Sport
Squash keeps your heart rate near its maximum for most of a match, with sprints, deep lunges and twists in a closed court and a hard, fast ball. Most injuries are to the ankles, calves, knees and back, and the ball and racket cause rare but serious eye injuries. Rarely, people with heart disease have died on court, and in one series most of them had warning symptoms first.
No squash injury prevention programme has been tested, so this guide says plainly what it borrows. It covers what squash asks of your body, the common injuries, your heart, the eyewear rules of World Squash, England Squash and Scottish Squash and why open eye guards don't work, heat, Squash 57, a 10-minute warm-up, a ghosting workout and a strength routine, with each move shown in 3D.
Elite players averaged 92% of their maximum heart rate, and club players stay near 160 beats a minute for the whole match. The Compendium of Physical Activities gives general squash 7.3 metabolic equivalents (METs), vigorous activity.
In a series of 60 sudden deaths linked with squash, most were from heart disease, and 45 of the people who died had reported warning symptoms beforehand, most often chest pain. If you have heart disease or symptoms, see your GP before you play.
In a lab test, the ball reached the eye in all 17 hits on open eye guards. World Squash recommends eyewear for every player, and England Squash requires it for under-19s in competition and for all ages in doubles.
Leg injuries were 48% to 76% of the total across studies, with the ankle and heel the commonest site in English professionals.
No squash injury prevention programme has been tested. The warm-up, calf and leg strength work and gradual build-up on this page are borrowed, and we say where from.
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Elite players' core temperatures reached 39.0 to 40.1 °C in mild conditions. Drink, cool down between games, and know the warning signs.
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In 7 elite players, including the world number 1, heart rate averaged 92% of maximum and oxygen uptake 86% of maximum, rallies averaged 18.6 seconds, and the ball was in play about 70% of the time. In club players, the ball is in play for 10 seconds or less about 80% of the time, with rests of about 8 seconds, and heart rate stays near 160 beats a minute for the whole match at every standard.
The Compendium gives general squash 7.3 METs. The UK National Health Service (NHS) counts activity as vigorous when you can't say more than a few words without pausing for breath, and asks adults for 150 minutes of moderate or 75 minutes of vigorous activity a week.
From the T to the four corners and back: deep lunges, twists and reaches, short sprints and hard stops, with swings close to your opponent in a closed court. Ball speeds of up to 230 km/h are cited in a 2026 review.
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The sites the studies point to:
In 21 fit young men, heart rate stayed around 80% of predicted maximum for whole games, and 7 had irregular heartbeats (ventricular arrhythmias) during play, which a maximal treadmill test didn't reproduce. In 5 volunteers, blood pressure measured in an artery rose only modestly on average, but single beats reached 200 mmHg. In 10 older male players, adrenaline and lactate surged, and potassium dropped and irregular heartbeats appeared in the minutes after play.
Aerobic fitness to recover between rallies, repeated sprints with changes of direction, deep lunges and a strong push back, calf and Achilles strength, trunk control for twisting and reaching, and racket-arm endurance.
Studies counted injuries in different ways, per 1,000 hours of play, per 1,000 days of play, per player, or as survey and hospital counts, so figures in different lines aren't comparable. Almost every squash study looked back in time.
The numbers, by group:
The commonest site in English professionals (20.8% of injuries), and the ankle and lower leg were the commonest in New York club players. A previous injury raised the risk, as reported in the 2026 review. Our ankle sprain and chronic ankle instability guides cover these.
Squash caused 8% of the winter Achilles ruptures in a Stockholm series, and a review for GPs lists Achilles ruptures among squash injuries. Calf strains were reported in female players, as the 2026 review describes. Our Achilles rupture, Achilles tendinopathy and calf pain guides cover these.
The thigh was 12.7% of professionals' injuries, the knee 10.8%, and the hip and groin 9.5%, and in one club study knee injuries came with long recoveries, as the 2026 review reports. Our hamstring strain, groin strain, hip pain and knee pain guides cover these.
