all righty so hello welcome everybody to the national fellow online lecture series today we're going to be talking about esports medicine i'm dana i'm the pete's sports medicine fellow at northwestern and lurie children's and will be your moderator today this lecture is sponsored by the amssm online fellows education subcommittee which is co-sponsored by the education committee and the fellowship committee so these lectures should serve as an adjunct to your fellowship programs normal education provide direct access to some experienced sports medicine members and guest speakers and assist in your caq exam preparation so before we start a few quick reminders mute your microphone turn off your video you can submit questions at any time throughout and at the end of the talk i as the moderator will go through the chat and based on the questions we'll uh talk about them with dr moore and after the program i'll send an evaluation link if you could fill it out that would be great so to introduce you to our expert speaker today dr melita moore is quadruple board certified physician in pmr sports medicine brain injury medicine and lifestyle medicine she served as a team physician in the nba 2k league the wnba and the nba g-league she's the ceo and founder of levels unlocked enterprises and the executive director of health e-gamer foundation whose emphasis is on e-sports and stem through a wellness lens she has been instrumental in introducing the sub-specialty of esports medicine and having been one of the select team physicians of a professional esports team in the united states she is an international leader on health and wellness for gamers in the field of esports medicine she's also an editor for the handbook of esports medicine and a board member as well as chair of the health and wellness commission for the global esports federation so with that thank you so much dr moore for being here and i will let you take it away dana thank you so much for the invitation i'm so excited to be able to speak to the fellows this evening um you know day to night we go back to our uc davis days so i appreciate you reaching out to ask me to give the talk on esports medicine and i see my wonderful mentor dr tanji the father of sports medicine here so we're happy to see you dr tanji and hopefully everyone will be able to learn something about esports medicine today all right um here are my disclosures uh as data mentioned i'm on the board and the chair of the health and wellness commission for global esports federation i'm also an advisory member for an esports global fund a medical advisory board member for international hospital group and the ceo of levels unlocked enterprises so these are our learning objectives for today so i'm excited to talk about esports medicine and for any fellow who may not know or anyone who may not know what esports is we're going to learn that today um we're going to hopefully gain knowledge about the gaming esports injury we're going to talk about this 20 20 20 rule and common esports injuries but before we go forward i do want to acknowledge today from united nations international day of sport for development and peace and so typically you raise a white card in honor of peace through sport and we just really need to be able to appreciate and understand that sport is powerful um and that we need peace in the world right now so if anyone has their white card we hope that uh you can wave it dr tanji has his and so we are acknowledging peace and sport today esports and gaming oh let me move this thingy okay esports there we go or not okay there we go so there is a difference between esports and gaming and so esports it's an organized competitive video gaming and gaming is just what most people do when they're at home um doing traditional video gaming so esports it's organized competitive video gaming usually the esports athletes or e-athletes that's controversial in the esports world some of the gamers like to be called e-athletes athletes esports athletes or some just like to be called gamers or players um but they are professional athletes and so i know this looks like a bunch of um funny words under here this lol doesn't mean laugh out loud these are actually game titles and so when we talk about esports this competitive video gaming there's usually certain genres of gaming and so those could be first person shooter games they could be battle royale or strategy type games so this lol means league of legends um cod is call of duty uh cs go is counter-strike go dota 2 and nba 2k so if you've never heard of these titles this these are what esports players they compete in um the other very important thing because you will get really um talked really badly about in the esports world with regard to how you spell esports and so we typically see it um various ways a lot of times we see a lowercase e and a capital s that is incorrect esports is a sport just like basketball or football so if it's the middle of a sentence it's lowercase it was at the beginning of a sentence it's uppercase and uppercase e so just remember that it's just any other type of sport so um if you are doing any publishing or any research just make sure that we are spelling esports correctly people are stickler in the industry for that there are over 3 billion gamers worldwide that's half of the population or people that identify as gamers i myself am not a gamer and people ask me well how are you taking care of these professional uh gamers and i say i'm not an nfl or nba player either but i do know how to take care of an acl and mechanism and injury and how to treat it so i tell people the same thing um i am in my gaming chair today just because we're having this lecture so this is a beautiful chair um for my ergonomically correct setup and so 64 of american households own a video game device which is crazy um 60 of americans say they play video games and in 2021 americans spent 60 billion dollars on video gaming so i'm really grateful that dana asked me to do this talk because if you aren't aware of esports and gaming this is certainly what we are seeing this is the it's not a trend um it's here to stay and more so especially uh during covet or since covet oh okay we talk about gaming types there's three different major gaming types one is pc gaming so that you do on your laptop or your pc setup the other is console which most people are familiar with so on xbox or playstation or the nintendo switch and mobile gaming so aarp put out a stat in 2019 that there are 55 million americans over the age of 55 that mobile game more than four hours a day so that is we are talking about this this is across the age spectrum when we're talking about gaming a lot of mobile gaming um and so the casual mobile gaming and all people are doing candy crush or pokemon or words with friends or wordle that's actually mobile gaming um but when you're playing a video a video game title india is huge for mobile gaming uh china africa and so that's where we really see the most of the mobile gaming but we're starting to see it worldwide this is the stadium so you all as fellows might be used to being courtside um on the sideline this is now the new sideline and so this is actually a setup of the nba 2k league and as dana mentioned um i was a team physician for the nba 2k team here