and lacerations were reported to be highly prevalent by approximately 50%, particularly in the attempt to knockout opponents. Frequent injuries occurred in the non-protected region of the head causing epistaxis (haemorrhage from the nose) or lacerations over the face. Arguably researchers cannot underestimate the influence of recurrent head injury impacts although reports have associated higher risks of encephalopathy in which symptoms may stay unknown for years. For those Muay Thai boxers that may be already susceptible to Parkinson’s disease reports suggest they may be exposed to greater risks of additional head trauma from repetitive bouts. Consequently other studies suggest that kick boxers may be at risk of pituitary dysfunction due to traumatic head injuries and particularly isolated growth hormone deficiency and therefore must be screened for such conditions. [7,8.16,17-24, 26-28].


4. Leg injuries    

The second most prevalent injury reported in Muay Thai is lower leg injuries due to the shin being utilised as part of attacking opponents. Potentially this can lead to haematomas, laceration and contusions on the lower leg [7-16].

Unfortunately, often at the professional levels, no shin protection (guards) is allowed. To withstand impacts on the shin bones from opponent’s, traditionally Muay Thai fighters and masters conditioned their shin bones through years of training by striking or kicking their shins with toughened objects such as sticks or by kicking banana trees.


It is suggested that these impacts create micro-fractures on the shin bones through a process called  cortical remodelling. The micro-fractures eventually heal to form a hardened bone on the bones surface. By continually creating these micro-fractures the Muay Thai boxer develops hardened shins. Therefore according to this martial arts principle, conditioning is a combination of bone reconstruction with osteoblasts and osteoclasts, as well as the destruction of the affront sensory fibres. This type of conditioning is not as healthy for the shins due to injury risks. In the western world we often see this as a misconception as the banana trees and sticks often used by fighters are generally soft. Nevertheless in reality this encourages a high pain and stress threshold on the bone and skin of the fighter’s lower legs. Today Muay Thai boxer’s particularly in the western world condition their shins in a much healthier way to avoid unnecessary injuries see Muay Thai conditioning and training.        


5. Injuries in other regions    

Other common Injury sites reported (although not exhaustive) were fractures of the digits (hands and feet), nose, ribs, carpal bones and metacarpals as these regions are often given little or no protection and subjected to high impact forces from elbows and knee strikes. However a study reported that there was no immediate deleterious effect on renal and liver functions. It has been hypothesised that muscle imbalances are common in boxers due to utilising the anterior musculature more than the posterior. However to date there is no study on chronic or overuse soft tissue injury in Muay Thai athletes [7,16,17,21, 25, 29-31]. 


6. Health benefits


Physiological capacities

Research into the health benefits of Muay Thai training remains limited. Although a study into the physiological capacities of Muay Thai performance was conducted by means of a gas analyser and heart rate monitor. The research suggested that aerobic metabolism and anaerobic glycolysis both remain a challenge for the fighter especially after an initial burst of anaerobic glycolysis due to the ongoing increases in aerobic demands.


Develops motor coordination

A study found training in similar martial arts such as kickboxing like Muay Thai may promote the development of motor coordination due to better muscular recruitment performances in experienced athletes. [32-34].


Psychological effects

A psychological study reviewed professional kickboxers to establish the contribution of psychology to help develop or maintain expert performance. The study identified three psychological mental skills that attributed to being a successful kickboxer; mental toughness, high motivation and high self-efficacy. Further research is required to help substantiate these claims in Muay Thai training. Although mental skill training combined within the physical training environment potentially may improve the quality of practice.  


7. Muay Thai Conditioning and Training

Recreational Muay Thai boxers will often train in fitness studios or classes. Professional Muay Thai boxers will often train in boxing studios and compete monthly whether it’s regional or internal [1-17, 26-35].


