Gamers - watch out! a ticking time bomb

5 Dangerous Gaming Injuries And How To Avoid Them

Gamer's thumb

How to protect against injuries



Korean gamers serious injuries.

Lee Young-ho (right>>) is the best player in StarCraft and has won everything in this field.

Repetitive strain had injured Mr Lee's muscles, deforming them and making surgery the only option to save his illustrious career. 

Gaming in South Korea had reached a dangerous place, where professionals and amateurs alike were destroying their lives and their bodies.

Korean gaming


Smash Bros. designer's arm injury sounds like it's getting worse.

Masahiro Sakurai (right>>) is a Japanese video game director, designer, and writer, best known as the creator of the Kirby and Super Smash Bros. series. 

Apart from his work in those series, he also directed Meteos in 2005 and Kid Icarus: Uprising in 2012.

Masahiro Sakurai says the the tendon sheath inflammation symptoms in his left forearm are "especially hard to deal with."

Development on the upcoming Super Smash Bros. game for Wii U and 3DS is taking a physical toll on director Masahiro Sakurai. After revealing last year that he's suffering from calcific tendinitis and muscle ruptures in his right shoulder (which is affecting his right arm), he has now spoken out to say this condition is now affecting his left arm as well.

"The tendon sheath inflammation symptoms in my left forearm are especially hard to deal with." Sakurai said in his latest Famitsu blog (translated by Kotaku). "I've been moving the controller as gently as possible.

What specific impact Sakurai's arm injury has on the development of the new Super Smash Bros. game remains to be seen, but it could be serious. Sakurai said in February 2013 that, "If this disorder lingers, or if it never gets fixed, there's no telling what impact that would have on the project."

Sakurai is the director on the new Super Smash Bros. game, meaning he presumably tests the project on a regular basis. As fans of the series know, Smash Bros. requires fairly advanced hand/finger motions, which are likely problematic for Sakurai considering his injury.


5 Dangerous Gaming Injuries And How To Avoid Them

Imagine that you can no longer grasp a can of drink without your wrist feeling like it wants to explode... That, my friend, is what that innocent-looking game console can do to you. I’m not speaking about this as a medical expert, or as a concerned parent hoping to sway kids from playing video games, but as a witness to the pain and suffering that extreme gaming can cause to the human body.

My gaming addiction actually started when I was about 13 – caused by the original Ultima series produced by Origin Systems. After seeking out magic runes and battling cyclops well into the night, I had officially caught the gaming bug. It was an affliction that stuck with me through the rest of school, into college, and even into my early marriage and parenting years. I eased off of gaming a little in college, but it wasn’t until after our children had entered their toddler years and there was a little more free time, that I re-entered the gaming action in full-force once again. That time, it was Medal of Honor Online.

The combination of staying up all night playing Medal of Honor, working at a desk all day as an automation engineer, and then writing online in the evenings eventually took its toll. I started feeling a strange tingling in the wrist, combined with a numb feeling up the side of my thumb. This eventually evolved into a terrible pain whenever I bent my wrist or my thumb at a certain angle or squeezed my hand. I was completely at a loss as to what was causing it, until one night while gaming, I realized that I was resting my wrist flat on the desk, with my hand tilted at an odd upward angle on top of the mouse. It was then that it dawned on me – I officially had Carpel Tunnel Syndrome.
A Gaming Injury You Don’t Want!

A visit to the Doctor confirmed my fear. I had aggravated the major nerve that passes over the carpal bones in my wrist, through the 'Carpel Tunnel. The Doctor at least gave me some good news – it wasn’t a syndrome unless the condition returned again after recovery, but the bad news was that recovery would require immobilizing my thumb for several weeks, potentially months. My gaming days were over.

When you make a living on the computer, the prospect of having your mouse-hand immobilized and rendered incapable of using a mouse is a scary thing. Let’s just say I learned to use the mouse with my left hand for a while.

Thankfully, when it comes to ergonomic issues and repetitive use injuries that could potentially be related to your on-the-job responsibilities, employers are usually pretty good about helping you correct your workstation so that the injury doesn’t happen again. My employer gave me a full ergonomic assessment, and the ideas I learned from that assessment, I was able to apply at home on my gaming workstation.

This particular injury – aggravating the carpal tunnel and associated nerves – is the first I want to focus on, because it’s the most common injury among gamers. It goes by many names – Gamer’s Thumb, Nintendonitis, Nintendo Thumb, and even WASD Wrist (referring to the W-A-S-D movement keyboard keys used in first-person shooters).