52% of 495 competitive players in New Zealand had had a back injury, more often men, higher-grade players and those who played most, and a third of them said squash started it. Our back pain guides cover it.
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The shoulder was half of elite players' arm injuries in one study, and the elbow 21% of injuries in another, as the 2026 review reports; poor racket control is suspected, not shown. Our tennis elbow and shoulder pain guides cover these.
In Australian pennant players, 17.5 eye injuries per 100,000 playing hours, and 26% of them had had one; rackets caused 61%. In an English eye hospital's records, the ball was the main cause, and severe eye injuries were rare but more frequent than in other sports. Retinal detachments from squash balls do worse than ordinary ones. More in the eyes section below.
Collisions with walls, rackets and opponents cause cuts, broken teeth and head injuries: 4.5% of 600 players had had a dental injury, as the review reports. We found no concussion rates for squash. Our concussion guide covers the graduated return.
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No squash injury prevention programme has been tested. What follows comes from the eyewear evidence, the governing bodies' rules, associations in surveys and advice borrowed from other sports, each graded on its own evidence.
A 2026 review of injuries and illnesses in squash found no trial of a way to prevent them, and almost every study looked back at injuries rather than following players forwards.
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Lensed eyewear made to the standard protects; open guards failed. The rules and the evidence are in the eyes section below.
No squash warm-up has been tested. In South African teenagers, players without a suitable warm-up reported more injuries (43% against 27%), a cross-sectional association reported in the 2026 review, and a 1997 review advised a warm-up before every session. The warm-up on this page is built on our warm-up guide.
No trial in squash. Because squash is among the sports behind Achilles ruptures, strengthen your calves twice a week, build court time gradually, and get Achilles pain checked rather than playing through it, as our Achilles tendinopathy guide advises. After an ankle sprain, our ankle sprain guide's balance programme and a brace for sport apply.
Back injuries went with higher grades and more frequent play. No study has tested prevention in squash; trunk strength and building play gradually are our suggestion, and our back pain guides cover treatment.
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Elite tournament players reached core temperatures of 39.0 to 40.1 °C at mild temperatures, and the authors call muscle cramp an early warning sign of more serious heat illness. A 1997 review warns that hot, humid courts add to the strain. Drink, cool down between games, and stop for the NHS heat warning signs.
Measures without good evidence, or with evidence against them:
In 31 players in England Squash's performance programme, men's rank went with repeated-sprint ability and change-of-direction speed. In 31 world-ranked players, a squash fitness test tracked aerobic fitness, change of direction and repeated sprints, and higher-ranked players changed direction faster. These are associations.
No training trial has been run in squash players. Across racket sports, jump training improved change of direction, and interval training improved fitness in low-quality studies. Analysts of elite men's squash recommend ghosting patterns that copy match play.
Moving round the court as if playing a rally, without a ball. Our ghosting workout uses intervals matched to rally and rest times: 15 to 20 seconds of movement with 10 to 20 seconds of rest, in rounds, starting easy.
No squash study. In other sports, a taper of about 2 weeks that cut training volume by 41% to 60% while keeping intensity worked best. Our reading: keep court sessions sharp and halve gym and conditioning work in the last week or two before a key event.
In 19 female national-level players, the playing arm's upper arm bone carried 15.6% to 17.8% more bone mineral than the other arm, with bigger differences in those who started before or around puberty. In a 5-year follow-up of tennis and squash players, most of the gain stayed after they cut back.
"Tennis or squash" went with a 15% lower risk of death in two US cohorts, and racket sports with a 47% lower risk in British adults. Healthier people may be the ones who play.
