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Ready Player 1: How e-sports athletes get in shape for game day

Professional gaming is growing, but so are injuries and mental health issues among e-sports athletes

Ankit 'V3nom' Panth, a Mumbai-based professional Counter-Strike: Global Offensive player, is well known in the gaming fraternity as the face of Team Brutality, one of India’s prominent e-sports teams, but he is also a devoted fitness enthusiast. (Courtesy: Red Bull)

Last month, Thomas “ZooMaa” Paparatto, a professional gamer and e-sports athlete, announced on Twitter that he was quitting competitive gaming. The 25-year-old from New York said he was “stepping down and will no longer compete in competitive Call Of Duty for the foreseeable future”. The reason? A recurring thumb and wrist injury. Playing through the weakness and pain in his hand, ZooMaa tweeted, “just wasn’t possible any more.”

Behind the glamour of streamers and glut of battle royales, professional gaming is a serious sport gaining momentum. At the 2018 Asian Games held in Jakarta, Indonesia, e-sports was included as a demonstration sport, featuring six gaming titles and athletes from 18 nations, including India. At the 2022 Asian Games in Hangzhou, China, e-sports is set to become an official medal event.

Another aspect of professional gaming that is growing, worryingly, is the injuries. Paparatto’s was just the latest instance. According to a 2019 The BMJ (originally called the British Medical Journal) study, e-sports players too are susceptible to overuse injuries. The study looked at 65 collegiate-level e-sports players from nine universities across the US and Canada, analysing their gaming and lifestyle habits, and possible musculoskeletal (involving muscles, ligaments and tendons, and bones) complaints. The most common injuries included back and neck pain, wrist injuries and eye fatigue.

The results found players practised 3-10 hours daily, but 40% of the participants did not participate in any form of physical exercise. “Among the players surveyed, only 2% had sought medical attention,” the study explains. Are these issues finally being addressed and if so, what are professional e-sports players doing to stay fit?

Sudin Dinesh, 27, a Fifa e-sports player known in the gaming community as “The Headmaster”, knows how bad such injuries can be. During the 2015 Electronic Sports World Convention (ESWC) India qualifiers in Mumbai, a niggling back injury resurfaced. “The seating setup we had at the venue was a bit weird,” he recalls. “The chairs were like bar stools and weren’t comfortable at all. Sitting on those for too long was not easy and eventually my back started hurting again. I had to take a break and use some pain-relief spray before continuing,” says Dinesh, who now works with the Chennai-based e-sports company Playtonia.

Just like a footballer’s running style or gait affects their body in the long term or stress fractures hamper fast-paced bowlers in cricket, sitting posture and ergonomics are key for professional gamers.

Unlike traditional sports, there are very few traumatic injuries in e-sports, says Caitlin McGee, performance and e-sports medicine director at 1HP, a California-based organisation of healthcare professionals who provide services for e-sports competitors. “The most common injuries we see are overuse injuries, especially tendinopathies,” says McGee. Tendinopathies or tendinitis result from inflammation or irritation of a tendon. “The good news about these kinds of injuries in this context is that they are both preventable and treatable. A lot of the underlying problems for our players are related to either postural dysfunction or weakness. The other complicating factor for a lot of our patients is how long they go before speaking with a medical professional,” she explains on email.

Part of the work 1HP does involves dealing with everyone from high school club teams to professional e-sports organisations like Complexity Gaming and CLG. They not only educate the e-sports world about the role of health and wellness in performance and career longevity, but also the medical world about the unique needs of e-sports competitors.

Despite the burgeoning popularity of e-sports and professional gaming in India, such awareness is limited here. “While everybody talks about growth (in the sector), it’s also important to look at this aspect of e-sports athletes,” says Lokesh Suji, director, Esports Federation of India (Esfi). “We would definitely want to have physiotherapists, orthopaedics and psychologists with Esfi. We bring up this issue (of injuries and health) whenever we are interacting with our athletes and the e-sports community on our Discord channel,” Suji says on the phone.

In such circumstances, it often comes down to individual effort. “The general assumption is that gamers are lazy. They are not,” says Gnana Shekar, CEO of the Chennai-based e-sports organisation Team Tamilas, one of the top-ranked PUBG Mobile teams in India. “Ever since the ban, our PUBG team has been busy creating different content but apart from light sessions in the gym, the bare minimum we do is yoga, running and stretching exercises. Yoga actually helps with eye strain and back issues,” says Shekar.

