Living on 1HP: Early Research into Health and Performance in Esports

[Music] thank you hi guys I'm Kate I'm a physical therapist and I'm here with some of the team from 1hp to talk about the early Research into health and performance in Esports so to kick things off we'll do a little bit of an introduction and then we'll dive right into it so like I said my name is Kate I'm a physical therapist I've been a physical therapist for about six years now since 2015. I've been working in Esports for about the same amount of time I'm the co-owner of a company called one HP which is a company founded by physical therapist and we provide health and Performance Services to players to teams to schools as well as helping non-endemic companies understand the Esports Healthcare landscape and we provide our expertise for everything from compression gear to new research initiatives we are also every single one of us absolute gaming Fanatics ask me

about my Guild Wars 2 crafting level hack sometime uh I got my graduate degree from the University of Delaware number one to BT program in the country uh I'm also the editor a co-editor of the handbook of Esports medicine which is the first clinical textbook in the field of Esports health and performance I'm also an associate editor for the annals of Esports research which is the first ever North american-based Esports research Journal and I'm here with two of my colleagues Elliot and John so Elliot wanted to hand it off to you excellent thank you Kate my name is Elliot Smithson and first and foremost I'm also a huge gamer as Kate mentioned um played World of Warcraft for about 10 years got into the fortnite scene after that but I've been playing games since I could hold a controller um a little bit more relevant to my medical history I finished my undergraduate degree from the University of Central Florida in athletic training and Sports Medicine then I went on to Marshall University and got a master's in the same degree I finished my

Doctorate of physical therapy in 2019 from University of Saint Augustine with a heavy emphasis on manual therapy techniques I've been working in sports medicine and Performing Arts medicine for the past 10 years in various facets Esports really caught my interest because of a blending of several passions of mine for helping Gamers actually optimize their not only performance but also their health and ability to continue doing what they love without pain it's a great pleasure for me to be speaking to you guys today and I really hope you guys can take something away from this lesson that we can all apply to our individual practices hi everybody I'm Dr Jonathan Chung DC I'm also a personal trainer I'm the chiropractor on the team I'm from Canada as well so the the northern contingent of one HP I did my undergrad and life sciences and a minor in economics from Queens I also did my doctor chiropractic at the Canadian Memorial Chiropractic

College in Toronto I've been with one HP for a while now about a year it's been an awesome time I've learned a ton and I'm hoping that I can help the listeners here uh learn some more stuff about Esports research it's a very interesting topic and it's something that we need to be evidence-based practitioners which we should all aspire to great so let's talk a little bit about why we need that research in the first place um because Esports medicine is a fairly new field and in fact up until about I don't know two years ago or so we didn't even really have a name for this field of medicine it was just we were healthcare workers who happened to do Esports stuff and within that time coined the name Esports Healthcare or Esports medicine and when I say we I don't just mean the team at one HP there are other physical therapists there's physiatrists there's absolutely Sports psych professionals working in this industry but we're pretty short on data right now or at least published peer-reviewed replicable data

um the reason that we need that data um well for one thing there's a pretty large population of people that play Esports and they've probably got specific needs we need to make sure we're knowing what they are so we can address them appropriately um two we need to consider the financial consideration for teams and developers um so looking at the way that the NFL for example or the WNBA has invested in research on their players that affects player longevity player injury risk player performance all of which has a financial tie-in to the league and to the I guess the the ownership there it's similar in Esports and really this is a field in a population that is distinct enough to need its own data sure there's some similarities between office workers and Esports competitors I'm sure there's some similarities between traditional Sports and Esports competitors but they're still in our opinion as people who've worked in this field for six plus years now distinct enough to need their

own research one of the questions we get asked a lot uh is are Esports Sports and our Esports competitors athletes as though this determines whether or not this research should be done on this population uh and honestly our answer is who the heck cares whether they're athletes or not who that cares whether this is sports or not we don't decide that something's not worth studying understanding or approaching with intention just because it is or isn't a traditional sport and so we should give the same amount of consideration uh to Esports competitors that we do to sports competitors even if we're considering the specifics of what they do in different ways and sure we can draw from what we know in sports science about competition about psychology in particular about periodizing training schedules but we need to make sure that when we're doing this research we're not just thinking of Esports as a more sedentary version of traditional Sports because it's not

so in the meantime who can we borrow from yeah quite a few really um as I mentioned we can absolutely look at office workers and traditional athletes um office workers obviously use much of the same equipment as a large population that plays uh Esports competitively keyboards mice monitors um not so much uh using joysticks and controllers as much so they're leaving out our console playing uh players a little bit with with just comparing that office worker research we can also look however at folks like air traffic controllers who do a cognitively demanding task sitting in the same position for a really long period of time that's applicable to Esports looking at musicians competing performing in front of a large crowd having some component of entertainment as well as skill at what you're doing in addition to them maintaining a single static posture with really precise fine motor movement definitely Esports and chess competitors heavily cognitive also involves stable static posture doesn't

