09 Aug Wrist Health in Gaming – LA Valiant’s Physical Therapist, Strength & Conditioning Coach

Hello guys!

My name is Matt Hwu and I’m a Doctorate of Physical Therapy (OCS), Strength & Conditioning Specialist working with the LA Valiant to keep their players healthy and prevent any gaming injuries from occurring (wrist pain primarily)

I wanted to write this in the light of overwatch league ending and likely…. A lot of people grinding for the next season. This is also however for anyone curious about wrist pain or health in gaming.  Here is a big overview of how I help our team and many other pros keep their WRISTS healthy through long grinding sessions (scrim blocks, twitch streams, etc. etc.)

WRIST PAIN? ADDRESSING THE ELEPHANT IN THE ROOM (CARPAL TUNNEL SYNDROME)

I want to start off first my making sure our community truly understands wrist pain. There are truly an abundance of misconceptions when it comes to understanding wrist pain in the community so I want to set it all straight here.

One of the most common misconceptions about gaming and injuries is that those who have wrist pain are experiencing carpal tunnel syndrome. I want to clarify once and for all that most wrist pain in gaming is muscle and tendon overuse and is EASY to manage – and the treatment should NEVER just be – wear a brace, stop playing as much and take medication.

There are several reasons why this happens but I think the most important two are..

1. The way search engine optimization works on the internet – wrist pain almost always leads to an article about carpal tunnel syndrome so most people associate it with the condition
2. Misunderstanding from treating physicians – I think the misconception is not only limited to the gaming community – I feel that many doctors who encounter a patient presenting with this type of pain almost automatically assume they are dealing with carpal tunnel syndrome and often do not realize the impact of labeling it in such a way. (Most of the time it leads to the patient or gamer going online to research which will often offer them limited information about how to treat the injury)

And unfortunately i’ve treated several gamers/patients who have been told to just wear a brace, take medication and stop playing as much as treatment. Okay so how should we deal with muscle and tendon injuries then?

Because we are dealing with muscle/tendons, it is all about improving the tissues tolerance to load.

I’ve written about this several of times but basically our bodies behave as if they have an overheating meter. The more we repeatedly use our muscles, the more they begin to overheat with overheating representing tissue strain or irritation. Things like posture, proper scheduling, ergonomics, conditioning affect how quickly our tissues overheat. Things like rest, stretching, icing, etc. allow it to cool down more quickly – Here’s the article explaining this concept http://www.1-hp.org/2017/10/02/what-gamers-need-to-know-about-health-avoid-injuries-by-preventing-overheating/

HOW WE SHOULD APPROACH WRIST PAIN IN GAMING

Now that we have cleared that up – how should we approach wrist health? The most common cause of overuse is 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 here for those interested (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 many people have posted 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) https://youtu.be/lzjOCYkn8mY
2. 6 Minute stretching routine (mostly for after games to undo stress of repeated use) https://youtu.be/PXkSDfgAHGw
3. Specific Exercise Routine I gave to a pro OW player to address his pain https://youtu.be/gIb9LI-a3yc , heres the full case study about him

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:

1. Play with poor wrist position causing muscles to fatigue more easily and lead to breakdown/overuse
2. Do not have the endurance to handle the 6-8 hours of repeated mouse and keyboard use.
3. 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.

Last thought – ADDRESSING WRIST PAIN TAKES TIME

This is the hardest truth for most players to swallow. Many pros and casual 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.

Thanks and Bye!

Hope this was helpful for you guys! Let me know if there is anything else you want me to write about. I usually write content on my website but felt this sort of long-winded post would reach you guys more easily. If ya’ll wanna follow me i’m on twitter @HPFORGAMERS