Abstract
The number of people participating in electronic gaming has increased exponentially in recent years. Gamers are susceptible to injuries. However, there are limited studies on gaming-related symptoms and musculoskeletal pain complaints amongst casual gamers. This study aimed to characterize gaming-related symptoms in adults participating in electronic gaming. An online survey assessing gaming characteristics, addictive qualities, and gaming-related symptoms was completed by 250 self-reported adult gamers (median age: 37.5 years; 56.0% female). Prevalence rates of gaming-related symptoms and musculoskeletal pain complaints were 61% (n = 153) and 34% (n = 86), respectively. Gaming session durations were significantly longer in participants reporting gaming-related symptoms or musculoskeletal pain complaints (P < .001). Addictive qualities were independently associated with greater odds of having gaming-related symptoms (OR[95%-CI]: 3.69[1.84-7.39]; P < .001). Suboptimal screen height, concurrent mood disturbances, and concurrent sleep changes were independently associated with greater odds of having musculoskeletal pain complaints (P < .05). Further analyses revealed significantly increased prevalence of mid-back, low-back, or mid + low-back pain in participants reporting poor ergonomics (P < .05), compared to good ergonomics. Overall, increased time spent gaming, poor ergonomics, addictive qualities, and mood/sleep complaints were associated with gaming-related health conditions. As gaming continues to expand, recognition of gaming-related health conditions and their predisposing factors is critical.
Keywords: electronic gaming, musculoskeletal, pain
Introduction
The gaming industry has expanded exponentially, with over 226 million American adults and children engaging in some form of gaming in 2021. 1 Nearly 70% of American adults participate in video games. 1 Additionally, ∼90% of United States (U.S.) children participate daily in video games (PC, console, and mobile gaming).1-3 The level of play ranges widely, from casual gaming to organized competitive video gaming, often by professional gamers, known as electronic sports (esports).
Individuals participating in esports or casual gaming may be susceptible to overuse injuries and other gaming-related health conditions, including musculoskeletal injuries, metabolic disorders, sleep disturbances, mental health conditions, and vision complaints.4-9 These medical issues are becoming more notable with the rapid expansion of the gaming industry. Although the literature surrounding esports is expanding, there remains a scarcity of studies examining the health of casual gamers, particularly when examining the ergonomic aspects of gaming setups and gaming-related behaviors that could contribute to the development of gaming-related health conditions.
Previous literature on gaming-related symptoms or musculoskeletal complaints have focused primarily on the esports population. One survey examined the prevalence of musculoskeletal complaints in collegiate esports athletes and found that 42% reported neck and back pain, but this study excluded casual gamers and did not assess gaming ergonomics. 5 Another study focusing solely on competitive gamers showed a prevalence of musculoskeletal pain of 42.6%. 10 A recent systematic review evaluated musculoskeletal disorders in video gamers, which included both esports athletes and casual gamers, and found excessive game time (>3 hours) to be associated with the presence of musculoskeletal disorders; 11 however, the articles included in this review were predominantly conducted in the pediatric and adolescent populations. Only a few studies have investigated gaming-related health conditions in adults who participate in casual gaming, with one study reporting on pain while gaming (54% prevalence), and three studies reporting on internet gaming disorder or problematic game behavior; these were all conducted outside of the U.S.12-15 Additionally, most data regarding ergonomics and posture have been studied in office workers, 16 but not specifically in casual gamers.
The current study aims to determine the prevalence of health and musculoskeletal complaints in the gaming population in the U.S., and to analyze factors such as gaming ergonomics, gaming habits, and addictive behavior that predispose individuals to these complaints. The authors hypothesized that: (1) health conditions, including musculoskeletal complaints, have a high prevalence (>50%) in gamers; (2) improper gaming ergonomics are associated with gaming-related musculoskeletal conditions; and (3) increased time spent gaming, particularly in the setting of improper ergonomics, is associated with gaming-related health conditions.
