Body Mechanics and Adaptive Self-Care Solutions for Video Game Enthusiasts.

As a physical laborer, reader, writer, student, guitarist, painter, office worker, lab technician, manual therapist, people lifter, and daily video game player nothing matters more to me than the maintenance of my manual dexterity throughout my life. For all of the abuse that I’ve done to myself over the years as a “hands on kinda guy” nothing has done more damage to my posture than vegging out at the end of the day, slumped over on the couch, with a controller in my hands. Working in physical/manual therapy for a decade and producing adaptive self-care routines for countless people might qualify me to give advice, but useful methods for combating postural defects and chronic pain is a hard sell to gamers. Nobody wants to be told how to sit when they have fun. But hey, if you’re a few suggestions away from avoiding a deformed spine and chronic pain issues it could be worth your time.

I didn’t personally change my own body mechanics and self-care routine in terms of my gaming habits until I started working with eSports teams/players while living in the Los Angeles area. Seeing 18-22 year old kids from Korea, Russia and China with repetitive stress disorders, blown/slipped vertebral discs, and arthritis was a bit of a gnarly revelation. But hey, I’m not here to suggest that competitive gaming is exploitative; It is totally a choice, the same way physical athletics offer worthwhile rewards for pushing the limits of exertion so do those who are serious about eSports. I will say that all of these folks had three things in common: They didn’t take breaks, they didn’t know how to stretch, and they chose caffeine over proper nutrition and water. Every athlete knows how crucial these things are to success but even highly intelligent competitive video game players believe that the sedentary nature of their sport has minimal exertion requirements.

The first and perhaps most important takeaway here is that sitting and playing a video game is not only physical exertion of a body in an unnatural position, but that mental exertion affects your body in equally important ways. I’m not just talking about the folks who play hours of Dota 2 or Battlegrounds every night! Even if you’re just picking up Hohokum or Tetris for 45 minutes while your mom cooks your dinner, hand-eye coordination, mental focus, and sustained body positioning are taxing. Think of it like shopping. If you’ve every followed a significant other through several stores as they peruse the shelves, or theater-hopped between a couple of movies, you likely felt the need to nap afterwards. Don’t discount the fuel-guzzling SUV that is your brain.

“Ha ha ha! Even I will (very) slowly destroy you(r posture)!”

The brain needs glucose to function but that doesn’t mean you need candy to think better and honestly it doesn’t generally matter what food you eat so long as you don’t starve while you play. Your body has a quite amazing ability to make what it needs from all kinds of foods, you’re an omnivore. Eat something, drink water, close your eyes, stretch your body, and take a break once per hour. In terms of caffeine intake improving competitive play, most studies show a predictable peak and crash you’d expect regardless of continual uptake. The chemical receptors in your brain can only… whatever just google it and stop overdosing your kidneys and liver on caffeine for no good reason. It isn’t enough to just say “Stretch, damnit!” and walk away, so I’ll try and use the concept of reciprocal training and inhibition to give you the tools to figure out when and what parts of your body to stretch while suggesting three key areas of the body where extended gaming affects postural balance and causes pain: Head/neck, shoulders/chest, and hips/lower back.

Here, I will posit how modern day human beings are constantly at war with over-stimulation by way of globalization and the patterned constant nagging of physical afflictions (forward posture, craned necks, powerful thumbs) that result are proof of self-determination theory as a valid future epidemic that would preclude the collapse of western civi… Oh, uh I mean: Lets talk about where it hurts and why!

Your giant head  VS  The unbearable weight of existence.

The average human head weighs about 11 lbs (5 kg) and it takes a network of over 30 muscles, and some serious connective tissue, to keep it from dropping off your spine and exploding on the concrete like a jack-o-lantern the day after Halloween. To determine what potential damage (strain) you’re doing to yourself by playing PC or console games first you must consider the position your body is in: Seated. Shoulders forward, arms forward and likely raised, bent at the elbow. You cannot help but lean forward with your neck and crane that hilarious eleven pound water-filled brain-case that is improperly supported. The only effective solution to correcting the impending kyphosis (hunched forward posture) this posture brings is almost always going to be an ergonomic chair, but if that isn’t realistic I have several suggestions and some critical thinking exercises to help with alleviating the inevitable neck pain.