so much require you to have perfect Precision but I suppose if you know you want to make sure you're not touching your night when you mean to pick up your Rook I guess that requires some amount of precision here um but even with our ability to borrow from the research that's been done in each of these regions Esports is still separate and distinct from all these fields sure we described overlaps but none of them are 100 this fits exactly the Venn diagram is a perfect circle so to provide evidence-based care we need evidence we need our own evidence evidence that's specific to Esports competitors so let's talk a little bit about the data that exists right now John what do you got for us well we do have some research it's not like we are completely devoid but we need more it's just not enough we have some anecdotal advice from osteopaths or people who have some ideas on how to use acupuncture on Gamers we have some specific pain presentation research so uh for example

low back but the the very rare thing that we don't have a lot of is causation of pain studies and those are very important as you can imagine because if we understand the pathology of a condition then we can be much more proactive about preventing it or treating it uh there's also studies um for gamers uh we're not just looking at um studies that necessarily have to do with pain specifically I think there's a lot of different facets of um the medical literature that are being looked at here is that correct John yeah exactly uh we are like Kate mentioned pulling from other fields so the causation and pain study I talked about where we're looking at the speed and force of keyboard operation that was done on systematic and asymptomatic office workers uh the other important part of Esports is the performance aspect which does have some research on it and looking at some of the emotions and some of the differences between a pro player and Casual player are also really

Illuminating for us when we're trying to determine how to treat this population it's really really interesting right now being in the Esports research field because there's just so many things we need and if we can get some of those really really into interesting topics and we're going to talk about that a little bit but you can do some really really awesome things in the space yeah and so there's there's a reason that there's three musculoskeletal medicine professionals on this call there aren't too many of us who work in Esports I mentioned there's a couple there's a couple more than even just work at 1hp but the number of folks who are really experienced and and experts in this particular field is limited and I don't even call myself an expert I'm just reasonably experienced at this point uh we have experience we have some degree of expertise but we don't have data and without data we can't provide this kind of education to medical professionals

who aren't as in the know about gaming or who aren't Gamers themselves potentially so we end up with this awkward gap between players and the professionals that they go to um you know we've had plenty of players come to us and say oh yeah you know I went to my doctor and because I had wrist pain and he told me to put on a brace and just rest for a while and that's not really an option for folks who Esports is their job their career they make money off of this they need to be able to do it and they need something more proactive than just rest Embrace which doesn't really work anyway for most tendon issues um so part of the reason why we need this data obviously is is for medical professionals to do better by the Esports Community but part of the reason we need the research too is so that Esports competitors take their health and their performance seriously and recognize that they're being taken seriously yeah it's it's kind of a mark of respect to be doing this kind of research that yeah this field is serious enough that it deserves its own time and attention um so we're going to go into a little bit of of some of the studies that are out there right now this is by no means

a comprehensive review this is just a look at kind of some of the samples of the work that's available currently we'll make some recommendations about what we think could additionally be done and then to talk a little bit more about the overall research landscape exactly so this study was basically talking about what we were just discussing that you need to treat Esports players like real patients they deserve care they deserve good care they deserve evidence-based care they also mentioned like we've been talking now we need more research too we want to be the most seven space we can and really push that side of things because that's where Healthcare is going the interesting part about the study was it is an editorial but it has a very powerful message and I hey John just for for folks who aren't in like the the research field what's what's describe what an editorial is too it's more of an opinion piece so we're

not really running an RCT we're not doing randomized control trial we're not uh so much looking at subjects but we're looking at what a need might be in this particular case And discussing it so that there's more information on the topic and starting that dialogue I will also say from a very pragmatic perspective people writing editorials and getting them published in in research journals is a really great way to convince your academic institutions that oh we should fund grant money for this particular research project where you want to test Gamers on things that's one of the utilities of editorials for sure definitely and this was a Hallmark of early research yeah this was a this was a good paper I enjoyed it and one thing they brought up which is interesting is that Esports is getting bigger which means that competitions are getting bigger prize pools are getting bigger and there's a lot of pressure on the line when you're competing at the international for a million dollars or more and you can imagine that for some players

that that's a lot but if we can get ahead of that and look at some of those risk factors and be proactive then you won't have people retiring early they'll have long fulfilling careers and that's what we want for every gamer John as our resident DOTA nerd I do have to know what the last time a team competed for only a million at the international was like at least six years ago at this point uh prize pool for I gotta say 2019 was like what 23 million I think overall that's nuts yeah that's not no more pressure though right right sorry I gotta defend my DOTA no no please fact check me I like it but yes there's we we know that there's a lot of pressure we know that there's a lot of competition we know that things are getting and more uh more and more sports teams are buying into the Esports World um but we still don't have that much data on how to optimize play and practice Yeah in Esports exactly

