Gaming
We’ve seen a few high-profile cases of injuries in esports, but how can they be prevented? We spoke to Caitlin 'Lurkaderp' McGee about a physical therapist’s job in competitive gaming.
The world of esports has developed and blossomed far more than many may have envisaged over recent years. We’ve seen competition develop from where players once battled it out for mouse mats and headsets, all the way up to Dota 2’s The International 7 where the best part of US$25,000,000 was on the line. As the industry and competition has developed, so too have the backroom staff put in place to support the world’s fiercest competitors. It’s most definitely not unusual to now see a team have a coach or a data analyst and there’s not a professional outfit without an official manager these days.
It’s also not uncommon to see some of the world’s best players adopting somewhat bizarre seating positions while competing. Be it hunching extremely close to the monitor, or with feet also on the chair, esports players can showcase truly odd ways of playing. While many outside the world of competitive computer gaming would scoff at the prospect of a gamer getting injured, the reality is that it can, and has, happened.
Poor ergonomics are but just one potential reason for problems emerging; problems that could realistically put a premature end to any player’s career. We spoke to physical therapist Caitlin 'Lurkaderp' McGee about her work in and around the esports scene as she looks to provide invaluable advice to players on how to best protect themselves from the threat of injury.
Tell us a bit about your professional background and how you ended up in the wonderful world that is esports?
So, I have an undergraduate degree in Neuroscience, Exercise and Sports Science. I then went on to get my Master’s in Anatomy and Clinical Health Science before completing a Doctorate in Physical Therapy. The Master’s I actually got by accident because I took a few extra anatomy courses when I was in grad school and they said “if you want to pay $50, you qualify for a Master’s in Clinical Anatomy”, so obviously I did.
With regards to gaming, I didn’t really get into it until after graduate school. I was in New Jersey on a rotation dealing with traumatic brain injuries. which is pretty heavy stuff to work with PT-wise. It involved dealing with a lot of badly-off people, but it was very emotionally draining, yet substantially rewarding, place to work. I loved it.
Equally, I was getting pretty worn out. I had a friend who lived down in DC. He’s 'ThatPhageGuy' who now works on statistics for FGC. I went to crash on his futon for a job interview, but he said: “OK, but the deal is, you have to stay for the weekend and you have to play any video games I invite you to play”. When I arrived, he was there and doing statistical work for Dota 2. He was doing statistics for a Chinese game on the Perfect World Servers and was ranting and raving about how terrible it was to try and push statistics through the Great Firewall and sometimes they just wouldn’t show up for another 20 minutes. I had no idea what he was doing or playing, but I thought to myself that it looked awesome and I really wanted to try it.
So just like that, you decided Dota would be your first foray into gaming? That’s quite the baptism of fire…
Rather than pick a reasonable title with an easy learning curve or overly welcoming community I decided that the first game I should ever play should totally be Dota 2. It was definitely a baptism of fire and it turned out that I loved it. Originally I was just working in statistics but ThatPhageGuy started developing some bad wrist and hand pain issues, and at the same time I had been constantly ranting to him about terrible ergonomics I was seeing on stream at tournaments.
I was starting to help him with his hand injury and he asked if I was aware of the amount of people who had similar injuries. Equally, I thought there were a lot of people who already worked on that kind of thing and there wasn’t space for me. I think eventually my ranting got too much about bad ergonomics, he got fed up with me and told me to either shut up or do something about it. I then wrote a guide to PC ergonomics and apparently there just weren’t that many people doing things like that because people really liked it.
I started to write more and more guides, more articles and would randomly get messaged with questions that I would answer as best I could. Eventually I got in touch with Charlie Yang, which led me to working with Twitch for a while as a contractor for events at Beyond the Summit which is what, way down the line, led me to meeting [fellow physical therapist] Matthew Hwu and starting up 1HP. It’s been quite the wander.
When you talk about getting infuriated by poor ergonomics on stream, what in particular sticks out to you?
Starting from the top down: people who have poor posture and slouch too much. Then there’s people either not using their arm rests at all or having them way below the desk height. We also see people resting their wrists on the pointy edges of the table. In particular, when you look at Counter-Strike: Global Offensive players, they have their keyboards all the way sideways and the monitors just inches from their face. Those were the things that were really winding me up.
Since you started out, have you seen palpable change? Have people taken your pearls of wisdom on board or do you feel it’s falling on deaf ears?