The most common complaint I get from office workers, those who spent 6-7 hours or more at a desk and work at a computer, is posterior neck pain and headaches. Their solution is to put heat on the back of their neck and take an ibuprofen (Advil, Motrin, Anadin, Nurofen) and these actions are fundamentally stupid. Why? By heating the painful muscles on the back of your neck you’re actually letting them stretch more and the real cause of the problem is that you’ve overstretched the muscles to begin with. Heat and analgesics are short-sighted ‘band-aids’ for problems you can easily solve with a basic understanding of musculo-skeletal physics (kinesiology) and some targeted resisted stretching.

If you’re doing one action (leaning forward) too much and you’re not going to stop, guess what? The solution to any pain-causing action is an equal and opposite reaction! Science! This is most often called reciprocal inhibition in manual therapy or your personal trainer would employ the concept in reciprocal training. Most skeletal muscles are complete idiots that have no idea how to relax themselves but the body’s physiology has an inherently intelligent design! Every muscle has an agonist (an actor, the hero) and an antagonist (opposition, the villain) and the body is structured so that any opposite action signals relaxation in the muscle that opposes it. This is the case in all mammals, not just humans and allows for maximum efficiency in muscular action.

So if the back of your neck hurts it is almost always overstretched so, you’d think the first thing you need to do is to stretch it backwards, right? No, wait! You’re about to hurt yourself. Stretch the antagonistic muscles of the anterior (front) of your neck. Plenty of silly websites and videos out there can show you how to stretch the front of your neck but it honestly doesn’t matter how you do it as long as you understand what constitutes an effective stretch. First, you breath in and out of stretches. You don’t need to hold a stretch, wobbling around, and should never hold your breath. Take a goddamn yoga class and learn how to breathe while you stretch! They were supposed to teach you this shit in physical education classes when you were a kid anyhow:

  1. Stand up straight without forcing it. Calm your shit.
  2. Take a deep breath and exhale as you move into the stretch.
  3. Take another breath while you are in the stretch but use your inhale to determine the limit of your stretch, this should never hurt. If it hurts, reduce the stretch. If it keeps hurting, stop doing it immediately.
  4. As you exhale, slowly release the stretch. This takes practice, but you’ll get a feel for it fast and you will be getting the most out of your efforts.
  5. Not every stretch attempt needs to progress the limits of the stretch. Do not rely on counting or timing, learn the sensation of slight progress.
  6. Take time between muscle groups to assess pain reduction or increase.
A look at anterior neck muscles from staggered view, top right is the jawline. Note the sternocleidomastoid and scalene muscle locations.

Don’t feel like stretching? Go get a therapeutic massage. I highly suggest an experienced (at least 3+ years) massage therapist who specializes in deep tissue massage therapy. A qualified and licensed professional is able to follow instructions and will appreciate you knowing which muscle groups need attention. For neck pain/headaches from gaming and/or extensive computer use I suggest asking for: Deep tissue on anterior neck (scalenes and sternocleidomastiod “SCM”) and pec major, as well as any assisted or resisted stretching. Do not have them focus on your upper back and shoulders, they’re essentially doing more harm by stretching already overstretched muscles. If you’re too weirded out by professional touch then you’re probably just as afraid of exercise… but strength training aimed at your upper trapezius, and rhomboid muscles will produce dramatic and positive results. If headaches are your main issue watch this video on how to access your SCM, grab it and move your head around. Let go if you feel your pulse, don’t pass out like an idiot holding your jugular. Doing this will benefit anyone who plays games, uses computers, and especially those who look down at their smartphone for most of the day.

Your shoulders and chest  VS  The crippling pressure to succeed.

