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 con-sistency 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. <br/><br/>Methods: Following PRISMA guide-lines (PROSPERO ID: CRD420251081709), a search conducted across MEDLINE, Embase, and Web of Science (from inception to 12 June 2025) yielded 12 studies, and a ran-dom-effects model estimated the pooled injury rate. <br/><br/>Results: The pooled injury rate ap-proximated 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. <br/><br/>Conclusions: Lack of standardisation hinders risk assessment and prevention within squash; therefore, future research requires an international con-sensus on injury surveillance, particularly as squash enters its Olympic era.