Squash and Sudden Death

In a recent blog posting, I described the longest squash match ever played. It took place in 1983 between Pakistan’s Jahangir Khan and Gamal Awad of Egypt. In a postscript, I mentioned that Gamal Awad died of a heart attack in 2004 at the early age of 49.

But four years before the match between Khan and Awad, the men’s world-ranked number 13 player, then aged 27, also died of a heart attack. Except this time, it was on court during a tournament match in Australia.

The heart attack victim was Jahangir’s elder brother, Torsam Khan.

Squash and Heart Disease

Seven years after Torsam’s death, I was working as a research scientist for what is now one of the world’s largest pharmaceutical companies. I was also spending an inordinate amount of time playing squash at the company’s sports club which was located on-site just a couple of hundred metres from the research library. And it was while I was browsing the scientific journals in the library that I came across a very interesting article.

It was written by Robin Northcote, Clare Flannigan and David Ballantyne of the Department of Medical Cardiology at the Victoria Infirmary in Glasgow, Scotland. Now, some of you may know that Scotland had (and still does have) one of the highest levels of heart disease in the world, a situation not helped by certain local dietary preferences such as the infamous deep-fried battered Mars bar. So, looking back, the appearance of the Northcote article in the British Heart Journal didn’t come as an enormous surprise to me.

The article had the arresting title, Sudden death and vigorous exercise – a study of 60 deaths associated with squash’. And, by the way, sudden death was defined as “death occurring within 1-24 hours of the onset of symptoms” with the study looking at subjects who had “collapsed while playing squash or within an hour of playing”.

Squash and Psychology

After consulting a few of my fellow squash-playing scientists, I remember citing the article in the squash club newsletter I was then editing. It didn’t generate much, if any, feedback from squash club members even after I’d pinned a copy of the article to the noticeboard outside courts 1 and 2. Anyway, it certainly didn’t result in an exodus from the squash leagues or a noticeable reduction in the number of squash courts booked.

Nearly 25 years after it first appeared, the Northcote et al article is still worth reading. The authors state that, “Many individuals in this study with known medical conditions continued to play squash. Men in middle age seem reluctant to acknowledge that they may be in poor physical condition or health. We and others have noted that sportsmen tend to deny physical infirmity and prodromal symptoms.” Prodromal symptoms (or sets of symptoms) are ones which might indicate the start of a disease before specific symptoms occur.

Most of the people in the study had professional or executive jobs with only 2 of the 60 subjects working in what were regarded as ‘non-sedentary’ jobs. The authors go on to state that, “In addition to a tendency to ignore prodromal symptoms and pre-existing disease at least half of the subjects in this series may have been type A personalities, and this in itself may have increased their risk of sudden death and the development of coronary heart disease”.

Personality typing theory emerged in the 1950s and described two common but contrasting types of people, the highly-strung Type A and the easy-going Type B. These types were regarded as  corresponding to patterns of behaviour that could respectively raise or lower a person’s chances of developing coronary heart disease. Despite its citation in the Northcote study, the theory has since  been regarded as obsolete by many researchers in contemporary health psychology and personality psychology.

But, whatever theory you choose to believe, the overall message remains the same. The risks associated with playing squash and experiencing sudden death originate, at least partially, in the mind.

Exercise-related Sudden Death

In 1994, Northcote published another exercise-related sudden death study in the Oxford Textbook of Sports Medicine (Oxford University Press, Oxford, UK). This time, he looked at a range of sports and activities including running, swimming and soccer, and sudden deaths occurring in the mainland UK, i.e. England, Scotland and Wales. His findings are presented in the following table.

Sport / Activity Number

(Male)

Number

(Female)

Mean Age

at Death

Squash 124 2 44
Soccer 53 32
Swimming 50 6 53
Running 38 1 37
Badminton 26 49
Rugby 14 30

Although squash is at the top of the table, Northcote emphasized that there is a very low statistical risk of sudden death from any sport and that the figures don’t  imply that squash is more dangerous than other sports. Nevertheless, his table does show that a significant number of squash players have probably died unnecessarily, for reasons not unconnected to those proposed in his 1986  article.

Squash and the Mind

So, nothing for squash players to worry about?

Well, in 2004, I had a heart attack. Not something I’d recommend although I’ve certainly found it to be character forming if not personality changing. Unfortunately, or come to think of it fortunately, I wouldn’t have made Robin Northcote’s original study as I hadn’t been playing squash immediately beforehand. But the incident did lead me to take a renewed interest in my own psychological makeup, how it influenced my approach to squash, and how I could change it for the better. In other words, how I could change my mindset to re-connect with squash, feel the passion again – and reduce the risk.

Well, I’m still taking an interest and things certainly do seem to be getting better in all respects. Although I am, of course, still working on it. Promise.

Squash en français – At the Movies

Un Film de Lionel Bailliu

I’m pretty sure there aren’t many movies featuring squash that have been nominated for an Academy Award. But French director Lionel Bailliu’s Squash is just such a film. Nominated in 2003 in the Best Live Action Short Film category, the action in this 27 minute film takes place entirely on a squash court. Two businessmen, Alexandre (played by Malcolm Conrath) and his boss Charles (Eric Savin), play a squash match. The on-court mood ebbs and flows dramatically as the rules are bent and both players test their opponent’s mental and physical endurance. And not in a nice way!

Boulot et Squash from Fort Mathieu on Vimeo.

