Squash under strain: a systematic review and meta-analysis of injuries and illnesses in squash players

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.