Welcome to our third monthly grab bag of questions – again every month we answer popular questions we receive through email, twitter, instagram, etc. about gaming and health. Let’s get right into it! This week we address forearm pain as a PC player, preventing finger injuries and gamecube controller ergonomics.

1| I have pain at my forearm here (picture provided) when I play games alot – why?

This is a question we have gotten over and over. While I have written in alot of detail regarding repetitive strain and overuse – I figured I’d try to answer this question in a more brief manner for anyone who wants to get a quick understanding of what is happening.

There are two great articles you guys can check out which may help your understanding of what is going on.

  1. What gamers need to know about injuries in gaming
  2. Managing RSI in gaming

This is a question i’ve received from both the pros I work with along with some patients I’ve worked with in the past.

Why do you have pain here? I included both of these pain regions because it often begins in the red one first (well call that P1) and then progresses to the purple one (we’ll call it P2). So what is causing your pain in both of these regions?

P1 is a muscle group which controls the bending of your fingers (I.e. clicking or typing). While there are other muscles there which control the wrist bending – they aren’t used as actively as those which bend your finger while you play on the PC – for the nerds it is – Flexor Digitorum Profundus, Flexor Digitorum Superficialis. Two muscles controlling the bending of the fingers.

Guess what? P2 are the TENDONS of these muscles which travel through the carpal tunnel at the wrist. They often become overused with continued play even after feeling pain at the forearm. So to answer the question: You are feeling pain at the muscle and its respective tendons. Lets answer they why quickly…

As I have said many many times before – it is overuse and repetitive strain. The tissue can’t handle the stress that is applied to it over time and we often discount the pain we feel because it goes away when we rest. What we don’t realize is our tissues are getting weaker and can’t handle playing for long periods of time because of this weakness/lack of endurance. Again in an article i’ve written – I want our community to understand our muscles and tendons behave like overheating meters (See the article i’ve written about it here) and in order to both MANAGE the pain that we are dealing with along with PREVENTING the pain we have to perform exercises to improve our endurance and ability to handle loads for longer periods of time.

Here are my go to exercise walkthroughs you guys can perform

  1. 9 minutes every day to build endurance
  2. 6 minutes after games alleviate stiffness and stress placed upon the muscles after your gaming session

If you have more questions about why you are feeling the pain – feel free to dm me on twitter 🙂

2| Hello, I have a question about some pain I’m having. I had what I thought was a shoulder injury a year ago and rested it until stretching rehab as of two weeks ago. I went to the doctors for it last year and they said to just rehab it, it’s probably a tear and everything’s fine. When I did the over arm stretch while I was resting (illustrated in the middle) I felt around with my hand in the back of my armpit and there was immediate soreness. Its tender with a numbing and tingling sensation up my hands and shoulder area. Any idea what this might be? Thanks for reading.

While it is tough for me to truly answer this question (due to the varying tissues it could potentially be and my not being able to assess you to clearly determine the source of the numbness/pain) – I want to provide some guidance on what you can do if you have this same pattern.

Based on the description given – I am not given much information on what the potential injury was however based on the pain location and behavior I believe it is a combination of muscle irritation with nerve entrapment. The muscle irritated is one of three (latissimus, teres major and teres minor) based on the location and typically with gamers there is likely nerve entrapment at various sites due to poor posture (pec minor, 1st rib and scalenes)

This probably seems like foreign language to you guys but basically – the pain is due to muscle, the numbness is due to a nerve. Instead of attempting to provide you a shotgun approach and give you random exercises which may or may not help – I suggest reaching out to a local PHYSICAL THERAPIST. A family practice physician will not perform an in-depth musculoskeletal examination to determine the source, contributing factors to your pain and often only provide medication to help with pain (not truly addressing the cause of the pain). This is not a slight to MDs in anyway – based on education regarding musculoskeletal injuries we are more equipped to evaluate and treat these type of injuries.

SO seek out a physical therapist or ask for a referral for PT from your MD. You will find out the following with your shoulder pain.

1. Tissue Source – What tissue is actually causing your pain
2. Contributing Factors – Posture, Ergonomics, Wrist Endurance/Strength, Mobility, motor coordination, etc.
3. Expectations with management – how long it will take for you to reduce your pain and improve function
4. Answering any questions associated with the injury

3| Hey I wanted to ask you what exercises I should do to prevent finger injuries from playing the piano/video games. Although I didn‘t experience any pain yet I want to ask, to prevent that from happening

There’s plenty you can do to prevent injuries! You’ve done the first already–you recognized that playing piano and playing video games results in stressing some of the same muscle groups.  There are a few ways you’ll want to address those stresses: stretches, strengthening, modalities, and positioning.