The cause of the aggravation can be from any number of repetitive actions including:

1. Constantly pressing the “fire” button on the game controller with your thumb. After hours of over-use, you’ll experience some swelling at the base of your thumb, and this swelling can actually pinch the nerves in your wrist.

2. Holding your hand at an odd angle over the keyboard to press the movement keys while playing a first-person shooter or other, similar game. Again, this causes swelling in the wrist that can pinch nerves.

3. Using a standard PC mouse during extended game play that requires repetitive firing with the index finger while moving the mouse quickly around with the thumb. The twisted position of your wrist over a standard mouse can accelerate the aggravation, swelling and pinched nerves in the wrist.

Using an ergonomic mouse can help significantly when it comes to it causing the wrist issues, but it does little to help with keyboard or game controller issues.

However, if you look at what the ergo-mouse does to relieve stress on the carpal tunnel, you can apply the same concepts to other gaming behaviors that cause the same symptoms. The mouse forces you to keep your hand in the natural “prone” position, rather than twisting your forearm to flatten your wrist, which stretches the nerves and tendons in the carpal tunnel. This is basically what you need to do in other situations as well. You could either try to hold the game console controller in a way that keeps your wrists straight, or you could purchase a specialty controller for your console. You can even buy specialty controllers for your Android!

Even though you use the latest and greatest ergonomics, there’s nothing that replaces good, old fashioned stretching. The best way to avoid repetitive motion injuries like carpal tunnel is just to pause the game, get up and walk away, and make sure to do plenty of carpal tunnel prevention stretches often. It’s just like any other athletic event where a part of the body is overtaxed – stretching is absolutely critical to avoid injury.

Posture – Sit Up!

There are two really common gaming positions for avid gamers. There’s the “couch slouch”, where the gamer is just chilling with feet up on the coffee table and slouched back into the couch. Then, there’s the “full-on” position – usually in the heat of an FPS battle – that involves leaning forward, elbows on knees, head tilted forward, and all attention and focused on the screen.

So what’s the problem? Everything! There’s extra pressure on the elbows (not to mention the legs), the wrists are twisted and thumbs extended unnaturally, and worst of all that 10 pound head of yours is now extended forward – placing the strain of supporting it directly into your spine right between your shoulder blades. This is exactly the posture that leads to the other common gaming pain complaints – sore shoulders and elbows, sore thumb, and back pain.

If you’re going to spend so many hours gaming, ditch the couch and opt for an ergonomically correct gaming chair that supports you in all the right places. And, by all means, sit up straight and keep that 10 pound bowling ball of a head balanced squarely on top of your shoulders – that alone will alleviate many of those aches and pains.

Full-Contact Injuries

You wouldn’t think that sports injuries would make up one of the more common gaming injuries, but thanks to the advent of the Wii, gamers now have to deal with many of the same injuries that athletes do, and sometimes even more. Those innocent-looking Wii Nunchucks turned out to be not so innocent after all.

It didn’t take long after the Wii came out for reports of various injuries to roll in. One Osteopath in the UK told Sky News that he had seen 20 patients with back strain just a few days following Christmas that year. The story even prompted a Wii spokesman to issue tips to gamers on how to avoid injuries while playing the Wii. Those tips included avoiding “excessive and forceful actions”, always wearing the wrist strap, and making sure people and objects are far enough away from you.

It doesn’t take very long surfing the Internet to hear stories from other gamers about Nunchucks flying out of their hands and striking people that are nearby, a flailing arm smacking a gaming partner in the head, or the controller going airborne and breaking something made of glass. Yes, those wrist straps were not made just so you don’t drop the thing on the floor.

Pulled Muscles and Sprains

Athletes that run marathons know that not stretching before any rigorous physical activity will lead to pulled muscles, or even worse, injuries like a sprained ankle. Stretching loosens up the muscles and prepares your body for the stress that is to come – even for just a 30 minute run. But once the Wii and other motion-sensor gaming consoles came out, you’ve got a whole population of former couch potatoes suddenly jumping up and trying to do 1-2 hours of activities like tennis, boxing and bowling without giving a second thought to stretching first. Afterwards, there’s all sorts of confusion about all the terrible muscle pains and soreness.



Gamers Thumb

It's not surprising that the human body is not designed to play video games efficiently, the species hasn't spent the last million years fiddling with their thumbs!. The biggest impact ergonomics has in video gaming is often finding a control scheme that is efficient for the body. This often revolves around a controller for your hand or hands. The most popular style of controller is a two handed controller with the thumbs doing most of the work. And that is what leads to Gamer's Thumb.

