Integrated analysis of health dynamics in esports: injury profiles, intervention strategies, and health optimization protocols

INTRODUCTION

The electronic sports (eSports) that encapsulate the excitement are commercialized through a computer video gaming tournament with audiences to speculate, to create an experience that simulates traditional sports. Gamers or e-athletes indulge in these games as teams in multiplayer or individual mode. With the immense support of streaming services like Twitch and YouTube, the popularity has spread amongst the masses to witness and celebrate these tournaments. The audience treats them as professional sports players. Common electronic sports games to mention are League of Legends, Call of Duty, Counter-Strike, Call of Duty, Dota 2, Fortnite, Madden NFL, and Overwatch. The competition and the recognition of the event as a sport with grades of achievement increases the impulse for the e-athletes to engage more in the sport which serves as a drive for this industry to thrive and prosper! Though eSports have become common for the past few years, it does not imply a recent development. This sporting domain has roots that are hinged to the beginning of competitive computer gaming and retro-competitive online games. Though the eSports industry has gained interest in this decade, it was formally institutionalized at the beginning of the new millennium as its origin dates back to the 1980s. In fact, in 1958, hundreds of students lined up for an analog computer at the Brookhaven National Laboratory. Over the next three days, thousands would play the world’s first-ever game designed for entertainment purposes only, Tennis for Two.¹ Esports traces its origins back to 1972 when home consoles first became common. The first esports event happened in 1972 at Stanford University, where students competed in the video game Space War. Esports origin relies heavily on launching the World Wide Web in 1989 and the early 1990s software and hardware technologies with network and multiplayer functions.² Game journalist Tristan Donovan points to the Intergalactic Space Warfare Olympics held in 1972 at the Massachusetts Institute of Technology (MIT) as the first electronic gaming competition in history. At the end of the 70s of the last centuries, the combination of the first computers, recreational pleasure, and the vision of aspiring entrepreneurs laid the foundation for today’s thriving electronic entertainment industry.

Time magazine’s 1981 interview of teenager Steve Juraszek for his record in a 16-hour game, Life magazine’s feature on the Twin Galaxies arcade and its star players, and the inclusion of the best player of the year in the 1985 Guinness Sports Record are examples of the contribution of the media toward the professionalization of eSports and its players, in addition to its appeal to the public and the interest of other industries in the entertainment industry.³ History has led its way with events that implicitly witness the appreciation of eSports way ahead of time that is expected. These events bookmark the growing interest of eSports in the audience as well as emphasize the importance of media in the evolution of eSports. Esports have been parallelly evolving with the evolution of computers and the amusement of online games. With the facilitation of technology and exploration of features that mold electronic games to emerge as an enriching experience, gamers also become professional over time, gathering their group of audiences and promoting the gaming sport to reach a point where Esports is competing in the gaming market rendering excitement the equal excitement that the traditional sports brought in! An exponential growth of the eSports industry, along with potential business opportunities, has been witnessed in recent times.⁴

In 2023, 31.6 million esports viewers were accounted for, according to Insider Intelligence’s forecast.⁵ According to the Esports Federation of India, eSports is expected to have a 1.9 billion global market with 532 million international fans and 152 countries engaging in eSports.⁶ The numbers promise an enormous amount of support and participation from gamers and fans of gamers all around the world to witness this competitive electronic sport. Esports is being broadcasted through live-streaming platforms with a hundred million players participating. According to the recently presented data by Josh Howarth, the gaming market has a current valuation of 282 billion and is expected to raise its bars to 363 billion. According to the latest data, there are around 3.32 billion active gamers worldwide.⁷ The sporting qualities of competitive computer gaming are still questioned amongst public health domain members and media. The definition of sport has been rethought with the arrival of eSports into our lives. The health benefits we obtain from traditional sports are argued with the health implications due to prolonged engagement with computer gaming and eSports encouragement. Sports are regarded as a virtue, whereas computer gaming is viewed as a vice.⁸ Strong arguments have been raised against the consideration of esports under the domain of sports, and it is implicitly referred to as a misnomer. The most convincing reason is that esports are not inadequately human: they lack physicality, they fail to employ decisive whole-body control and whole-body skill, and cannot contribute to the development of the whole human.⁹ The sole purpose of this review is to emphasize the health implications, potential injuries, and managing the impacts of eSports amongst professional gamers, viewers, and global audiences.