Materials and Methods
Ethics and Participant Recruitment
This cross-sectional survey study was approved by the Institutional Review Board at Hospital for Special Surgery (IRB #2020-2221; 535 E. 70th Street, New York, NY). All procedures were conducted in accordance with the Declaration of Helsinki. Individuals ages 18-100 years who self-reported participation in gaming from a casual to a professional level were eligible to participate. Types of gaming included PC, console, and/or mobile gaming. A description of the study, instructions for participation, and survey link were distributed to potential participants via coaches and ResearchMatch. ResearchMatch is an online recruitment tool used by researchers to recruit participants for studies. Some participants distributed the link to other potential participants. Informed consent was obtained through the use of an information screen containing a description of the study, confidentiality/privacy language, and research authorization language. The screen appeared prior to the survey and included a question asking if the potential participant would be willing to participate in the study. Responding “yes” represented the participant’s informed consent to participate. A screening question ensured that participants were ≥18 years old. All responses were collected anonymously.
Data Collection and Survey Details
The survey was developed by study investigators, tested by departmental staff, and reviewed by an internal clinical research panel. Testing and review were performed to assess flow, ease of responses, consistency of responses, and timing. All questions were custom-made (see Appendix for questions and response options). The survey was built on Research Electronic Data Capture,17,18 and all data were inputted directly by participants. Demographics, gaming type, duration of gaming, gaming setup, addictive qualities, presence of gaming-related symptoms, and past treatments received for symptoms were collected. Gaming setup included the distance away from the monitor (PC gamers) and the height at the center of the screen (PC and console gamers). Poor ergonomics was defined having one of the following: (1) a distance of less than or greater than arm’s length from the monitor; or (2) having the center of the screen above or below eye level. 19 Addictive qualities were assessed by asking if the participant had felt impaired control over gaming, increased priority given to gaming over other activities to the extent that gaming takes precedence over other interests and daily activities, or continued gaming despite the occurrence of negative consequences in the past 12 months. Responses of “strongly agree” and “agree” were considered as positive for addictive qualities, whereas responses of “neither agree nor disagree,” “disagree,” and “strongly disagree” were considered as negative for addictive qualities. Gaming-related symptoms included musculoskeletal pain, vision changes, sleep changes, mood changes, numbness or tingling, and blood clots. Pain was further categorized as headaches, neck pain, shoulder pain, elbow pain, hand/wrist pain, mid-back pain, low-back pain, and hip pain. Lastly, participants were asked if they had undergone previous occupational/physical/hand therapy, injections, or surgery.
Statistical Analysis
Continuous variables were summarized as medians and interquartile ranges, and discrete variables were summarized as counts and percentages in the descriptive analysis. The prevalence rates of gaming-related symptoms and musculoskeletal pain complaints were presented with 95% confidence intervals (CI). Comparisons of continuous and discrete variables were analyzed using Wilcoxon rank-sum tests and chi-square tests, respectively. Crude and multivariate logistic regression were employed to assess the association between gaming-related symptoms or musculoskeletal pain complaints and participant characteristics, including gaming duration, mood/sleep changes, addictive qualities, and gaming setup. Parameter estimates are reported as crude or adjusted odds ratios (ORs) and 95% CIs. P < .05 was considered to be statistically significant. All analyses were performed with Stata, version 14.2 (StataCorp., College Station, TX).
Results
Participant Flow and Characteristics
A total of 314 responses were received from February 10, 2021 to May 26, 2021. Of these, 49 declined to participate, and 15 completed less than 50% of the survey. The remaining 250 participants were included in the analysis (Table 1). Most participants (56%) identified as female.
Table 1.
Participant and Gaming Characteristics.