Squash and Fair Play

Four years after its initial release, Bailliu expanded Squash into a bitter and nail-biting commentary on the cut-throat nature of office politics in his feature debut Fair Play.

Eric Savin reprised his role as Charles, a shrewd businessman who takes his scheming employees on an ultra-competitive weekend outing. Featuring rowing, jogging, canoeing and rock climbing as well as squash, the weekend is less to do with team-building than the survival of the fittest. And although Charles may be top dog today, ambitious worker Jean-Claude (played by Benoît Magimel) is determined to make his way to the top no matter what the cost.

Check out the Fair Play website, and your French, at:

http://www.tfmdistribution.com/fairplay

Squash in England – Coach Identities

Squash Coach Roles and Obligations

A few weeks ago I posted on the responsibility of new squash coaches in England to promote a balanced lifestyle, a concept which can mean different things to different people. Since then, I’ve qualified as a squash coach myself, a process which involved meeting and working with a number of experienced coaches.

Not surprisingly, most of them qualified at a time when the role of a squash coach was less complex than it is today. Or, more accurately, the environment within which people now coach squash is more complex. This doesn’t mean to say that, in the past, squash coaches weren’t expected to perform a variety of roles. Far from it. They were certainly expected to be good teachers and to run coaching sessions efficiently and effectively. But the range of issues about which they were expected to have a working knowledge and the statutory obligations they were required to meet were undoubtedly far fewer than today.

Teacher, Role Model, Innovator

By way of example, take a look at the roles of the coach as identified in the current training programme for new squash coaches in England: Teacher, Manager, Psychologist, Motivator, Guide, Role Model, Adviser, Leader and Friend. On the basis of my recent experience alone, I’d also add Mentor and – when coaching young people – Guardian. The course also makes it clear that squash coaches should share good practice with other coaches across the United Kingdom – a social networking role which, I believe, shouldn’t be targeted exclusively at squash coaches. Nor should it be limited to coaches based in the United Kingdom. Good practice, particularly when it relates to such a wide range of roles, can emerge anywhere in the squash world.

Squash Coach Identities

So, which roles will individual squash coaches most identify with? Well, if we return to the concept of a balanced lifestyle, we can at least begin to understand the need for squash coaches to find their own personal balance. That balance should help them to identify not just with their squash coaching roles, but with their other key squash roles (such as Competitor) and life roles such as Life Partner, Parent, Employee, Business Owner and so on.

The Squash Coach as Gardener

As human beings, we all acquire and discard roles throughout our lives – some of us more easily than others. But our own personal identities – the identities we give ourselves – are not so easily changed. Which is where metaphors can be useful. England Squash and Racketball has likened its squash coaches to gardeners, nurturing their coachees by providing them with care, resources and individual attention. In terms of their genetic makeup and physiology, every coachee, every person is unique and needs different types of support at different times as they learn and develop.

Sensing those individual needs as they arise and responding appropriately is the biggest challenge facing squash coaches today.

The Inner Game of Squash

Holistic Sports Coaching

In the 1970s, American tennis instructor Tim Gallwey wrote The Inner Game of Tennis, a book which described his own novel approach to sports coaching. His approach included aspects of what are now possibly best  known as sports psychology, performance coaching (or life coaching) and meditation. Gallwey proposed that, for each player, their sport is made up of an outer game – played against an opponent – and an inner game, which takes place inside the player’s mind.

Tim Gallwey

Tim Gallwey

Squash in the Mind

The inner game approach requires players to make specific non-judgmental observations about what Gallwey called critical variables associated with playing their sport. Amongst other things, these variables could include the flight or bounce of the ball during rallies, the position of the player’s feet or their squash racket head, or even the sound made when they or their opponent hit the ball. The purpose of making these observations is for the player to become increasingly aware of their playing state, leading their body to automatically adjust and correct itself to achieve the best performance it can. This inner game effectively takes place inside the player’s own mind and is played against lapses in concentration, nervousness, self-doubt and self-criticism. In other words, it’s played against self-imposed obstacles put in the way by players themselves – a problem which will be equally familiar to squash players as to tennis players!

Squash Health

In response to the book’s success, Gallwey followed up with further inner game books on golf, music, skiing, work and, in 2010, stress – possibly written in recognition of the increasing work life challenges faced by many people as a result of global economic uncertainty and changing employment trends. This series of writings has gradually expanded the range of tools and techniques which can be used to coach the inner game in different life contexts – from sport, to work and, increasingly, to health. In fact, the series could be seen as harmonising approaches to coaching the body and coaching the mind.

Squash for the Soul

The idea of harmonisation fits neatly with the concept of a balanced lifestyle or a healthy work life balance – something which many people strive to achieve during their lives and which squash coaches are expected to promote. And one strand of the inner game approach which Tim Gallwey describes at the end of The Inner Game of Tennis
deals directly with this. He talks about “the inner game off the court” and the need for players to realise that the skills they need to achieve their life goals and overcome barriers are the same whatever they are doing. Under the memorable (and very 1970s) heading ‘Unfreakability’ he outlines the need to acquire the ability to see the true nature of what is happening around you – “and to be able to respond appropriately”.

The skills Gallwey is describing are characteristic of meditation or what he calls ‘the art of quieting the mind’. And it’s the ability to concentrate and maintain a state of inner calm off court as well as on court which is a key teaching of the inner game approach.

Squash for the soul, you might say…