Built on the rules and the NHS guidelines:
In a 1986 series of 60 sudden deaths linked with squash (59 men, average age 46), heart disease of the coronary arteries was the certified cause in 51. 45 had reported warning symptoms beforehand, most often chest pain, and 22 had a known heart or circulation condition, most often high blood pressure. The series can't tell you the risk of squash: there's no count of how many people played, and how the cases were found isn't known.
Heavy exertion multiplied the risk of a heart attack in the following hour by 5.9 on average: by 107 in people who usually exercised less than once a week, and by 2.4 in those who exercised 5 or more times a week. In 21,481 male doctors, vigorous exertion raised the short-term risk of sudden death, but the absolute risk was tiny, about 1 in 1.51 million bouts of exercise, and lower in men who exercised regularly. The American Heart Association says the risk is highest when unfit people exercise vigorously.
In 21 fit young men, irregular heartbeats during and just after squash didn't show up on a maximal treadmill test. In 50 people, including 20 squash players, peak heart rates during their sport were higher than in a standard exercise stress test, in squash and running alike. Our reading: a normal stress test doesn't rule out trouble on court.
Answer the PAR-Q+ (Physical Activity Readiness Questionnaire for Everyone) first, and with heart disease, ask your cardiac team before playing, as our heart disease guide advises. Take chest pain or unusual tiredness before, during or after squash seriously, never play through chest pain, palpitations or feeling faint, and don't smoke after playing. If you're unfit, build fitness before hard matches: an old adage says be fit to play squash, don't play squash to get fit. In competition, the rules give no recovery time for breathlessness or cramp: you continue or concede, so stopping is your call.
In its 2025 singles rules, World Squash, the World Squash Federation (WSF), "recommends that all squash players should wear protective eyewear, manufactured to an appropriate National Standard, properly over the eyes at all times during play including the warm-up, whether social, league or tournament", and eyewear "is mandatory for all doubles and junior events sanctioned by the WSF". Its eyewear page adds that under-19s must wear it in its team and junior championships, and names ISO 18527-2:2021, BS EN 18527-2:2021 and ASTM F3164-19 as the standards.
"Eye protection must be worn by all junior players (under 19) during any competition, including when competing in adult age groups. It is also mandatory for players of all ages when playing in doubles competitions." England Squash strongly recommends it for everyone in training and practice, asks glasses wearers to wear squash eyewear over their glasses or prescription squash eyewear, and says to look for BS EN 18527-2:2021.
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Its policy requires approved eyewear for under-19s in its sanctioned events and competitions, coaching courses and other organised activity it endorses, including any warm-up before a match. Its list of accepted standards is older than World Squash's, so check with your club or coach (our suggestion).
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The international standard, ISO 18527-2:2021, covers eye protectors for squash, racquetball and Squash 57. It doesn't cover protectors without lenses, and it has no specific tests for protectors worn over prescription glasses. Our reading: prescription squash eyewear made to the standard is the tested option, though England Squash also accepts squash eyewear over glasses.
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In a lab test of 13 eye protectors, the ball reached the eye in all 17 hits on open guards, against 1 in 54 hits on lensed protectors. In Canadian reports from 1978 to 1981, 52 squash and racquetball players were injured while wearing open guards, against 2 wearing lensed ones. Across racket sports, a median 93% of eye injuries happened without eyewear, and only eyewear meeting updated standards went with no injuries.
Only 8.9% of 303 Melbourne players wore approved eyewear in 2000, and in an earlier survey, 35% of the few who wore eyewear wore prescription glasses they thought were protective. A club campaign of posters, stickers and eyewear on sale raised the odds of players wearing suitable eyewear 2.4 times.
Squash played on a squash court with a bigger, bouncier ball, 57 mm across and weighing 40 g. It was called racketball until a 2016 rebranding led by World Squash with England Squash, partly to avoid confusion with racquetball, a different North American game.
World Squash calls its injury risk "generally lower" than squash's and doesn't make eyewear mandatory, but encourages it, "particularly amongst less experienced players". No study has compared injury rates, and the squash eyewear standard covers Squash 57. Our reading: the slower game can be a way in for beginners and older players, with eyewear.