| Characteristics | All Participants (n = 250) | Female Gender Identity (n = 140) | Male Gender Identity (n = 90) | Gender Non-Conforming (n = 17) |
|---|---|---|---|---|
| Age; years | 37.5 (27-52) | 41 (28.5-54) | 39.5 (27-52) | 25 (23-30) |
| Gender identity | ||||
| Female | 140 (56) | |||
| Male | 90 (57) | |||
| Gender non-conforming | 17 (7) | |||
| No response | 3 (1) | |||
| Race/Ethnicity | ||||
| White | 204 (82) | 117 (84) | 71 (79) | 15 (88) |
| Asian | 23 (9) | 11 (8) | 10 (11) | 1 (6) |
| Black or African American | 16 (6) | 10 (7) | 5 (6) | 1 (6) |
| Hispanic or Latino | 9 (4) | 4 (3) | 5 (6) | 0 (0) |
| Other | 8 (3) | 4 (3) | 3 (3) | 0 (0) |
| American Indian/Alaska Native | 5 (2) | 2 (1) | 3 (3) | 0 (0) |
| Years of gaming; years | 15 (8-25) | 12.5 (8-21) | 20 (11-30) | 10 (7-15) |
| Hours spent gaming per week; hours | 15 (8-25) | 15 (8-25) | 15 (8-30) | 10.5 (10-28) |
| Hours spent gaming per day; hours | 2 (1-4) | 2 (1-4) | 2 (1-4) | 2 (2-4) |
| Duration of gaming session; hours | 2 (1-3) | 2 (1-3) | 2 (1-3) | 2 (2-3) |
| Type of gaming | ||||
| PC | 145 (58) | 71 (51) | 58 (64) | 13 (76) |
| Console | 126 (50) | 67 (48) | 45 (50) | 13 (76) |
| Mobile | 155 (62) | 99 (71) | 50 (56) | 3 (18) |
| PC gaming | (n = 145) | (n = 71) | (n = 58) | (n = 13) |
| Number of monitors used | ||||
| 1 | 100 (69) | 54 (76) | 35 (60) | 9 (69) |
| 2 | 38 (26) | 17 (24) | 16 (28) | 4 (31) |
| 3 | 7 (5) | 0 (0) | 7 (12) | 0 (0) |
| Monitor size; inches | 24 (16-27) | 22.5 (15-27) | 27 (18-28) | 20 (15-27) |
| Distance from monitor | ||||
| Less than arm’s length | 34 (24) | 20 (28) | 9 (16) | 5 (38) |
| At/around arm’s length | 88 (61) | 39 (55) | 39 (67) | 7 (54) |
| Greater than arm’s length | 23 (16) | 12 (17) | 10 (17) | 1 (8) |
| Height at center of screen | ||||
| Above eye level | 12 ((8) | 3 ((4) | 6 (10) | 2 (15) |
| At/near eye level | 87 (60) | 43 (61) | 36 (62) | 7 (54) |
| Below eye level | 46 (32) | 25 ((35) | 16 (28) | 4 (31) |
| Height of seat from floor; inches | 24 (18-30) | 24 (18-25) | 24 (19-30) | 24 (19-30) |
| Console gaming | (n = 126) | (n = 67) | (n = 45) | (n = 13) |
| Height at center of screen | ||||
| Above eye level | 38 (30) | 20 (30) | 11 (24) | 6 (46) |
| At/near eye level | 75 (60) | 39 (58) | 30 (67) | 6 (46) |
| Below eye level | 13 (10) | 8 (12) | 4 (9) | 1 (8) |
| Height of seat from floor; inches | 22 (17-25) | 22 (18-24) | 24 (17.3-30) | 20 (16-24) |
Results are medians (interquartile ranges) or counts (percentages).
Gaming Characteristics
Information on gaming characteristics are shown in Table 1. Most PC gamers reported using a single monitor (n = 100; 69%). More than half of the cohort (62%) reported poor ergonomics, defined as either improper distances from the monitor (greater/less than arm’s distance) or improper height at the center of the screen (above/below eye level). Small percentages of participants reported using a specialized gaming chair (n = 12; 5%) or standing while gaming (n = 24; 10%). Forty-seven (19%) participants reported gaming competitively in tournaments or leagues; of these, 4 received payments for gaming. Addictive qualities were reported by 30% of participants (n = 74).
Gaming-Related Symptoms, Musculoskeletal Pain Complaints, and Treatments
The prevalence rates of gaming-related symptoms and musculoskeletal pain complaints were 61% (n = 153; 95% CI: 55%–67%) and 34% (n = 86; 95% CI: 29%–41%), respectively (Table 2). The most common areas of musculoskeletal pain were the hand/wrist (73%), neck (65%), and shoulder (57%). A small percentage of participants reported receiving treatments (Table 2). Participants who reported musculoskeletal pain complaints were more likely to receive therapy or injections (therapy: 31% vs 12% without pain, P = .005; injections: 29% vs 10% without pain, P = .005). Furthermore, a larger percentage of participants who underwent previous therapy or injections identified as female (66% vs 53% without therapy, P = .17; 66% vs 53% without injections, P = .20), but these were not statistically significant.
Table 2.
