Electronic Sports

Original Editor - Carina Therese Magtibay

Introduction[edit | edit source]

Electronic sports (esports) which is one of the fastest-growing sporting activities in the world is an individual or team video game competition that is usually sponsored by different business organizations[1]. Similar to traditional sporting events, esports tournaments comprise of rules, systems, gameplay, evaluation, and broadcasting. [2]

Gaining traction in the early 2000s, esports exponentially increased over the years, garnering over 450 million viewers across the globe and more than $25 billion in revenue last 2019.[3] It began as a LAN-Party (local area network) community where video game enthusiasts met on weekends to play with and against each other.[4] With the advancement of technology, allowing for faster and easier access to the Internet, esports is now a common recreational activity that is also recognized as a sport.[2]


Esports and Physiotherapy[edit | edit source]

The lack of general physical activity in conjunction with repetitive microtrauma in hand and upper extremity muscles among esports players lead to health risks and musculoskeletal injuries. On average, gamers spend 3 to 10 hours training per day, resulting in complaints of: [6]

  • eye fatigue
  • neck pain
  • shoulder complex pain
  • back pain
  • wrist and hand pain.

There are two main causes of significant esports-related musculoskeletal hazards:[7]

  1. Sitting for an extended period of time often with poor posture
  2. Fine motor strain through repetitive actions
    • Professional esports players perform an average of 10 moves per second or up to 500 to 600 moves per minute[8]
    • Esports load is nearly triple the 8000 to 11000 keystrokes (130-180 actions per minute) of office workers[9]

According to DiFrancisco-Donoghue et al. (2019), physiotherapists, along with esports coaches, trainers, sports physicians, psychologists, etc., should collaborate for a holistic approach in the assessment and improvement of esports players' performance. Physiotherapists act as primary care providers in a multidisciplinary model of care to address concerns related to overall physical activity levels, injury prevention, injury management, and competitive performance. At present, clinical management of esports injuries relies primarily on musculoskeletal first principles of assessment and treatment.[10]

Musculoskeletal Health Promotion and Performance Optimization Recommendations[7][11][edit | edit source]

• Begin with 3 to 5 min of warm-up stretch with 5 min of stretching every 2 h.

• Stretches throughout gameplay. Muscles to stretch:

  1. Pectoralis and anterior shoulder muscles
  2. Quadriceps and hamstring muscles
  3. Gastrocnemius

• Muscles to strengthen:

  1. Cervical and core muscles
  2. Periscapular muscles (treatment of scapular dyskinesia)
  3. Gluteal and deep hip muscles

•Exercises should include:

  1. Regular seated toe raises while gaming
  2. Flexion, extension and rotation of the cervical, thoracic and lumbar spine

• Maintain appropriate posture:

  1. Adjust chair or couch so knees are horizontally positioned with respect to floor and upper arms are in line with torso
  2. The spine should be in a neutral position so that the head, chest, and hips stack on each other
  3. Consider use of padded wrist support during gaming.

• Heightened awareness of a possible DVT if athlete reports lower extremity pain, swelling, orerythema. Screening for underlying risk factors should be considered prior to competition season (e.g., factor V Leiden mutations or use of oral contraceptive pills).

• Consider having a presentation by a sports medicine physician and physical therapist regarding these recommendations.

Potential Health Promotion Strategies in Esports[edit | edit source]

Esports doesn't have to be a sedentary sport. There are Health Promotion Strategies to incorporate physical activity in esports:[12]

  1. Digital Technologies. Automation and technological advancements may be linked to physical inactivity due to increased occupational sitting and screen-based entertainment, but it can also promote healthy behavior through fitness trackers, smartphone applications, and wearable technologies that offer innovative solutions.[12][13] [14]
  2. Movement-Based Games and Exergames. Esports genres incorporating motion-enhancing, mediating cross-spatial immersive technologies such as augmented reality (AR), mixed reality (MR), or virtual reality (VR) encourage physical activity and represent a potential for competition in physical esports.[15][16] [17]
  3. Media Ecosystem. Effective health campaigns spread and foster awareness, recognition, reach, and engagement[18][19]. Social media platforms are useful for health message dissemination by providing access to at-risk or “hidden” audiences and increasing engagement.[20]
  4. Physical Activity to Enhance Esports Performance. Just like traditional sports, the performance of esports athletes does not solely rely on playing the game repeatedly. Training should also include specific skills in non-gaming environments. Several studies suggest that physical exercise can positively modulate the anatomy, physiology, and brain function, thus, boosting a player's cognitive abilities[21][22][23].