Ankit “V3nom” Panth, a Mumbai-based professional Counter-Strike: Global Offensive (CS:GO) player, is well known in the gaming fraternity as the face of Team Brutality, one of India’s prominent e-sports teams, but he is also a devoted fitness enthusiast. “When I started my career, I noticed people slouching at gaming cafés. When I work out, I make it a point to do a lot of back exercises, like deadlifts, because you sit for hours, especially during tournaments when you get only five- to 10-minute breaks,” says the 31-year-old. “Being an FPS (first-person shooter) player involves a lot of wrist movement, so I also focus on my forearms and biceps,” says Panth.

When they are not competing in tournaments, many professional players stream content on platforms such as Twitch and Facebook Gaming, which involves playing video games online live for hours, with an audience watching. Panth is also a regular on the streaming circuit, with nearly 96,000 subscribers on his YouTube channel, often playing CS:GO and the FPS game Valorant. “When I am streaming, I stand up and stretch after every game. I also keep myself hydrated and splash cold water on my eyes regularly,” he adds.

“Cricketers and footballers take care of themselves to maintain their stamina. People think that sitting in front of a computer screen does not require stamina. But you forget the number of times your fingers are clicking the mouse or how much your wrist moves. If you don’t have enough strength in your wrists and forearms, it will hurt you in the long run.”

A file photo from December 2020 shows gamers taking part in an esports tournament at the Dukenburg district centre in Nijmegen, the Netherlands.
A file photo from December 2020 shows gamers taking part in an esports tournament at the Dukenburg district centre in Nijmegen, the Netherlands. (AFP)

Injuries vary from player to player, depending also on the platform they play on. Games like Valorant, Call Of Duty, another FPS, and CS:GO require constant and swift hand-eye coordination with a keyboard, mouse and, in some cases, controllers. Meanwhile, an e-sport athlete playing the real-time strategy video game Clash Royale would manoeuvre their hands on a smartphone or tablet. Gamer’s thumb, known as De Quervain’s Tenosynovitis, is a common injury in such cases, with the tendons that move the thumb becoming inflamed. “There are some postures and positions that put more strain on the body than others,” says McGee.

Sports psychology in this field too is a relatively new phenomenon. In a November 2019 study, published in the International Journal Of Gaming And Computer-Mediated Simulations, researchers from the University of Chichester in the UK said e-sports gamers experience the same stressors as other athletes. They found e-sports players faced over 50 stress factors, including communication problems and concerns about competing in front of live audiences. These mirrored the mental conditions footballers and rugby stars experience in high-profile tournaments.

Karan Manganani, an e-sports athlete from Surat, Gujarat, who represented India at the 2018 Asian Games, says one cannot overlook the psychological impact of professional gaming. Manganani, 20, is an ace Clash Royale player. This game requires lightning-quick reactions. “It’s a fast game where you have to predict the opponent’s next move,” says Manganani, who is also known as Jin Kazama, a moniker taken from the popular Tekken character. Apart from working out, Manganani meditates for at least 30 minutes daily.

“Tackling the mental issues is still a challenge from an India perspective because e-sports still doesn’t have the parental support it needs,” says Suji, adding that even e-sports can become toxic, falling prey to cyber-bullying and performance-related stress. The bulk of gaming today happens on the cloud and the virtual world can be unforgiving. “In traditional sports, you will find athletes who are mature in terms of their age,” adds Suji. “But by virtue of our target audience, we are talking about an e-sports athlete who is aged 14 and above. People tend to hide behind a virtual identity and sometimes you don’t know whom you are up against.”


Golden rules for e-sports athletes

- Get seven-nine hours of sleep a night. Research supports the role of sleep in not just reducing injury risk, but actively improving performance.

- Focus on exercises to improve endurance. E-sports competitors need muscular endurance of the hand, wrist, forearm, and postural muscles.

- Remember the 70/20/10 rule of performance: 70% of improvements in performance will come from consistently getting enough sleep, exercise, appropriate nutrition, and hydration.

— Caitlin McGee, performance & e-sports medicine director at 1HP

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