Esports, injuries and how to stay healthy as a gamer

This month, the Journal of the American Osteopathic Association published an article entitled An Osteopathic Physician's Approach to the Esports Athlete. It is among the first medical papers that makes specific treatment recommendations for esports athletes.

Waldo, a Luckbox community member, CS:GO fan and third-year medical student, picks out the key points from the article offering advice to gamers on how to stay healthy...

Some notes before we start

The information in this article will be coming from the original Journal of the American Osteopathic Association (JAOA) paper. This article contains no medical advice from me, as I am unqualified to offer it.

Osteopathic physicians (DOs) are doctors in the United States who possess an unrestricted license to practise medicine, just like an allopathic physician (MD), but also have extra osteopathic training to use manual medicine to treat musculoskeletal (and other) pathology. That differs from an "Osteopath" in Europe, who may only be trained in the craft of manual medicine and cannot prescribe pharmaceuticals, etc. Always take care to fully understand the qualifications of those from whom you seek healthcare advice.


I really dig the science of all of this, so I'm going to analyse it each aspect of the study and break it down to digestable pieces. If it's too much, skip to the TLDR heading further down and grab some quick takeaways for how to game healthier. If you're here for all of it with me, let's get to it.

"You're going to go blind"

This is just the nature of the beast. You have to perceive a screen to participate in an esport. It's unavoidable. So how do you avoid being within the 90% of people (who play for three hours or more in one sitting) that this study asserts experience symptoms from screen fatigue?

It's pretty simple actually. Keep the center of the monitor lower down (a few inches below staring straight ahead) and keep it 1.5ft to 2ft away from your eyes. And for the love of God TAKE BREAKS.

The article offers an easy-to-remember 20/20/20 rule as a solution: Focus on an object at least 20ft away that isn't a screen for 20 seconds at least once every 20 minutes.

You can absolutely do this between rounds, between matches, while in queue, whatever works. Different parts of your brain process material ingested via a screen and via the tangible world around you due to depth perception and other differentiating factors.

Give the screen perceiving part of your brain those breaks! You don't want vision problems, headaches, or back pain from sustained leaning forward for hours at a time getting in the way of you reaching your goals.

Or, at the very, least don't play as close to the screen as İsmailcan "XANTARES" Dörtkardeş is in the clip below (and this isn't even the closest I've seen him to a screen while playing).

Putting the team (and the strain) on your back

Speaking of back pain, gamers have poor posture. It's a stereotype that we have a terrible habit of perpetuating with our actions. Our precious "gaming chairs" are questionably terrible for our bodies, and you wouldn't believe how I've seen some of my friends sit (while console gaming in particular).

The JAOA article emphasises the need for good posture while competing and practicing, but also recognizes that that doesn't always happen. It recommends muscle stretching, muscle strengthening, and seeking out osteopathic manipulative treatment for the musculoskeletal imbalances that are created by prolonged, repetitive poor posture.

Specifically focused on the neck, core, and upper back. Taking extra time to stretch those muscles is important. Even if you are not using a muscle to lift weights, contracting it and holding tension in it warrants loosening it up before and after competition.

Take a second to appreciate that Jonathan "EliGE" Jablonowski actually has really solid posture here. And look how far he is from the screen (bonus points!).

Flick of da' wrist (plus the arm and shoulder)

The above paragraph about posture is also super important for shoulder mobility and shoulder strength. I won't beat it to death, it's just super important for a whole lot of reasons. Another super important thing that esports athletes need to be wary of is the strain that they put on their wrists.

Don't be surprised if at some point we start seeing serious esports professionals wearing wrist braces up on the stage, especially for long best-of-fives. Gamers are a notorious demographic for sustaining carpal tunnel syndrome, as is anyone who is constantly performing fine motor tasks with their hands.

The ligaments that run through the wrist get inflamed and swell, compressing the nerve that runs through, causing loss of finger function and tingling in the fingers.

This is an esports problem that dates all the way back to MLG Columbus but was (likely, not confirmed) highlighted most recently by Johannes "nex" Maget's issues that forced him to take a step back from the BIG roster.

If the problem gets bad enough, they can do surgery to cut the transverse carpal ligament that the fingers' ligaments are rubbing up against, but that's for extreme cases. Usually the answer is simply icing, resting, and using some anti-inflammatory medication.