HEALTH IMPLICATION OF E-SPORTS

Sedentary lifestyle and its consequences on physical health

Sedentary lifestyle and its consequences: Engaging in activities while seated before a screen is identified as sedentary behaviour.¹⁰ Research indicates a higher prevalence of metabolic syndrome, increased risk of obesity, cancer, type 2 diabetes, and greater overall mortality among individuals who dedicate prolonged periods to sedentary pursuits like watching television, videos, or using a computer.^11-15 However, Wijindaele et al conducted a cross-sectional analysis revealing a positive correlation between time spent in sedentary activities and the occurrence of metabolic syndrome and its components.¹⁶ While active video gaming allows both children and adults to expend more calories compared to sedentary video games, the substitution of video games for actual sports or unstructured play requires further examination.¹⁷

Vandewater et al identified a connection between weight status and the duration of time spent engaging in video games.¹⁸ Activities that require energy expenditure in the range of 1.0-1.5 metabolic equivalent units (METs) are considered sedentary.¹⁹ Research has indicated a negative correlation between metabolic syndrome and physical activity participation.^20-25 The World Health Organisation (WHO) and other international bodies' recommended levels of physical activity for elite esports athletes were met by the 115 participants in the research, which involved 5.3 hours of training per day, including 1.1 hours of physical exercise.^26-28 Elevated levels of physical activity have been found by Ekelund et al. to potentially attenuate the negative effects of television viewing and act as a protective factor against the development of metabolic syndrome.²⁹

Musculoskeletal Issues

Extended periods of sitting coupled with poor posture and repetitive movements associated with gamepad, mouse, and keyboard use are identified as significant contributors to musculoskeletal hazards in the realm of eSports.³⁰ According to multiple studies, wrist and hand pain is the most common complaint among e-athletes, closely followed by back and neck pain.³¹ Early research on hand and upper limb injuries coined the term “Nintendinitis”.^32,33 Typical e-athletes might experience head flexion, repetitive or prolonged wrist bending, and described twisting or thrusting motions of the thumb as they adopt a hand-held mobile gaming position and maintain a prolonged inferior viewing angle.³⁴ Esports athletes face an elevated risk of wrist and hand injuries due to their engagement in a high volume of actions, reaching up to 500-600 actions per minute (APMs) involving keyboards, mice, or gamepads.^31,35,36

The most prevalent symptoms among athletes who play video games pertain to the neck (42%), back (42%), wrist (36%), and hands (32%), based on the prevalence rates of symptoms.³¹ A common ailment among e-athletes is "Gamer's Neck," often referred to as the "Nintendo Neck".³⁷ This condition is caused by persisting to sustain incorrect posture and is defined by spinal flexion and axial pain that travels from the cervical to the lumbar area.³⁸ A study conducted by Sekiguchi et al looked at how 200 baseball players were impacted by playing video games.³⁹ Based on their study, there is a strong link between playing video games for three hours or longer every day and suffering severe elbow or shoulder pain.³⁹ According to Di Francisco Donoghue et al., wrist, hand, and neck/back injuries account for 42%, 36%, and 32% of all reported injuries.³¹ The most commonly injured regions during esports, according to Lindberg et al., are the shoulder (11%), neck (11%), and back (31%).⁴⁰ A different study revealed that the wrist and hand joints [66%] are most afflicted in esports followed by other body parts such as the shoulder (18%), neck (6%), lower back (5%), and mid back (2%).⁴¹

Mental health

Esports, unlike traditional sports, have their demerits in the aspect of maintaining sound mental health whilst investing a lot of time on screen, encouraging addictive behaviour and leading a sedentary lifestyle, which has its own physical and psychological health effects the World Health Organization lists ‘Gaming Disorder’ as a Mental Disorder.⁴⁵ The prevalence of esports and the popularity of competitive computer gaming elements amongst gamers and viewers over a prolonged period could determine the physiological and psychological effects. Measures have to be taken to protect against some health risks and are of paramount importance to be noted. Awareness should be spread amongst the gamers, and the viewers indulged in esports by healthcare practitioners and policymakers.