Gaming-related symptoms, areas of musculoskeletal pain, and treatments.
| All Participants | Female Gender Identity | Male Gender Identity | Gender Non-Conforming | |
|---|---|---|---|---|
| Gaming-related symptoms | (n = 153) | (n = 84) | (n = 54) | (n = 13) |
| Pain | 86 (56) | 52 (62) | 26 (48) | 6 (46) |
| Vision changes | 61 (24) | 36 (43) | 19 (35) | 5 (38) |
| Sleep changes | 71 (46) | 42 (50) | 27 (50) | 2 (15) |
| Changes in mood | 40 (26) | 20 (24) | 18 (33) | 2 (15) |
| Numbness or tingling | 68 (44) | 41 (49) | 18 (33) | 9 (69) |
| Blood clots | 1 (1) | 1 (1) | 0 (0) | 0 (0) |
| Areas of pain | (n = 86) | (n = 52) | (n = 26) | (n = 6) |
| Headaches | 43 (50) | 30 (58) | 9 (35) | 4 (67) |
| Neck pain | 56 (65) | 36 (69) | 16 (62) | 4 (67) |
| Shoulder pain | 49 (57) | 33 (63) | 13 (50) | 2 (33) |
| Elbow pain | 25 (29) | 17 (33) | 6 (23) | 5 (83) |
| Hand/wrist pain | 63 (73) | 36 (69) | 20 (77) | 1 (17) |
| Mid-back pain | 22 (26) | 13 (25) | 8 (31) | 1 (17) |
| Low back pain | 40 (47) | 25 (48) | 12 (46) | 2 (33) |
| Hip pain | 18 (21) | 14 (27) | 3 (12) | 1 (17) |
| Treatments | (n = 153) | (n = 84) | (n = 54) | (n = 13) |
| Physical, occupational, or hand therapy a | 35 (23) | 23 (27) | 10 (19) | 2 (15) |
| Injections b | 32 (21) | 21 (25) | 9 (17) | 2 (15) |
| Surgery c | 14 (9) | 7 (8) | 7 (13) | 0 (0) |
Results are counts (percentages).
aMost commonly for carpal tunnel syndrome or cervical radiculopathy.
bInjection type was not specified.
cIncludes carpal tunnel surgery, cubital tunnel surgery, cervical discectomy, rotator cuff repair, and eye muscle surgery.
Factors Associated with Gaming-Related Symptoms
Univariate analyses were performed to compare age, gender identity, gaming duration, addictive qualities, or gaming setup between participants with and without gaming-related symptoms (Table 3). Hours of gaming per day, hours of gaming per week, and gaming session durations were significantly longer for participants with gaming-related symptoms. Furthermore, a significantly higher number of participants with gaming-related symptoms reported addictive qualities. Compared to those without gaming-related symptoms, a greater percentage of participants with gaming-related symptoms reported suboptimal distance from the monitor and suboptimal screen height.
Table 3.
Participant characteristics, gaming history, gaming setup, and addictive qualities in participants with and without gaming-related symptoms.
| No gaming-related symptoms (n = 97) | Gaming-related symptoms (n = 153) | Crude Logistic Regression a | Multivariate Logistic Regression a | |||||
|---|---|---|---|---|---|---|---|---|
| OR | 95% CI | P value | OR | 95% CI | P value | |||
| Age | 37 (28-51) | 38 (26-52) | ||||||
| Gender identity | ||||||||
| Male | 36 (38) | 54 (36) | ||||||
| Female | 56 (58) | 84 (56) | ||||||
| Gender Non-Conforming | 4 (4) | 13 (9) | ||||||
| Years of gaming | 15 (9-24) | 15 (8-25) | ||||||
| Hours of gaming per day | 2 (1-3) | 3 (2-5) | ||||||
| Hours of gaming per week | 10 (6-20) | 18 (10-30) | 1.03 | 1.01, 1.06 | .002* | 1.02 | 1.00, 1.04 | .10 |
| Duration of each gaming session | 2 ((1-2) | 2 (1.25-3) | 1.30 | 1.07, 1.58 | .009* | 1.14 | .93, 1.39 | .20 |
| Addictive qualities | 13 (13) | 61 (40) | 4.28 | 2.20, 8.35 | <.001* | 3.69 | 1.84, 7.39 | <.001* |
| Suboptimal distance from monitor (PC gaming) | (n = 54) 18 (33) | (n = 91) 39 (43) | ||||||
| Suboptimal screen height (PC or console gaming) | (n = 78) 35 (45) | (n = 119) 55 (46) | ||||||
| Poor ergonomics | (n = 78) 45 58) | (n = 119) 77 (65) | ||||||
| Multiple monitors | (n = 54) 16 (30%) | (n = 91) 29 (32) | .95 | .53, 1.59 | .832 | .75 | .43, 1.31 | .32 |
Results are medians (interquartile ranges), counts (percentages), or odds ratios (OR) and 95% confidence intervals (CI).
