BackgroundMuay Thai is a style of kickboxing that allows full-contact blows to an unprotected head, torso and legs, and, as in any combat sport, there is an inherent risk of injury. Previous observational studies have shown there is a substantial risk of injury in competitive kickboxing. None of these studies, however, have investigated the potential role of psychological risk factors and, consequently, little is known about the perception of injury risk among these athletes. Notwithstanding the important role risk perception may play in the occurrence and prevention of sports injuries, there is very limited empirical data pertaining to athletes in full-contact combat sports such as Muay Thai.Because the development and successful implementation of effective injury prevention policies for combat sports are likely to benefit from an increased understanding of the perception of injury risk and sport safety attitudes and behavior of its participants, further study is warranted.MethodsMuay Thai fighters were invited to complete an online survey in which they rated the perceived risk of injury in a range of different sports, including Muay Thai kickboxing. Perceived comparative risk was obtained indirectly by subtracting perceived risk of injury to oneself from perceived risk of injury to a peer. Data were analyzed using descriptive statistics, comparison of means, and ordinal logistic regression.ResultsContrary to the best available epidemiological evidence, Muay Thai fighters perceived the risk of injury in their own sport to be average and significantly lower than that in other collision and contact sports, including popular combat sports such as boxing and mixed martial arts. On average, Muay Thai fighters perceived their own risk injury to be significantly lower compared to their peers (p < 0.001).ConclusionsThere appears to be a mismatch between injury risk perception and actual risk among Muay Thai fighters. Moreover, these athletes also exhibit a slight degree comparative optimism or unrealistic optimism. Because behavior is determined by perceived rather than actual risk, underestimation of injury risk and concomitant overestimation of ability to negotiate risk may lead to an increased frequency of injury. Future injury prevention strategies in combat sports such as Muay Thai kickboxing should consider educational- and psychosocial-based interventions that include efforts to correct erroneous beliefs and attitudes about actual risk of injury in the sport.