Daniel Hathaway, aka FunnyAstro, has been a member of the Philadelphia Fusion esports team for two years, but he’s been playing video games since he was 6. Honing his skills for eight hours a day, often with few breaks, hunched over a gaming console playing Overwatch has taken a toll.

“The back of my right shoulder blade was in lots of pain,” said Hathaway, 21, who lives in Reading, England, and plays alongside teammates from Israel, France, Denmark and Korea.

Hathaway saw Bradley Smith, a sports medicine physician at Rothman Orthopaedics, who recommended through telemedicine a daily stretching regimen to alleviate the pain and prevent future discomfort.

“I usually stretch my wrists and arms throughout the day to avoid wrist injuries, but I never had a routine that included shoulder stretches,” Hathaway said. “I add the shoulder stretch before bed whenever I feel like my pain could come back.”

As the official team doctors for the Fusion, as well as Nerd Street Gamers, a Philadelphia-based network of esports facilities and events, Rothman physicians treat players’ injuries, which often stem from overuse. These include wrist tendinitis from repetitive mouse movements and prolonged keyboard use, and upper-back and shoulder-blade pain from poor posture while playing.

Esports, once a subset of sports culture, has grown dramatically into a thriving industry where players can earn millions of dollars in prize money and endorsements. Total esports viewership is expected to grow from $454 million in 2019 to $646 million in 2023, according to Business Insider Intelligence estimates.

And the idea of the lone gamer playing in his parents’ basement has steadily evolved into teams and networks on such streaming platforms as YouTube.

Since beginning work with the players in February 2020, Rothman physicians have also encouraged good habits in nutrition and exercise. They stress taking breaks to prevent injuries, and focus on the athletes’ overall health and well-being.

“It’s similar to business folks who are on the computer all day and teenagers, especially during the pandemic, on Zoom for school or on their phones,” Smith said. “Leaning forward puts strain on the muscles that help stabilize the shoulder blade. That can cause pain in the upper back and shoulder blade areas.”

Yet, for gamers who are uber-focused on their craft, and likely take few breaks, these ailments tend to be more severe than they are for the average desk worker.

Treatment starts with correcting patients’ posture by showing them how to pull their shoulder blades together and sit up taller in their chairs. For gamers who might play for 10 straight hours, it’s important that they take breaks, stretch every few hours, and do strengthening exercises for the upper back, shoulders, and core.

Physical therapy can be very helpful for gamers, Smith added, especially focusing on posture, ergonomics, stabilizing the shoulder blades, and stretching.

“Like anything in life, moderation is the key,” said Smith, and that goes for diet, too. “They tend to eat things quickly while they are at the computer, like energy drinks, partly because when they are playing hard and being competitive they want that extra edge,” he said.

Yet high-carb, sugary drinks can cause your blood sugar to peak and crash, which can make you tired. High-caffeine drinks can make you jittery, hyper and have trouble sleeping.

In addition to adding fruits, vegetables and protein, performing cardiovascular exercise can also help improve concentration and focus, Smith said.

Anthony Bush, 17, makes sure he takes a break every hour or so during his eight hours of gaming on a typical summer day. He has attended the Nerd Street Gamers weeklong camps twice, most recently in East Falls in July. There, he honed his gaming skills but also learned lessons in healthy gaming, both physically and mentally.

“In the morning, we do different stretches,” said Bush, from Mount Laurel. “The coaches are very positive and push you to have a better mentality, to calm down. I used to get more angry while playing video games but have learned it’s a lot more fun to play when I’m calmer.”

Gaming is a social activity for the rising senior at Lenape High School. “We’ll go biking or play volleyball or go to the pool and playing online is just another way to hang out with [friends] and have fun,” he said.

While previous studies pointed to mental-health concerns, including isolation, depression and emotional suppression from too many hours spent playing video games, that research mostly looked at solitary game play, said Mitch Prinstein, chief science officer at the American Psychological Association in Washington. Today, much of game play occurs in networks where players are interacting with others.

“What was a behavior that was relatively rare has now become ubiquitous,” he said. “As norms change, so can the research change.”

While Prinstein doesn’t see a risk in moderate amounts of individual game play, there can be risks for kids who might already have difficulties in a particular area. So for instance, a child with aggression issues probably should refrain from aggressive games.

“The key to any activity where people are more socially isolated in a physical sense, is to make sure it is time limited, that they step away from what they are doing and invest time and effort into other areas that provide satisfaction,” said Matthew Wintersteen, associate professor of psychiatry and human behavior at Thomas Jefferson University.

There are many benefits to video game playing, including camaraderie, participation, satisfaction over good work, competition, and sense of reward, he said.

Add to that good reflexes, stamina, focus and attentiveness, said Rothman’s Smith. “There’s a lot more thought and strategy involved than many people realize,” he said.

Hathaway — whose specialty is Lucio, a DJ and damage-dealing freedom fighter whose songs can heal or speed up his teammates — makes sure he eats three meals a day and works out daily each morning, lifting weights and doing cardio. He offers this advice to young gamers: “Grinding long hours can be helpful but you need to make sure you keep a good schedule involving exercise, good sleep, and proper nutrition.”

Tips for parents

  • Monitor your kids’ game play to understand the content.

  • Discuss how the child perceives that content in relation to real life, as in, “in real life I wouldn’t run someone over with a car.”

  • Pay attention to how much total screen time your child gets each day, including game play, social media and other digital media usage, and television.

  • Encourage breaks from game playing such as taking a walk or playing basketball.

  • Help your kids think creatively to find non-screen activities they enjoy.