this next study was also very interesting it was a scoping meta review which is when you're looking at research for people who aren't as familiar you're looking at other reviews so you're taking a wide bird's eye view of what might be out there in the research and surprise surprise we need more first prize there's not much surprise there's gonna be a theme Here guys it's yeah yeah can you tell that we we structured the presentation in a certain way to to maybe push a certain agenda I've but the interesting thing is that some of those Hallmarks of gaming and Esports that we assumed were in inviolable are perhaps not quite so much so one thing we a lot of people assume is that Esports can make you more sedentary and predisposes to you to weight gain but and in one of the reviews that this scoping review looked at it was non-significant findings and of some of those other uh

social aspects of gaming yes it can be a little isolating at times but it can also expand your friend group online and I'm sure that many of us and who have been stuck at home for a certain period of time I'm sure you can understand that uh seeing someone virtually and spending time with them it's not the same as being in person but it's still a very powerful and very nice experience and gaming is one of the things that facilitates that it's it lets us connect with each other which to me is one of the most beautiful things about it uh did Elliot did you have any thoughts um yeah I think that there is some research out there that kind of looks at um just what you were talking about um the socialization aspect of gaming um I believe it was a study looking at World of Warcraft players and how they um are actually able to fight off um kind of the symptoms of the earth pitfalls of gaming uh internet gaming disorder uh better than some of their

counterparts that play solo games so I really think that speaks to uh the the fact that social gaming really does uh have some positive impacts on people's ability to um have better mental health um so more studies like this that are specific uh for gamers uh mental health I think are really really critical um I think it's also really key that we're looking at not just the you know how do we how do we make sure that Esports is competitive how do we make sure that Esports competitors are healthy and performing at their best but also looking at the general overall landscape of I guess the community um that surrounds that whole Esports competition sphere so looking at uh does does playing this particular game competitively uh have any impact on your fine motor control does it have any impact on your ability to regulate your emotions does playing a team game versus playing a solo game have an increased or

a decreased effect on your ability to control your emotions how does team communication play into that um you know that that feeling of tilt that feeling of being you know stressed out and anxious and frustrated at a game um these are all really great questions that we don't have a whole lot of answers for there's there's definitely more research on the psychological side of non-competitive gaming um and kind of the social health there but there's not nearly as much on the communication teamwork and performance side of Esports as associated with mental health as associated with mental skills like emotional regulation uh like executive function exactly so one of the things that this scoping review shows us is there's not all that much we need more yes exactly uh this one was pretty great though and I know John you're pretty excited to talk about this one because this was one of the first ones that discussed yeah like gamer Health specifically it's to be clear not just Esports but they're really again there's there's not too many studies that are differentiating gaming from Esports like

Competitive Gaming right now um so we did have to fold in some of the non-competitive gaming studies here yeah exactly so this was a really really awesome Health guide and they looked at trying to optimize three things which is we want to build awareness of common msk problems and health hazards they want to promote Health in the gaming space and then some recommendations for performance I I love this framework it you want to treat Gamers holistically and it's not just pain but you also want to care about performance you play games have fun and to compete uh and especially in Esports the competition side is Paramount so performance has to be considered in the situation one thing that I didn't love about the study was they did mention carpal tunnel quite a few times and Kate will explain why that perhaps is not uh ideal a little bit later uh they did a great job about ergonomics

even to my uh some bass lines so just to run through for anybody who doesn't know generally ergonomics are a way for you to hold yourself for a long period of time without a ton of strain on your muscles to ideally decrease pain but ergonomics aren't everything it's also are you taking breaks are you hydrating enough are you sleeping enough is your nutrition on point is there mental health solid all those things contribute to your Pain's perception and your overall health as well and we also know that actually changing your posture is the best okay it's smiling very widely right now because she loves talking about this we have a camera people think about you know people think about their chairs like ah I'm sitting in my chair for so many hours while gaining my chair must be the most important part of my posture and my ergonomics um I did not coin this phrase I stole it from a designer from Henry Miller but the phrase is your best posture is your next posture which is to say moving around consistently is better than any one posture could ever be you've

probably seen me fidgeting around in my chair during this presentation and we're only 20 minutes in at this point um strongly recommend everybody who's tuning in right now do a little bit of Shifting around do a little bit of great stretch break opportunity but that's something that we really want to make sure as we're doing this research we're incorporating we're not Reinventing the wheel so to speak so yes we want our own Esports specific research but we also want to take what we already know from really analogous Lifestyles office workers chess workers chess players air traffic controllers you do have to sit for long periods and incorporating what we know there about consistent movement and rather than like going and testing are Gamers better at playing if they maintain the same position or are they better at playing if they change positions often we know the answer it's going to be the second one we don't need to do that study you can if you really want to or somebody's going to fund it but perhaps we should put our you know research efforts into more specific regions Perhaps Perhaps and there's also the performance aspect of ergonomics too