Regression analyses were performed with the following factors: hours of gaming per week, duration of each gaming session, addictive qualities, and multiple monitors.
*P < .05.
Logistic regression analyses were performed with factors achieving significance in the univariate analyses. The use of multiple monitors was included as a covariate. In the crude model, hours of gaming per week and gaming session durations were significantly associated with greater odds of having gaming-related symptoms (OR[95% CI]: 1.03[1.01-1.06] and 1.30[1.07-1.58], respectively; P ≤ .009) (Table 3). Addictive qualities were associated with greater odds of having gaming-related symptoms (OR: 4.28; 95% CI: 2.20-8.35; P < .001) (Table 3). In the multivariate model, addictive qualities were independently associated with greater odds of having gaming-related symptoms (OR: 3.69; 95% CI: 1.84-7.39; P < .001) (Table 3).
Factors Associated with Musculoskeletal Pain Complaints
Age, gender identity, gaming duration, addictive qualities, gaming setup, mood disturbances, and sleep changes were compared between participants with and without musculoskeletal pain (Table 4). Similarly, hours of gaming per day, hours of gaming per week, and gaming session durations were significantly longer for participants with musculoskeletal complaints (P < .001 for all). Suboptimal screen height was significantly more common among those with musculoskeletal pain (P = .049). However, there was no significant difference in the percentage of participants with musculoskeletal complaints reporting addictive qualities (P = .11), compared to those without musculoskeletal complaints. Interestingly, significantly higher percentages of participants with musculoskeletal pain complaints reported concurrent mood disturbances (30% vs 10% without pain complaints; P < .001) or sleep changes (47% vs 19% without pain complaints; P < .001).
Table 4.
Participant characteristics, gaming history, gaming setup, and addictive qualities in participants with and without musculoskeletal pain symptoms.
| No musculoskeletal pain complaints (n = 164) | Musculoskeletal pain complaints (n = 86) | Crude Logistic Regression a | Multivariate Logistic Regression a | |||
|---|---|---|---|---|---|---|
| OR (95% CI) | P value | OR (95% CI) | P value | |||
| Age | 40 (28-53) | 35 (26-50) | ||||
| Gender identity | ||||||
| Male | 64 (39) | 26 (31) | ||||
| Female | 88 (54) | 52 (62) | ||||
| Gender Non-Conforming | 11 (7) | 6 (7) | ||||
| Years of gaming | 15 (8-24.5) | 15 (10-25) | ||||
| Hours of gaming per day | 2 (1-3) | 3 (2-5) | ||||
| Hours of gaming per week | 13.5 (7-22.5) | 20 (10-30) | 1.02 (1.01, 1.05) | .001* | 1.01 (.98, 1.03) | .54 |
| Duration of each gaming session | 2 (1-2.5) | 2 (2-4) | 1.33 (1.12, 1.59) | .002* | 1.20 (.96, 1.50) | .11 |
| Addictive qualities | 43 (26) | 31 (36) | ||||
| Suboptimal distance from monitor (PC gaming) | (n = 85) 30 (35) | (n = 60) 27 (45) | ||||
| Suboptimal screen height (PC or console gaming) | (n = 124) 50 (40) | (n = 73) 40 (55) | 1.79 (1.00, 3.22) | .050 | 1.99 (1.03, 3.86) | .041* |
| Poor ergonomics | (n = 124) 69 (56) | (n = 73) 53 (73) | ||||
| Multiple monitors | (n = 85) 30 (35) | (n = 60) 27 (45) | 0.62 (0.36, 1.05) | .074 | 0.61 (0.32, 1.18) | .14 |
| Mood disturbances | 16 (10) | 24 (28) | 3.58 (1.78, 7.20) | <.001* | 2.68 (1.08, 6.69) | .034* |
| Sleep changes | 31 (19) (2.10, 6.64) | 40 (47) | 3.73 | <.001* | 2.64 (1.25, 5.59) | .011* |
Results are medians (interquartile ranges), counts (percentages), or odds ratios (OR) and 95% confidence intervals (CI).