Gamer's Thumb is a repetitive stress injury that affects the thumb and wrist. Pain and sometimes a popping sound are present on the outside of the thumb at or near the wrist. There can also be a decrease in grip strength or range of motion.

You see, the thumb is very good at pulling inwards towards the wrist.

The muscles and mechanics of your anatomy supports this function. This provides grip, what the thumb is really for and what separates us from most animals. The thumb is more like a jaw and less like a prehensile tail. In other words it excels at clamping down on stuff but isn't really made to be a dexterous appendage performing lots of three-dimensional motions. That puts a lot of repetitive stress on the thumb joint and the muscles and tendons attached to it.

Gamer's Thumb can be a form of tendonitis, tenosynovitis or a combination of both of those disorders. In either case it means something is irritated, inflamed and swollen. In Gamer's Thumb there is an inflammation in the tendons and/or the synovial sheaths that cover the tendons that control the motion of your thumb.

It can be quite painful and reduce your ability to grip.

Whichever part of the anatomy is irritated and inflamed it squeezes the tendons and constricts their ability to slide within the sheath. The inflammation results in swelling and pain that can run from the tip of the thumb all the way down to the wrist and even the upper portion of the forearm.

In Gamer's Thumb you often feel the pain when you turn or flex your wrist or when you make a fist or grab something. It often occurs in gamers who play daily for long periods and is even more prevalent in gamers who do not stay physically active.

If left untreated Gamer's Thumb can worsen and the repetitive inflammation and irritation of the tendon's synovial sheaths causes them to thicken and degenerate. This can result in permanent damage leading to a loss of grip strength and/or range of motion as well as constant pain and probably the end of your gaming experience.

Gamer's Thumb is technically known as De Quervain's syndrome. There are many aliases for De Quervain's syndrome with one in homage to the inventor of the current hand controller scheme, Nintendo Thumb. De Quervain's Syndrome can be treated at home effectively if it has not gotten that severe. If you are a serious gamer you should consider trying to prevent De Quervain's syndrome to keep your hand healthy and your top scores high.

The Technical Explanation

If you flatten your hand out with the back of your hand downward then your thumb can move in two ways. It can move up and back down. This moves your thumb out of the plane of your hand and is called palmar abduction. Your thumb can also move left to right staying within the plane of your hand. This type of movement is called radial abduction.

These tendons are housed within synovial sheaths through the wrist passage. Synovial sheaths are kind of like a stiffer, outer tube that can bend but does not kink. The result is that when the wrist is bent or twisted the tendons can still slide back and forth through the wrist passage without getting snagged.

The tendons pass through an opening in the wrist on the thumb side. This opening is covered in a slippery membrane called tenosynovium. Constant friction against this surface by inflamed synovial sheaths can cause inflammation in the tenosynium as well. Inflammation of a tensynovium is called tenosynivitis.

The tendons involved in Gamer's Thumb are those attached to the extensor pollicis brevis and abductor pollicis longus muscles, or the muscles that move your thumb in radial abduction. The muscles run side by side on the back of your forearm towards your wrist and the tendons run along the thumb from the tip to your wrist through an opening in your wrist where they then attach to the muscles.

In Gamer's Thumb, irritation from repetitive stress causes the inflammation in the tendon or synovial sheath which leads to swelling and enlarges a portion of the tendon making it difficult for the tendon to pass through the opening in the wrist. Or it causes inflammation in the tensynovium which results in the same thing. Often, when one is swollen it causes the other to become irritated and inflamed as well, thereby compounding the probl

"I have RSI (Repetitive Strain Injury or in this case, gamer's thumb,) and I can barely play any game anymore. Constantly moving my mouse in a counter clockwise fashion on CSS and TF2 has left me with a huge bump on my tendon sheaths that has weakened my thumb to the point where my gaming sessions are now less than an hour. Gaming with the thumb-stick is even worse as I can barely aim anymore."


To protect against injuries, do the following:

- Keep wrists straight; do not let them bend downward when holding a game controller.
- Practice good posture while playing. Sit in a chair that provides solid back support with feet comfortably on the floor.
- Take frequent breaks. Remember to rest every 20 minutes or so to give neck, head, shoulder and hand muscles a break.
- Parents, watch for problems! Look for warning signs such as headaches, fatigue, muscle pain or cramping, and suggest a break or alternate activity.

Gamer's Thumb usually responds quickly to physical therapy intervention. 



Lee Young-ho and his scarred arm below

Masahiro Sakurai






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