Squash-related injuries occurred at a pooled rate of 0.74 injuries per 365 athlete-days or 2.01 injuries per 1000 athlete-days with high heterogeneity (I2=99.65%), indicating substantial methodological differences across studies.
Systematic Review
Squash playing is associated with a pooled injury rate of 2.01 per 1000 athlete-days, but accurate risk assessment is severely hindered by methodological inconsistencies in the current literature.
Effect estimate: 2.01 injuries per 1000 athlete-days (95% CI 95% CI: 0.72–5.67)
p-value: p=<0.0001
Background: Squash, a high-intensity sport with growing global popularity and an upcoming 2028 Olympic debut, is known to pose a wide range of potential health risks. However, epidemiological research of squash-related injuries and illnesses lacks consistency regarding reporting metrics and methodological standardisation. Therefore, this study aimed to systematically review the global literature to identify the incidence, prevalence, and anatomical distribution of reported squash-related health issues, calculate a pooled injury rate, and highlight research gaps. Methods: Following PRISMA guidelines (PROSPERO ID: CRD420251081709), a search conducted across MEDLINE, Embase, and Web of Science (from inception to 12 June 2025) yielded 12 studies, and a random-effects model estimated the pooled injury rate. Results: The pooled injury rate approximated 0.74 injuries per 365 athlete-days (95% CI: 0.26–2.07) and 2.01 injuries per 1000 athlete-days (95% CI: 0.72–5.67); however, extremely high heterogeneity (I2 = 99.65%) revealed significant methodological inconsistencies. Lower limb soft tissue injuries were most common, though regional patterns varied substantially. Additionally, risks from cardiovascular strain and hyperthermia were noted within the literature, alongside a generally poor uptake of protective equipment and a significant research gap on squash-related illnesses. Conclusions: Lack of standardisation hinders risk assessment and prevention within squash; therefore, future research requires an international consensus on injury surveillance, particularly as squash enters its Olympic era.
McCartney et al. (Wed,) conducted a systematic review in Squash players of all levels and demographics participating in any level of squash. Squash-related injuries occurred at a pooled rate of 0.74 injuries per 365 athlete-days or 2.01 injuries per 1000 athlete-days with high heterogeneity (I2=99.65%), indicating substantial methodological differences across studies.