Squash Risks
How Do We Get Injured?
By A. Martin Clark, Jr., MD
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Cassie Jackman suffers a back injury; photo by Steve Line/Squashpics.com
The overall risk of injury in squash has traditionally been thought small when compared with other sports. Aside from eye injuries, little is known about the patterns of injury in squash players and the effectiveness of countermeasures taken to prevent injury. I decided to investigate the incidence and characteristics of injuries in squash players in order to accurately recommend ways to prevent injury.
Detailed questionnaires were sent via e-mail to 20 active players, and 50 questionnaires were distributed to six New York squash clubs. The questionnaires assessed training, playing and competition load as well as injuries sustained while playing squash over the last two years.
These results (BELOW) suggest that there is a relatively high incidence of injury sustained while playing squash. The majority of the injuries sustained (64%) are lower extremity injuries. The sport is known as one that requires frequent twisting and lunging. Therefore, while the incidence of knee injuries in the short term was small in this study, many players had long-term knee injuries requiring surgery. Also of concern was the high frequency of short-term and long-term hip injuries. While there was only one hip resurfacing procedure in this study, many squash players, especially at the professional level, have been known to retire early on account of hip problems. In fact, femoral head resurfacing has become a popular alternative to total hip replacement. Many fan favorites such as Rodney Martin and Geoff Hunt have chosen to undergo this procedure.
There were few upper extremity injuries requiring treatment, which is ironic for a racquet sport. The stroke is less restricted than in other racquet sports, perhaps allowing for less tension at the elbow and wrist. Fewer shots are hit overhead, which probably accounts for fewer shoulder injuries than one would see in tennis.
In general, there is a relatively high incidence of short-term and long-term injuries in squash. Therefore, total body conditioning, stretching, and lower extremity weight-training should be a part of every squash player’s regimen. Ask your local personal trainer or physical therapist to help establish a workout schedule. Also appropriate footwear is key in order to prevent both short-term and long-term injuries. Remember to take all aches and pains seriously and consult your local orthopaedic surgeon for injuries!
The Study:
Sixty-two questionnaires were completed by players in the United States, the United Kingdom and Australia. The mean age was 38 (range of 15 to 71) and the mean years of playing squash was 14 (range of 6 months to 35 years). Twenty-two of the 62 players (35%) reported sustaining at least one injury during squash participation over the last two years. Injury was defined as missing at least one week of squash participation as consequence of the injury. A total of 36 new injuries were sustained by those 22 players who reported injuries.
Hip/groin injuries (25%), neck/back strains (13%), shoulder/elbow injuries (13%), foot and ankle injuries (9%), Achilles/calf injuries (9%), hamstring strains (6%), quad strains (6%), and knee injuries (6%) were the most commonly reported injuries. The mean age of those reporting injury was three years greater than those not reporting injury. The incidence of injury was 1.8 per 1000 competitor-exposures.
Twenty-five players (40%) reported at least one chronic injury related to squash. Chronic injuries were defined as those injuries continuing to influence the athlete or those injuries that had required surgery or continued treatment/bracing. Twenty-nine chronic injuries were reported. The predominant chronic injuries were foot/ankle (24%) followed by hip/groin (21%) and knee (21%). However, back pain or sciatica (17%) and chronic shoulder or elbow problems (17%) were reported as well. Nine players (15%) used consistent bracing for injuries.
Eleven players (18%) have had at least one surgery related to squash. There were 16 total orthopaedic surgeries and one eye surgery. Most of the surgeries were knee surgeries, including ACL reconstructions and arthroscopies for meniscal tears. There were also three foot surgeries, one femoral head resurfacing, and one shoulder procedure. Forty-five of the 62 players (73%) wore protective eyewear, and a total of eight lifetime eye and other facial trauma injuries were reported for all participants (I know you have heard it from Will Carlin before, but eyeguards are mandatory!).
Dr. A. Martin Clark, Jr. is currently a fourth-year orthopaedic surgery resident at New York Presbyterian Hospital in New York City. Marty was four-time US National Champion and attained the highest world ranking (No. 59 while in medical school) of any other American man to date. Dr. Clark is starting a database on squash players, their playing frequency, and squash-related injuries. If you would like to be involved in this valuable research, fill out the questionnaire.
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