An epidemiological study of musculoskeletal injuries in league squash players in the eThekwini Municipality

Background: Internationally squash is a very popular sport with over 15 million players worldwide from 135 nations. With the rapid growth of squash comes a rise in the number of injuries occurring during play. Despite squash being such a popular sport, several reports have stated that there is a paucity of literature and limited research that has been conducted on the injuries occurring from playing the sport. A study of this nature would create an awareness and understanding of the prevalence of injuries in squash which will allow for event organisers, medical personnel, managers and coaches to adapt training approaches that will minimise the development of injuries. Objectives: This study aimed to investigate the prevalence of musculoskeletal injuries in squash players within the eThekwini Municipality, and to identify selected factors associated with an increased risk of injury in order to improve the management of squash players. Methods: A quantitative, descriptive questionnaire-based survey was conducted on 126 league squash players in the eThekwini Municipality. Statistical analysis was performed on the results obtained from the questionnaire using IBM SPSS version 24. A p value < 0.05 was used to indicate statistical significance. Associations between demographic variables and the prevalence of injury were first tested using chi-square tests in the case of categorical variables, and t-tests in the case of continuous variables. The variables that were associated at the p = < 0.01 level of significance were entered into a binary logistical regression to analyse the risk factors of injury. A backward selection method was used, using likelihood ratios. Odds ratios and 95% confidence intervals of the variables remaining in the model at the end were reported. Graphical representation of scores by groups was done using graphs and tables. Results: One hundred and twenty-nine squash players responded giving a response rate of 69%. The period prevalence and point prevalence of squash related musculoskeletal injury was 62% and 25.6% respectively. A predominance of injuries to the lower limb were recorded (67.65%) compared to the upper limb (21.4%) and the back and trunk (11.3%). The foot and ankle were the most common anatomical site of injury (22.5%) followed by the knee (15%), the thigh (13.8%) and the elbow (13.8%). Alcohol consumption was considered to be a risk factor for injury (p = 0.03); for every increase in five units of alcohol consumption the odds of incurring an injury increased by 29%. The likelihood of injury decreased in those that did weight training; the odds of an injury for a player not doing weight training was 3.3 (1/0.305) times more compared to a player who did weight training. Thus, it was more likely for a player not doing weight training to sustain an injury. Conclusion: The lack of evidence that players train off the court, and the large amount of alcohol consumed on a weekly basis shows that for the majority of players in the eThekwini Municipality squash is more a recreational activity than a professional activity. Despite the study sample being ranked in the top three divisions, this study found that within the eThekwini Municipality squash has not developed on a professional level. Results found that players were more likely to get injured if they did not do weight training and/or consumed alcohol. The population seems to be living a sedentary lifestyle in which squash is their only weight training activity, and after their squash session they consumed alcohol. This lack of training and alcohol consumption predisposes them to lower limb injuries, especially the ankle. Given these results coaches, team captains and medical practitioners should put together cross training programs, which would be a helpful injury prevention. Future studies could look at the effect that cross training programs have on lowering injury prevalence.