Esport Injuries — A Whole Lot From Nothing!

Learn about the types of injuries esports pros can face and how to prevent them.

Although it might appear like I am writing like a broken AI, you might think: What the hell?! Injuries from sitting around and playing games?! At least when it comes to my own experiences and exposure to various institutions and groups of people, I would expect such a reaction from the wider population (despite the fact that with an average age of a gamer being somewhere between 26 and 35, everyone is likely to be “gaming” somehow (1–4)). 

Yes, people who use their hands a lot for mostly computer-driven work are likely to suffer from a series of injuries. You see what I did there? I wrote “people”, and not necessarily gamers. So let us get into what injuries gamers and esports athletes are likely to be affected by, and why this is rather a small “sub”-population of all people who use computers, consoles or any type of operational tool that has analog or digital interfaces. We are all at risk!

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The Rise of Computer Work — and Pain

What I have alluded to simply means that nowadays many people are likely to be mainly doing some sort of mental work that requires the usage of computers. And we are not simply doing it every then and now, but it rather has become something that occupies most of our work time - which could easily mean that you are spending somewhere between 6 and 10 hours working through your hands by using a keyboard, mouse and a monitor. 

This seems rather obvious, and most of the gamers and esports athletes by now might stop reading. Yet, the reality is that the average person that works like this does not realize that they are almost at the same level of risk of (overuse) injury, as gamers and esports athletes. This is a particularly emphasized misalignment of understanding when it comes to children who are gamers. “These games are bad for their eyes!” (No, not necessarily; they actually have some benefits, check out this article here for more), “Children and their consoles nowadays — they all have bad posture because of it!”, or “They are getting weaker, and all that clicking will give them carpal tunnel!” are rather typical expressions that you can find being thrown around. So, how are all office or mental workers, computer users, and thus us, the gamers, and you, the aspiring esport athletes affected?

For starters, this is not something new right now in 2023, and we cannot blame “the last couple of years of tech advancement” — not really surprising either when you consider that many mental workers started utilizing computers daily early in the 90s. Already in 2000, it was found that in the United States “work-related upper limb disorders” increased from 18% for occupational illness in 1982 to 65% in 1998 (5). Yes, that is two years before the PlayStation 2 was released. 

Types of Injuries

And yes, I am being overly dramatic and cheeky here: in the study, the only people who could be considered computer users were security and commodity brokers, as well as real estate agents and managers. In the meantime, the classical workers who would mainly suffer from these upper body issues were meat packers, mechanics, or slaughterhouse workers. But it was found at the same time that people who could be considered doing “lighter” physical work, or none at all, such as computer users or musicians, were already having similar work-related pain in their upper body (6). Conditions included, but were not exclusive to:

• postural misalignment with protracted shoulders in 78%
• head forward position in 71%
• hyperlaxity of fingers and elbows was found in over 50%
• carpal tunnel syndrome in 8%
• radial tunnel syndrome in 7%
• cubital tunnel in 64%
• shoulder impingement in 13%
• medial epicondylitis in 60%
• lateral epicondylitis in 33%
• and peripheral muscle weakness in 70%! 

That is a lot of different issues (and I cut them short here!) for people who simply use the computer on a daily basis - like all of us gamers and the likes of any esport athletes. Similar to the original author's highlights, I would like to point you to the fact that the ominous “carpal tunnel syndrome” was found to be only a problem in 8% of the cases. Considering that it is something constantly being repeated over and over again in the esports world, based on this data it may contribute to a rather small proportion of injuries. 

This is particularly interesting as it is generally an injury that keeps being a topic of discussion, despite the other diagnosis mentioned before having likely a much greater impact (7,8). The most critical one to pay attention to is the 70% of muscle weakness — something that underlines that already in 2001 we were looking at population-wide issues of simply not being fit enough. Yes, to work at the computer (or play some fancy instruments to be fair)! 

Furthermore, it appears that not only office and mental workers, or gamers and esport athletes might be running into these issues: in similar fashion, ESPN even reported in recent years on how chess players are suffering from issues around posture, upper body injuries, as well as a likely lack of nutritional support during matches and tournaments (9). 

Unfortunately, the prevalence of upper body injuries in the general work population is only increasing (10), all the while computer usage and esports popularity is as well. This does not bode very well for anyone who wants to improve their game and “grind” their way to success. Without appropriate regular physical training, you will be running into some sort of upper body problem soon. Office workers are already beating everyone else for how often they get neck problems (ranged 17.7 – 63%), as well as specifically neck pain (ranged 34 – 49%) (11). 

And that is critical, as it was further shown that for office workers musculoskeletal neck and shoulder symptoms were the most reported to reduce productivity (12), for 17% of the population of the Netherlands had to take sick leave because of “just neck pain” (13,14), and all of that is resulting in a steep increase in direct (e.g. treatments) or indirect (i.e. decrease in productivity) health care cost (15). Nevertheless, if all of that does not convince you that upper body injuries for gamers and esport athletes pose a real risk and danger, let us have a look at the specific research for our population.

I get it though, you might be thinking: well ok, these are office workers that do a bit of clicky click every day, they ain’t professionals with full support teams, medical and performance staff. Technically, I can personally not agree more - you would think that professional esports athletes are putting their bodies first. Yet, although this is an increasing trend, there are enough players out there (and teams as a matter of fact) that believe that esports is just a head thing and the body does not really contribute to the performance. 

