HEALTHGAMEFAQs#4 - OVERWATCH GAMING PAIN EDITION

Welcome to our fourth monthly grab bag of questions - again every month we answer popular questions we receive through email, twitter, instagram, etc. about gaming and health. This month we decided to do it a little differently. I made a reddit post on r/competitiveoverwatch and r/overwatch which led to quite a few questions relating to Overwatch. So this is focused purely on those questions I've received.

1| What’s your opinion about mechanical keyboards? I use a regular membrane keyboard at work, and a Cherry MX at home to play, and I’ve noticed straining in my fingers after playing for a while. Is the longer actuation distance (how deep I have to press the key to get an input) relevant?

Actuation force (the force that you have to press your key for it to register) has definitely been shown to be related to musculoskeletal symptoms (I believe it was > 56 centinewtons of force which equates to the Cherry MX Blacks or higher) Blue/Red/White are 50/45/55, respectively. So Cherry MX is generally okay. With regards to what you are feeling Work & Gaming are often different when it comes to APM and again posture/ergonomics/scheduling all come into play again. I would say it is most likely the fact you are gaming with higher APMs that is causing your fingers to feel more strained. In terms of general causes of overuse it is commonly one of three things

Poor Wrist Position/Posture (starting off neutral)
Poor Wrist Conditioning
Playing too much (poor scheduling)

So if we work backwards it means we should…

WRIST POSITION IS KING: Pay attention to our wrist position for both your mouse and keyboard hand. I just finished working with a pro CSGO player whose starting mouse position was tilted to the right which was the major cause of his pain. After we corrected this position (expecting time to retrain using his mouse in neutral) his pain reduced significantly. SO PAY ATTENTION TO YOUR POSITION! I have a full guide on my website for those interested (r/http://www.1-hp.org/2016/10/28/esports-health-it-starts-with-ergonomics-and-posture/)
CONDITIONING YOUR WRISTS: Ensuring we can tolerate the repeated stress of playing for extended periods of time (scrim blocks, new patch releases, bootcamps, etc. etc.). We have to EXERCISE and build up the endurance of our wrist and hand muscles. This means following some of the routines you guys have already posted in this subreddit in addition to some that you guys can find online. Here are some routines I’ve come up with for both prevention and warming up
1. 9 Minute Prevention routine (to build up tissue tolerance) r/
2. 6 Minute stretching routine (mostly for after games to undo stress of repeated use)
3. Specific Exercise Routine I gave to a pro OW player to address his pain
PAY ATTENTION TO HOW MUCH YOU CAN PLAY: Like I said before our muscles and tendons have overheating mechanics which means if you play too much or do not pay attention to how many hours you have played consecutively it can lead to tissue breakdown and irritation. The bottom line is.. TAKE BREAKS AND PERFORM THE STRETCHING ROUTINE I listed above!

So what about things like, stretching, bracing, kinesiotaping, icing, heating, massage? These are all really common suggestions from the internet as well. These are all helpful for PAIN MANAGEMENT and address the SOURCE of the pain (tendon/muscle) but it does not change the fact we:

Play with poor wrist position causing muscles to fatigue more easily and lead to breakdown/overuse
Do not have the endurance to handle the 6-8 hours of repeated mouse and keyboard use.
Play for 10-14 hours every day (an exaggeration, but you can get it)

These again are the MAJOR CAUSES. And that is what we should address.

2| Does the the shape of the mouse make a difference? I've noticed my wrist gets sore quicker with certain mice or is this just a coincidence?

Yes it can. Shape in addition to weight, DPI all can play into how much we utilize the muscles of our wrist and hand. Those with a higher base (closer to the beginning of your wrist) cause the wrist arch to be higher affecting the length of certain muscles being used. This can lead to overuse more quickly as you experience. I would say though DPI and mouse preference aren't things I recommend changing as they are smaller causes to the wrist pain. It is more worth having the player develop better wrist conditioning through exercise than to ask him/her to change his mouse/DPI settings. That is utilizing some of the routines I list above :)

3| I have a minor cubital tunnel syndrome happening, where my pinky and ring finger of both hands go somewhat numb. I believe it's from my setup with how I have my arm rests (and aggravated by how I sleep, with arms curled into me.)

It's obviously less common than carpal tunnel syndrome, but I was hoping you could do something similar on this. Because there isn't much information on the net on keeping this from happening.

I've found that it is relatively rare for cubital tunnel syndrome to occur with FPS players and instead it is often a mild case of thoracic outlet syndrome. This basically just means it has to do with your shoulder position limiting space for your nerves to travel down through your arm and it often manifests as ulnar nerve symptoms (the pinky/ring finger numbness) It is hard for me to give you specific recommendations here so I would absolutely seek out a local physical therapist so they can perform a thorough evaluation of your ergonomics, posture and truly identify the entrapment site of the nerve from your neck -> arm and then help you find a way to address it. From my experience - if your arm rests are too high it can cause this - and yes sleeping on your back would be the better position instead of the potentially closed off position of your wrists being bent (but it could also be your shoulder if you sleep on your side) Seek out a physical therapist or ask for a referral for PT from your MD and you will find out the following 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

4| So, as someone who is relatively high ranked in OW (not quite gm yet), and an avid weight trainer, how can I still train for strength but avoid wrist problems: specifically are there wrist strengthening things I should be adding?

I ask because I recently went through a powerlifting program and was making really great gains, but started to get really bad elbow pains on both arms and it basically crippled me gaming wise, and I decided it was absolutely not worth it at that point.

Remember it is more about endurance than it is about strength. Higher volume with lower load (5-10% BW) for wrist exercises. And again it is also considering everything else I mentioned above relating to scheduling, posture, ergonomics even your shoulder position. So to give you something actionable - maybe add 1xfatigue with a 3-6# weight of wrist extension/flexion every day or at the end of your workout. To really get specific recommendations on what you should do based on your schedule and lifestyle I would see a local physical therapist :)

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