Regression analyses were performed with the following factors: hours of gaming per week, duration of each gaming session, suboptimal screen height, mood disturbances, sleep changes, and multiple monitors.
*P < .05.
In the crude logistic regression model, hours of gaming per week and gaming session durations were significantly associated with greater odds of having musculoskeletal pain complaints (OR[95% CI]: 1.02[1.01-1.05] and 1.33[1.12-1.59], respectively; P ≤ .002) (Table 4). Additionally, sleep change and mood disturbances were significantly associated with greater odds of having a musculoskeletal pain complaint (OR[95% CI]: 3.73[2.10-6.64] and 3.58[1.78-7.20], respectively; P < .001) (Table 4). In the multivariate regression model, suboptimal screen height, mood disturbances, and sleep changes were independently associated with greater odds of having musculoskeletal pain complaints (P = .041, .034, and .011, respectively) (Table 4).
Analysis of Gender Identity, Poor Ergonomics, and Addictive Qualities by Areas of Musculoskeletal Pain
There was no association between gender identity and areas of musculoskeletal pain (Supplemental Table 1). A higher percentage of participants who reported poor ergonomics had mid-back, low-back, or both mid- and low-back pain, compared to those practicing good ergonomics (Supplemental Table 2). Furthermore, elbow and mid-back pain were more prevalent among participants who reported addictive qualities (Supplemental Table 2).
Discussion
The current study showed that a large percentage (61%) of participants reported gaming-related symptoms, of which pain, sleep changes, numbness and tingling, vision complaints, and mood changes were most common. Of the musculoskeletal categories, hand/wrist pain, neck pain, shoulder pain, headaches, and low-back pain were most prevalent. Increased time spent gaming, poor ergonomics, addictive qualities, and mood or sleep complaints were associated with gaming-related health conditions. While female gender did not show statistical significance for any measures evaluated, having a majority of female respondents adds to the current literature from a previously underrepresented population of gamers.
The prevalence of reported gaming-related symptoms (61%) was higher compared to previous studies,5,10 which had demonstrated 42-43% of competitive gamers reporting symptoms. Another study showed that 54% of casual gamers reported symptoms. 12 The reason for this is outside the scope of the current study and warrants further investigation; however, it is worthwhile to note that the median age was higher than that in previous studies. Increased hours of gaming and duration of gaming sessions were found to be significantly associated with having gaming-related symptoms or musculoskeletal pain. While the optimal duration of gaming sessions and overall time spent gaming has yet to be delineated in the literature, these data suggest that decreasing the time spent gaming may be associated with fewer gaming-related symptoms. Prior studies have shown that collegiate or professional level gamers may play 3-10 hours daily and have recommended frequent rest breaks (every 20-60 minutes), ensuring regular physical activity, and reduction of overall hours of gaming may promote safer gaming habits. 5 However, there have been no studies to clearly delineate a “safe” number of hours or duration of play for the casual gamer.
Furthermore, a significantly higher number of participants with gaming-related symptoms reported addictive qualities, although this did not reach statistical significance in subjects reporting musculoskeletal pain. However, statistically significant associations were noted between musculoskeletal pain and both sleep and mood changes. These associations are critical given the often irregular hours and routines gamers adopt. These data support a recent meta-analysis showing a strong association between bedtime media device use and poor sleep quantity, poor sleep quality, and excessive daytime sleepiness. 20 Poulus et al. suggested that esports athletes may benefit from the same sports psychology interventions utilized by traditional sports athletes. 21 While the latter study did not investigate the casual gamer, our findings support the importance in treating sleep, mood, and addictive qualities, which are highly prevalent in both the esports athlete and casual gamer. As with other addictive behaviors and disorders, a multidisciplinary approach is recommended. 5 Education regarding sleep hygiene, in addition to screening questions addressing sleep, mood, and addictive behaviors, should be included in the evaluation and treatment of this population.