So I think it’s pretty funny that I’ll occasionally get a message of: “Whenever I see your tweet pop up on my timeline, even if it’s not actually about ergonomics, I automatically improve my posture.” That’s a legacy that I am pretty happy with.
Interestingly, at tournaments I don’t try to change people’s posture all that much. If you’re thinking about a new posture, and trying to adopt a better posture then although it’s better, it’s also something that you’re thinking about in that moment. It’s really not ideal because you’re competing at the highest level and your focus should be on gameplay. It’s a lot better to be able to send somebody home with a guide, telling them they should be looking to work on, and telling them the exercises to do. I think that’s most definitely the better approach.
I have definitely noticed the players that I’ve been in contact with most saying: “Oh, I’ve been consistently doing the stretches and it feels a lot better” or “I have been consistently taking those breaks, like you said, and I find I can practice for longer as long as I do take those breaks”. Sometimes it’s even “I got a new chair and my god, it makes a world of difference, you weren’t kidding”.
I think the improvement is definitely something I’ve seen, and I think a lot of players were kind of at that point, or mirroring that point around the time that I entered the scene. I think a lot of players were getting to the point where they thought: “something’s got to give, either I have to stop playing or there’s a way I can prevent this from happening”.
You’ve worked across a multitude of titles from CS:GO, to Dota, to Smash. What challenges does each title present?
Starting from the most general, to the most specific, there are definitely aspects of lifestyle changes, posture and ergonomics that are helpful and valuable for everybody. The elements we’ve talked about such as taking breaks, thinking about your posture, activity levels outside of gaming, sleep, nutrition and hydration are all very important. They also apply to everyone; they’re universal.
When you look at different controllers, they all present different challenges. Take the GameCube controller versus your fight-stick versus a keyboard and mouse. They all present different types of stresses because of what muscles and what motions you’re using and performing most frequently. When it comes to repetitive stress injuries, it’s dependent on which specific stresses you are repeating. There’s definitely a difference between controller types, and then there’s even differences between the same controller type.
When you look at things like Dota versus Counter-Strike, there’s a huge difference partially because of how people organise their set-ups or tend to, anyway. Then it’s based on where the primary motion is coming from. Is it coming from your wrist, elbow or shoulder? What’s the degree of motion? What’s the velocity? What’s the grand total of stress? Is it a couple of big stresses or a large number of very tiny stresses? Is it a big motion ending with a precise stop or is it several, small motions each with their own precise stop?
All of those things will apply different stresses. You can certainly take some things between gaming scenes and apply them to everyone, but there’s a lot more specificity that’s required to actually get the best level of performance improvement and minimise the risks of injuries.
We’re still fairly early on in the general lifecycle of esports and injuries are fairly rare still. Do you think that we’ll see more emerge as times goes on? Were the high-profile injuries such as Chessie and Fear down to gaming or just exacerbated by it?
I have to be careful when talking about specific players and their injuries as unless a player has talked about it first in public, I can’t talk details. In Chessie’s case, he has publically mentioned on stream that I have worked with him in the past and I’m fairly familiar with his case in particular. It was partially gaming related. Being in a particular position for a long period of time is going to exacerbate other things that were going on.
Generally, I don’t think players consider outside forces, the things other than gaming that they’re doing that might be causing stress. Take a non-gaming example, when my parents first got their dog. They both developed tendinitis in their right elbow and they couldn’t figure it out until I asked them if they were only walking their dog holding the leash in the right hand.
It’s little stresses that people don’t necessarily think about that and sometimes gaming will exacerbate those out-of-game stresses. I think as esports continues to grow, we’re going to see more injuries not as a consequence of bad ergonomics, but simply as a consequence of an increased player-based leading to more chances for injuries to occur and thus more injuries.
Do you think more and more teams will pick up PTs and they'll become a staple of the backroom staff in esports?
As there’s increased awareness, I think the injuries we do see will be less severe. I think that the behind-the-scenes will most definitely continue to grow in terms of professionals supporting players. Just like NFL teams have athletic trainers and therapists, it wouldn't be a ridiculous thing to see that being transferred to esports.
Teams like Cloud9 have one already. I work already with the Counter Logic Gaming PT, so we’re definitely moving towards that. I think we’re going to see a continued growth in support staff because people are realising it is necessary. We’ve moved from where esports was fairly small and done on the side, to a genuine career path where there are a plethora of opportunities for people to play at a very high level. As a result I think the support network will need to be built up in order to support and maintain both the high level of competition and even just the more casual gaming scene that doesn’t want to be in pain when they’re playing video games.
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