your muscles have an optimal length tension relationship where they can react the fastest they can be the strongest and ergonomics is part of that it puts you in the positions that your muscles can work the most effectively and making that connection for some of my some of our our Gamers we've worked with it makes a big difference because suddenly it's not just oh do this and I won't hurt as much it's also do this and I'll click more heads do this and I'll I'll play better that's important and if we're able to put the numbers in front of people say look if you do this healthy thing you will perform better if we have the data and the research to back that up we can point them to a study and say yes we can prove that this helps yeah that makes all the difference in the world because the gaming population and Esports in particular is justifiably skeptical of non-endemic folks let alone medical folks coming in and wanting them to make changes to what they're doing so if we're able to say yeah we can prove that this will make you play better then absolutely that's so much better than just saying I'm an expert and you should listen to me we

have to give a why here's why listen here's the proof I think that is a really interesting Paradigm um coming in as non-endemic people in the space or even if you have some gaming experience unless you've played at a professional level there is a lot of skepticism about um your ability to make meaningful changes to the habits and behaviors of these players because the mentality really is hey I made it this far on my own when everybody else doubted me um they're coming from a lot of oftentimes uh resistance from friends and families that like have questioned like their journey to professional gaming um I think we're seeing less and less of that as these things become more accepted there are organizations dedicated to um educating parents on how Esports is actually a profitable profession and can build these life skills but in order to kind of facilitate that that pathway for these players to actually make um make their dreams come true it's

really important that we are able to actually provide the research that shows that this can be done in a safe and healthy way and how to uh really demonstrate the benefits and we'll talk a little bit more about that later the benefits of gaming on kind of what we can take away as a society as a whole but anyway we're going to transition speaking of performance uh into kind of a more sports psychology mental health kind of intertwined with physiology type study here so this was a really interesting study that looked at both psychological factors and physiological factors so that kind of means more body response to stress and specifically pre-game stress and while we took a look at the study and we kind of concluded that it was fairly obvious information what they they ended up doing or finding was that professional players have

greater psychological stress responses than non-professional players before a match and I think that can kind of go without saying in a lot of our minds like of course that the pro player with money on the line is going to have more stress than uh the amateur player who's just playing kind of for fun or for bragging rights but it's really important that we start laying the foundation um for all of the work to be done on top of this so now you can take a study like this and then cite this in other studies given that this is already a known Factor like yes we know that uh the psychological factors of stress are going to be greater in professional uh players so now you can start building the case out for hundreds of other studies on top of this so foundational work like this while it may seem very very simple and very very

rudimentary is still wildly important in developing the field for everyone that comes after right um so I think enough start go ahead Kate it's it's not just I mean it's obviously important for researchers and professionals but again this is also really important to Gamers to teams to competitors um because sure they'll take a look at this and say like yeah no of course I'm more stressed when I'm playing you know in the finals of the international than I was when I was playing in the 82l amateur Dota 2 league in the the US um but sometimes research needs to quantify or prove obvious things that everybody in the industry knows so that one we can communicate this to outside people and so that two we can find the ways to address it because if we can't establish in the research this is a thing we need to address then how do we test what's the most effective way to address it we've Quantified something we've only theorized about previously

which means we can address it more consistently and we can say yes absolutely we need folks who have sports psychology backgrounds who have performance psychology backgrounds um we've provided concrete evidence here that competing at a high level is not the same as just casually playing and so that's important data for the players that's important data for the teams that's important data for anybody who wants to talk about like how are they making a million dollars playing video games I play video games I should have gone into Esports no you're not actually any good at it Jan um but like so so studies like this well to those of us who've ever had any exposure whatsoever to Esports are like no duh of course this is the result this is really really important to making sure that we're providing the best possible care to players because we're able to say yes we've established without a shadow of a doubt this is peer reviewable replicable data that says yeah this exists and we

need to address it as a result exactly it's validating for for and that's the important part and it's not just for us but for anyone who might be new to the space who thinks like Kate just said it's just video games how can it how could it be stressful it is when there's billions of dollars on the line I think anybody would be a little stressed and I like that they in this study not only looked at the psychological factors and psychological research can sometimes get a bad rap for not being um expressly objective but they actually looked at the cortisol levels in these players so cortisol is a stress response hormone so they really went in and did the blood work and looked at the actual cortisol response and noticed that it was higher so it's not just something that you can say is quote unquote in your head um but there is an actual physiological response to this which I think is just a really cool blending um both the psychological and the physiological yep uh you can't entirely disassociate the two they kind of have

to work together and I really think that that is um something that once the entire Esports industry understands we will see a major explosion in progress as far as uh performance goes and um I've been really interested to see actually uh that a lot of the places where teams have been interested in investing kind of more long term so far has been in that that psychological side of things which I think is fantastic yeah um because that is such a key component of things but as this and other studies will show it's there's we we do have to address both sides of it it can't we can't just address the body or the mind we need to address the two in conjunction in order to improve not just Health but performance right this goes back to the our Esports and athlete uh athletes uh discussion where um it's oftentimes um brushed off that uh the whole athletic component because they it's not