Cognitive effects

It is established from the collection of studies tabulated in the review article that Video Gaming and Internet Gaming Disorder. Internet gaming disorders are defined by continuous and repeated involvement with video games, often leading to significant daily work and educational disruptions and has been suggested by American Psychiatric Association (APA) as a tentative psychiatric disorder, have a negative impact on the brain structures and specific neural alterations.^46,47 The massive scale of participation, controlled environments, structured skill rating, pervasive social nature and large data repositories could be an optimal set-up for research on the neuroscience of athletes' cognitive abilities. Understanding neurological changes as expertise develops is a central topic in cognitive psychology and cognitive neuroscience. This facilitation could pave the way for understanding the positive/negative effects of gaming on neurocognition.⁴⁷

Psychological wellbeing

Some of the ill-effects would include Psychological and Physiological Anxiety and Stress, Identity Transformation and Mental Well-being development process of eSports professionals, Addiction and musculoskeletal pain.^48-52 It is established from the collection of studies tabulated in the review article that Active Video Gaming and Internet Gaming Disorder have a negative impact on: Personality and Psychological Well-being, Mental disorders and Sleep, Psychological Distress and Reward Seeking, Leading to Depression, Leading to Anxiety, Sleep.^53-58 Long hours of online gaming were associated with the presence of the following mental health implications such as depression, social phobia, obsession-compulsion, interpersonal sensitivity, hostility, phobic anxiety, paranoid ideation, psychoticism, ADHD, gaming addiction.⁵⁹ Esports, when accompanied by numerous negative mental health implications, becomes a matter of concern, especially amongst the younger generation who are entering the zone of competitive computer gaming without knowing the limits and being unaware of the consequences of their extensive gaming in their routine lives.

COMMON INJURIES IN ESPORTS

Carpal tunnel syndrome

Carpal tunnel syndrome (CTS) stands out as the most frequently identified entrapment syndrome affecting peripheral nerves in the upper extremity.⁶⁰ According to a published article, a robust correlation exists between the occurrence of carpal tunnel syndrome and repetitive hand movements.⁶¹ Thomsen et al determined that biomechanical elements, including forceful actions, repetitive motions, and uncomfortable postures, elevate the likelihood of developing CTS.⁶²

A study identified that an awkward typing stance poses a risk for the onset of CTS symptoms, particularly with increased degrees of ulnar deviation in wrist posture, deviating from a neutral flexion/extension position.^63,64 Epidemiological data indicates that occupational factors contribute to the onset of CTS, with increased risk linked to professions involving extended periods of repetitive and forceful movements, uncomfortable or fixed postures, localized mechanical pressure, and exposure to vibration.^65-69 Additionally, a bibliometric investigation by Ram et al affirmed a prevalent association between CTS and prolonged engagement with computers and keyboards.⁷⁰ Liu et al conducted a study involving clinical examinations and median nerve conduction tests on symptomatic office workers spending more than 6 hours per day working on computers. The research revealed a significant positive correlation between a larger wrist angle (less than 20 degrees of extension) during keyboard use and an elevated risk of developing CTS.⁷¹ Ali et al presented evidence indicating that computer professionals working over 12 hours daily for eight years face a heightened susceptibility to CTS.⁷² Additionally, Di-Franciso-Donghee et al observed that esports athletes practicing 3-10 hours daily frequently experienced hand and wrist pain, among other complaints.³¹