Built on the site's warm-up guide and racket sport warm-up (editorial): no squash warm-up has been tested. The 4-minute knock-up is World Squash's rule, and World Squash recommends eyewear from the warm-up on.
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The movement on the figure: Walking lunge
Lunges, split squats and side lunges for the corners, calf raises for the Achilles, Copenhagen planks, side planks and bird dogs for the groin and trunk, and forearm and band work for the racket arm. Each has a 3D demo.
3D demoDumbbell lungeIntermediate · A dumbbell
3D demoRear-foot-elevated split squat (Bulgarian split squat)Intermediate · A bench or box
3D demoSingle-leg Romanian deadliftAdvanced · A dumbbell
3D demoCossack squatIntermediate · No equipment
3D demoShuttle runsAdvanced · No equipment
3D demoSingle-leg calf raise from a stepIntermediate · A step + A wall
3D demoSeated bent-knee calf raise (soleus raise)Beginner · A bench or box
3D demoCopenhagen plankAdvanced · A bench or box
3D demoSide plankIntermediate · No equipment
3D demoBird dogBeginner · No equipment
3D demoThoracic rotationBeginner · No equipment
3D demoWrist-extensor eccentricsBeginner · A dumbbell
3D demoStanding band external rotationBeginner · A band + An anchor pointThe first two are new: a ghosting session and a strength routine. The racket sport warm-up and the tennis and padel routine come from our tennis and padel page, and the hamstring and groin routine from football.
A 30-minute squash conditioning session: a warm-up, then ghosting intervals from the T to the corners at three levels, front-corner lunges and a cool-down.
30 minIntermediate9 movesA wall, A dumbbellA 35-minute routine for squash players: lunges, split squats, one-leg hinges and side lunges, calf raises, Copenhagen planks, trunk work and forearm lowering.
35 minBeginner14 movesA wall, A dumbbellA 12-minute warm-up for tennis, padel, squash or badminton: skipping, leg swings, trunk turns, band shoulder work, forearm circles, shuttles and landings.
12 minBeginner10 movesA wall, A bandA 25-minute routine for racket players: the five-part Shoulder Control programme from handball trials, band rotations, forearm lowering, hops and balance.
25 minBeginner12 movesA dumbbell, A cable machineThe Nordic hamstring and Copenhagen adduction programmes from the football trials: a 10-week build, three adductor levels, then once a week in season.
15 minIntermediate6 movesA wall, An anchor pointA 15-minute barefoot routine for stronger toes, arches, calves and ankles, finishing with balance. You need only a towel, a wall and a resistance band.
15 minBeginner11 movesA wall, Other / check instructionsThe McGill big three for the core: curl-ups, side planks and bird dogs, each held for 10 seconds at a time in falling sets of 5, 3 and 1 reps.
12 minBeginner3 movesNo equipmentA lower body workout at home: split squats, slider hamstring curls, single-leg bridges, step-ups, band walks and calf raises, with dumbbell options.
30 minIntermediate12 movesA wall, A stepA 20-minute no-equipment HIIT workout: jumping jacks, jump squats, mountain climbers, burpees, skips and bear crawls.
20 minIntermediate10 movesNo equipmentThe Norwegian 4x4, a well-studied interval session for raising VO2 max: four 4-minute hard efforts with 3 easy minutes between, on a bike, rower or treadmill.
40 minIntermediate3 movesCardio machine, A wallA 25-minute interval session on a bike or rower: one-minute hard efforts with two minutes easy, building from 4 to 8 rounds.
25 minIntermediate1 movesCardio machineWrist mobility and forearm strength for desk work, climbing, push-ups and handstands.
10 minBeginner7 movesA wall, A dumbbellFit the strength routine into 2 days of a plan, and the ghosting workout into a cardio day, away from hard matches.
