How to Approach Knuckle Pain in Gaming | Based off a FAQ | HEALTHGAMEFAQS#5

Hello guys, Welcome to the an in-depth version of healthgameFAQs – a type of content we will be having exclusively on our patreon (coming out soon!). In this article I will be answering the question about pain in the knuckles that I have received. I followed up with this gamer to learn a little more about his/her pain and pain behavior in order to provide more specific recommendations. He has allowed me to share the details of what he has provided to benefit our community! So lets get into it 😀

His question: Knuckle pain with PC gaming

Do you have anything for helping with knuckle pain, or could this help with knuckle pain? I’ve invested a lot of energy into figuring out proper ergonomics and i still dont know if i have it perfect, nor is my setup as good as it used to be, nor can it be… but ive been told i might have carpal tunnel, and then told it was tendonitis but i have no idea which it was when i had pain. Right now im having pain between or around my metacarpophalangeal joint, and its really been bugging me when im playing shooters. Its on the left hand and i use a razer orbweaver which i wish had better ergonomics but is better than any other single product ive tried. In order to better understand what he was feeling and the potential source of the pain I asked some more in depth questions. Below is a summarized version of his response.

His Pain profile and behavior: Joint irritation

Profile: Streamer who plays most genres, played COD, BFV betas, Wasted, Ring of Elyseum. Pain Description: L. knuckle pain, Achy, constantly at a 1-2/10 Pain Behavior: Things that make it worse

• Playing FPS games, gaming on the PC in general, 3/10 after 1 hour, 4-5/10 after 3-4 hours
• Reaching out with his middle finger to press the 3 key
• Pinching
• Lateral resistance of the finger

Things that help

• Not gaming, pain will begin to subside
• Avoiding reaching with the finger
• Mainly avoiding activity

General Ergonomic View:

Overview

Sideview

My thoughts and recommendations: Joint irritation

I believe you are dealing with joint irritation of the metacarpophalangeal joint (aka your knuckle joint!). The joint is located where you had posted you are experiencing the pain.  The following recommendations are based on the details provided in addition to what I have seen most commonly with gamers (pro/casual). (Remember I have not been able to perform any assessment to identify postural, lifestyle, or physical factors which may be contributing to his pain). Let’s talk about why this is potentially happening..

What is happening? Too much stress on your knuckle from gaming

As I mentioned above your knuckle joint has become irritated from repetitive stress of gaming. The muscles may not have enough endurance to handle the repeated clicking and thus the joint takes more compressive stress. The more you game, the more the joint becomes inflamed and irritated. Before I describe the next portion of what is happening – I think it is very important for you to understand how our body works. I have written this in great detail here – basically our tissues behave like they have an overheating mechanic. The more stress we place on it by clicking, the closer it comes to overheating. The size of the meter is based on our conditioning (exercising to improve endurance, strength, coordination). At this point your joint (knuckle or metacarpophalangeal joint) is only a small meter and can only handle so much before becoming irritated (overheated). Got it? Good! The next thing we have to realize is.. And of course this is also dependent on how long you have been dealing with it.. The constant aching or pressure you might be feeling at your knuckle may be an adaptive mechanism from your nervous system. The longer we experience pain, the better our body becomes at producing pain. While it is probably true your METER size is reduced (knuckles can’t handle as much stress), your nervous system is naturally more sensitive because it wants to protect the tissue so it causes the meter to INCREASE more quickly with each “click” SO as an example:

1. Each click before may have raised heat of the meter 4 units
2. But now that you have been dealing with the pain for awhile each click raises the heat of the meter 8 units.

Make sense? Alright so lets move onto WHY

Why is this happening? Different factors leading to overuse with knuckle pain in gaming

While there are many ways this can occur, the most likely reason based on my experience and what you have told me is… Poor Wrist & Hand Conditioning, Poor Initial Ergonomics/Posture, excessive gaming. It is most commonly these three factors which lead to tissues becoming irritated and weaker. We often only begin to pay attention to our ergonomics/posture after we feel some aching. And we do not realize that in addition to changing this vital component, we have to also work on the conditioning of our wrist/hands (exercise) and monitor our schedule. What I am suspecting is that you may not have had great ergonomics/posture initially until you began to feel pain – after which you sought out resources to address this issue. Due to the pain (tissue irritation) the joint and the muscles surrounding it became weaker and lost proper coordination. Even though you may have addressed the posture, the fact that you were not conditioned enough to tolerate the your sessions of gaming did not change. You may not have paid attention to your schedule either (how long you were playing without taking a break or stretching in between games) So the bottom line is that..