Training routines

A typical Muay Thai boxer training routine may begin with a 15-30 minute session of warm-up exercises stretching and callisthenics. Traditionally stretches and warm-up exercises would predominately be based to the specific ritual dance. This is often followed by punch, kick, knee, elbow drills using mitts, kick pads, heavy bags and various other types of pad and sparring workout drills. As the Muay Thai boxer performs the drills a hissing sound of exhaling air is often heard as they practice their breathe control. Sparring contact is also dependent on levels of ability. Other types of training would include (although not exhaustive) weight lifting, rope skipping, running, swimming and shadow boxing. To avoid injuries whilst training dangerous body strikes are omitted during the sparring session. To prevent overuse injuries a typical training session may last approximately two hours. Professionals will often train each day but varying the different types of training intensities to suit their individual needs guided by their trainer, coach to prevent training errors and risks of injury [1,18-26].    


Conditioning shins and body extremities 

There is no quick method to condition the shins or body extremities but with regular sparring and training drills by kicking/punching training bags or Thai pads will help condition your shins and body extremities in preparation for fighting. It is recommended that beginners start with softer training bags and Thai pads and then gradually increase the density to heavier training bags and Thai pads. A useful tip if you don’t have access to harder pads is to ask your sparring partner to increase the resistance on the pads when holding your kicks or punches. By kicking and punching the pads/bags with power will help condition your shins/body extremities and will prepare your shins/body extremities when making shin to shin or other extremity contact with opponents.



Sparring or partner drills can help test your shins and body extremities readiness for combat. To avoid unnecessary injuries whilst sparring it is recommend that you wear shin guards and other suitable protective gear. Full on contact without protective gear whilst sparring such as shin to shin contact with partners may cause unwanted injuries and cause the fighter to miss a fight completely. A useful tip when sparring with partners as both of you will be feeling the impact whilst wearing the protective gear is to stop if you feel too much pain or ask your partner if you can both spar lighter. It is important whilst performing any sparring training to remain as healthy as possible to prevent unnecessary injuries and avoid missing out on any future training sessions.   


Focus and control training

As in most combat sports there is a strong desire to knockout the opponent by targeting the opponent’s head region. In Muay Thai fighters will often practice by kicking a small object from a suspended rope such as a lemon to advance the focus control of the lower body.


Carry-over training

The emphasises of carry-over training is to induce the transfer of neuromuscular stimulus and firing patterns of particular muscle groups following a strengthening exercise routine to a sports specific capability. A typical example would be to ask the boxer to perform a set of power snatches thereafter a set of straight punches to the training drill bag.  This type of training is thought to improve the development and carry-over to encourage the facilitation of increased power production when striking.  Studies have also suggested that plyometric exercises might be beneficial as part of Muay Thai conditioning programmes to promote endurance and power when striking [35].


Specific sports training

Utilising the links of the kinetic chain, studies suggest professional boxers mainly generate transferred force through the kinetic chain from the lower body extremities. Although amateur and lower level boxers are suggested to predominately generate the transferred force of the kinetic chain through the trunk and arms (upper body extremities). Hence the use of specific motor patterns of generated force should be optimised as part of the conditioning training program. As the rate of generated force is predominately high in Muay Thai due to kicking and punching movements, training should focus on the production of power besides strength. Studies have shown for example that snatch, jerk and clean exercises reveal better power outputs in comparison to squats and deadlift exercises.  As Muay Thai is a very physical demanding sport involving aerobic metabolism and anaerobic glycolysis, interval, explosive, speed and spar training is highly beneficial to generate both energetic pathways.  A study also demonstrated that sparring and pad drill training required comparable V02 (43 and 41 ml kg-1min-1, respectively) approximately amounting to 70% of VO2 peak  [32, 44, 45]. 


How to reduce energy leakage

Fine tuning muscle tension (by means of muscular pulses) through exercise and combat training helps the fighter address energy leaks and reduce risks of injury. For example fighters will keep some abdominal tension to act as resistance from opponents impacts. However through the correct instruction this will improve the fighter’s movements without reducing the ability to breathe and move effectively.


How to train &
manage body weight

Often fighters will try and compete at their minimal body weight to fight opponents of lesser mass. Thus they may be hesitant to submit themselves to a strength and conditioning training program due to the fear of gaining body mass.