perceived to be much movement involved but as we know from working in this area um and as you can see from the musculoskeletal pain patterns that we're about to talk about um there is a lot of movement going on here um if you're using your body to do something you should be addressing that just as much as the mind but it is it is interesting how much uh emphasis is placed on the psychological in Esports um but segwaying myself here into the next uh the next slide uh there was yeah yeah there was a study done um and danish Esports athletes and this was a survey so again this is kind of a Hallmark of early research um a survey is not necessarily the best way to um get hard objective data and it's we're not testing anything here so you're not comparing one group to another like the previous study actually did um you are uh just looking at responses of these athletes so you may not be

getting the highest quality of um metrics from this but it is definitely worth looking at um and then actually taking these findings and then progressing them into more of kind of a randomized control trial study um but anyway they had 188 responses which is pretty good for Esports to be honest it really is honestly and uh they were pretty representative of the population um and 42 report reported having um some kind of musculoskeletal pain which is absolutely huge if 50 of your population is complaining of something it is definitely worth um they're hurting and yeah and as musculoskeletal professionals as physical therapists um we we have this uh this study is a little bit closer to our hearts um but that doesn't mean to say it's

more important than any of the other factors that we've been considering here but a lot of the pain sites that people were reporting 31 of people were reporting back pain so whether or not uh they were differentiating between upper back lower back um I'm not entirely sure in the study um but back pain seemed to be the biggest uh the site of uh pain for these players and that I think is um massively groundbreaking for uh perceptions of the community I think every time that uh someone not endemic to Esports has um brought up what I do or I tell them that I work with professional players they're like oh yeah they must get a lot of carpal tunnel right that's the number one response that I get um I got a couple issues with that which we will again discuss about that don't worry yep uh carpal tunnel is an issue in the hand and that's not even the biggest uh issue that we see when we pull Gamers at large

um the most of the pain is in the back so even just foundational studies like this can be so meaningful um just to be able to point to this and be like no it's actually back pain neck pain is huge um shoulder problems can develop there's a lot of hip and uh kind of glute pain that go along with gaming as well nerve symptoms that can be uh triggered by tight muscles there's a lot more to this than uh wristband I actually pulled up the supplemental research on this where they kind of list out um the percentages of players here that are experiencing different uh region or pain in different regions of the body um so the it goes back at 25 or at 31 neck at 11 should around 11 headaches at eight percent forearm at seven percent risked at six percent hand and fingers at five percent that is that that's huge like to understand that

no it's not really all wrist and hand pain if you've got other areas of the body that need exploring here and that's going to change kind of the um the way that we approach uh studying this population and molding future studies so um I hope I've uh kind of delivered the point here of how important these foundational studies are and um how simple it is to come up with a concept and just run with it as far as the study goes because chances are you are doing something meaningful whether you think it's a very specific topic or a very simple topic um and we'll get a little bit into kind of more action steps later on how um we can go about uh formulating some of these uh study topics but I I just think that's huge that one of the one of the things that we can run into with a survey study which this one was is we're not getting necessarily objective data that we've measured we're getting someone's perception of what's

going on which it can absolutely build out surveys that make things less subjective more objective we can build in questions that kind of back check each other in order to establish internal consistency within a survey but survey studies like this are a really great place to start for two reasons one they're pretty darn inexpensive and when nobody wants to fund your research you need an expensive study to start with and two the result of this study you can then take it especially if you get it published and say look we have published data that establishes back pain as a serious problem for Esports competitors we want to research that further then you can actually get grant money for that stuff um so kind of within kind of the progression of research yes we'd love to be testing a whole bunch of things that we we've observed either anecdotally or from our experience but survey studies like this basically quantify that observed experience and then let researchers actually study it in a way that's consistent and objective and

reliable over time so for all that survey studies can get a bad rap they're really really valuable for as Elliot said the kind of foundation laying for building the research for a field um and it's it's really important though to consider here's what a survey study is good for establishing do people have pain of some sort and it's really important to note that in this particular study they didn't pathologize any of the pain which is to say they didn't say this their their reporting then that they have sciatica or uh yes they've confirmed that they have thoracic outlet syndrome they're describing where they have pain they have not ascribed a diagnosis to that pain which is accurate fair and reasonable in a survey study because in order to diagnose somebody with something there's usually a diagnostic criteria you have to go through so if you were diagnosing same sciatic nerve issues um you'd probably want to look at their range of motion in their back you'd want to look at their hamstring flexibility

you'd want to test the mobility of the sciatic nerve you do certain clinical tests like a slump test for example to put that sciatic nerve under tension and see does that replicate the symptoms you'd also want to rule out other things so you might go in and palpate kind of the gluteal tuberosity which is the butt bone basically seeing is there is there tenderness here that I would associate with like a hamstring tendinopathy you might check out and see is their weakness or tightness in the glute muscles that I might uh think that there's a muscle compensating that's putting pressure on this nerve and so all of those things go into creating a diagnosis a survey can't replicate that but a survey can give you general information about pain now why am I going on and on about how a survey can't diagnose yeah I'm gonna come back to yours I promise but this was just a bit of a segue to miss all right fine so there was a survey study uh that looked at carpal tunnel syndrome symptoms in Esports competitors

