If your A-list competitive gamers damage their fingers, wrists, hands, back, or knee joints, who’s the esports organisation going to call? GamerDoc. Her name is Dr Lindsey Migliore, a Washington DC-based certified doctor and a life-long avid gamer.
Combining her passion for gaming and expertise in sports medicine, Migliore belongs to a rare breed of specialists who understand the physical demands and emotional stress suffered by professional esports players tempted to sacrifice too much for glory.
In this candid Esports BAR interview, she urges the industry to rank the health and wellbeing of players as high up as their hunt for revenues to maintain its current supersonic growth.
“There is going to be a team doctor for all of these esports organisations and teams one day, because we know that science can make better athletes,” she says. “So, it is only a matter of time before organisations say: ‘This is worth my money’.”
Esports health should be serious business
As the global revenue of esports is forecast to rise to US$1.1bn this year and up to US$3.6bn by 2025, investors have high hopes.
However, Migliore adds that esports decision makers could slow down the growth rate if they fail to avert the avoidable injuries and potential mental-health issues triggered by the exertions incurred in such an aggressively competitive profession. She says the competitive-gaming industry should look at and learn from the long-established professional physical sports, which are frequently compared to esports because of the combative element in both.
According to the British Medical Journal, the top-flight and very affluent English Premier League soccer organisation loses an estimated £45 million a season in injury-related setbacks.
In the US, research organisation Forrester reports that US$20bn is lost in the economy because of sports injuries at school and colleges alone. Meanwhile, injuries among professional traditional-sports athletes can cost US leagues and other organisations the equivalent of one-third of all athletes’ hefty salaries combined.
“Exacerbating matters is the medical profession, which keeps dismissing the fact that video gaming can cause players physical harm”, Migliore states.
“Traditional sports injuries is a healthcare crisis in the US. We have billions in money going into preventing sports injuries because of how much they cost,” declares Migliore, “That is something we in esports really need to think about because organisations will be saving money, be performing better, earning more, attracting more sponsors in the future.”
Esports athleticism under pressure
Migliore breaks down the physical, emotional and mental demands on career esports players:
Flexing the hand
About 30 different bones and the surrounding muscles, ligaments and tendons in one hand alone perform about 600 actions per minute when playing competitively on the gaming device.
“These are muscles that were not developed or designed to do this. As a result, these tendons and structures can get damaged on a very small scale,” Migliore explains.
“You might not even feel the damage. But if you were to look at the fingers under an ultrasound, they might look a bit different from how they should be.”
Many young players do not even believe it needs to be in their training regime. But it requires the synchronisation of numerous parts of the body. In a first-person shooter game, for example, “you need to track a player across the screen with your mouse. Your eyes have to look at the player, it has to focus on the correct distance,” states Migliore, a Call of Duty aficionado.
“Your eyes have to move sideways as the player moves sideways. The hand needs to move at the same speed as the enemy. If the enemy stops for a second, you need to stop too. If there is any delay in any step, you are not going to be as good as the other person.”
Excessive sedentary position
Sitting for hours gaming is unhealthy. Migliore refers to a study by the NYIT (New York Institute of Technology), a medical school where she is a faculty associate.
She says: “They found that college esports athletes had a lower percentage of lean body mass when compared to people their age who were not collegiate esports athletes. But they did not find a difference in weight.”
This is crucial as having a higher percentage of lean body mass is associated with better health.
The anxiety accompanying the fear of failure among esports gamers has been intensifying as the size of cash prizes rises. In fact, mental-health issues were addressed during Esports BAR+ Americas event last year.
Migliore emphasises that physical injuries and emotional fragility go hand-in-hand in such a demanding environment. “There is still a huge stigma in the general population and also in the esports worlds. A lot of it has to do with the culture these kids are growing up in,” she says.
“That culture says put your head down, grind, don’t complain because that is how you are going to get to the top. But that is not the answer and it’s not good for us. It is hard enough to be a 16-year-old kid without the whole world watching and many wanting you to fail.”
Injury prevention is easier than cure
Physical damage to the body is expected in traditional sports. In esports, on the other hand, “injuries are 97% preventable,” Migliore asserts. “Because there are fewer outside factors affecting your play.”
All the more reason investing in healthcare initiatives should not be prohibitive, she argues.