Anterior posture, typically accompanied by kyphosis (a sort of hunch-backed appearance where the curve of the thoracic vertebrae is exaggerated) has become increasingly prevalent as computers, mobile phones, and compact cars have changed the positioning of our bodies while we work. After a decade of performing postural and gait (walking stride) analysis on the general public I feel comfortable saying that technology as both entertainment and workplace medium negatively affects posture in 90% of all cases. Then again, I’ve only ever seen people who have postural issues so my professional anecdotes do not constitute data to live by. I tend to crumple into the worst hunch-backed posture when I’m playing competitive or difficult games. I’ll lean forward and clench my chest when holding a controller as a sort of natural way to increase concentration. It’s caused some pretty terrible headaches while fighting through Bloodborne‘s difficult and spooky chalice dungeons and after 80+ minute Dota 2 matches that involve long periods of paranoid strategic movement and defense. What does chest do in times of stimulating hand-eye coordination?

By flexing the major chest muscles, breathing shallow, and curling the body forward you’re compressing the chest cavity and most of your organs; Clamping down on two major blood and nerve pathways that extend from your neck to your arms and upper chest can cause issues with circulation and might lead to carpal-tunnel syndrome or thoracic outlet syndrome. If you are a PC gamer who plays with a mouse and keyboard this can be even more troublesome because it poses the threat of constricted vital flow on one side, and uneven shoulder height on the other depending on how ergonomic your mouse level is. To be fair, these are the same issues most guitar players face as their two arms are doing two very different tasks and it won’t become crippling if you understand how to to take care of the two issues with two different solutions. Similarly, visual artists who use physical media tend to use their dominant hand to illustrate and their other to hold or stabilize media. These inconsistencies in muscle tone are necessary and while they are treatable with the same thought process, there is no need to ‘fix’ them for sake of your body shape unless you are in pain. Become crooked for your art, not for your video game funtime.

The first group of muscles to consider are the rotator cuff, a group of several muscles that primarily attach from your shoulder blades to the ‘cap’ of your shoulder. They are the major agonists (actors) in outward rotation of the arm. When you’re holding a controller or extending your arm to use a mouse they are fully stretched forward for extended periods of time. This worsens posture because it also overstretches small supportive muscles like the aforementioned rhomboids that attach from your shoulder blades to your spine. Again most people feel these symptoms as back pain typically heat or massage their back and shoulders and perpetuate the problem. The antagonistic group of muscles for this problem that should be targeted in treatment is the pectoral muscles of the chest, including the small and very painful pec minor. So, and you should be catching on to the reciprocal methodology here, treatment focused on relaxing the chest and strengthening the middle back and posterior shoulders will be most effective.

Diagram of the rotator cuff muscles from Shoulder Doc Australia. As they shorten (flex) your shoulder rotates backwards.

Rowing machines do a hell of an effective job in strengthening these areas of shoulders and back especially if you are only flexing on the pull and easing forward. As you’re sitting there right now, hold your arms up like you’re a greased up 80’s bodybuilder showing off his biceps. Don’t flex, just hold that position and pull your shoulders back. Alternately get into push-up position and hold it for short periods of time while breathing, even if it does require a fair amount of chest strength you’re positioning those back and shoulder muscles into an active alignment. At the very least you should be stretching your arms and chest after or during extending periods of gaming. By taking a break and putting your muscles through their full range of intended motions you can avoid a lot of pain and common postural issues. Here’s an article that shows some basic rotator cuff care options.

The most important takeaway here is remembering that your upper back pain and bad posture more than likely stems from tight and overpowering chest muscles. Personally speaking, having my chest stretched and massaged has one of the more palpable and miraculous feeling outcomes: A huge increase in blood flow to the head and arms. So much so that you might feel light-headed alongside an increase in endorphins. Regular chest stretching and massage not only improves the tone of these muscles, which do not at all need to be constantly tight and flexed, but it will take pressure off of your internal organs that comes with forward leaning posture. This simple bit of self-care can greatly reduce peptic issues like heartburn and other symptoms of gastric reflux common to folks with poor posture and poor diet. Chest stretches tend to take a lot more work because most every task in your everyday life involves forward rotation, their primary action. Chest tightness and back pain can both be easily treated with upper back strengthening and any efforts to relax the chest muscles. I find deep tissue massage of the pecs and rowing machines do the most efficient job, but if you’re interested in weight training or stretches there are countless resources out there targeting this issue.