Two full-body strength sessions a week: the minimum that meets health guidelines, with every set, rep and rest, and an 8-week progression.
2 training days45 minBeginner3 days a weekA beginner gym plan: three full-body sessions a week, alternating workouts A and B, with sets, reps, rest and an 8-week progression.
3 training days45 minBeginner3 days a weekA 3-day strength plan for men over 40 with power and bone work, two cardio days and mobility, built on research on ageing muscle.
3 training days45 minBeginner3 days a weekA weekly plan for women over 50: strength, bone-loading and balance on 3 days plus walking, built on UK osteoporosis consensus advice.
3 training days45 minBeginnerThe PAR-Q+ asks about a heart condition or high blood pressure, chest pain, dizziness or losing consciousness, other long-term conditions and their medicines, a bone or joint problem that activity could make worse, and being told to exercise only under supervision. If you answer yes to any, check with your GP or a qualified exercise professional first. If you're over 45 and not used to hard exercise, ask a qualified exercise professional before the hardest sessions, and delay if you're ill.
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Most people who died in the squash series had heart disease, and most had warning symptoms. See your GP or cardiac team first; our heart disease guide asks people with heart disease to check before sports with sudden bursts of effort, such as squash.
Heavy exertion raises the short-term risk of a heart attack most in people who rarely exercise hard, and over-40s and newcomers had more injuries in a club survey. A 1997 review advised a medical check-up before taking up squash after 40, especially with heart disease or its risk factors. Get fitter first, start with Squash 57 or gentle games, and build up (our suggestion).
The NHS says hypertrophic cardiomyopathy is "the most common cause of sudden unexpected death in childhood and in young athletes", and that most people with it inherit it. See your GP before competitive squash, and about palpitations if heart problems run in your family.
Squash is among the sports behind Achilles ruptures. Follow our Achilles guides and build calf strength before full play.
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Back injuries are common in competitive players. Use our back pain guides, and build court time back gradually (our suggestion).
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Glasses and contact lenses aren't protection. Choose prescription squash eyewear made to BS EN 18527-2:2021, or squash eyewear over your glasses, as England Squash allows. The American Academy of Ophthalmology (AAO) advises anyone with reduced vision in one eye to ask their ophthalmologist before high-risk sports.
Eyewear is compulsory in any England Squash competition and in World Squash's junior events, and England Squash strongly recommends it for all play.
The NHS says it's usually fine to keep doing the activities you already do, but advises against sports with a risk of falling or bumping your tummy, and against starting a new vigorous activity. A 1997 review thought most women with normal pregnancies could keep playing squash, especially early on, telling their doctor. Talk to your midwife or GP.
Our replacement guides discourage high-impact sport. Ask your surgical team; Squash 57 may be a gentler step (our reading).
The NHS says to call 999 if:
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Call 999 if someone faints while exercising, isn't breathing, or can't be woken within a minute. Call 999 or go to A&E (accident and emergency) for palpitations that don't go away or come with chest pain, shortness of breath or fainting. In a match, the rules give no recovery time for breathlessness, so stop and concede.
Call 999 if someone was knocked out and hasn't woken, can't stay awake, has a fit, has problems with their vision or hearing, has clear fluid coming from their ears or nose, has new numbness or weakness, or has problems walking, balancing, understanding, speaking or writing. With suspected concussion, the UK guidelines for grassroots sport say "If in doubt, sit them out": off at once, no sport for at least 24 hours, a check by a healthcare professional or NHS 111 within 24 hours, no competition before 21 days, and a GP if symptoms last more than 28 days.
Go to A&E or call 999 if something hit your eye at high speed, your sight has changed, you have severe pain in the eye, a headache or sensitivity to light, you feel or are sick, you can't move your eye or keep it open, or blood or pus is coming from it. Ask for an urgent GP appointment or contact NHS 111 if it isn't getting better after 24 hours.
