The topic of esports medicine and the roles of the multidisciplinary healthcare team in esports has been a subject of much discussion in recent events. Due to ambiguity in roles, piecemeal multidisciplinary support, and healthcare providers without proper training in the space much of the medicolegal liability currently falls on the esports teams and game publishers. In order to mitigate this risk systems must be put into place that allows for the players to receive competent, timely, multidisciplinary esports medical care for both physical and mental needs.
This article written by Agostino Rossoni et al. from the Laboratory of Clinical Physiology and Sports Medicine in Italy begins by discussing the growing phenomenon of electronic sports (esports), which is defined as a form of sport facilitated by electronic systems and human-computer interfaces. Despite its international recognition, there is still resistance as to whether esports can truly be considered a sport. This paper aims to review the different injuries that esports athletes may experience and emphasizes the importance of a pre-participation evaluation and injury prevention program.
The question remains whether esports can be considered a physical sport discipline. Two criteria for classifying a sport are physical performance and institutional stability. Although there is no general agreement on the classification of esports, global organizations exist, and different genres of games can be categorized. Professional esports players share similarities with traditional physical athletes and have mental and physical concerns, such as stress and short career life. esports has many benefits, including improvement of health and well-being, cognitive development, and social interaction. However, some harmful effects are also present, such as potential child safety issues, exposure to violence, and musculoskeletal overuse. Professional esports athletes train on average 5 hours a day to improve their game skills and motor abilities, sustain high levels of attention, and make important decisions under time pressure during competition.
The author discusses the health problems associated with esports, which include physical and mental health issues. The most common physical problems are musculoskeletal complaints, such as neck and back pain, and repetitive strain injuries like carpal tunnel syndrome (editor’s note: carpal tunnel is rarely seen in esports and tendinopathy spectrum disorders are much more prevalent). The article suggests that preventative measures, diagnosis, and treatment of esports-related issues are necessary to address these health problems. Proper posture, stretching, and strengthening exercises are recommended to alleviate musculoskeletal complaints. Diagnostic instruments and ergonomics assessment tools can also be used to screen for and assess these esports medicine issues.
The article then highlights the importance of eye health and the potential hazards of excessive screen time, particularly in esports where players are required to focus on a computer screen for extended periods of time. The article suggests limiting playtime and using devices like screen glasses to avoid these hazards. Additionally, the evaluation of athletes’ eye health should include assessing visual acuity, eye position and alignment, extraocular movements, and oculomotor performance training. Eye exercises are recommended to optimize performance. The American Optometric Association’s 20/20/20 rule is also suggested, where players take a 20-second break every 20 minutes to look at something 20 feet away.
esports athletes often have poor nutritional habits, with irregular meals, frequent snacking, and unhealthy food choices. A balanced diet is crucial for esports athletes, and personalized diets should be followed to maintain strength and energy. Deficiencies in nutrients may cause symptoms of fatigue, depression, and dementia. Energy drinks (EDs) are commonly used by esports athletes but may have negative health effects, including cardiovascular side effects, dyslipidemia, and weight gain. Caffeine is a common ingredient in EDs and may improve cognitive and physical performance, but its dosage should be closely monitored to avoid adverse effects. Nutritional screening questionnaires and doping control rules should be implemented to ensure esports athletes’ proper nutrition and supplement use.
Recent literature has questioned the effects of gaming on the human brain, as long hours of online gaming could be linked to mental health issues such as depression, social phobia, obsession-compulsion disorder, and gaming addiction. The use of validated questionnaires can be useful to diagnose these problems. Screens of digital devices may interfere with sleep and blue light-blocking glasses and a sleep hygiene plan can improve sleep duration and quality. When using virtual reality devices, players may develop symptoms similar to motion sickness, the so-called cybersickness. However, active video games have a positive psychological impact, and gaming was shown to be effective also as a therapy against mental disorders, such as attention deficit hyperactivity disorder (ADHD). Recent studies suggest a promising positive relationship between esports and neural plasticity, making esports a valid field for neurocognitive research.
Physical fitness is an important aspect for esports athletes, despite the common misconception that esports is a passive activity. While video games may not improve cardiorespiratory fitness, almost 90% of elite esports athletes exercise regularly in the gym for about 5 hours daily, which is more than the physical activity recommendations of WHO for both children and adults. However, a significant portion of esports athletes do not recognize the important relationship between physical and mental health and do not participate in any form of physical activity.
It is important to screen the physical fitness of esports athletes, including cardiorespiratory fitness, muscle endurance and strength, body composition, balance, and flexibility, in order to set a correct training plan, monitor progress, and evaluate physical functioning. The esports world has enormous potential for physical activity and health-promoting efforts, and several platforms have developed eGames where level advancement requires the player to walk, run, and ride a bicycle, mixing reality with the virtual world.
The cardiovascular system is an important aspect of esports that has received increasing attention in recent years. Studies have shown that playing esports can lead to an increase in heart rate, blood pressure, and cardiorespiratory fitness. The increase in heart rate is indicative of an activation of the sympathetic nervous system, possibly through the release of catecholamines, which is particularly evident during competitive play.
While these cardiovascular adaptations can be beneficial in the short term, prolonged sitting during gaming sessions can lead to water retention and potentially deep venous thrombosis. Additionally, mental stress and heightened emotion, such as anger, can trigger cardiac arrhythmias in predisposed individuals. Yamagata et al. hypothesized that cardiovascular sequelae in esports athletes could be caused by sleep deprivation, psychological stress, and stimulant use.
Because some esports players may have hidden or known cardiovascular disease, it may be useful to implement a pre-participation evaluation for esports athletes by the esports medicine team, similar to what is already practiced for skill discipline athletes. This could include a medical evaluation investigating family and personal history, a comprehensive physical examination, a resting ECG, and a resting blood pressure value, as well as echocardiography, Holter ECG, and magnetic resonance imaging as needed. The goal of such evaluations is to identify cardiovascular conditions that may increase the risk of sudden death in young players.
In addition, as esports continues to grow, there is a need for standardized regulations and guidelines to ensure fair play and prevent doping. It will also be important to address issues of mental health and stress management for esports athletes. Another potential area of research could be the development of training programs for esports athletes that optimize their cognitive and physical abilities, as well as their teamwork and communication skills.
As esports continues to gain popularity and acceptance, the medical community should stay informed and engaged in efforts to promote the health and well-being of esports athletes. This will require collaboration between esports organizations, medical professionals, and researchers to develop evidence-based guidelines for training, injury prevention, and overall health maintenance. With continued attention and research, esports has the potential to become a safer and more sustainable discipline for both amateur and professional esports athletes.
Rossoni A, Vecchiato M, Brugin E, Tranchita E, Adami PE, Bartesaghi M, Cavarretta E, Palermi S. The eSports Medicine: Pre-Participation Screening and Injuries Management-An Update. Sports (Basel). 2023 Feb 1;11(2):34. doi: 10.3390/sports11020034. PMID: 36828319; PMCID: PMC9966106.
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