um which not unreasonable they do specify it's about symptoms but the danger of a kind of study like this where you're ascribing the results of a survey a player describing where their pain is located to a diagnosis is you haven't actually confirmed they have that diagnosis and you can by publishing that research create a misconception about how common carpal tunnel is or isn't now this is not published research this is my anecdotal experience as a physical therapist who's been doing this for six years I have in my time and I'm treating Gamers treated exactly one case of carpal tunnel syndrome and it was in somebody who developed their carpal tunnel syndrome from a manual labor job and they also happened to play games which is where their symptoms presented the most so the games brought out the pain they didn't cause the pain so there's there's saying that you have symptoms associated with carpal tunnel syndrome does not mean you have carpal tunnel syndrome some of the symptoms that are associated with carpal tunnel syndrome are

associated with other conditions like tendinopathy like other median nerve issues like something like cubital tunnel syndrome double Crush syndrome a cervical radiculopathy a thoracic outlet syndrome follow books are words that just sound like jargon if you're not in the medical industry um but it's basically the gist of it is it's very very difficult to diagnose any of those things without being Hands-On with a person and it's absolutely impossible to diagnose somebody with those conditions over a survey so it's really important as we're starting to develop the research and the foundations for this field that we a contextualize our research and make it really clear that we're looking at player reported pain as opposed to ascribing a diagnosis to it and two it's really important that the folks who are doing research have familiarity both with research and with gaming there's got to be a blend of both this this can't be a one thing or the other which again we'll get into a little bit later on once I let Elliot talk about performance

yeah yeah where was I um all right so this study about performance um was actually interestingly put together I've never seen a study kind of done like this but it was kind of a two-part study so in the first part of the study what they did was they developed this uh kind of litany of abilities that they think that Pro Gamers should have or um be able to be proficient at um so they kind of broke this down into several categories here's psychic or mental abilities including personality social abilities um the condition category so those are things like uh physical fitness endurance speed flexibility um Constitution so these are things like um sounds like a DND stat sheet yeah

yeah I really feel like they were very heavily inspired by uh kind of uh RPG style uh stats yeah um but anyway Constitution is things like um your age like your nutrition sleep um things like kind of Baseline factors and then media competency um so those are like things like your ability to network um socially through internet media like Reddit and Twitter and like kind of finding information about the game and stuff like that um so these competencies they then turned into a survey um and then they set the survey out to a bunch of different Gamers um I think uh 1835 players uh they sent this survey to um so basically what they were looking at was do these individual competencies change based on the game that you're

playing and again this is this is another study where it's like yeah obviously it's going to but it is good to have data like this in order to continue building that case up uh but yeah they ended up finding that the different games do have different skills that are more important or perceived important for these players um so while kind of oddly put together I think they did come out with some good information that can be used um by uh both people in our profession as well as game developers as well as Sports psychologists nutritionists all these different fields can I think maybe pull at least something from this uh study just to kind of look at uh what the perceptions of large uh games actual population um are so come out of a study like this is testing

what skills are actually most important via an objective measure compared to what players perceive as most important and if there's a mismatch they are determining why is there a mismatch how do we help them understand which is actually the most relevant skill for what they're doing um those are absolutely things that can then be built off of a study like this it's the really great thing about research is it builds more research it builds more understanding it lets us as professionals provide better care and it lets players play better if we help them implement this research yeah so we've got some proposed best practices for research when it comes to researchers specifically and we want to dig into that a little bit for sure [Music] um the first one is I kind of mentioned that we wanted uh we didn't just want non-endemic folks to come in and do research on games without having any experience as Gamers that's not to say that you need to be an avid gamer in order to do games research but

you need to at least be familiar enough to kind of I guess respect the culture have some degree of cultural competency around Esports um this is not an Us Versus Them Venture this is not the gaming industry versus Academia um this is and should be a venture that incorporates the knowledge and the experience of folks who are endemic to Esports the players the coaches the staff and then the research qualifications of non-endemic academic folks um combining those two things together gives us studies that are relevant that are well designed um and that actually have bearing on the on the Esports world so they don't just have uh theoretical research use they've got practical actionable use in the field that that is being studied which research should do research should provide you know at least some amount of benefit to the folks who are being studied um and kind of on that note um I think it's really important when it comes to research to incorporate subjects into

