LET’S TALK about the current state of eSports from a healthcare perspective. I’ve officially be working from within the eSports industry for 8 months now and I’ve seen and learned so much. So today with this article, I want to offer my thoughts about eSports and the competitive gaming scene – more specifically, about whether the infrastructure of healthcare (Involving Physical Health, Injuries, Nutrition and Mindset management) has been keeping up with the massive growth of the industry.

As you guys know, esports has made leaps in growth this year.

Establishment of E-League: A professional CS:GO League broadcasting on TBS and twitch over 10 weeks with a 1.4 million prize pool. The DOTA 2 International: Year after Year this event surpasses its prize pool total – this year reaching a record 20 million. The largest in eSports history And now the WESG: A 3.7 million prize pool competition sponsored by Alibaba

I also read that The DOTA 2 International and LCS championships surpassed the viewership of the NBA finals the past couple of years. There Is no doubt that our industry is rapidly developing and I love it. No more dark and grimey basements for competitions, its only big bright lights now.

But with all of this growth, how have we been doing in the realm of healthcare infrastructure?

Unfortunately we’re behind, although we are moving in the right direction.

When I say healthcare infrastructure, I mean the management and perspective on Physical, Mental, Nutrition and Lifestyle of competitive gamers and professionals who dedicate long hours into perfecting their skill. Before I begin to talk about how we are behind, it is important to define what eSports is in the context of being a sport. The nature of it is obviously completely different than that of a traditional sport.

Defining eSports – Why we need to better understand the sport

An understanding of what eSports are not only helps those who look in from the outside better understand our community but also assists support staff aiming to improve the performance of their athletes more effectively make an impact on the various aspects of player management.

eSport: A static, endurance sport which tests our executive functions through a virtual environment.

Comparing eSports to traditional sports, eSports are more static (little to no movement within small ranges of motion) than dynamic (a lot of moving bodies and at high velocities and power with the body moving through wide ranges of motion). And when we think about it, traditional sports have a physical game at its foundation whereas eSports have a virtual game at its foundation. (not to say that the repetitive movements at your shoulder and wrists, and fingers aren’t physical)

So extending that thought process a little further, traditional sports are more a test of physical capacity. While I don’t want to underscore the mental component, the physical component is at the foundation what’s being challenged. Although that’s a different story at the highest level.

eSports however are more a test of cognitive capacity and what is referred to as Executive Functions – so reasoning, problem solving, cognitive flexibility, working memory, attentional control, all of those as they relate to managing the intricate details of a complex or well-designed game. The physical component to eSports which as I mentioned earlier, is essentially a lot of small movements at the wrists, hands and sometimes shoulders (that could change with VR in the future).

This leads me to the discussion of what TYPE of sport eSports can be considered. If we analyze the physical demand just a little bit, we can see that it is definitely not a power or explosive sport like basketball, football, volleyball but more an endurance sport like running. Cyclical, repeated movements over an extended period of time, for which our body needs to be conditioned in order to prevent injury. And just like with running, the mindset component is huge, which is why many resources have been allocated to work on this aspect.

Okay, so It’s a more static endurance sport, with more of an emphasis on cognitive capacity. What does that mean in terms of injuries? Here are my thoughts as a Physical Therapist.

Injuries in eSports – Digging Deeper into why they happen

Traditional Sports are VERY unpredictable when it comes to injuries. There are so many moving bodies at once in the team sports that are out there, and because of this it creates a lot of opportunities for injuries all over the body. And of course depending on the sport, some body parts are injured more frequently than others. For instance, with something like soccer, the knee is subject to a lot of strain with the exposure to a lot of pivoting type movements in let’s say high-pressure situations.

eSports on the other hand is very predictable when it comes to injuries. It’s essentially what many of us do all day at hunched over in front of a computer at work, but to the extreme extent. Repetitive Strain in the name of the game. Millions of “actions” or little movements of the wrist/hand/forearm are performed throughout the day that consistently load the muscles and tendons that we use when we binge or play consecutive competitive matches.

All we really have to understand is the physical stress theory, which is basically our bodies will either adapt or breakdown to the cumulative stress that is applied to it. I will be elaborating further about this in another article… along with why I believe Physical Therapists are the most equipped to provide support for all the gamers and eSports athletes in our community.