Sleep: Not for the weak

Blue light is something that gamers are aware of but the science remains inconclusive about a good way to combat its effects.

The long and short of it is that blue light promotes a state of wakefulness by inhibiting melatonin production in the pineal gland. So exposure to blue light soon before bed reduces the quality and efficacy of the time that you actually spend sleeping, resulting in poor performance in things like school or work the following day.

Blue light-filtering glasses and orange-tinted screens that limit blue light at the source are popular but not scientific supported at this time.

Best practice to get a good night's sleep is to avoid grinding late into the night and trying to sleep right away. Call it quits a bit earlier, give your body some buffer time to wean down, and then maybe you'll sleep well enough that your first games the next day won't be so embarrassing that you have to write them off as "warm ups".

Recognise you have a problem

Alright, this isn't just a thing your parents complain about when they think you play too much.

Anything in life that is pleasurable and stimulates dopamine release in the brain has the capacity to be addicting, from candy bars to bumper cars.

The reward centers involved with the mesolimbic dopamine pathway that "flow" from the ventral tegmental area (VTA) to the nucleus accumbens are activated every time we feel motivated to do something. Game developers have abused our biology with things like loot crates, timing level ups to keep people motivated as a game drags on, and by creating external "achievements" (that were never a part of old school systems like the Nintendo 64) to up our gameplay hours even after the storyline is complete.

Studies have shown biological changes in brain structure density in those addicted to gaming. If you start realising that you're super irritable with people IRL and only want to be in the server, you might need to talk to a professional counselor or therapist. Gaming is meant to be fun, you don't want it to take control of your life. Be self-aware if things are going too far.


You wouldn't put cheap gas in a Ferrari

This is an area where we straight up suck and pay dearly for it. Gamers are notoriously awful to their bodies in terms of fuel, whether it's artificially ramping up as needed with caffeine, or sustaining ourselves with junk food.

But let's focus on how terrible we are about caffeine consumption. It was Mountain Dew when we were growing up, now it's energy products that we're all aware of (I won't name names) that are completely unregulated since they are classified as supplements and not medications (therefore out of the purview of the Food and Drug Administration).

We consume more and more over time as our body up regulates the receptors needed to respond to its presence, to borderline (and sometimes past borderline) dangerous levels where we can see heart problems.

Plus on the other side of preventative, healthy lifestyles, not all gamers have bought into the idea of being a balanced esport athlete that regularly hits the gym quite yet.

With childhood obesity being a key issue in long term health, we have to ensure that we do a better job pushing that balance for the younger generations of gamers. This study recommends at least 7,000 to 10,000 steps a day and at least 2.5 hours of moderate intensity exercise per week.

To hammer that home, the JAOA article brings up a more somber point, one of esports' finest who was taken from us way too soon (though I don't know if the authors are aware of that fact, as the information in the study does not mention his passing). It demonstrates the seriousness and importance of being healthy as an esports athlete.

The authors allude to a professional esports athlete having suffered from deep vein thrombosis (DVT), or a blood clot, in his knee back in 2012 (eventually diagnosed in January 2013, per the patient's Twitter account). They are almost certainly referring to Geoff "iNcontroL" Robinson.

Robinson died in July 2019, news that shook the esports world. One of the scary things that blood clots can cause is something called a pulmonary embolism, which is where that clot flows all the way back to the lungs and blocks blood flow in a major artery there. As was the case with Robinson, they can be sudden and fatal.

We can take solace in the fact that his passing was painless and swift, but we can honor his memory by taking all of the steps that we can to ensure that none of the industry's athletes is taken too soon ever again. He was only 33.


So, what are the key takeaways from the JAOA article? It's pretty simple and mostly common sense.

Get outside, sit up straight, put good food in your body, have a social life with friends and family IRL, and take breaks while playing. Nothing you haven't heard before, but now this article is specifically addressing your aspirations as an esports athlete as a risk factor for all of the problems listed above due to the habits that gamers feel that they need to adopt while trying to reach their dreams.

It is absolutely possible to maintain good physical and mental health while pursuing or maintaining an esports career. You just have to make it a priority and see it through.

Pictures: Sean Do, Pexels, and Frederick Tendong