In an experimental investigation, the average carpal tunnel pressure (CTP) exhibited an increase from 5 mmHg during resting before placing the hand on the mouse to 17-19 mmHg after the hand was positioned on the mouse, escalating further to 29-33 mmHg during the act of dragging the mouse.⁷³ Factors influencing CTP encompass wrist pressure, forearm posture, finger posture, and fingertip force.⁷⁴ CTP elevation is associated with forearm rotation beyond 45 degrees of pronation and wrist deviation from a neutral position, particularly in wrist extension.^75-77 An extension of the wrist angle beyond 20 degrees poses a potential risk for the development of CTS.⁷⁸ The observed U-shaped relationship between wrist posture and CTP during typing aligns with findings from other studies measuring CTP at static wrist postures or with simple wrist motions.⁷⁴ Prolonged elevation in intracarpal pressure can lead to intraneural edema, ultimately resulting in median nerve demyelination.⁷⁹ Greening et al proposed that pathological changes in the sub-synovial connective tissue, such as noninflammatory fibrosis and thickening, may also contribute to CTS.⁸⁰ New onset CTS often manifests as pain and paraesthesia in the lateral three digits and lateral half of the ring finger.⁸¹ Advanced cases may involve tingling sensations in these digits.⁸² In a survey of frequent computer users, 29.6% reported hand paraesthesia, and 10.5% met clinical criteria for CTS.⁸³ Over time, symptoms may progress to a weakened grip and difficulty in holding heavy objects.⁸⁴ The reported prevalence of CTS in the general population varies from 0.7% to 9.2% among women and from 0.4% to 2.1% among men.⁸⁵ A study on gamers found symptoms of CTS in over 60% of participants, with more than 50% reporting functional impairment.⁸⁶ A recent systematic review and meta-analysis by Mediouni et al investigated the potential association between CTS and computer-related work.⁸⁷ Reducing the duration, frequency, or intensity of exposure to forceful repetitive work, extreme wrist postures, and the vibration is likely to contribute to a decrease in the incidence or severity of CTS in the working population.⁸⁸

Lateral epicondylitis

Lateral epicondylitis, commonly known as tennis elbow, is referred to as "Mouse Elbow" in the esports community, as it is prevalent among gamers who engage in repetitive wrist extension and forearm pronation while using computers.⁸⁹ This condition primarily involves the exaggerated condition of the common extensor tendon of the elbow, specifically the extension carpi radialis brevis (ECRB).⁹⁰ Prolonged exposure to repetitive movements during computer use is associated with a poor long-term prognosis for individuals with lateral epicondylitis.⁹¹ High-quality evidence that a large amount of repetitive movement exposure raises the chance of acquiring this syndrome was provided by a meta-analysis based on two studies.^92-93

ESWT= Extracorporeal Shock Therapy, TENS= Transcutaneous Electrical Nerve Stimulation, LLLT= Low-Level Laser Therapy, KT= Kinesio taping, IFT= Interferential Therapy, ROM= Range of Motion, SWD= Shortwave Diathermy.

Patients report pain as their main symptom, with clinical symptoms including pain that is localized around the lateral epicondyle and occasionally radiates to the forearm.⁹⁴ Studies have shown that a substantial number of patients with lateral epicondylitis remain to have discomfort and functional loss even two years following treatment, including a decrease in handgrip strength.^95-97 Lateral epicondylitis may progress into an ongoing medical condition. While the precise cause of lateral epicondylitis is not fully understood, it is believed to result from a degenerative process involving vascular proliferation and hyalin degeneration of the ECRB and extensor digitorum communis at the lateral epicondyle. This degeneration is attributed to factors such as overuse, repetitive forceful movements, poor circulation, strength deficits, or muscle imbalance.^97-99 Histopathologic examination reveals a degenerative, noninflammatory process characterized by disorganized collagen, immature fibroblasts, and neovascularization, termed Angio fibroblastic tendinosis.¹⁰⁰ Esports players, engaging in 10 hours or more of gaming activity per day, are at an increased risk of developing lateral epicondylitis, potentially impacting their physical performance.⁸⁹ In a detailed examination of predominantly computer-using injured workers, 7% were identified with radial tunnel syndrome, and 33% were diagnosed with lateral epicondylitis.¹⁰¹ Lateral epicondylitis is the most commonly diagnosed elbow condition, affecting 1% to 3% of the general population annually, with workplace activities contributing to 35% to 64% of all cases.^97,102,103