So just to sum up, esports, while complicated virtually, is quite simple physically. We can do very easy things, to prevent “retiring”, or “unable to participate in competition” a reality.

When there is injury, there needs to be someone who understands holistic rehab, to get the gamer or professional back to their former self and better. A lot of players who have come back rarely achieve their previous form (mostly because they use the absence of pain as a metric for being better). It’s not just about masking the pain with some tape (while it can be helpful) – The long-term solution is more than that guys. That’s why I’m here.

Why Infrastructure is Important

One reason for the delay in growth of health management infrastructure is because most of the community does not understand the nature of eSports and injuries.

We need to be honest with ourselves – these injuries and the pain that comes along with them is one of the biggest issues in eSports and it’s not only being ignored but again people just don’t understand it well. I see posts surface on all of the subreddits, hltv forums, league forums, team liquid forums, really just any forum related to competitive and daily gaming every 2 months or so talking about wrist pain, lower back pain, and even numbness. These posts blows up and hits the front page or become a ridiculously active thread and then just disappear. Why? Because EVERY GAMER HAS DEALT WITH PAIN. In fact, like I said it’s somewhat expected. And it’s surprising that There doesn’t seem to be any established resource out there to help.

I believe this is in-part due to the professional scene. Injuries continue to occur with each month that passes by at the professional level and are often mismanaged due to management by Physicians who do not have an adequate understanding of the musculoskeletal system (to get a perspective, MD coursework offers 1-2 classes on the musculoskeletal system, while PT’s spend 3 years with the musculoskeletal system as a primary focus). Tournament hosts, league owners and organizations are only beginning to realize the importance of this and have finally begun utilizing those like myself for the players. Finally. But it’s still quite behind as the surfaced has only been touched with this and because the barrier of entry low for our industry, it is easy for those who may have great intentions, provide services which lead to a poor understanding of health management. It is not only massage. It is not only exercise. It is not only changing your nutrition. It is everything.

One day, the infrastructure will be there. I have a vision that it will be. I see that esports athletes will have this well-developed and supportive health & fitness infrastructure that will not only arm the professionals but the rest of the community with the proper knowledge to stay healthy and continue gaming.

I see a support team of professionals like myself heading to these major competitions with the team to keep the players focused from the moment they step onto the plane to the moment they guys spawn on the rift. To keep players physically relaxed throughout competition, in between matches, series with targeted manual techniques, nerve facilitation exercises, specific stretching. To keep every player on each team on a nutritionally sound program so you guys can perform and think optimally, with properly timed meals surrounding your competition time.

I hope to see this vision come true and I do want to become part of it.

The Solution:

There are several ways this can happen…

1. Awareness

The first being awareness. We have to acknowledge that this is an issue. We meaning the organizations, league owners, tournament hosts, all have to be honest in our reflection of how much of an actual problem this is and the simple steps we can take to address it. We all need to understand eSports as a sport more clearly but also have to be willing to make the necessary changes to incorporate the measures to keep the community and its players healthy. So whether it be changing the structure of competitions, or advocating on a consistent basis on the standard of healthy living within esports, some steps should be taken to push the awareness of the importance of health maintenance while playing games.

2. Top-Down Approach

Another way we can help the eSports community stay healthy is to start from the top down. Again, I mean helping the professional eSports athletes establish healthy lifestyles and proper fitness/behavior. This will trickle down into the rest of the community. I am so happy that CLG is the pioneer on this front and was willing to bring me on to help their players. It has been an incredible journey with them thus far, and I am excited for what is to come. I can only hope that other organizations follow in CLG’s footsteps

3. Holistic Resource

Finally – there has to be an actual resource that will be able to provide the eSports community with simple, practical and effective advice on how to manage the 5 important aspects of health: Exercise, Nutrition, Injury Management, General Health Practice & Prevention and Mindset. With accessible and easily applicable information, the eSports community can break away from all of the negative stereotypes associated with gamers so that in the future when gamers are mentioned, this is the type of person you will think about. I am working extremely hard to develop 1-HP to become this resource.

I am happy about the direction eSports is headed with healthcare, and hope we all take the steps toward creating a better community!