1. You felt pain
2. Now you have better ergonomics & posture.
3. You are still weak which means you will continue to irritate the joint when you game
4. You may or may not be managing your schedule better and incorporating some stretches in between your games

Ok ok, enough science and whats and whys. Lets get to how you can address this issue.

How to reduce your knuckle pain

I hope it is clear by now that your pain will improve if you address the issues listed above

1. Proper Wrist Conditioning
2. Better habits around gaming
3. Maintaining proper ergonomics and posture
4. PATIENCE -> TISSUE ADAPTATIONS TAKE TIME.

Proper Wrist Conditioning

How do we build up our heat meter? We perform exercises to improve the endurance of the muscles you use to WASD in all of your games. This means the muscles that control your fingers when they press the key down. The muscles are…

1. Flexor Digitorum Superficialis
2. Flexor Digitorum Profundus
3. Intrinsic Hand Muscles (Lumbricals)

  These all cross the knuckle joint and fatigue of them can lead to irritation of the joint. I have created a general injury prevention routine which includes exercises that target these muscles that you can check out here! This is an easy routine you can include either at the beginning or end of the day. As with most endurance/strength building routines you do not want to perform the exercises right before you play (to not fatigue the muscles just before you begin your session). This means it is best to do your exercises 1-2 hours aside from when you plan on gaming or utilizing your hands more frequently. Additionally, I would add some exercises for you to perform on a daily basis to ensure that you build more specific endurance for those muscles

1. Eccentric Wrist Flexion with Finger Curls (3×12, 2-3x/day) To build up endurance
2. Tennis Ball Squeeze 2×10(3-5”), 2-3x/day to increase general grip strength
3. Theraputty Exercises | EXERCISE OF THE WEEK #2

Better habits around gaming

This is an important one – but we want to do everything we can with our day to day behavior to promote healthy joints and muscles. This means being mindful about how you are playing and taking breaks at the right time. My general recommendation is to take a 2-3 minute break every hour to do some stretches. Here are some options of what else you can do during your gaming break from a previous article I have written. One of my favorite stretching routines to recommend is my 6 minute routine which targets all of the muscles surrounding the wrist and forearm and can be beneficial for you to alleviate some stress from repeated use. The more you are disciplined with incorporating breaks and stretching into your gaming schedule, the easier the path to recovery will be for this.

Proper Ergonomics and Posture

While your keyboard ergonomics seem fine from the pictures you sent me, it is also important to evaluate your posture to prevent any potential contributions to earlier muscle fatigue. If your shoulders are not in the proper position, it can cause the muscles at your forearm to fatigue more easily and irritate the joint in your middle finger earlier. Refer to my complete guide on posture to check your own posture!!

Your Knuckle Pain will go away – Be Patient

Being consistent and patient with the recovery process is key. This is the hardest truth for most gamers to swallow. Many gamers may stick with a program for 2-3 weeks, notice only a slight improvement, and then give up. This is one of the largest initial barriers to success. Tissues take time to adapt and develop in strength/endurance. Research shows that it takes roughly 6 weeks for tissues to make a change in strength. This means for the full resolution of a chronic or moderately chronic injury, you need to be consistent with exercises and lifestyle changes for at least six weeks. That’s not to say that it will take six weeks for you to feel any change. Usually, you’ll notice a difference in 1-2 weeks as you have more efficient activation of your muscles and develop more awareness of your body’s limits. The bottom line is you have to remember to be consistent with your exercises and stay on track with your injury treatment program to stay on the road of recovery. That’s all! Hope I was able to help you and get you started on a better path with self management. We will be creating more of these in-depth posts for our patrons (our patreon will be coming out soon, look out for the announcement). Sign up for our newsletter to find out when that will be happening but until then… PLAY MORE HURT LESS.