“Right now, they only see the upfront costs. They see how much your clinics cost. They don’t see the player they just trained for the past six months, who had a wrist injury and now has to sit on the sidelines for the next year; they don’t see the cost of that.”
Sometimes, getting the correct advice costs nothing. “All you need to get those benefits is to exercise for 15 minutes a day. It makes gaming easier, learning new skills easier. You have a lower risk of diabetes, you have lower risk of heart disease, you have a lower risk of a lot of chronic illnesses that can pop up later.”
The medical dream team
Migliore recommends every esports team should have immediate access to a physiotherapist. “They are medically trained, they understand the human body, and they know how to fix you.”
She also advises players to prioritise healthy eating habits and sleep requirements. “If you want to be the best at what you are doing, you can’t afford to ignore sleep; you can’t afford to ignore nutrition, you can’t afford to ignore exercise.”
The other medical professionals she considers useful for esports organisations include a sports psychologist or a mental-performance coach, occupational therapists, certified hands therapists, vision specialists, and massage therapists.
Migliore admits she gets frustrated by members of the medical sector and related academic institutions who remain sceptical about video gaming and are dismissive of investing in extensive research.
“That was when I realised that maybe I should be the one to give the correct answers and not stop pursuing my passion for the rest of my life,” offers Migliore, who is now co-authoring Handbook of Esports Medicine: Clinical Aspects of Competitive Video Gaming, which is scheduled to be published by Springer Medical this year.
She practices what she preaches at Ezone Esports, a subsidiary of Copenhagen-based esports talent agency Acezone.io. Launched by Frederik Byskov, co-founder of leading Danish esports organisation Astralis Group, Ezone offers a free online service to help players enhance their performance rates by improving their physical and mental health.
She also provides injury-prevention programmes for Sweden-based Learn2Esports, and has set up related clinics for esports organisations like Evil Geniuses.
Apart from herself, Migliore says there are still only a handful of qualified dedicated esports-medicine experts worldwide. These include Dr Hallie Zwibel and Dr Joanne Donoghue at the NYIT; Dr Vonda Wright, Dr Melita Moore and Caitlin McGee.
Benefits for the business of esports
“Currently, the constant grind of gaming is known to shorten many professional esports careers to between only three-to-five years”, Migliore says. She is adamant this need not be the case. “Many champions in physical sports play professionally for decades.”
She points to global traditional-sports superstars like Tom Brady leading his team to this year’s NFL Super Bowl victory; basketball’s LeBron James at the NBA; tennis ace Serena Williams; and British soccer icon David Beckham. They boast careers lasting about 20 years each.
She agrees that many professional gamers end their playing days early to transition into jobs in other parts of esports. “Some are getting paid more to be a coach or the board needs someone in the C-suite to be a representative.”
Others, she suggests, should use their game-related storytelling skills to inform aspiring players and fans about the benefits of healthy lifestyle choices. “Not only is it going to get more buy-ins for your team and your players, but it can also encourage people to practice healthy lifestyles,” she says.
Educate the players and investors
Additionally, esports players should make an effort to maintain their academic education alongside gaming. “It is about options. If you are the greatest Call of Duty player alive and you want to live your dream life until you are 25 years old, that is fantastic. But what are you going to do when you turn 25?”
Continuing at school and getting a degree or specialist skills do not mean the end of gaming, she observes. “Esports needs people with specific niche training. We need marketers, we need nutritionists, we need dieticians.”
She equally wonders why investors and sponsors should not include the health-and-wellbeing programme at an esports organisation in the due diligence required before making a financial commitment.
Migliore pulls no punches about the reasons why.
“If you are an investor and your esports organisation has no health and wellness initiatives, that could be a red flag of a larger cultural issue. Do these coaches, organisations care about their players? Because there is a difference between not knowing that services exist and knowing services exist and choosing not to pay for them.”
Reality check: esports seeks ROI
Migliore acknowledges there is much work to be done to bring esports up to speed in the health stakes. “That is how business works. It has to be profitable and it has to be a good business decision.”
Yet, she is confident many esports enterprises have started going down the healthy-players path and more will continue to do so. The benefits will soon outweigh the fear of losing money. “In 10 years’ time, I predict all this is going to be the norm.”