Apparently safe: risks hidden beside eSports

Widespread around the world, eSports are affected by prejudices which hide the true risks

Not only vision and sleep disorders: the lack of structured training plans for professional gamers favours the onset of injuries. The most frequent cases involve carpal tunnel, tennis elbow and back pain.

The global impact of eSports, both as a phenomenon of entertainment and as professional activity, does not allow us to ignore the true nature of what is now considered a sport. The vastness of the public connected to the events of this discipline has been growing steadily over the years, estimated at 495 million spectators worldwide in 2020, with a great focus on the performance of high-level players generally subjected to strong intensity competition.

The Fortnite World Finals (five hours of gameplay) achieved 1.8 million watch hours in 2019, while League of Legends garnered 100 million viewers for the Riot Games multiplayer arena world cup, with 1.7 million people connected on Twitch. In Italy eSports fans are 1.6 million, plus 15% in 2021, while in Germany the pool is even wider, with 6.4 million enthusiasts in 2020.

The activity is so popular that 80 colleges and universities in the United States created their own eSports teams. However, prejudices about this sport are hard to clear: eSports are often considered non ‘physical’. A few people know that behind the success of professional electronic sports player there is also training, although there are still no well-marked paths as in the case of a football player, for example.

Yet, as in all disciplines, even eSport professionals are prone to injuries, mainly due to hard exercise, even in the amateur and mass categories. A player who sits in front of the computer for ten hours a day to improve his skills causes serious damage to his health. Some doctors, especially in the US, are asking to treat these professionals like athletes in other sports in schools and colleges.

“Poor posture can produce exponential forces on the neck, back, shoulder. Eye fatigue is the most reported ailment, caused by the pixelated images seen on the computer ” explained Hallie Zwibel, doctor at the Nyit Center for Sports Medicine, author of a research published on the British Journal of Medicine. “There is a lot of high-speed thinking that strains the eyes even more in the long run,” she points out. The blue light coming from the screens can suppress the melatonin hormone, favouring episodes of insomnia. The average duration of training (5-10 hours a day) among the 65 athletes observed, favours the onset of injuries from overuse in the hand, wrist, and other parts of the body.

While this activity can hardly appear physical, observers note that a player usually performs up to 300-400 very precise actions per minute (apm). The range of motion is small, but the repetitive gestures generate a risk of irritation for the tendons, inflammation and other similar disorders. Added to a sedentary lifestyle, this favours the onset of problems of the musculoskeletal system, a detail that delineates the group “profile of risk” of eSports players.

eSports can be so tiring that athletes sometimes retire in their twenties and there are several cases of famous players suffering from serious injuries. It happened to Hai “Hai” Lam “, a League of Legends professional who had to suspend his activities at 22 for a wrist problem; or Clinton” Fear “Loomis, a Dota 2 player, who suffers from a serious case of “tennis elbow”, which forced him to miss several competitions.

Also known as “mouse elbow”, this disorder is caused by an overload on the muscular system that flexes and stretches the wrist. The increased tension leads to subtle cracks at the base of the tendons around the elbow and, if exertion is continued, chronic inflammation and severe permanent pain can develop, which can radiate down the forearm to the hand. Recovery may require stopping activities, for a period of a few weeks to many years.

Another type of injury occurs when pressure increases on the nerves in the centre of the arm and on the small vessels that supply the carpal tunnel: insufficient oxygen and nutrients arrive, function is impaired and disturbances can occur, from a brief tingling in the wrist, to prolonged or permanent symptoms on the entire arm, compromising the sensitivity of the fingers and the ability to perform precise hand movements. The injury can be treated conservatively, but if the syndrome is advanced, surgery is inevitable. Recovery times are 4-6 weeks, avoiding heavy activities for this part of the body.

The third most common physical problem in eSports is back pain, usually caused by a lack of training, poor posture, and stress. Ignoring it can sometimes lead to a herniated disc, sciatic nerve irritation, or other pathological patterns. However, many complaints are caused by muscle tension and not a spinal disease. These problems may be prevented by exercising, an ergonomic chair or even just changing seat.

Researchers argue that schools need to provide prevention and treatment plans for eSports injuries as they do for traditional athletes. According to Zwibel, even non-professional players should be careful, as they could also suffer injuries from overuse and eyestrain. In general, there is a lack of holistic training structures, which can make this type of competitive activity sustainable in the long term, although some professional athletes have already begun to integrate physical activity and better manage their nutrition, alongside continuous computer training, to reduce the risk of injury.




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