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Contact NHS 111 if you heard a snap, grinding or popping noise, can't walk on tiptoe or up stairs, or have swelling and bruising in your calf and ankle. Our Achilles rupture guide says to get it checked the same day.
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Call 999 or go to A&E for back pain with pain, tingling, weakness or numbness in both legs, loss of feeling around your genitals or bottom, changes in your bladder or bowels, or chest pain.
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Cramp can be an early warning of heat illness on court. Heat exhaustion should improve within 30 minutes of resting somewhere cool, cooling down and drinking; call 999 if it doesn't, or for a very high temperature, hot skin that isn't sweating, a fast heartbeat, fast breathing, confusion, a fit or loss of consciousness.
Heavy exertion raises the short-term risk of a heart attack most in people who rarely exercise hard, and the old advice is to get fit to play squash, not to play squash to get fit.
45 of the 60 people who died in the squash series had warning symptoms, most often chest pain. Stop, and call 999 for the NHS signs.
In lab tests the ball reached the eye in every hit, players were injured wearing them, and the international standard excludes them.
Ordinary glasses can make an injury worse. England Squash asks glasses wearers to wear squash eyewear over them, or prescription squash eyewear.
Irregular heartbeats during squash weren't reproduced on a treadmill, and heart rates in sport ran higher than in stress tests.
No study we found links recreational squash with knee arthritis; knee injuries were about a tenth of professionals' injuries.
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World Squash calls its risk "generally lower" and still encourages eyewear, and the squash eyewear standard covers it.
Build aerobic fitness, repeated sprints and quick changes of direction, which go with ranking in elite players, plus leg and calf strength twice a week. Ghosting intervals copy the game. If you're starting from little exercise, get fitter before you play hard matches.
Moving round the court as if playing a rally, without a ball: from the T to a corner, a lunge and a swing, then back to the T. Our ghosting workout uses intervals matched to rally and rest times; no trial has tested a ghosting programme.
About 10 minutes before you go on court: skipping, leg swings, trunk turns, band shoulder work, calf raises, lunges and half-pace ghosting. Then the 4-minute knock-up the rules allow, with your eyewear on. No squash warm-up has been tested.
England Squash requires it for under-19s in any competition and for all ages in doubles, and World Squash recommends it for everyone, including the warm-up. Choose lensed eyewear made to BS EN 18527-2:2021; open guards and ordinary glasses don't protect.
Rarely, and mostly in people who already have heart disease; most of those who died in one series had warning symptoms first. Hard exertion raises the short-term risk most in people who rarely exercise hard. Answer the PAR-Q+, see your GP about chest pain, palpitations or fainting, and never play through them.
Leg injuries, especially the ankle and heel, thigh, knee, hip and groin and calf, plus lower back pain and elbow and shoulder problems. Eye injuries are rare but can be serious.
Warm up, build court time up gradually, keep your calves strong, and get Achilles pain checked rather than playing through it; no prevention trial exists. A snap or a feeling of being kicked at the back of the heel needs checking the same day.
Yes: the Compendium of Physical Activities rates general squash at 7.3 METs, about 255 kcal in 30 minutes for a 70 kg person on our calculator. "Tennis or squash" went with a 15% lower risk of death in two US cohorts, an association.
Yes, with care. Answer the PAR-Q+, see a qualified exercise professional first if you're not used to hard exercise, start gently or with Squash 57, and build up; over-40s and newcomers had more injuries in a club survey.
Squash played with a bigger, bouncier ball, 57 mm across; it was called racketball until 2016. World Squash calls its injury risk generally lower and encourages eyewear, especially for less experienced players, and the squash eyewear standard covers it.
Exercise education for people who play sport, not a personal prescription or a diagnosis, and clinical review of these pages is pending. Check with a GP or physiotherapist before hard training if you have a heart condition, chest pain, dizziness or an injury that isn't settling, and stop for sharp or increasing pain. Health disclaimer.
