Sports Rehabilitation for E-Sports Athletes

Original Editor - Narayani Nagare Top Contributors - Narayani Nagare

Introduction

Electronic sports (E-sports) is a rapidly expanding field where players or teams compete in multiplayer video games using computers or mobile devices.

Unlike traditional sports that encourage physical activity, full-time esports athletes often spend between 5.5 to over 10 hours a day seated during training. This extensive screen time is aimed at enhancing eye-hand coordination, quick reaction times, and fast decision-making. However, the high intensity of their training combined with specific postural habits can lead to health risks comparable to those associated with sedentary lifestyles. Research has shown that sitting for 6–8 hours can elevate the risk of all-cause mortality, cardiovascular diseases, and orthopedic injuries resulting from poor posture.

Most studies on esports-related injuries have concentrated on computer gaming, leaving a significant gap in research on mobile esports games. Notably, recent findings indicate that over 90% of millennials prefer mobile devices for gaming, which presents distinct challenges. Mobile gamers exhibit different postures, play in varied environments, and engage with their devices in ways that differ from those using computers. These differences can lead to unique postural adaptations, muscle fatigue, and repetitive injury patterns due to prolonged and intense training.

Professional esports athletes remain seated for long periods, and excessive exposure to blue light from screens can contribute to eye fatigue and potential retinal damage. Prolonged sitting is associated with chronic health issues and premature mortality. Additionally, the weight gain linked to sedentary behaviors in esports players may heighten the risks of cardiovascular diseases and diabetes. Poor sitting posture, combined with unhealthy habits such as smoking and excessive caffeine consumption, can exacerbate musculoskeletal problems—risks that are often correlated with video gaming.

The prolonged postures common in mobile gaming, such as forward head positioning and slouched shoulders, can strain the musculoskeletal system. Reports indicate high incidences of physical issues, including neck (42%), back (42%), wrist (36%), and hand/finger (32%) tendinopathy. Abnormal postures during extended sitting can lead to muscle strain and fatigue, compromising spinal support and increasing stress on ligaments and intervertebral discs, resulting in pain and discomfort. Factors such as repetitive motions and non-neutral postures further contribute to muscle imbalances and strain.

As mobile esports athletes face unique physical demands, understanding these health risks is critical. There is a pressing need for research to establish best practices for musculoskeletal health care within the esports community, particularly given the industry's rapid expansion. The potential health risks associated with high-intensity mobile gaming extend beyond professional players, as the increasing use of mobile devices for communication, entertainment, and work among adolescents and adults has led to a rise in related orthopedic injuries. Investigating the health and musculoskeletal concerns of esports competitors can provide valuable insights for injury prevention and education. Therefore, this study aims to explore the health risks and complaints of full-time elite mobile esports players.

Health problems commonly faced by E-athletes are as follows :

Body Part	Mechanism	Injury
Musculoskeletal system	Aberrant sitting prolonged posture	Neck pain
		“Text neck” syndrome
		Low-back pain
		Radiculopathy
		Gluteal pain
		Hamstring Tightness
	Repetitive movements	Shoulder overuse tendinopathy
		Elbow overuse tendinopathy
		Wrist overuse tendinopathy
		Cubital Tunnel Syndrome
		Carpal Tunnel Syndrome
		“Gamer’s thumb”
		Microtrauma
Ocular system	Long-lasting screen vision	Eye fatigue
		Dry eyes
		Temporary alterations of visual functions in children
	Virtual reality headset gaming	Alteration in the ocular surface and tear film
	Vergence-accommodation conflict	Decreasing vergence ability and accommodative facility
	Increased neural plasticity	Increased visual attentional resources in multi-object tracking
Nutrition	Overeating	Weight increase, obesity
	Energy expenditure, metabolism	Sedentary lifestyle, higher body fat percentage
	Wrong alimentation	Nutrients’ deficiency
	Increasing use of caffeine and energy drinks	Cardiac arrhythmias
Neurological system	Long-lasting screen vision	Headache
		Stress
		Insomnia
	Virtual reality headset gaming	“Cybersickness”
Mental Health	Addiction, isolation, several playing hours per game	Gambling
		Depression
		Stress
		Other psychosocial problems

Injury Prevention for E-Athletes

Injury prevention strategies for E-Athletes are as follows :

Stretching routine before and during gaming

Strengthening exercise

Appropriate posture

Appropriate ergonomics

Limit continuous gaming

Specific eyewear

Maintain volumes in an acceptable range

Adequate level of physical fitness

Adequate level of caloric and water intake

No excessive use of caffeine and energy drinks

Prefer healthy social interactions and team building

Relaxation techniques and meditation

Anxiety and stress control

Exercise Recommendations for E-Athletes

Exercise protocol for E-Athletes may include a warm up protocol, followed by an injury-prevention protocol and finally a cool-down protocol.