Regarding gaming ergonomics, a greater percentage of symptomatic participants reported suboptimal distance from the monitor and suboptimal screen height. Suboptimal screen height was also significantly more prevalent among those with musculoskeletal pain. Specifically, participants who reported poor ergonomics had a higher percentage of mid-back and low-back pain. This suggests that maintaining an optimal screen height may reduce the risk of musculoskeletal pain, particularly in the mid-back and low-back. Ergonomic modifications may be considered to reduce the risk of gaming-related symptoms. Given the high prevalence of hand/wrist complaints in this population, the authors recommend maintaining the wrists in a neutral position when gaming, in addition to regular breaks and preventative exercises.4,22 While further studies are warranted, the authors suggest a monitor distance of roughly arm’s length, screen height at or near eye level, and centering the screen in front of the individual to avoid asymmetric postures. The spine should be maintained in a neutral position, aligning the ear over the shoulder and keeping the shoulders over the hips.4,23
Despite the high number of study participants reporting gaming-related symptoms, a relatively small percentage sought treatment. It is recommended that gamers who develop symptoms discuss treatment options with a sports medicine physician. As 52% of participants reported having an eye examination in the past year, eye symptoms should be specifically addressed, and annual eye examinations should be recommended by the physician.4,5 Interestingly, participants of female gender were more likely to receive injections or physical/occupational/hand therapy, compared to participants of male gender, although this was not statistically significant. Previous studies have shown that females are more likely than males to seek medical care. 24
Limitations
This study represents a cross-sectional survey rather than a longitudinal study or a randomized trial with a control group. Thus, it was not possible to determine causality between gaming characteristics and gaming-related symptoms or musculoskeletal pain. Future investigations may study the effect of ergonomic and gaming habit interventions on gaming-related symptoms. Additionally, this survey did not address gaming performance or time off from gaming due to symptoms, which could be independently studied as they relate to time spent gaming, gaming habits, ergonomics, and gaming-related health conditions. Furthermore, 56% of participants identified as female, which may limit the generalization of results. Although many studies have shown that gamers are predominantly of male gender, especially in younger populations,13,25,26 a Netherlands-based study had 63% of its participants who were of female gender, and the Entertainment Software Association showed that females in certain adult age groups were more likely than males to participate in video gaming to unwind and play for longer durations per week.1,14 The median age of 37.5 years in this study was relatively high and could be due to the inclusion of casual gamers, whose ages may range widely. In addition, although this survey was administered during the COVID-19 pandemic, pre-pandemic gaming behaviors and symptoms were not assessed. We also did not assess the chronicity, duration, or severity of gaming-related symptoms and musculoskeletal pain. Lastly, we provide solutions for the symptoms experienced by gamers in our cohort; however, providing simple advice is not likely to change the behavior of gamers with addictive behaviors, and a team approach is recommended.
Conclusions
As electronic gaming continues to expand, recognizing gaming-related health conditions and their predisposing factors is critical. This study shows a high prevalence of complaints in gamers and provides important data characterizing gaming habits, ergonomics, and associated symptoms in this population. Increased time spent gaming, poor ergonomics, addictive qualities, and mood or sleep complaints were associated with gaming-related health conditions. The findings suggest the importance of monitoring time spent gaming, promoting proper ergonomics and regular exercise, recognizing gaming-related complaints, undergoing regular eye examinations, and screening for mood disorders, sleep issues, and addictive qualities. This is best accomplished via a multidisciplinary approach.
Supplemental Material
Supplemental Material, sj-pdf-1-ajl-10.1177_15598276231175396 for Characterization of Gaming-Related Symptoms and Musculoskeletal Pain Complaints in Individuals Who Participate in Electronic Gaming by Roderick Geer, MD, Jennifer Cheng, PhD , Rachel Rothman, BA, Zafir Abutalib, MHS, and Kathleen Davenport, MD in American Journal of Lifestyle Medicine
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by grant number UL1TR002384 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH), for REDCap use.
Supplemental Material: Supplemental material for this article is available online.
ORCID iD
Jennifer Cheng https://orcid.org/0000-0001-8458-619X
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Supplementary Materials
Supplemental Material, sj-pdf-1-ajl-10.1177_15598276231175396 for Characterization of Gaming-Related Symptoms and Musculoskeletal Pain Complaints in Individuals Who Participate in Electronic Gaming by Roderick Geer, MD, Jennifer Cheng, PhD , Rachel Rothman, BA, Zafir Abutalib, MHS, and Kathleen Davenport, MD in American Journal of Lifestyle Medicine