Neck pain and low back pain

A study found that neck and back pain are experienced by about 35% of collegiate esports athletes when they play. Neck pain (NP) is a prevalent issue among individuals who spend an excessive amount of time in front of computers.^104-106 Sedentary behavior, prolonged use of computers, low-intensity activities, increased tension, strain on the upper back and neck, and improper posture are the primary root causes of this problem.^107-109 There is evidence in the scientific literature to support the claim that neck pain is mainly brought on by static loading and repetitive neck muscle movements, with a beneficial relationship seen between neck flexion and neck pain.¹¹⁰ Research investigating posture during gaming suggests that players' capacity to remain centred and erect during the first half hour of play decreases, which contributes to forward head posture.^111-112 The cervical extensor muscles endure a further 10 pounds of torque force for every inch as the head moves forward.¹¹¹ According to Jung-Ho and Groszek, the upper cross syndrome may be exacerbated by extended positioning when combined with severe neck bending.^113,114 The micro-lengthening of posterior cervical structures as a result of persistent submaximal stretching may be explained through biomechanical parameters like creep, which may also trigger persistent muscular spasms and microstructural disintegration. This is particularly apparent in the levator scapulae, sternocleidomastoid, and upper trapezius muscles, which surround the cervical spine.^112,115-117 Janda's patterns of muscle imbalance indicate that reciprocal inhibition of tight structures promotes weakness in deep neck muscles, including serratus anterior, lower trapezius, and rhomboids, which in turn contributes to postural neck syndrome.^118-120 Asymmetrical tension of the cervical joints caused by prolonged maintenance of high cervical angles might cause displacement from the typical lordotic neutral alignment.^117,120 Research shows that those with symptoms flex their necks around five degrees more than controls lacking symptoms do, and this difference holds even when the pain gets exacerbated during continuous typing sessions.¹²⁰ According to Holte and Westgaard and Mork and Westgaard, people who suffer chronic pain might develop altered patterns of muscular activation as a coping mechanism.^121-122 According to Hogg-Johnson et al the incidence of neck pain in the general population ranges from 15.5 to 213 per 1000 person-years, demonstrating the pain's broad impact.¹²³ Furthermore, people who use computers and video display devices have been found to have a higher incidence of musculoskeletal problems.^124,125

Low back pain

Leading a sedentary lifestyle is commonly recognized as a significant contributor to the risk for low back pain (LBP), and numerous researchers have pointed out the possible long-term effects of exerting too much strain on these anatomical systems.^114,126 Prolonged and repetitive over-rotation or flexion of the trunk of the body may contribute to non-specific LBP, especially when people must rotate their trunk around to face a computer monitor that is not in front of them.^127-129 An additional investigation revealed a favourable association between the length of time spent in the vicinity of a screen and the probability of experiencing spinal column pain.¹³⁰ Adopting a slumping posture in the lower back increases pressure on the intervertebral discs, potentially leading to herniations.¹³¹

Backward-leaning seats flatten the lumbar lordosis, enhance the potential hazards of kyphotic posture, and contribute to posterior pelvic tilt.¹³² Reduced activation of the multifidus and erector spinae (longissimus) muscles, as well as weakening in the transverse abdominis and buttock muscles, are the results of an increased posterior pelvic tilt.¹³² The relationship between low transverse abdominis muscle activation and a slumped posture is corroborated by Rasouli's research.¹³³ Research shows that women are more likely than men to experience environmental risk factors, which may contribute to the higher prevalence of LBP. More specifically, rates of 44.8% in the upper back and 56.1% in the lower back have been recorded documented.^134,135

Shoulder pain

Shoulder and neck pain are the most widespread type of pain encountered by esports athletes; research suggests that these symptoms occur more frequently than other upper extremity problems among computer users.¹³⁶ Bernard analyzed more than 20 epidemiological research and found that prolonged shoulder postures (over 60 degrees of flexion or abduction) and repetitive motions are linked to shoulder pain.¹³⁷

