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As competitive video game squads increase at colleges, experts say players are developing hand, neck, and wrist injuries. Getty Images

Most people probably don’t think of playing video games as a strenuous activity, let alone an athletic endeavor.

But the rise of competitive gaming, or esports, has transformed the landscape into one that more closely resembles competitive sports — complete with the risk of getting injured.

New research published in The BMJ studied 65 college esports players, finding that many of them reported pain in their hands, wrists, neck, and back as well as eye fatigue.

Dr. Hallie Zwibel, the study’s lead author and director of the New York Institute of Technology (NYIT) Center for Sports Medicine and a specialist in esports medicine, told Healthline that there just isn’t that much data out there concerning best practices for esports participants.

“As the team physicians for NYIT student-athletes, our core responsibility is to ensure the health and well-being of each and every player,” he explained. “When athletics decided to add esports at the varsity level we searched for the best practices in caring for these players. Usually, the way we do this is by consulting medical journals for research on these topics. However, to our surprise, there was very little information available.”

To that end, Zwibel and his colleagues set out to take a closer look.

In the past, competitive gaming was largely limited to hobbyists who competed against each other.

But in recent years, esports have become big business.

The National Basketball Association (NBA) and Take-Two Interactive Software, manufacturer of the popular NBA 2K video game series, teamed up in 2017 to launch a competitive gaming league.

The NBA 2K League pays players a five-figure salary and offers up to $1 million in grand prizes, along with health and medical benefits. Players can also make extra income through endorsement deals.

On the collegiate side of esports, about 125 academic institutions in the United States have varsity gaming programs, complete with a national governing body.

Like traditional athletes, competitive gamers need to put a significant amount of time into their craft. Zwibel found that the college esports players averaged 5 to 10 hours of gaming daily.

Gamers who play as a hobby have the option of stopping when they start to experience strain injuries. But that’s not always possible for people who are earning money or a scholarship for their gaming prowess.

What are their options?

“Just like a professional athlete would not walk into a game and start playing, they stretch,” explained Dr. Steven Beldner, co-director and co-founder of the New York Hand and Wrist Center of Lenox Hill. “There are specific stretching exercises because when something is stretched out, it’s less likely to be injured.”

Zwibel said that physical complaints such as hand and wrist sprain are to be expected for esports athletes, as they can make several hundred action moves in a minute as they game.

In addition, more than half of study subjects reported experiencing eye fatigue, which Zwibel said is likely due to computer vision syndrome.

“This occurs because of increased demands on the eye due to the lack of contrast and definition in pixel-generated computer images,” he said.

Then there’s the fact that esports takes a mental toll, which Zwibel says was the biggest surprise in the study.

Zwibel said that the psychological community has not reached a consensus on diagnosing addiction to video games.

“Based on this study, it seems that addiction to gaming is a real phenomenon but is not necessarily present in those playing at a high level,” said Zwibel. “We need to work in the medical community to better refine this diagnosis to avoid mislabeling players and to make certain that those with mental health issues are identified and receive the appropriate medical care.”

The strain injuries associated with gaming (and, for that matter, with long hours working on a computer) are hardly life-threatening, but they can affect quality of life.

Beldner said that if a primary care physician diagnoses these issues, the patient will typically be referred to a therapist.

“They’ll try an anti-inflammatory like Advil or Aleve to try and calm it down. Sometimes the therapist will give them a splint to rest the area and calm it down that way. For a lot of people, that’s all they need,” he said.

For people who don’t respond to these interventions, a cortisone shot that targets the afflicted area can be an option.

To mitigate the risk in the first place, it’s all about proper ergonomics.

Beldner says it’s important to be at eye level to the screen, with elbows bent to about 90 degrees so they’re parallel to the floor, and the wrists straight and unbent.

“Most people respond to ergonomic modification and then splinting and therapy,” said Beldner. “Some people need an injection. Very few go on to need surgery.”

While the NYIT study provides valuable data on a new phenomenon, Zwibel says there are still plenty of unknowns.

“The biggest takeaway is not what we found from our study, but what we still don’t know,” he said. “Now that we have identified these issues in players, we are actively working on inventing ways to limit their impact to prevent injury and improve overall health. Even more exciting for us is to apply sports science to this population to actually optimize their performance during gameplay.”

Playing video games is now a legitimate career for those who are skilled enough to be involved in these esports.

Long hours of gaming can cause eye fatigue, along with neck, back, wrist, and hand pain.

Proper stretching, ergonomics, and consulting with health professionals can help mitigate and control these risks.