Pre and post training recovery

Many fighters and athletes enjoy sports massage, Thai Massage due to the many benefits and effects of massage and foam rolling can have towards their recovery. A nutritious diet is also encouraged for adequate fuel intake by eating the right amount of kilo-calories during training [1]. 


8. Injury Prevention

Studies suggest that adequate strength training can prevent sports injuries by one third and overuse injuries by 50% with greater effects if combined with proprioception training. As Muay Thai boxers have been hypothesised to be prone to common muscle imbalances as they have the tendency to use the anterior musculature more than the posterior.


Adequate strength and conditioning exercises combined with proprioception training is recommended to prevent the boxer’s likelihood of injury. Furthermore this will help address common muscle imbalances and insufficient weaknesses of the boxer’s posterior musculature (e.g. strength ratios between shoulder anterior and posterior rotator cuff muscles) [51].

Neck exercises will help the fighter generate adequate eccentric strength particularly during defensive combat to help absorb impacts from opponents. Strength training the spinal muscles may also be beneficial to prevent knockouts to the abdomen and thorax. Detecting training errors by means of sport specific movement exercises during training for example may also prevent the likelihood of injury occurrence [31,46-49]. 

Preventing head, neck and face injuries

Due to the aggressive nature of Muay Thai relative to other combat sports the use of protective headgear, mouth guards may be useful.  see the ideal fighting position [28].


Preventing leg injuries

Some Muay Thai boxers may not perceive certain soft tissue trauma as injuries such as minor contusions or abrasions however this is still not an accepted norm and therefore regarded as an injury. However amateur levels were not as susceptible to shin injuries due to the mandatory rules of wearing shin guards therefore the use of shin guards may limit your injury risks if you’re an amateur see the ideal fighting position and conditioning training. [8].


Preventing injuries in other body regions

Traditionally the rules of Muay Thai were very aggressive. Boxers traditionally protected their hands by bounding them first with cotton cloth, to be then dipped in glue to be finally sprinkled in grounded glass. Today in modern Muay Thai bouts, boxers wear the standard international boxing gloves that are used for European boxing to protect their hands. To avoid other unnecessary regional injuries professional fighters often wear trunks with or without T-shirts, mouth guards and groin protectors. Anklets are optional but are recommended for protection of ankle injuries.


It is mandatory in some tournaments today that combat fighters wear shin guards and headgear for additional protection although often used in amateur levels and not in professional bouts. 


Amateur Muay Thai boxers are permitted to make full contact and wear shin guards, mouth guards,  groin protector, trunk pads, elbow pads, boxing gloves, anklets and protective head gear for injury prevention. All body targets are permitted except for the groin {1,2,8, 18-25] see the ideal fighting position and conditioning training.


9. The ideal fighting position

The ideal fighting position is to maintain optimal balance to assist in the efficient transfer of energy to the body extremities. This will enable the fighter to generate power for both offensive and defensive actions.  


Position of the head

It is imperative that athletes obtain a good head position to avoid knockouts and broken noses. Familiar words trainers will tell their students is ‘Chin Down’, ‘Hands Up’. Ideally the head should be slightly tilted anteriorly with the chin in approximation with the collar bone. This adopted position imperatively helps to avoid unnecessary soft tissue injury of the nose and eyes [28].  


Position of forearms elbows and fists

The position of the elbows, forearms and fists are also very important in Muay Thai for both offensive and defensive capabilities. Ideally the rear elbow and forearm should stay near to the body to protect the solar plexus, liver, ribs and to avoid flaring of the elbow. The rear fist helps to protect the face and positioned near to the cheek and jaw bone but positioned with consideration for an appropriate pathway to strike the opponent as and when required. The lead arm acts as the first line of offence and defence. The lead forearm and elbow protects the solar plexus and ribs but positioned slightly away from the body’s midline due to being highly active during combat. The lead fist is positioned at nose level to help protect the midline body without obstructing the fighter’s line of sight.