Prolonged static positions are associated with musculoskeletal conditions in office workers, and prolonged static muscular activity and repetitive tasks tend to exacerbate pain symptoms.^138-139 Numerous research investigations have identified potential risk factors for shoulder pain, such as reiterated tasks, workplace design, and physical exposure from static body postures.¹⁴⁰ Studies in clinical settings have confirmed that the most prevalent type of shoulder discomfort among computer users is associated with muscular fatigue, particularly in the trapezius muscle.¹⁴¹ According to a study by Hedge et al, the risk of musculoskeletal disorders is dramatically increased while using computers for more than four hours a day.¹⁴² In a prior investigation, office workers at KhonKaen University reported a three-month prevalence of shoulder pain, with the right shoulder reporting higher frequency (51.1%) compared to the left (41.1%).¹⁴³ Furthermore, the research revealed that female employees experienced more instances of shoulder pain in comparison to their male colleagues.¹⁴³

Other injuries

De Quervain’s tenosynovitis, ulnar neuropathy, trigger finger, cubital tunnel syndrome, and medial epicondylitis are also found in the case of esports athletes.^144-147

Vision-related issues

Prolonged exposure to computer screen time has deteriorating effects on the visual and ocular systems in the human body. To understand the irreversible defects in their vision and the functioning of their ocular system, strong awareness has to be raised amongst computer gamers, especially those engaged in esports, which demand more screen time and attention to the eyes.

Computer vision syndrome

Computers, being a part of our daily lives, primarily as a medium for electronic sports to be conducted, could present themselves with various ocular symptoms due to their prolonged usage. These symptoms include eye strain, tired eyes, irritation, redness, blurred vision and double vision and the syndrome is referred to as computer vision syndrome.

Many esports’ athletes have computer vision syndrome, characterised by symptoms including blurry vision, low back pain, and tension headaches. This condition is found in 90 per cent of individuals using a computer for more than 3 hours per day.¹⁴⁸ Lack of contrast and definition in pixel-generated computer images increases strain on the eye. Consequently, saccadic movements, accommodation, and convergence increase while the blink rate decreases, which fatigues the oculomotor system.¹⁴⁹

Eye-strain and fatigue

Since eSports also demand practice, there is a heavy load on the eyes of esports athletes, and the most commonly reported complaint is eye fatigue. More than 25% of collegiate esports athletes practise more than 5 hours daily. This sport solely demands hand-eye coordination with a heavy focus on the screen for extended periods, which is not optimal and healthy for the eyes. When routinely done by eSports athletes, this practice would result in Computer vision syndrome, discussed in the previous section.

MANAGEMENT AND PREVENTION STRATEGY

Physiotherapeutic interventions

Esports competitors need to warm up adequately to avoid musculoskeletal injuries, much like conventional athletes do.¹⁵⁰ Despite warming up is frequently linked to enhanced performance as well as potential benefits for minimizing injuries, its application in upper extremity processes has not yet been established beyond a reasonable doubt.^150,151 Stretching should be done for three to five minutes as part of warm-up activities, and then again for five minutes every two hours.¹⁵² The warm-up may also involve aerobic activities like walking or running.^150,153

Professional esports players run the danger of suffering injuries that could end their careers,³¹ which are mostly caused by extended bad postures and repetitive motions of the upper extremities that can cause musculoskeletal problems.^154-155 To reduce these risks, physiotherapists advocate the initiation of core stabilization exercises, as the core muscles play a crucial role in maintaining proper body positioning.¹⁵⁶ Furthermore, it is recommended that esports athletes take regular breaks, such as a 5-10-minute break every hour or 20-minute break every 3 hours, to alleviate the axial load on the lumbar spine.^157,158

