Gaming and RSI: The Spirit is Willing but the Wrist is Weak

Confined in a room while sitting on a couch or a gaming chair with cokes or beers on the side (and some slices of pizza boot!), as well as a keyboard and a mouse at hand – this is just but the life of an average gamer who’s at home living the leisurely lifestyle of gaming.

While some may think that gaming is a past time that is all chill and fun, there is a reality about gaming that only fellow heavy gamers would understand – it’s not all rainbows and butterflies every time.

Like having to work in an office, gaming can be as stressful, tedious, and prone to aches and nagging pains resulting from the repetitive nature of the activity (though the fun part overpowers all of these).

The toil is even truer for hardcore and professional gamers who spend countless hours mastering their craft – after several hours of adrenaline-filled, red bull-pumped gaming, the resulting outcome has always been same – it is tiring (both physical and mentally), if not something that results to sore pains which many gamers are familiar of but do not give a care about…until the pain is already excruciating, if not debilitating, like a Repetitive Strain Injury on their hands.

What are Repetitive Strain Injuries?

The name itself is already very telling of what a Repetitive Strain Injury (RSI) is. Put in both medical and computing terms, an RSI is a kind of injury arising from the overuse of hands for doing tasks in repetition like writing, clicking on the mouse, and typing on the keyboard.

At its mild cases, an RSI can be easily alleviated and fixes itself from the pain over time. However, more serious cases of RSI can be potentially debilitating as the pain is synonymous to a person having a serious case of arthritis, the latter of which is basically about the inflammation of the joints.

What makes an RSI different from any kind of arthritis, however, is that instead of the joints, RSI is more affecting towards the muscles and the nerves, if not the combination of both, each of which or both of which are the root cause of pain.

The two most common cases of RSI include the Carpal Tunnel Syndrome and the Guyon Canal Syndrome which are both pretty much the same, only differentiated by the affecting areas each is attributed to.

History of RSI

Not until the early 1980s, RSI was oblivious in the medical field, let alone for workers who do tedious office jobs. It was not until female office workers who had gone from the transition of using typewriters to computers that RSI, due to its now known symptoms, was identified as a medical condition rather than simple occurrences of pain.

Seeing how these female workers perform their duties with their typewriters and how they did after making the transition to using word processors on their computers, the root cause of the issue was blamed towards the workers’ increased efficiency at work due to continuous typing that is not entirely possible seen when they were using typewriters.

Yet the same clinical issue is also becoming a trend among people who play video games for a hobby for long durations of time, basically for the same nature of activity.

Professional and non-professional gamers alike are not immune to this health condition which likely affects a good portion of the population who play games as a hobby, if not for sports.

Pathophysiology of RSI

Since the discovery of RSI back in the early 1980s, continuous learning about this medical condition have found new insights of what makes RSI a case among people who do repetitive work with their hands such are the gamers who play several hours in succession or longer.

The pathophysiology is simple: Routinely doing a set of work involving the hands rapidly without much ceasing causes a microscopic-level tears to either or both our tendons and muscles which, in turn, affects the circulation of the blood in the affected area – commonly, as an RSI condition, the hands. As the blood supply is diminished, recovery time from the micro-level injury is thus lengthened.

repetitive strain injury cycle

A simple RSI Cycle diagram. Credit: kinetesisspineandjoint.ca

Adding more to the problem of simply just having micro-level wear-and-tear are the byproducts of metabolism accumulating on the affected area which then calls for an inflammatory response from the body and hence the cause of inflammation among people afflicted of RSI.

As the swelling, resulting from inflammation, puts pressure on the nerves of the affected area, pain could escalate which then can be excruciating for some. With a likely pain on the upper extremities arising from the condition, RSI-afflicted individuals therefore experience a sense of weakness and restrictive movements as well.

Lastly, as there is a direct correlation between blood circulation and the level of synovial fluid in certain parts of the body—including the hands—people with RSI are also aggravated by the increased level of friction and pressure on their affected upper extremities, most likely resulting to increased level of pain.

The Gaming Life Chose Me

RSI is particularly common for MOBA or real-time strategy gamers whose actions-per-minute (APM) is associated with their skill. Furthermore, according to a Starcraft wikia, most proficient players can average from 150 to 200 actions per minute, but it’s not rare for professionals to reach up to 500 to 600 actions per minute – that’s 10 actions every second.