Future of Esports[edit | edit source]

While training of professional sports athletes is based on well-established scientific research, high-evidence literature on esports training is still limited.[24] With the rapid pace of esports' development, more prevalence data, especially longitudinal data on specific musculoskeletal conditions across esports games and across levels of performance are needed.[10]

References[edit | edit source]

  1. Hamari J, Sjöblom M. What is eSports and why do people watch it?. Internet research. 2017 Apr 3;27(2):211-32.
  2. 2.0 2.1 Giakoni-Ramírez F, Merellano-Navarro E, Duclos-Bastías D. Professional esports players: motivation and physical activity levels. International journal of environmental research and public health. 2022 Feb 16;19(4):2256.
  3. Ahn J, Collis W, Jenny S. The one billion dollar myth: Methods for sizing the massively undervalued esports revenue landscape. International Journal of Esports. 2020 Oct 4;1(1).
  4. Werder K. Esport. Business & Information Systems Engineering. 2022 Jun;64(3):393-9.
  5. British Esports. What is Esports? Available from: https://www.youtube.com/watch?v=5VAd4UsXyVo [last accessed 22/2/2023]
  6. DiFrancisco-Donoghue J, Balentine J, Schmidt G, Zwibel H. Managing the health of the eSport athlete: an integrated health management model. BMJ open sport & exercise medicine. 2019 Jan 1;5(1):e000467. BibTeXEndNoteRefManRefWorks
  7. 7.0 7.1 Emara AK, Ng MK, Cruickshank JA, Kampert MW, Piuzzi NS, Schaffer JL, King D. Gamer's health guide: optimizing performance, recognizing hazards, and promoting wellness in esports. Current Sports Medicine Reports. 2020 Dec 1;19(12):537-45.
  8. Lewis J, Trinh P, Kirsh D. A corpus analysis of strategy video game play in starcraft: Brood war. InProceedings of the Annual Meeting of the Cognitive Science Society 2011 (Vol. 33, No. 33).
  9. Szeto GP, Straker LM, O’Sullivan PB. The effects of speed and force of keyboard operation on neck–shoulder muscle activities in symptomatic and asymptomatic office workers. International Journal of Industrial Ergonomics. 2005 May 1;35(5):429-44.
  10. 10.0 10.1 McGee C, Hwu M, Nicholson LL, Ho KK. More than a game: musculoskeletal injuries and a key role for the physical therapist in Esports. Journal of orthopaedic & sports physical therapy. 2021 Sep;51(9):415-7.
  11. Hallmann K, Giel T. eSports–Competitive sports or recreational activity?. Sport management review. 2018 Feb 1;21(1):14-20.
  12. 12.0 12.1 Ketelhut S, Martin-Niedecken AL, Zimmermann P, Nigg CR. Physical activity and health promotion in esports and gaming–discussing unique opportunities for an unprecedented cultural phenomenon. Frontiers in sports and active living. 2021 Sep 16;3:693700. BibTeXEndNoteRefManRefWorks
  13. Lewis BA, Napolitano MA, Buman MP, Williams DM, Nigg CR. Future directions in physical activity intervention research: expanding our focus to sedentary behaviors, technology, and dissemination. Journal of behavioral medicine. 2017 Feb;40:112-26.
  14. Spanakis EG, Santana S, Tsiknakis M, Marias K, Sakkalis V, Teixeira A, Janssen JH, De Jong H, Tziraki C. Technology-based innovations to foster personalized healthy lifestyles and well-being: a targeted review. Journal of medical Internet research. 2016 Jun 24;18(6):e128.
  15. Marshall J, Linehan C. Are Exergames Exercise? A Scoping Review of the Short-Term Effects of Exertion Games. IEEE Transactions on Games. 2020 May 18;13(2):160-9.
  16. Martin-Niedecken AL, Schwarz T, Schättin A. Comparing the impact of heart rate-based in-game adaptations in an exergame-based functional high-intensity interval training on training intensity and experience in healthy young adults. Frontiers in Psychology. 2021 Jun 21;12:572877.
  17. Farrow M, Lutteroth C, Rouse PC, Bilzon JL. Virtual-reality exergaming improves performance during high-intensity interval training. European journal of sport science. 2019 Jul 3;19(6):719-27.
  18. Hair E, Pitzer L, Bennett M, Halenar M, Rath J, Cantrell J, Dorrler N, Asche E, Vallone D. Harnessing youth and young adult culture: Improving the reach and engagement of the truth® campaign. Journal of Health Communication. 2017 Jul 3;22(7):568-75.
  19. Lelutiu-Weinberger C, Pachankis JE, Gamarel KE, Surace A, Golub SA, Parsons JT. Feasibility, acceptability, and preliminary efficacy of a live-chat social media intervention to reduce HIV risk among young men who have sex with men. AIDS and Behavior. 2015 Jul;19:1214-27.
  20. Kostygina G, Tran H, Binns S, Szczypka G, Emery S, Vallone D, Hair E. Boosting health campaign reach and engagement through use of social media influencers and memes. Social Media+ Society. 2020 May;6(2):2056305120912475.
  21. Chang YK, Labban JD, Gapin JI, Etnier JL. The effects of acute exercise on cognitive performance: a meta-analysis. Brain research. 2012 May 9;1453:87-101.
  22. Toth AJ, Ramsbottom N, Kowal M, Campbell MJ. Converging evidence supporting the cognitive link between exercise and esport performance: a dual systematic review. Brain Sciences. 2020 Nov 15;10(11):859.
  23. Kramer AF, Colcombe S. Fitness effects on the cognitive function of older adults: a meta-analytic study—revisited. Perspectives on Psychological Science. 2018 Mar;13(2):213-7.
  24. Nagorsky E, Wiemeyer J. The structure of performance and training in esports. PloS one. 2020 Aug 25;15(8):e0237584.