Ergonomics Intervention

When designing computers, ergonomic concepts must be considered because ill-conceived systems can greatly exacerbate musculoskeletal issues.²²⁵ Maintaining a repetitive and incorrect posture may result in musculoskeletal problems, whereas changing posture can lead to better clinical outcomes, according to Cramer et al.²²⁶ Poor shoulder position has been related in studies to musculoskeletal problems in the upper limbs and neck.^227-228 Awkward postures have been connected to low back pain, according to Lis et al.²²⁹ Nevertheless, a recent, encouraging study discovered no connection between non-neutral shoulder postures and disorders or symptoms related to the hands, arms, or neck.²³⁰

It is suggested that esports athletes utilize controllers and keyboards with the appropriate sensitivity to avoid putting excessive pressure on their fingertips repeatedly.²³¹ Increased keystrokes and mouse use can result from time constraints and the introduction of new software, which increases physical burden.^232-233 Maintaining a neutral spine position where the head, chest, and hips are in alignment—as additionally assuring that the knees are horizontally positioned about the floor and that the upper extremities are in line with the torso are the most important factors to consider.²³¹ Six suggested actions include choosing the ideal keyboard and mouse configurations, sitting in a suitable display position, adjusting lifestyle and customary behaviours, and choosing the appropriate desk height to improve the gaming position and alleviate stress on athletes.²³² Furthermore, certain ergonomic measures are necessary to reduce visual problems. These include positioning the monitor's centre 5 to 6 inches below a straight vision line at a distance of 20 to 28 inches, modifying lighting to reduce glare, correcting refractive errors, accommodating astigmatism, engaging in eye exercises, and, most significantly, adhering to the "20-20-20" rule, which requires looking 20 feet away for 20 seconds every 20 minutes.²³⁴

Psychological intervention

A study conducted on stress and coping in electronic sports athletes informs us that there is some overlap between mental toughness (MT) and stress-coping processes in high-performing traditional sports and competitive esports athletes.²³⁵ This research result implies that psychological interventions (for instance, imagery intervention) successfully practiced by traditional athletes could also be translated to esports athletes to reduce stress and anxiety while playing in tournaments. Imagery Interventions are a type of sports psychology intervention.

Imagery is also called Visualisation or mental rehearsal. It means using your senses (e.g., seeing, feeling, hearing, taste, smell) to rehearse your sport in your mind.²³⁶ Imagery and Visualisation involve a mental rehearsal through imagery aids in familiarising players with potential scenarios, sharpening reactions, and boosting confidence. As imagery interventions have been proven to be beneficial for traditional athletes, it could be an efficient intervention strategy to manage anxiety in competitive situations such as esports tournaments as recent research successfully implies imagery intervention on League of Legends video game players to reduce stress and optimize their performance.²³⁷

The most common techniques besides ‘Imagery Interventions’ are ‘Goal Setting’ and ‘Self-Talk and Positive Reinforcement’. Goal setting establishes clear, achievable goals and helps in guiding focus and motivation. It aids in breaking down larger objectives into manageable steps, enhancing performance. Self-talk and Positive Reinforcement cultivate a positive inner dialogue that can significantly impact performance. Encouraging self-talk and affirmations bolster confidence and resilience.²³⁸

CONCLUSION

Likewise, with conventional sports, engaging in esports exposes participants to an array of risks that are associated with their musculoskeletal system, eyesight, and psychological well-being. Musculoskeletal issues such as overuse tendinopathies and dysfunction in the cervical and lumbar spine, are more common in esports athletes owing to sedentary lifestyles, inadequate ergonomic support, and repetitive upper extremity motions during gameplay. Additionally, extended gaming sessions and light-emitting diode monitors have increased vision-related issues such as computer vision syndrome, eye strain, and fatigue. Finally, the quantity of time spent playing online games can affect the development of mental health conditions such as depression, anxiety, apathy, and sleeplessness. This study provides the framework for addressing the awareness and mitigation of health hazards faced by esports athletes. Also, it provides a strategy that is intended for coaches, trainers, and sports medicine specialists to improve their health and well-being and ultimately assist overall performance optimization. In summary, the necessity for interdisciplinary research to enhance awareness and establish uniform protocols for addressing health hazards in eSports is undeniable.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: Not required

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