Game on: Essential injury prevention tips for electronic sports athletes

Although the risk of injury is lower compared to other sports such as football and soccer, E-sports athletes are particularly predisposed to overuse and repetitive motion activities which comes from the unique nature of the sport.

Jacob Sexton, M.D., a primary care sports medicine physician at Children's HealthSM, provides tips on preventing and treating gaming injuries. Dr. Sexton explains that "E-gaming related injuries are multifactorial and dependent on the gamer themselves. Factors such as posture, length of gaming activity, gaming station set-up (console vs. PC), current physical activity levels, and controller grip style can all contribute to development of video game related injuries."

Common gaming injuries

E-sport athletes injury patterns are comparable to individuals who work on a computer daily. These injuries can affect multiple body systems but common injuries observed include:

• Carpal Tunnel Syndrome (CTS): Inflammation of the median nerve which courses from the forearm to the palmar wrist. Symptoms of CTS include weakness, sensory changes to the thumb / index / long finger, nighttime pain. Typically, this condition is caused by repetitive motions and improper mouse/keyboard ergonomics.
• Ulnar Neuritis (UN): Inflammation of the ulnar nerve (funny bone) which course from the inside of the elbow to the pinky side of the wrist. Symptoms of UN include poor grip strength, sensory changes to the ring / pinky finger, nighttime pain, uncomfortable "popping or snapping" at the elbow. Typically, this condition is caused by prolonged elbow flexion and compression of the elbow on a hard surface.
• Lateral Epicondylitis (Tennis Elbow): Inflammation of the common extensor tendons of the outside elbow. Symptoms of LE include persistent elbow pain, pain with extension of the wrist, pain with gripping, pain with rotational activities (opening a door). Typically, this condition is related to overuse and degeneration of the tendons.
• DeQuervain's Tenosynovities (Gamer's Thumb): Inflammation of the tendons which course from the elbow to the thumb. Symptoms of gamer's thumb include pain along the thumb, decreased strength, pain with rotation (opening doors). Typically, gamer's thumb is related to overuse and irritation of the tendons as they pass the wrist bones towards the thumb.
• Tendinitis: Inflammation (swelling) of the tendons (tissue connecting muscle to bone). Typically, tendinitis is related to overuse, decreased strength, and improper ergonomics.
• Myofascial Pain: Contracture of soft tissues (trigger points) at large muscle groups such as the trapezius and scapula. Symptoms can include nerve pain, soreness, headaches, and neck stiffness.
• Thoracic and Lumbar Back Pain: Prolonged sitting results in decreased core muscle activation and strength resulting in postural back pain. Typically, causes of back pain in E-gamers is related to poor performance ergonomics and dynamic strength.
• Thoracic Outlet Syndrome: Poor posture, prolonged computer activity, and weak core stability can result in mechanical compression of the major blood vessels leaving the neck and shoulder. Symptoms of thoracic outlet syndrome include activity dependent pain, numbness, discoloration, and weakness. The pain and symptoms typically resolve after completion of activity.

7 tips to prevent gaming injuries and keep your child healthy

Here are some ways to help reduce your child's risk of developing gaming-related injuries:

1. Attend to pain or stiffness.

• Rest: For initial onset of symptoms, a period of rest from video games is appropriate.
• Medications: Tylenol and NSAIDs (ibuprofen, Aleve), as needed.
• Stretching and strengthening: Developing a strength and conditioning program outside of the video game setting.
• Ice: Icing can provide temporary relief for pain and stiffness. Approximately 15 minutes ice placed directly onto the affected area.

2. Check ergonomics and posture.

Chair and posture:

• Back and lumbar support are recommended but the degree of each is a personal preference
• Arm rests are advised and should be adjusted so that the resting pads are equal to the height the desk
• With appropriate arm height, the wrist and hands will naturally fall into optimal alignment

Controller grip:

• Traditional controller grip: Traditional controller grip requires slight to moderate finger flexion but typically keeps the wrist in a neutral position. This is a better option for wrist and hand optimization.
• Claw controller grip: When using the claw grip, controller optimization occurs by having the ability to push more buttons in a shorter period. This method is most seen in the professional and competitive Esports world. Claw grip places the wrist and fingers in too much flexion (bending) and carries an increased risk of injury.

Mouse:

• Mouse should be even with the keyboard
• While holding the mouse it is best to maintain neutral wrist position. If your wrist is resting on your desk during gaming, then your wrist is unlikely to be in neutral position
• When playing games requiring aiming or fine movements, it is optimal to use the entire arm for the mouse, not just the wrist. By utilizing the entire arm, you are going to increase optimization and longevity

Keyboard:

• Keyboard positioning should remain flat or at a level where you can maintain a neutral wrist.
• Utilizing the incline extension (clasps at back of keyboard) places the wrist in slight extension. Utilizing a wrist bolster can assist in maintaining neutral wrist position
• The height of the keyboard should allow for the elbow to be bent at 90 degrees. This allows the wrist to sit in a more natural position.

Monitor:

• Proper monitor height varies depending on the gamer and monitor equipment
• Optimal position occurs when the neck rests in a neutral position without extension (head tilted back) or flexed (head tilted forward).
• Typical monitor size recommendations (diagonally) is 24"-32" monitor.

3. Stretch regularly.

Aim to take a stretch break at least once every hour. Try these simple gaming stretches to prevent injury by keeping your joints moving:

• Extend your arms out to the side
• Move the neck up and down gently
• Roll the shoulders
• Stand up and sit down a few times

4. Take breaks.

We get it – if your kid is wrapped up in the latest game, it can be difficult to pull them away. However, it's important. Set a timer for a 5-minute break every hour or so. Take a lap around the house, drink water and try some quick stretches.

5. Mix it up.

Make sure that video games aren't the only things your kid is doing. Encourage them to stay interested in other hobbies and take breaks away from screens.

6. Shut it down.

Be sure gaming isn't interfering with getting enough rest. According to the Centers for Disease Control and Prevention (CDC), kids age 6 to 12 need 9 to 12 hours of sleep a night, and teens need 8 to 10 hours a night. "Shut down gaming at least an hour before bedtime, as the screen light from videogames – like all electronic devices – can interfere with the body's ability to get to sleep," says Dr. Sexton.

7. Work it out.

Encourage your kid to stay physically active. The CDC currently recommends a minimum of 60 minutes of physical activity daily for adolescents and teens. Goals of physical activity include aerobic endurance, muscle strengthening and bone strengthening.

For more tips to protect your gamer, check out these healthy gaming habits for kids and teens.

Learn more

Children's Health sports medicine experts can help children and teens manage game-related injuries – and prevent future injuries. Learn more about the programs we offer to keep gamers healthy.

Extra Life – Play games. Heal kids.

Join gamers in North Texas who game and raise funds for Children's Health through Extra Life. If you sign up be sure to choose to support Children's Health, the local Children's Miracle Network Hospital.