Epidemiology of Squash-Related Injuries in New Zealand: A Review of Ten Years of Accident Compensation Corporation Claims and Costs
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Abstract
Squash is a fast-paced racquet sport that has steadily grown in global popularity for decades, now included in the 2028 Olympic Games. This increase in recognition has not been matched in squash-related injury literature. Squash is a physically demanding sport played in close proximity to opponents within a confined space, predisposing players to injury risk. Currently, no epidemiological studies investigate squash-related injury within New Zealand (NZ), and global squash-related injury data is lacking.
The systematic review investigated evidence surrounding most common squash-related injuries and prevention strategies. The epidemiology analysis gathered NZ squash-related injury data to determine common injuries to guide future injury prevention research and strategy development. Systematic searches of Scopus, Google Scholar, and the EBSCOHealth, used keywords related to squash and injury. The database searches were conducted on 26 July 2024 and included literature from 2004 until 2024. Inclusion criteria required studies to report on squash-related injuries and/or squash-related injury prevention strategies and have full text available published in English. Twenty-six articles included in the systematic review were 23 observational and three reviews. Lower limb injuries were reported as most frequent. Injury prevention strategies predominantly targeted severe eye injuries. The included studies were appraised using the Joanna Briggs Institute tools to assess quality and risk of bias for respective article type. Grading of Recommendations Assessment, Development and Evaluation were used to categorise included study evidence certainty based on study design; ranked from Very Low to High.
Data gathered from the Accident Compensation Corporation (ACC), where accidental injuries within NZ are lodged by healthcare providers, were obtained to assess squash-related injury epidemiology. Data were analysed using SPSS statistical software by sex, age, ethnicity, body site, injury type, geographical region, year, and cause of injury. Over the ten-year period 2012 to 2021 investigated in the epidemiological study, 39,949 squash-related injuries were lodged with ACC amounting to N$37,740,867. Lower limb injuries accounted for half of all claims with players aged 40 to 59 years most injured, and females represented one third of claims. Loss of balance/personal control and twisting movements were the most common mechanisms of injury.
The findings of the ACC epidemiology study agreed with literature from outside of NZ. Lower limb injuries continue to be identified as the most prevalent body site reported in squash-related injuries. Very little research has been conducted into the reduction of squash-related lower limb injuries. Based on the systematic review and epidemiology study findings, squash-specific injury prevention strategies are warranted. These should be targeted toward lower limb injuries, especially in men aged over 40 years. Programmes should have a focus on improving balance and proprioception of players, as loss of balance/personal control was the main mechanism of injury in NZ. The production of an injury prevention tool as has been created in NZ for team sports, rugby and netball for example, could be of use to reduce squash-related injury. Uptake of such a strategy may prove difficult as there are no regular trainings or games as with team sports where injury prevention strategies have been implemented previously.