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Published 5/1/2020
Julie Balch Samora, MD, PhD, MPH, FAAOS; Kerri Fitzgerald

eSports Gamers Emerge as the Newest Orthopaedic Patient

Editor’s note: This article is part one of a two-part series on eSports gaming and related musculoskeletal injuries. In part two, which will appear in the June issue of AAOS Now, sports medicine and hand and wrist specialists weigh in on these injuries and detail what orthopaedists need to know about treating and managing these patients.

As a pediatric hand surgeon, Julie Balch Samora, MD, PhD, MPH, FAAOS, has seen more and more gamers presenting to her clinic for overuse-type injuries. She realized she knew very little about eSports, and even her teenage son couldn’t provide much insight. Dr. Samora had the pleasure of meeting patient Jonathan Weber*, 15, who opened her eyes to the huge industry.

Jonathan has been competing professionally in the eSports industry for nearly two years. In such time, he has earned more than $200,000 in prize money competing in the game Fortnite, an online video game developed by Epic Games and released in 2017. However, he has also earned a diagnosis of wrist tendonitis/overuse as a result of training for up to 10 hours a day, most days of the week. Jonathan and his mother, Amy Weber, discuss the world of eSports and what other gamers and orthopaedists who treat them should know about the growing musculoskeletal injuries in this population.

AAOS Now: Can you describe the eSports gaming community?

Jonathan: It’s basically the best of the best top competitors in the video game community who play professionally and compete for large pools of money. In Fortnite—the game I play—usually you have to qualify to make it to the finals of the tournament. You have to go through a one- to two-month qualifying process. The first-place prize can be anywhere from $50,000 to up to $3 million for the World Cup champion.

How do you qualify for these competitions?

Jonathan: You have to get enough points to make it into the top 20 or 100 players in the world, depending on the requirements. Then you compete in the final tournament, and whoever gets the most points in the grand finals wins the tournament. The qualifier games are usually done online, but the final tournaments are done live in person in places like New York City, Los Angeles, Sweden, and Australia.

Can you talk about your personal winnings?

Jonathan: I’ve been competing professionally for about a year and a half and have won more than $200,000 in that time. The most I’ve won at one time was $100,000 for the Season 10 Fortnite Championship Series.

And now colleges are offering scholarships for eSports, right?

Jonathan: Yes. I haven’t looked into it much yet, since college is a ways off for me, but some colleges are looking to offer scholarships for eSports, such as Ohio State University.

[Editor’s note: In October 2018, Ohio State University announced a “first-of-its-kind” comprehensive eSports program. The interdisciplinary curriculum will focus on game studies, and the school will build an on-campus arena to complement the curriculum. The program will also entail scholarships to “exemplary eSports athletes.” Learn more at https://esports.osu.edu/faq.]

What does your gaming training look like?

Jonathan: I play every day for eight to 10 hours per day—weekdays and weekends. I go to school three times a week for two hours each day, and I do online school while I’m there.

Amy, what has this process been like for you as his parent?

Amy: It’s super exciting. Everything happened very quickly, and I’m very supportive of him.

Jonathan, can you describe the injuries you have sustained from your training and competing in eSports?

Jonathan: It all started in June 2019 when my wrist started hurting. I had just qualified for a tournament when these symptoms started, and I couldn’t play for two weeks straight because my wrist hurt so badly. I had to wear a brace. Two weeks is a long time in eSports to be missing practice. I have been gaming my whole life, but I had been playing competitively for about a year before my injuries surfaced.

Have you heard from other people in the industry who have experienced similar injuries?

Jonathan: Yes, I can name many people. One of my teammates had tendonitis, and he had to stop playing for about a month straight. He used to be considered the best in the world, but he really never returned to his preinjury level after the injury and taking a month off of training.

When I started tweeting about my wrist problems, I got a lot of messages from other pros talking about what helps them with their hand and wrist problems. I know someone else whose career was completely stopped by wrist problems. They can’t play anymore because it just hurts really badly, and they can’t handle it.

Is that something that scares you?

Jonathan: Yes, I think it’s one of the scariest things—when you have to take a two-week break from doing something you love—because you wonder, “Is it going to heal?” or “Am I going to be the same player I was before?”

Amy, how have you processed Jonathan’s injuries?

Amy: I’m happy Jonathan identified that he was having a problem and that he got the help he needed. We are fortunate that where we live in Ohio there is such a discipline around hand orthopaedics at the Nationwide Children’s Hospital. I was really excited to have access to that type of care for Jonathan.

What has been the course of treatment for Jonathan?

Amy: Icing, ibuprofen, ergonomic changes, activity modification, bracing, and recently, he started physical therapy. He also does daily exercises to strengthen his hand and wrist. Fortunately, Jonathan identified the problem early, so with some modifications and physical therapy, things should turn out well.

He has made some adjustments as far as ergonomics—how he positions the keyboard and mouse, how he sits at his desk, etc. Those are some tweaks he’s made along the way. It’s been trial and error as far as what works for him.

Going through this experience, it was interesting to me that there are many other players and parents in the industry facing similar challenges. With Jonathan being on the younger side of a lot of the professional gamers, fortunately, he was able to say, “Hey, I’m having an issue,” and get the treatment he needed. Some of the gamers who are a little older may not have really identified the pain as a challenge. Some have reached out to him to ask what types of things he is doing to overcome the pain.

This problem is becoming a bigger issue in the eSports industry, and it’s good to get in front of it. It’s going to be interesting to see where the eSports industry ends up in 10 years.

Treating the injuries

According to Dr. Samora, Jonathan has presented early in his gaming career, and hopefully with a focus on appropriate ergonomics and minimizing overuse (if possible, given the incredible practice demands he has), he can minimize short- and long-term effects.

In part two of this series, we will focus on the clinical perspectives of hand and sports specialists who treat musculoskeletal conditions of amateur and professional gamers.

*The patient and his guardian provided consent to discuss his injuries and medical care.

Julie Balch Samora, MD, PhD, MPH, FAAOS, is a pediatric hand surgeon at Nationwide Children’s Hospital in Columbus, Ohio, and the newly appointed deputy editor of AAOS Now. She can be reached at julie.samora@nationwidechildrens.org.

Kerri Fitzgerald is the managing editor of AAOS Now. She can be reached at kefitzgerald@aaos.org.