POSITION STATEMENT: The Systemic Problem of Esports Medicine
The recent allegations surrounding the treatment of a young EG player are deeply concerning, but, unfortunately, not entirely surprising. The factors that could lead to such a situation occurring aren’t limited to just one team or organization–they’re systemic. Preventing player mistreatment, whether it occurs deliberately, neglectfully, or just out of ignorance, requires proactive rather than reactive change. As experienced esports health and performance providers, our goals here are to identify some of the current risks to player health and safety and to propose potential roles organizations, publishers, and support staff can play in addressing them.
Currently, there is no standardized system in place in esports–either within teams, or across leagues– to address the health and wellness of these athletes. While providers might be contracted to support these athletes, they are primarily utilized reactively, or in response to injuries and crises, without an established process for preventive medical screening and care.
Whether out of ignorance of appropriate role and scope or due to budget considerations, esports organizations often hire one professional and expect them to wear multiple hats. In many cases, mental performance coaches are expected to be fitness and nutrition professionals, or personal trainers are expected to make recommendations about ergonomics and injury management. As medical and performance science professionals, it is our responsibility to clarify our scope of practice to the communities we work in and to ensure that players, coaches, and organizations understand what roles we can and cannot play within a team.
The responsibilities of various roles, managerial and medical, are often poorly-defined, and individuals may not feel empowered to act. If they do feel empowered, they still don’t necessarily know what actions they can or should take within the organization. One major confounding factor is the conflation of health and performance support in esports. There is a degree of overlap in the roles, certainly–a physical therapist with the right training can also provide programming for fitness and physical performance; a registered dietitian can ensure a team has access to healthy food services as well as managing meal content and timing for performance purposes; a psychologist has clinical education and licensure and might also have the skillset to help a team develop culture, improve communication, or manage performance anxiety.
Organizations are also at risk of hiring individuals who are a poor fit due to confusion over titles, degrees, and roles of similar health and performance professionals. For example, in the US, “psychologist” is a protected term, which means only individuals who have completed a clinical doctoral degree in psychology can call themselves psychologists. Clinical psychologists are therefore able to diagnose and treat mental health conditions. Some psychologists have the experience and training to provide performance-related services to teams, but not all do. “Sport psychology”, though, is slightly more nebulous. Some sport psychologists are also clinical psychologists. However, there are also non-clinical individuals who have completed Master’s or doctoral-level education in sport or performance psychology who can work on mental skills and the psychology of performance, but not diagnose mental health conditions.
Globally, mental performance professionals specialize in non-clinical mental and psychological skills related to improvements in the efficiency of learning, team culture/dynamics, and overall performance. But not every performance professional is appropriately trained to provide medical or mental health support within their scope of practice. There is a lack of consistent definition of titles such as “performance coach”, which can refer to a variety of clinical and non-clinical professionals who work on a team’s performance in some capacity. Due to the variety of backgrounds a performance coach can have, it is challenging to compare the scope of their education, licensure, or certification to other credentialed clinical and medical professionals within esports. This leads to confusion about who is best or even adequately equipped to provide appropriate scope of services to players.
The same issue occurs in physical health and performance fields. Physical therapists are not just fancier versions of massage therapists or personal trainers; they are medical professionals with advanced training and education in human movement and physical function. Athletic trainers are not just assistant physical therapists; they are autonomous professionals with a specific scope of practice in sport and exercise science.
Medical professionals are required to uphold certain legal and ethical standards that can generally be summarized as a mandate to act in a patient’s best interests. “Acting in a patient’s best interests”, in the case of a player with a severe injury, might mean a physical therapist advocating for the player’s rehabilitative needs, including any rest time, to coaching or managerial staff. In the case of a player with a mental health concern or an eating disorder, “acting in the patient’s best interests” might mean involving a psychologist or a psychiatrist in their care, in addition to the above-mentioned advocacy on the patient’s behalf to the organization.
Medical professionals have a responsibility to advocate for their patients, and organizations have a responsibility to provide adequate care for players by hiring competent professionals as well as listening to them.
Publisher and Key-Positioned Organizational Changes
Publishers hold the most power in terms of competitive and financial control in the esports ecosystem, positioning them to establish health and support standards across teams within their leagues. Publishers, organizers, players’ associations, and agencies could potentially subsidize the cost of player support and health services. We believe however there is a larger responsibility on the publisher to consider player health as they have direct control on all aspects of competitive mechanics, distribution, broadcast, and revenue, many of which have a direct or indirect influence on the physical and mental well-being of the players.
Policies established by publishers can ensure that organizations are held accountable for providing proper healthcare to their athletes. These policies must be comprehensive, covering not just physical injuries, but also mental health concerns. Additionally, player unions and agencies can work from the bottom up to ensure that players are receiving adequate healthcare and lobbying for systematic change.
An interim solution could be the provision of publisher-contracted medical staff to esports organizations participating in their ecosystem. In this system, rather than reporting to a team’s management, providers could function similarly to the independent doctors associated with NFL or NHL, offering a degree of distance from a team’s administration structure.
An Integrated Care Model with Education
To further support players, health education for coaches and staff is also crucial in the esports industry. Coaches and support staff often have a significant impact on the health and well-being of athletes and are the individuals who see players on the most regular basis. With education on health and performance concerns, they may be able to recognize issues and bring them to health and performance staff before they become more serious. However, the coaches must also be supported by trained professionals. They have enough of a burden on them, in terms of workload and responsibility, without being asked to act as arbiters of player health and fitness.
Medical providers should develop knowledge of the esports space through education, research, and community participation. Well-informed providers should then work with organizations to develop comprehensive healthcare plans that address the specific needs of their athletes within the appropriate scope of care for each provider; organizations should empower the providers who work with them to contribute to the decision-making process when it comes to player health. Additionally, medical providers should educate coaches and support staff on the importance of proper healthcare and the specific risks associated with esports. And last, but certainly not least, medical providers must have the ability to live up to their ethical and legal responsibilities as professionals. We have a responsibility to act; we must also have the capacity.
Dr. Matthew Hwu PT, DPT, OCS, CSCS
Dr. Caitlin Mcgee, PT, DPT, MS
Dr. Elliot Smithson, PT DPT, ATC, EMT
Landon Gorbenko MS