Esports Warm-Up Protocol Suggestions

Warm-up
Exercise characteristics	Examples
Aerobic—low intensity	• Marching on the spot with arm swings. • Light jog (indoors, outdoors, on a treadmill ... . ). • Cycling (indoors, outdoors, on a stationary bike ... . ). • Activities that use the bodyweight: jumping jacks, burpees ... .
Stretching	• Head turns and drops. • Arm circles (forward and backward). • Forearms rotations. • Forming a fist and spreading the fingers.
Sport-specific activities	• Solve crossword puzzles while lightly riding on a stationary bike or light jogging (cognitive skills + cardio activity). • Juggling with beanbags or balls (start with one then slowly start adding three or more). Variation: change in execution speed in response to an acoustic stimulus (eye–hand coordination + reaction time). • Lights hand touch (players have to touch the lights in response to an acoustic or visual stimulus; reaction time + cognitive skill). • Playing the game in which the player will compete in an easier environment (i.e., friendly matches, minigames from the actual game ... . ). • Breathing exercises, visualization exercises, or strategies to improve mood.

Forearms rotations

Solve crossword puzzles while lightly riding on a stationary bike or light jogging

Juggling with beanbags or balls

Lights hand touch

Knee to Chest Stretch

Esports Injury Prevention Protocol Suggestions

Injury prevention
Muscle/body part	Strengthening	Flexibility
Trunk	Suitcase carry Dead bugs	Cat-cow Knee to chest stretch
Back	Pull ups Barbell row	Child’s pose stretch Cobra stretch
Shoulder girdle	Overhead press Hands to elbows plank	Cross-body arm swings Cross-body shoulder stretch
Neck	Holding a neutral neck position while having a resistance band pulling toward a direction (forward, backward, sideway ... . )	Neck side, forward, and back bends Neck rotations
Pectoral	Dumbbell fly Dumbbell pullover	Corner pectoral stretch Lacrosse/tennis (hard) ball rolling
Arm	Biceps curl Eccentric triceps extension	Dynamic elbow extension/flexion Overhead triceps stretch
Forearm/wrist	Standing wrist extensions/flexions with weightlifting plates Barbell reverse curls	Wrist rotations Wrist flexors and extensors stretch
Hand	Fingers spread with resistance (i.e., elastic band) Squeezing a foam ball	Crossed fingers stretch Dynamic fingers extension/flexion

Esports Cooldown Protocol Suggestions

Cooldown examples

• Play in a soft, simple, and slow way (i.e., cooldown matches with the teammates or AI). • Gentle static stretches (similar exercises to those defined in “flexibility exercises”), followed by a 1-min hold of a posture in which the body and arms are allowed to fall forward while sitting or standing with feet wide apart (i.e., looking for a lengthen feeling in the muscles of the lower back). • Breathing slowly in a seated or lying position while quietly thinking about what was done.

Holding a neutral neck position while having a resistance band pulling toward a direction

Standing wrist extensions/flexions with weightlifting plates

Fingers spread with resistance

Esports Active Breaks Protocol Suggestions

Active breaks
Exercise complexity	Activity	Requirements
Low (6 min)	• High-intensity interval training (running, burpees, jumping jacks, cycling ... . ). • Calisthenics (pushups, planks, squats ... . ). • Flexibility and mobility exercises (they could be the same as in the injury prevention program) combined with breathing and relaxation exercises.	Time	+
		Equipment	+
		Preparation	+
Medium (6–15 min)	• Brief continuous aerobic exercise (running, cycling, walking ... . ). • Brief resistance training circuit (bench press, barbell rows, barbell back/front squat ... . ). • Brief games that promote movement, individually or in groups (Twister, do not let a balloon touch the ground, mirroring someone moving [i.e., a teammate or a video] ... . ).	Time	++
		Equipment	++/+++
		Preparation	++/+++
High (>15 min)	• Moderate duration continuous aerobic exercise (running, cycling, walking ... .). • Moderate duration resistance training circuit (bench press, barbell rows, barbell back/front squat ... .). • Moderate duration games that promote movement, individually or in groups (Twister, do not let a balloon touch the ground, mirroring someone moving [i.e., a teammate or a video] ... .).	Time	+++
		Equipment	++/+++
		Preparation	+++

This One-Minute Hand and Wrist Exercise Program can be performed while gaming to relieve pain due to prolonged loading of joints. It should be performed once every 1-2 hours.