From Matteo Bittanti's Game Arteritis art project. Make-up artist: Emma Alexandra Watts.
Dr. Levi Harrison, an orthopedic hand and upper extremity surgeon in Los Angeles, treats high level athletes who compete professionally in anything from hockey and volleyball, to tennis and ping pong.
These days, he told me, most of the professional athletes he treats are mixed martial arts (MMA) fighters, who punch, kick, and strangle each other unconscious in cage fights, the mats often soaked in blood by the time the match is over.
Right after them, his second most common type of patient is the professional eSports player, who sits at a desk and competes in video games like League of Legends and Counter-Strike: Global Offensive for cash prizes.
You might not think of eSports players as athletes, and you might not think of them as taking part in a high-risk activity. But the fact is that many of them are getting hurt, and they need help.
"I see MMA fighters and gamers more than anyone," Dr. Levi said. "The UFC guys I take care of, their hand injuries are unbelievable. There it's more because of impact. For the gamer, it's more repetitive motion, but they both cause significant problems."
"My wrist injury is something that I simply cannot ignore," Hai said in a statement to his fans. "It limits my ability to play as much as I need to and my ability to improve. I cannot keep up..."
Repetitive motion injuries come in many forms. There's carpal tunnel syndrome, which compresses the median nerve in the wrist, causing pain and numbness. Then there is tennis elbow, which causes the outer part of your elbow to feel sore and tender. Last but not least is trigger finger, also known as stenosing tenosynovitis, which causes one of your fingers to get stuck in a bent position.
It's likely that you're familiar with at least one of these because it's 2015, and most of our jobs involve hours of sitting at a computer, pushing a mouse around, and typing. You do that for a long enough time and you'll start to see some wear and tear.
A professional eSports player's job looks awfully similar, but they go at it much harder than you ever will.
"When we're practicing for our major tournaments we wake up at around 9:00 AM and start playing all the way until 2:00 PM, but that's just team practice," Jimmy “DeMoN” Ho, who plays Dota 2 professionally for team Champions of Summer's Rift, told me. "After that there's replay analysis that we either do individually, or we play Solo Queue [separately from the rest of the team] just to practice certain Heroes, which could take up another six to eight hours. You kind of just wake up, rinse, and repeat."
Changing Lanes, a documentary series that follows Jimmy “DeMoN” Ho, shows the intense training leading up to an eSports tournament.
Braxton "Brax" Paulson, another player for Champions of Summer's Rift, told me that an arm injury he suffered from playing traditional sports when he was younger can get aggravated and become extremely painful when he plays Dota 2, so he tries to take breaks and stretch when possible.
"It's something that needs to happen, so people understand," Paulson said. "Of course, if we're in the middle of something important, I'll suck it up and keep going."
Dr. Levi said that ignoring and pushing through the pain is how both MMA fighters and professional eSports players get in serious trouble.
"If you don't rest the body doesn't have a chance to heal itself, to go into a homeostatic state and say okay, now I can repair myself," Dr. Levi said. "Whether it's non-stop gaming or non-stop MMA training, the body doesn't like that, and there's a price."
There's no shortage of examples for eSports players who've paid the price. In April, Hai Lam, who played League of Legends for team Cloud9, announced his retirement at the age of 22, and listed his hand issues as one of the primary reasons.
"My wrist injury is something that I simply cannot ignore," Hai said in a statement to his fans. "It limits my ability to play as much as I need to and my ability to improve. I cannot keep up with the amount of Solo Queue games my teammates play and it’s not fair to them."
From Matteo Bittanti's Game Arteritis art project. Make-up artist: Emma Alexandra Watts.
Other players, like Heo "PawN" Won-seok, who plays League of Legends for team EDward Gaming, and Clinton "Fear" Loomis, who plays Dota 2 for team Evil Geniuses, have suffered hand and arm pains so severe they had to abruptly drop out and miss critical matches.
"I know that some pro gamers have retired because of hand issues," Dr. Levi said. "In my mind, I always think I wish they had come to see me. Maybe we could have worked out a strategic, focused therapy plan to help them. So often, many health care providers will tell a gamer 'oh, just stop playing and you'll be okay,' but that's not true. They already developed a problem."
Dr. Levi said that he treated five or six professional eSports players in the past five or six weeks, and that many of them fly in from all over the world—Australia, South Africa, the UK, Canada, Asia, and other parts of the United States—just to see him.
As part of his treatment, Dr. Levi asks players to bring in the keyboard and mouse or controller they play with. He'll watch how they use them, then give them five to 10 specific exercises and proper ergonomic positions for their hands based on what and how they play. What he teaches a League of Legends player can be different than what he teaches a Super Smash Bros. player, just as what he teaches a golfer can be different than what teaches a gymnast.
He wants to help them be functional by reducing inflammation and pain, which he believes can also help them improve their Actions Per Minute (APM), the total number of actions a player can perform in game in a minute, and how eSports players measure their speed.
Dr. Levi's hand and wrist exercises for gamers.
Not every player will have the means to go see Dr. Levi in person, so last year he released a video of some basic exercises that teaches them gliding exercises, massage techniques, pressure point techniques, and reminding them to take at least a three to five minute break for every one to two hours of play. It's not the same as professional treatment, but it's the kind of help that pro eSports players aren't getting anywhere else right now.
Major eSports events and tournaments don't have any medical oversight, either for drug testing or for the kind of injuries players can get from playing too much.
When I asked Ho if there's some official body within the eSports scene that's warning players about these dangers, he laughed.
Training non-stop might make you faster more quickly, but the pain will catch up with players sooner or later
"No," he said. "It's like, 'just play your game man.' That's all they care about."
Professional players sign contracts that allow companies to use their name and image to promote products and take a percentage of their earnings, but it's very unusual for them to get any sort of insurance at all.
"At the current state of eSports, I'd say that's unreasonable, mainly because of the way investments work," Paulson said. "It's very hard for one of these guys to get a long term investment from the team just because of the nature of the game."
However, both Paulson and Ho agreed that eSports is going to have to deal with hand injuries down the road if it keeps growing.
"It's a problem that exists that people don't realize yet, and by the time it comes to the point where they got to do something about it, they didn't take the precautionary methods to deal with it properly," Paulson said. "It's one of those things you never think is going to happen to you, and then when it does you're like 'oh shit, what do I do?'"
Dr. Levi told me that he drafted a letter to several eSports organizations and the companies that operate the related games, asking them if they would consider forming a board to oversee some of these eSports events with his help.
"I think in time, they will have to have—if not a medical review board—at least hand specialists there evaluating these players to make sure that they're not causing substantial damage to their hands and upper extremities," he said.
Most of all, Dr. Levi's message to eSports players is the same one he has for MMA fighters. He wants them to think long-term, and that means rest. Training non-stop might make you faster more quickly, but the pain will catch up with players sooner or later and decrease their APM, if not destroy their careers entirely. As Dr. Levi said, you only get two hands and 10 fingers. If they're gone, that's it.
"I have such respect for them, and so often they're underappreciated as athletes," Dr. Levi said. "I think that's because it's in a seated position, but their hands and their ligaments are still moving. A lot. It's a sport. It's real."