When it comes to stretching, both your forearms and your hands need attention. The muscles that control your fingers and hands are located both in your forearms and in the hands themselves. Beyond that, if you’re sitting for any extended period of time, your back and core muscles will also need a break. I recommend the stretches included in my How To Save Your Neck, Back, & Hands guide as a good place to start. Keep in mind, though, that these are the stretches that hit the MOST COMMON points of strain, not every point of strain. You may well find that other areas feel tight after playing either games or piano. Stretch those areas too!

Key points for stretching:

  1. Never stretch cold muscles! Always do a warmup first.
  2. Stretching shouldn’t be sharply painful.
  3. Don’t force a stretch or overstretch; you don’t have to push your muscles as far as they can possibly go to get a good stretch.

Stretching alone isn’t enough to fix or prevent injury, though. Injury occurs when your body is no longer able to adapt to a stressor. One of the ways you can help your body have a higher capacity for adaptation and a lower risk of injury (or, to use our Heat Meter analogy, to extend your meter and avoid overheating) is by STRENGTHENING those muscle groups that bear the brunt of your gaming and instrument-playing stress.

In addition to the resources we list in answer #4, this 5-minute series of exercises can help. It’s great for breaks between games/matches. (Not sure how frequently you should be taking breaks? Here you go!) It’s also worth taking the time to do a warm-up before you play either instruments or video games. Matt has two great guides here:

  1. Anti-Sitting Routine
  2. 5-Minute Full Body Warmup

Even if you strengthen your muscles and stretch them appropriately, you may still find that you’re having discomfort. Ideally, you’d take that as a cue to back off a bit with regards to volume or intensity of playtime. That’s not always realistic, though, and it’s important to manage symptoms as they flare up acutely. NOTE: If you’re consistently having pain and fatigue, or your pain and fatigue is worsening in spite of preventive treatment, that’s your body’s way of warning you that injury is imminent. If you’re only having the occasional flare, though, you can use ice, heat, and massage to manage them.

The specifics are outlined in the linked article, but in general:

  1. Use ICE for pain related to inflammation, which is characterized by swelling and local heat.
  2. Use HEAT for pain related to tension, which is characterized by stiffness and crampy, achy, tight pain.
  3. Use MASSAGE for pain related to tension but only AFTER muscles are already warmed up.

Last but probably MOST importantly, you need to consider your posture and positioning. When you’re playing piano, you’re sitting without back support. That means that even more than when you’re gaming, you need to engage your core muscles–abs and back–while sitting at the piano. When it comes to gaming, you should make use of the back support available to you rather than leaning forward and putting your weight through your forearms. Keep your arms supported as well, ideally at about bellybutton height and level with your keyboard (if you’re playing on PC).

Your posture should look something like this:

So, to recap:

  1. Warm up before you play piano or video games.
  2. Take breaks every 30-60 minutes and stretch, exercise, or move during those breaks.
  3. Use ice, heat, and massage when necessary.
  4. Prioritize good posture and ergonomics that support you.

4| I have this idea that I would like to try and I need some advice if ur willing to give it. I would like to design and possibly make a GameCube controller that is more ergonomic. I want to make one that is still a controller that feels somewhat like the original,unlike the boxx. So far I plan to make the controller larger overall as it is much too tiny for adult hands. Do you have any suggestions to modify aspects of the current GameCube controller? Does changing the triggers so the fingers don’t have to be bent at a strange angle sound like a good idea?

I’ll preface this answer by saying that industrial design isn’t an area I have much experience in. That being said, there are still some general principles I’d recommend incorporating into a controller redesign.

First, the force required to press the buttons or move the analog stick should be relatively low. The higher the force required, the greater the amount of fatigue over time. The buttons should also be spaced apart from each other enough that the incidence of accidentally mashing the wrong button is low.

When it comes to controller size, your target demographic is going to drive your design. Using a sample of anthropometric data on hand and finger size, you can get a better idea of what size will fit the majority of your players. Think of it like a bell curve–your goal should be to design a controller that fits the players falling within 1 standard deviation of the mean hand size.

You’re also right that button position is important. It’s not just the distance that your finger has to travel that matters, but also the angle, the number of times, and the other buttons you also need to hit. It’s equally important to have easy movement between two buttons you’ll need to hit in rapid succession as it is to have easy movement from a resting position to the button.

Consider finding ways to reduce the amount of grip strength players need to use by adding grip surfaces with increased friction or using grooves for the fingers to rest in. It might also be possible to keep the original controller shape but to increase the width enough, while keeping buttons close to the edges, to make it more convenient for players to rest their forearms on armrests while playing.

That’s it for this month’s questions–if you’ve got answers you’re looking for, send the questions our way (via twitter @hpforgamers & @caitmcgeept or direct email in the askmatt/cait links above) and we’ll answer them in the next iteration of HEALTHGAMEFAQS



Questions, comments, thoughts? let us know below!

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