Watch Your Back

The main source of interest and data here is a study on competitive Danish esports players, where it was found that musculoskeletal pain alone happened to 4 in 10 players (42.6%), the main areas of problems were the back (31.3%), neck (11.3%) and shoulders (11.3%), participated about 5.6 hours less in esport-related activities per week (16). The authors even stated that the prevalence of back pain alone that they found in adolescent esports players is higher than that of the same age group of non-esport players (31.3% vs 19.4%)! 

Similar data has been reported on college esports athletes where the major difference was that hand (30%) and wrist pain (36%) had a higher chance of occurring, but that could be rather “comfortably” explained by the first study having reported a lower average esports training volume of only 24 hours versus 38 to 70 hours in the second study (17). Thus, whatever type of activity you do at the computer, it is for sure that with increased intensity and time spent doing it, you are continuously increasing the likelihood that you will get some sort of issues in your upper body.

Unfortunately, all of my writing here about how there are many different upper body injuries to consider for gamers and esports athletes does not end the discussion and highlights the potential risks of our most favorite pastime. There is a collection of unexpected risks of “injury” (not in the classical sense understood like that) that we need to delve further into - I will do so in part 2. Finally, then I will give you some actionable recommendations that you can take to prevent some of these major issues occurring in part 3.

References:

1. Knowles R. Digital New Zealand 2022 (DNZ22) [Internet]. IGEA. 2021 [cited 2022 Oct 28]. Available from: https://igea.net/2021/10/digital-new-zealand-2022-dnz22/

2. Video Game Industry: Statistics, Demographics, Trends [Internet]. INTENTA. 2021 [cited 2022 Jun 14]. Available from: https://intenta.digital/gaming/video-game-industry/

3. Fact-Sheet-eSport-Studie-2021-scaled.jpg (JPEG Image, 1811 × 2560 pixels) — Scaled (36%) [Internet]. [cited 2022 Jun 14]. Available from: https://www.esportwissen.de/wp-content/uploads/2021/02/Fact-Sheet-eSport-Studie-2021-scaled.jpg

4. eSport-Studie-2020-FactSheet-scaled.jpg (JPEG Image, 1811 × 2560 pixels) — Scaled (36%) [Internet]. [cited 2022 Jun 14]. Available from: https://www.esportwissen.de/wp-content/uploads/2020/02/eSport-Studie-2020-FactSheet-scaled.jpg

5. Mani L, Gerr F. Work-related upper extremity musculoskeletal disorders. Prim Care. 2000 Dec;27(4):845–64.

6. Pascarelli EF, Hsu YP. Understanding work-related upper extremity disorders: clinical findings in 485 computer users, musicians, and others. J Occup Rehabil. 2001 Mar;11(1):1–21.

7. Hadler NM. Repetitive upper-extremity motions in the workplace are not hazardous. J Hand Surg. 1997 Jan;22(1):19–29.

8. Nathan PA, Keniston RC, Meadows KD, Lockwood RS. Validation of occupational hand-use categories. J Occup Med Off Publ Ind Med Assoc. 1993 Oct;35(10):1034–42.

9. The grandmaster diet: How to lose weight while barely moving [Internet]. ESPN.com. 2020 [cited 2023 May 11]. Available from: https://www.espn.com/espn/story/_/id/27593253/why-grandmasters-magnus-carlsen-fabiano-caruana-lose-weight-playing-chess

10. Linaker CH, Walker-Bone K. Shoulder disorders and occupation. Best Pract Res Clin Rheumatol. 2015 Jun;29(3):405–23.

11. Jun D, Zoe M, Johnston V, O’Leary S. Physical risk factors for developing non-specific neck pain in office workers: a systematic review and meta-analysis. Int Arch Occup Environ Health. 2017 Jul;90(5):373–410.

12. Hagberg M, Tornqvist EW, Toomingas A. Self-reported reduced productivity due to musculoskeletal symptoms: associations with workplace and individual factors among white-collar computer users. J Occup Rehabil. 2002 Sep;12(3):151–62.

13. Burdorf A, Naaktgeboren B, Post W. Prognostic factors for musculoskeletal sickness absence and return to work among welders and metal workers. Occup Environ Med. 1998 Jul;55(7):490–5.

14. Côté P, Yang X, Kristman V, Hogg-Johnson S, Van Eerd D, Rezai M, et al. The Association between Workers’ Compensation Claims Involving Neck Pain and Future Health Care Utilization: A Population-based Cohort Study. J Occup Rehabil. 2013 Dec 1;23(4):547–56.

15. Hansson EK, Hansson TH. The costs for persons sick-listed more than one month because of low back or neck problems. A two-year prospective study of Swedish patients. Eur Spine J. 2005 May 1;14(4):337–45.

16. Lindberg L, Nielsen SB, Damgaard M, Sloth OR, Rathleff MS, Straszek CL. Musculoskeletal pain is common in competitive gaming: a cross-sectional study among Danish esports athletes. BMJ Open Sport Exerc Med. 2020;6(1):000799.

17. DiFrancisco-Donoghue J, Balentine J, Schmidt G, Zwibel H. Managing the health of the eSport athlete: an integrated health management model. BMJ Open Sport Exerc Med. 2019 Jan 1;5(1):e000467.