A New Meta: Esports Injuries and the Changing Health Standards in the Industry

Feb 24, 2023

By Zach Holdsman, of Montgomery McCracken

Professional esports is beginning to enjoy more legitimacy but with that legitimacy, comes liability. Esports players can make millions of dollars, but the player’s long-term career outlooks are concerning. These players are sustaining detrimental injuries and retiring in their early-to-mid-twenties. Health risks and preventative measures are becoming more documented and as a result, more foreseeable. All of this culminates in a new pressure on esports organizations to take further action to support the health of their players.

The realm of esports has developed rapidly from a fragmented landscape of locally coordinated competitions to professional leagues funded by the same key people supporting traditional sports organizations. Recent years have brought about enormous prize pools, advertisement revenue, and sponsorship deals for those lucky enough to get involved and be successful in esports leagues. For example, League of Legends brought in more viewers than the Super Bowl in 2019 according to a report by CNBC[1]. An article in Forbes[2] reported that the value of esports was more than $1 billion in May 2022 and expected that value to reach over $7.1 billion by 2028. Prize pools alone can allow individual players in games like DOTA 2 to make over $7 million[3].

While in the past teams may have simply been a name for a group of players, many of the teams independently, and even the leagues that host them, have become much more. Consider the Overwatch League, which touted[4] a minimum $50,000 a year salary, health benefits, retirement savings plan, and housing and training facilities during the season. Many of these teams also have minor league organizations for finding fresh talent as well as college leagues.

However, just because the players are competing in a virtual world, does not mean they are not at risk of injury. Indeed, esports players appear to be very prone to chronic injuries from overuse resulting in retirement in their twenties. 1HP[5], which describes itself as a team of medical professionals and gamers that specialize in helping gamers avoid injuries, reported[6] that in 2021 they had 95 cases of tendinopathy across various tendons in the wrist and hands. They also reported 15 cases of thoracic outlet syndrome. 1HP also addresses issues related to the mental health of players. 

The knowledge of treatment, preventative care, and risks of injury to esports players is developing and being documented and distributed just like other fields of sports medicine. 1HP published the Handbook of Esports Medicine: Clinical Aspects of Competitive Video Gaming and two research publications in 2021:

  • McGee, Caitlin, et al. “More Than a Game: Musculoskeletal Injuries and a Key Role for the Physical Therapist in Esports.” Journal of Orthopaedic & Sports Physical Therapy 51.9 (2021): 415-417. 
  • McGee, Caitlin, and Kevin Ho. “Tendinopathies in video gaming and esports.” Frontiers in Sports and Active Living (2021): 144.

Most esports are played on a keyboard and mouse—not a traditional video game controller. As a result, the players are restricted to what is ergonomically feasible with a keyboard and mouse to avoid injury while practicing and competing. To make matters worse, the esports environment appears to allow for limitless practice time. It is well understood in traditional sports that players only have so many hours of practice before their bodies simply won’t perform the physical actions anymore, or at least to the degree where practice is more beneficial than harmful. Esports appear not as limited because the physical requirements are not as obviously taxing on the body. Injuries may not become apparent until long after the players have passed their bodies’ limits. Or worse, players may continue practicing despite injuries because they do not perceive their injuries as serious. 

This results in prominent players like Thomas “ZooMaa” Paparatto retiring at 25. The Washington Post reported[7] on this:

“For a while, I had no range of motion in my thumb,” Paparatto recalled in a recent interview with The Washington Post. A ganglion cyst, likely caused by gaming, had developed on one of his thumb tendons in 2016 and required surgery. “It was something I struggled with the entire second half of my career,” he said. “I always felt the wear and tear after long gaming sessions, and it was difficult to live the professional grind.”

That same Washington Post article discussed how some teams have been hiring in-house health professionals to support their teams. For example, Dr. Lindsey Migliore was hired as director of player performance for the esports organization: Evil Geniuses. Dr. Migliore was quoted by the Washington Post as saying, “We’re losing these players in their early 20s due to preventable injuries that could’ve been, and still can be, treated.” She then went on to detail some of the aspects of treatment plans that may be effective.

Based on a review of current litigation, there do not appear to be any claims by players against organizations for injuries suffered due to over-practice or competing in esports leagues and competitions. This is likely due to several factors: (1) player contracts have well-written assumption of risk clauses; (2) players are provided insurance, which may be deemed to be an adequate standard of care for the profession; (3) teams and organizations are engaging in practices similar to what is described above, where they retain health professionals to increase the health outcomes of their players; and (4) injuries occur slowly over time due to overuse and cannot be directed to specific incidents where there is a discernible and responsible party other than the player. It is unclear at this time how these factors may play a role in the lower leagues such as recruitment leagues and college-level leagues.

Those in the industry should be taking note of the developments in the field and ensuring their players are treated in accordance with the latest and best health practices if they want to keep their players in the game longer, help their players perform better, and reduce risk of liability.

[1] This esports giant draws in more viewers than the Super Bowl, and it’s expected to get even bigger, Annie Pei, Apr. 14, 2019, https://www.cnbc.com/2019/04/14/league-of-legends-gets-more-viewers-than-super-bowlwhats-coming-next.html

[2] From Reality To Virtual: Why Traditional Sports Are Getting Into Esports, Swish Goswami, May 17, 2022, https://www.forbes.com/sites/forbestechcouncil/2022/05/17/from-reality-to-virtual-why-traditional-sports-are-getting-into-esports/?sh=1bc32dd74736

[3] See https://www.esportsearnings.com/players

[4] Six-figure salaries, million-dollar prizes, health benefits and housing included – inside the Overwatch League, Noah Higgins-Dunn, Sept. 29, 2019, https://www.cnbc.com/2019/09/29/what-its-like-to-be-a-professional-gamer-in-the-overwatch-league.html

[5] See https://1-hp.org/

[6] 1HP 2021 Year in Review: Esports Medicine & Performance Team, Dec. 27, 2021, https://1-hp.org/blog/hpforgamers/1hp-2021-year-in-review-esports-medicine-performance-team/

[7] Aching wrists, early retirement and the surprising physical toll of esports, Gregory Leporati, Mar. 14, 2022, https://www.washingtonpost.com/video-games/esports/2022/03/14/professional-esports-athlete-injuries/

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