Your ‘tenderloin’  VS  The unnatural habit of being seated.

You were never meant to sit down for long periods of time. Sitting is an incredibly unnatural habit and one of our more recent human evolutionary challenges. For millions of years humans either stood or laid on the ground. The chair is an incredibly new invention that is far from ergonomic perfection in it’s design. The spine craves its straight, load bearing form and our gangly bodies are rarely mechanically supportive of actions outside of running, barely jumping, and lifting outside of intensive dedicated training. Being seated is not a natural state and extended periods of sitting put uneven pressures on the equilibrium of strength that it takes to stay upright. Most injuries to the low back result from weakened core strength muscles and sitting is more often than not the cause. But hey, you’re going to have to sit down to play video games. I can only offer my opinion on what type of chair to sit in, since ergonomics has never been my specialty.

‘Gaming’ chairs are often slouch machines with terrible low back support and the arm rests are often positioned in a way that creates a need to lean forward more than necessary. There is an art to position oneself at a desk and I think UCLA’s Ergonomics Labs describe it best for PC gamers, and some of that is applicable to the console gamer. The problem is that couches and recliners are complete shit for posture. What do I do? I mounted my television on a swiveling, extendable mount and use an ergonomic computer chair for extended periods of gaming. It is more important that you take ‘stretch, hydrate and shut-eye’ breaks every hour than it is what you’re sitting on, though. Returning to standing position at least every hour can make a huge difference for anyone who works at a desk, improving circulation and avoiding over-flexed anterior core muscles and hip flexors.

Ever eaten a pork tenderloin? That dry, boring cut of pork that is tube shaped? Well, the tenderloin is essentially the same on all animals but its positioning and function is uniquely postural for human beings. We homo sapiens have evolved to stand upright and as such have developed a shorter and more sturdy iliopsoas, a muscle group composed of the iliacus and psoas major (pronounced ‘so-azz’). It attaches from the spine to anterior hip and leg, so it is shortened (flexed) while you are sitting. If you sit for extended periods of time while you play games, as most people do, it becomes chronically flexed and since it is attached to your spine and your legs it quickly causes low back pain that is difficult to treat. My experience with psoas stretches and treatments has been pretty awful and uncomfortable as many of the stretches out there are either dangerous or lead to further back injury and any manual treatments for the muscle require someone pressing through your intestines to access the muscle while you crank your leg into different positions.

In most American schools they warn therapists to avoid manual psoas work due to the possibility of causing a rupture or aneurysm of the aorta (a giant vein) which would lead to immediate death in any case. Its also kinda close to the genitals. This is a silly thing taught for liability but manual work produces easier results than awkward stretching. Don’t be afraid to watch a few videos on how to access these muscles yourself, the key is finding the muscle and positioning your leg, just be careful not to push too hard on your intestines and cause diarrhea or constipation. If you can find a massage therapist willing to work on your psoas make sure you poop first if possible. Nothing worse than having to take a dump while paying for it.

So, I hope anyone who reads this and loves video games as much as I do takes a minute to consider their health between long sessions lost in other worlds. Many of these concepts of reciprocal function and problem solving are applicable to desk workers, musicians, and those who are generally dexterous.

Summary of key points:

  • Always eat something every three hours when gaming.
  • Drink water regularly while you play.
  • Take a break once every hour to:
    • Stand up.
    • Urinate.
    • Close your eyes.
    • Stretch your body.
  • Learn to stretch properly, focusing on breathing rather than mechanics.
  • Sit upright with your head balanced on your shoulders.
  • Stretch ‘open’ your chest, anterior neck and hip flexor muscles.
  • Strengthen your mid-back, core and posterior shoulder muscles.
  • Don’t be afraid to get regular massages and/or exercise targeting these areas.
    • If you’re in pain, consult a physical therapist or licensed massage professional.