Publications and what do I mean by that well uh in pain science research recently there's been this push to have uh as as co-authors on papers patients who are describing patient experience of pain especially when you're talking about um like the the provider understanding of a patient's pain or the patient experiences pain to have actual patients helping to write the papers now does that mean that every patient has all kinds of you know research background and experience no absolutely not that's why they're a call Author not a sole author um but we know that expertise is not confined to Academia there are experts in their field and we should absolutely make sure that the knowledge of those experts is well distributed and well transmitted because otherwise we're just doing research on something that the industry already knows and then that cements that kind of well they're these outside folks who don't know anything who came in and tested a thing that we could have told them if they'd bothered asking us so then there becomes kind of

this this head-butting thing whereas if you come in and you partner with folks who are already in the Gaming Community already in the Esports World players coaches staff US um then you were making sure that you've drawn what's already there so that you can build what isn't it it can't just be uh it can't just be a thing that that Academia does to gaming it has to be a thing we do with gaming is very recognizable when it is it's very very clear hyphen capital S and it's an immediate giveaway that these people have not talked to anything there is a also I will I will acknowledge some degree of possible okayness with that if it's a paper in another language and it just got translated into the translation engine put e dashboard VIP style guide says Esports single Warriors No hiding no capitalize this all right um so also important to consider when it

comes to research who pays for it so this is the question that everybody really is asking at the end of the day um and I think before we answer who's gonna pay for this I think we should answer why they should pay for it um so I really think that there's a lot of applicability of Esports to other fields so Esports is interesting because although we have established or tried to establish that it is not just a mental function it is kind of the Pinnacle of mental functioning competitively it really isn't a whole lot of other um kind of ways that we interface both um in kind of the neuromotor uh control facets of uh intellectual that's not the right word um it's difficult to find another field that quantifies

um all of these mental skills uh that we see represented in Esports in a competitive setting as well as we see in the Competitive Gaming World um so that being said uh there is application to other fields uh within kind of that sphere of like um mental functions so cognition is the ability uh to uh think essentially and there are studies out there that show that gaming actually does improve your ability uh to think uh critically rationally logically strategically all of these things that we uh value in uh Society um and in both children growing up as well as aging adults um so I really think that it is uh in the same way that when we send someone to the Moon we advance technology here on Earth um it is worth looking at these um these facets of uh cognition and fine

motor skills and how we can prevent um deterioration uh in patients with Alzheimer's by studying um how to push the boundaries with Competitive Gaming um and so who exactly would be interested in advancing this kind of line of knowledge I think both academic institutions as well as medical organizations are very interested in kind of understanding how to push the limits in this way as well as the government for various reasons whether it be developing practice guidelines for our Medical Health Systems either for military involvement um all of these institutions I think can have a vested interest in kind of pushing that line of knowledge into um understanding how the brain works at the highest levels right and so here we're talking about some of the more traditional structures of research funding academic institutions which publication publication publication medical organizations we provide care of

course we're invested in in the outcomes of our patients in government organizations both in terms of general for the public good um but also definitely there's when it comes to Esports there are military applications for the kind of stuff we study in gaming um but we are not at an academic conference or at a medical conference or at a government conference we're at the game developers conference so why should developers care yeah so the the first part of the answer to this is not all of them have to um which is to say yes developers care about the players who play their games to some extent and in some way we're talking specifically here about kind of the larger Esports um kind of organizations we're talking about the developers who create games specifically to be played competitively as an esport um and those are in our opinion the kinds of developers who are probably going to Care the most about this kind of research now that's not to say that smaller Indie Studios won't care

especially if say you're developing a game that incorporates aspects of mental health then sure absolutely you're probably interested in and maybe even invested in the kind of research that comes out about mental health and games um but if we're looking at health and performance in Esports then the developers who create games that are Esports are probably going to be the most interested here so why should those developers specifically care why should the gaming and Esports industry care about this well when it comes to a purely pragmatic Financial perspective having longer player careers having career longevity because players aren't injured and they're playing at a high level there's Financial value there people want to watch people play at the highest level people want to follow their favorite players and a lot of fans follow players more than they follow just teams leagues want to have players who are able to play consistently over time because that gets people tuning in to watch it which gets ad Revenue which gets your company money but in in kind of a more public Good Sense investing in this kind of research

creates a more stable more sustainable industry and sure Esports is Esports really started with so much Grassroots work um Esports really started with Community organization especially in you know the fighting games Community for example still does rely very heavily on a lot of Grassroots organization but if we want to create the kind of stability that we wished we'd had when we were first getting started in all of this if we want to create some reliability some degree of security some degree of infrastructure that doesn't mean we have to become stodgy and it doesn't mean we have to create the exact same thing that's already been done elsewhere that we don't particularly like we have the opportunity to create a new health infrastructure in Esports and a new performance and health model for our players um but we have to put the time and effort into it because otherwise we're just going to have to borrow from everybody else because that's the easier and less expensive way to do it if we want a community that is ours if we want an infrastructure that is ours