Fighting stance

In Muay Thai the boxer’s feet should be ideally staggered no wider than the shoulders with the weight evenly distributed and angled slightly to the side with the knees and feet approximately aligned facing the same direction. During combat, the rear heel should be slightly raised with the weight on the ball of the foot to promote stability reducing power leakage and to act as a trigger to move and attack opponents quickly. There are many variations in cadence and each fighter adopts their own unique style. However many of the elite professionals I have worked with adopt a cadence that contains no rhythm (no repetitive movements) as this prevents opponents from timing their counter attacks. More importantly cadences that are capable of moving efficiently e.g. forward, backward and turning using the correct parts of the feet are more challenging for the opponent to target.


10. Tissue Healing Process 

Like most sports there is a high risk that you may get injured or hurt whilst training or competing in Muay Thai. As discussed it is important to stay healthy to continually train and condition. If you experience any serious pains or niggles that just won't go away it is highly recommended that you consult a health professional or doctor to begin the tissue healing phases and acute soft tissue management


Healing Tissue process

Injuries often occur when fighters push themselves too hard due to the dramatic increases in training intensities. Apart from feeling pain for example they may notice signs of bleeding particularly to the shins. This is often caused by kicking or punching the bags or pads repetitively which may be the most likely cause of the soft tissue injury to the superficial layers of the skin. If you experience a soft tissue injury or any overwhelming pain it is always advisable to take time out to recover and get it checked by a health professional. For a new injury that does not require A+E follow the PRICER protocol. 


11. Ailments and Remedies

Please note if you experience any serious aches and pains please consult your doctor or nearest health professional. If you are pregnant or a nursing mother, it is highly recommended to seek a health professional for advice as some Muay Thai and Chinese based liniments/balms and ailments are contra-indicated. See our own Thai herbal compresses and Traditional Thai massage.


Muay Thai liniments/balms & Dit Da Jow liniments

Dit Da Jow is an ancient Chinese herbal rub, popular amongst fighters due to its various therapeutic properties. Often fighters will be seen rubbing Dit Da Jow or other Muay Thai liniments/balms and ailments to the skin before and after bouts.  Although anecdotal it is thought that they may help alleviate minor contusions (bruising) from impact injuries and consequently alleviate sore muscles.  However to date there is no reliable studies to imply its efficacy.  Although, if using Dit Da Jow or other Muay Thai liniment based ailments, they should only be used externally, and must not be applied on open wounds. Due to the variable liniments and balms available on the open market it is advisable to perform a 24 hour patch test first to avoid skin allergic reactions particularly if you have sensitive skin complaints.


Antibiotic creams

Antibiotic creams can also be beneficial to prevent minor bacterial skin infections for minor soft tissue injuries however always consult you health professional for advice. 


Thai Herbal Compress

Thai herbal compresses and massage may also be beneficial due to the many therapeutic benefits it can have.

12. Final thoughts

Muay Thai is a very aggressive martial arts sport similar to other combat sports such as boxing, Taekwondo and Karate-do due to its high impacts and injuries. It involves a multi-disciplinary team approach to optimise best practice and care, whether it’s being used for professional/amateur levels or generalised for public fitness studios. With the correct guidance from a multi-disciplinary team (e.g. coaches, instructors, personal trainers and sport therapists), athletes will be able to control body weight, enhance overall effectiveness of their training and receive the correct injury management.  


It is important that instructors have an understanding in musculoskeletal biomechanics to help prevent training errors and injuries. A good instructor will explain to students the importance relationships on how best to optimise musculoskeletal biomechanics for optimal power for offensive and defensive capabilities. For example how to punch correctly by implementing the cork screw technique with forearm rotation utilising the correct musculoskeletal biomechanics for maximum power and to reduce risks of sustaining a wrist or elbow injury i.e. lateral tendinosis.  


As always thanks for reading this article, enjoy your sport. If you enjoyed reading this article you may enjoy reading my other article on Mixed Martial Arts.


or Call: 01298 600477


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