This is why for professional esports stars, the gaming life is a huge balancing act. Benjamin “deMuslim” Baker, who plays for Evil Geniuses told NBC news in a previous interview that he has to take vitamins, exercise, and manage his time properly in order to perform at his peak. And while Benjamin Baker did not develop any RSI, other players weren’t as lucky.

Hai Wrist Injury

Cloud9’s Hai

North America’s most famous League of Legends shot caller, Hai Du Lam “Hai”, almost retired from the professional-scene due to his wrist injury, which kept him from keeping up with practices and scrims. Hai isn’t known for his mechanical prowess however, and he changed roles to jungle and finally to support where his superior in-game knowledge and leadership skill are better utilized, thus propelling a declining Butt9 to a Cinderella-esque gauntlet run and a shot at a World Title…though retirement doesn’t seem so bad:

Other players with RSI include Team Solo Mid’s “Bjergsen” and currently Hong Kong E-Sports’ “Toyz”. Toyz even had to retire in June 2013 when his Carpal Tunnel Syndrome did not permit him to play anymore. He finally returned as HKE’s mid laner in October 2014, saying that his wrist is finally better.

Risk Factors for RSI

Not all people get RSI and may likely explained by the differences in people’s lifestyles. However, here are the factors that may contribute to the development of RSI, especially amongst gamers:

  • Short interval (30 seconds or less), repetitive arm and hand movements
  • Improper sitting or body positioning
  • Underlying cardiovascular disease
  • Illnesses such as diabetes, arthritis, and gout
  • Pregnancy
  • Overweightness or obesity
  • Stress

There is Hope, But What To Do?

Will we be ever free from the threat of acquiring RSI as long as we keep playing games? Yes, we can – prevention is key! Here are some things that we can do.

Time Management and Gaming Efficiency

Luckily, for many people, Repetitive Strain Injuries are as optional as the choice we make on how long we play our games. Less time for gaming, less chances of acquiring RSI. More time for gaming, more chances of acquiring RSI – in the truest sense, this could be true, but telling this advice to gamers like us is futile – we’ll play the game as long as our wrist and fingers can move! Fortunately, most e-sports doctors say that it all boils down on playing the game as efficiently as possible – basically clicking less, but doing more (note that proper posture, exercise, and use of proper equipment still matter…). Totally unlike this guy who clicks for the sake of clicking:

Proper Posture and Exercise

Maintaining a proper posture is crucial to extending your gaming life. A few wrist exercises won’t hurt either and even promotes proper blood circulation to those often-abused areas. Good posture while sitting encompasses a variety of factors. You can identify proper posture by the following:

  • Your feet are flat while touching the ground or a foot stool
  • Knees bent at a 45 degree angle directly above your feet.
  • Your chair supports your lower and upper back.
  • Seat should be slightly sloping forward.
  • Shoulders are relaxed and arms relaxed at sides or bent while resting flat on the armrests.
  • Don’t hunch.

Use Ergonomic Equipment

steelcase white

Ergonomists and engineers alike are now looking at creating better equipment for gamers – ergonomic chairs with multiple adjustment points are now in the market, as well as ergonomic mice, keyboards, and adjustable desks.

Plenty of doctors are also diving into the e-sports scene to recommend proper wrist exercises and posture that minimize the chances of developing RSI. Doctor Levi Harrison is one of the more well-known doctors in the e-sports industry that advocates the use of proper gaming equipment and following a healthy lifestyle. He even has an e-sports coaching page on his website and I’m quite surprised to see that he’s worked with NRG, one of the newer teams competing in the LCS.

Educate Yourself With These Resources

RSI is not a frequently discussed topic – after all, why discuss about injuries, health, and posture when you can talk about dank memes? However, educating yourself about the perils of gaming too much (however impossible that may be) is still a good thing. As such, I created an educational resource for you which I will update every time I come across a suitable site or link. If you want something to be added here, just send me an email right here.

Resources for Gaming Ergonomics

Your Call

In the end, how we defeat RSI is a matter of choice – we can live a healthy gaming lifestyle which reduces the risk of RSI or we can live a life of an irresponsible gamer and suffer on its consequences later on.