and works best for us we need to take the time and money to invest into it um other reasons that developers could potentially care about this really great way of correcting misconceptions about gaming is providing research that says no you are wrong they're not basement Builders who just you know eat Doritos and drink Mountain Dew and no not just anybody could be a top tier Esports competitor the kind of folks who win you know eight million dollars at the international really are exceptional on par with you know making it into the NFL in terms of the elite tier of the thing that they do this also allows developers to tap into new markets as we alluded to having research that shows kind of the health benefits of competitive Esports as well as the ways in which Esports can be integrated into an overall healthy lifestyle absolutely improves parental support parents being the ones who have the money to buy the games that their kids play it's a pretty important Market to be tapping into so this kind of research absolutely should be funded by traditional institutions absolutely

should be studied by traditional academic medical and government organizations that being said it's absolutely research that the industry should be interested and invested in because it helps us create this more sustainable playing field for Esports to continue to be a viable option to design games to be played in for players to participate in and for support staff to then design the structures that keep all of that up and functioning um it's it can't just be a thing that non-endemics care about because if non-endemics are the only ones who care about this research then not endemics are the only ones who are going to do it and are going to end up with a whole bunch of people who don't know all that much about gaming not drawing on serious expertise that's already here that we could absolutely rely on for for real value when it comes to research so when it comes to research what do we need there's a reason I put three exclamation

marks here because having some standardized standardized care across the industry will do so much good I there's there's some very cool research out on tendons and not everyone knows that isometrics can be really pain relieving will not being that disrupted to a training schedule and there's just so much cool stuff out there that if we can standardize it and and help other practitioners understand what the best way to treat someone is we can make a humongous difference and think about the scale of how many gamers there are in the world there's millions billions of them and do they not deserve care any more than the millions and billions of people who play basketball that's not true they both need help it's not a you take away from one and then you take away from the other we can help both exactly so prevalence data is basically in a population how often something occurs and so having the understanding of how many people may

have a certain condition whether it be low back pain wrist pain finger pain can help us a lot with understanding okay where do we need to invest the most time and energy for let as we just learned with Elliot we have a lot of low back pain maybe instead of focusing so much on fingers and hands we should focus more on low backs with Gamers right and understanding the physical demands of gaming also really really helps us understand how to be proactive with injuries as opposed to reactive and as many of you might imagine using a mouse and keyboard very different from using an Xbox controller or a PS5 controller and then even then you play Valerian very different from playing DOTA and even if you play DotA if you're Solo Carry versus support that's very different inputs those would have very very we know that these are different but we don't know exactly how right and and we don't know what the distribution of pain that comes from these differences that

was actually relevant so like the studies that looked at all these back pain issues I don't think it was organized by actual games so like understanding very specifically to the population you're working with is so important yeah like great example exactly Smash Brothers we've seen more folks who play Fox having you know tendon paint across the back of their hand than folks who say Maine Peach now we can't prove that because we haven't done any research on it but anecdotally we're like yeah this absolutely makes sense and so being able to quantify that as John referenced allows us to create more consistent care guidelines that are more specific and less General because right now the the general guideline that gets given out by folks who don't know gaming well is rest Embrace without really looking into okay what game do you play what input device do you use how long are you playing for what character do you mean within the game that you play if you your game is a character if your game is one that has a main character that you might play um okay what are the most common inputs

you use on your input device are you wave dashing a lot as a smash Fox player are you in Dota playing invoker and having to do all the you know really complicated invoking combinations or are you like any playing vengeful spirit and just pressing look stuns are good okay but like all of this information is really helpful and really valuable for understanding what areas are most under strain and what areas should we be starting to prevent strain and what can we do for players to help them not get injured in the first place because we really run into a lot of players who don't want to see a healthcare professional because they don't think the healthcare professional is going to know what to do to help them which you know what Fair based on our track record so far that's that's a reasonable opinion to have but if we could have a few less you know highs and hexes in the world you know having to retire due to Medical injury he really could have been prevented uh then we end up with more top tier players we as Spectators get to enjoy it

a heck of a lot more the industry stays more sustainable and people leave because they want to leave not because they're forced out by a medical condition that absolutely could have been prevented if we just had the data and the professionals who were in the right place to help provide that care exactly we want to help health care providers help people better and that's the whole point of all this research and this entire presentation is that we can do better we do I think at 1hp we do a great job but we can help a lot more people and ultimately at the end of the day we're all just trying to elevate the entire ecosystem of Esports and the culture of gaming so I really think that that's a great uh kind of final note to end on here we we have a we have a bit of a motto at one HP and our motto is play more hurt less and we want that to be an option for players we want people to be able to play we want that to be a part of a healthy lifestyle we want Esports competitors to be competing at their best playing more but without hurting and in order to make that happen we need the research to

develop this industry to develop this field of Esports medicine and that's the way that we provide the best possible care to players so that they can play more and hurt less thank you so much for joining us for this guys um I think we've kept it to almost 60 Minutes I gotta be honest uh we've been in chat and answering questions this whole time this is a little weird because we're pre-recording this but if you ever have any future questions for us you can always reach out to us on Twitter um which I believe will be posted here um we're more than happy to answer questions at any time um because we really want to make sure that this is something that sticks around that this research really continues to grow yes absolutely thank you everybody thank you so much [Music] thank you