in washington dc called wizards district gaming i was there a team doctor for three seasons and then we won the championship uh the second the second year so this is the setup this is now your your new arena and pre-covet esports events sold out arenas they sold out football stadiums soccer stadiums sold more tickets than an nba team inside the nba team's own arena and so this is very popular um in 2020 it was uh league of legends that lol league of legends it was the third most popular professional sport behind nfl and nba which is crazy we're talking about esports and if like again this is one of the main titles league of legends third most popular professional sports league this actually was in 2018 from syracuse and these numbers actually changed during covet but if you can see this projection that esports actually jumped the number two as far as viewership in the us so 84 million views across the board for america watching esports during covet um when especially when all sports stop what we saw on espn was nba 2k league we now are seeing professional video gamers playing basketball we saw a lot of f1 sim racing and so it is very interesting to see how close these numbers will be with new data that has come out um and in the pandemic to see how far we esports is closer to the nfl this is an astounding slide here so this is the number of hours watched on streaming platforms so in the gaming world streaming is very very popular um most people have heard of twitch that is one main streaming platform youtube gaming um facebook gaming and so people typically in the gaming and esports space they watch other people game um and that's called streaming so i would have my own setup i would have my own camera and i'm talking i'm showing my game play and i'm streaming there were 5.7 billion hours of streaming watched on twitch in 2021 this is wild meet your new streamer if you haven't heard of ninja you've heard of him now tyler ninja blevins is the leader of the pack he is really leading the game from a streaming perspective when he goes live on his streaming platform and he actually has been bought out to go from platform to platform he's like the lebron james of serena williams of of streaming and so when he goes live to play a video game he typically will have over 70 000 people watching him at one time stream live you see this bottom line 300 000 a month just in streaming revenue he has um sponsorship with athletic companies with athletic shoes with apparel ninja has so much income coming in all from streaming he's not a professional gamer he's a professional streamer so streaming is something that is just really huge you can hear this is the cover of espn magazine and they're calling him a cross silver star so esports and gaming has certainly crossed over um long ago here is another example of a traditional athlete aerial powers wnba champion coming over and crossing over into the esports side and full disclosure area ariel is one of our clients for our brand management and events management company in esports and we're very proud of what she's doing as a female as a wnba player as an esports enthusiast she is a co-owner of an esports team um she is the leader of diversity equity in inclusion for team liquid which is the winningest esports team in the world and so this slide really demonstrates a few things um what i didn't know before i got into esports was anything about a digital dubai when we're talking about communities mostly communities of color in urban and rural areas not having access to wi-fi quality wi-fi we saw that play out a lot during the pandemic just with school but pre pandemic this digital divide was even larger i did not know that there was a huge disparity for women in gaming you would think this is just video gaming i'm getting on i'm putting on my headset and i'm playing on my xbox with someone else around the world somewhere but the disparity and the bullying that happens with female gamers once people hear their voice or they see them on their stream then there's a lot of issues that happen where they maybe let's just say it's nba 2k they're not going to pass the female player the balls and now she can't score the point so now she can't win her portion of the game so we really try hard to and that's one of my passion points in esports is making sure that we're giving opportunity um equity and visibility to people of color and women in gaming this is um a very proud side for me because in 2019 when my hospital i was working at the time asked me to be the team doctor for our nba 2k team i didn't even know what it was uh and they just said melita can you jump on this call i said okay fine at the time i was taking care of our nba g league team and our wnba team and i had a college that was taken care of and i got off the call and i said why was i alone there so oh you're going to be their team doctor i had no idea why a gamer would need a team doctor i'm working with the professional athletes this is what's going on in my mind at that time why would i now come and work with gamers but as i do when people ask you to do a task as i hope we all do you just step up and you do the work and so i really did a deep dive in 2019 about what a gamer could possibly need from a health and wellness perspective and there really wasn't much out there in 2019 with regard to research um certainly no books or very few books that were about gaming and esports and health and wellness and so i take pride in my hospital which was mixed our health really um being open and this is where you all have the opportunity to either where you are currently in fellowship or where you're going to go to next you have the opportunity to to pave the way and really be trailblazers in this space i told um our sports medicine team hey i think we should come up with the pre-participation physical for gamers which when our nba 2k league um they have one sheet in 2019 they had one sheet and if you just had decided to say this person is fit to play in the nba 2k league well what the heck does that mean we don't see that what are our soccer p participation physical or football pre-participation physical so why is it just signing a paper saying they're fit that didn't sit well with me so at that time we created a pre-participation physical and um throughout that work over the past several years i have been able to tour the world talking about health and wellness for gamers and so on the top right we did a healthy healthy gamer summit um which is our nonprofit and we did that in ghana really educating um the youth there in ghana about the importance of being healthy and well and how you can do that with with esports and talking about healthy digital lifestyles on the left i was in saudi arabia with the global esports federation we had a mobile pub g tournament and i got to talk about health and wellness and on the bottom right i spoke at the world expo in dubai in november about esports and the metaverse and i just really have to sit back and think about my very humble beginnings in sports and i did my sports medicine fellowship at uc davis in 2009 and to see kind of how my life has transformed how sports has transformed me over this decade is really mind-blowing to say i'm i'm speaking at the world expo and not about sports not about concussion i'm talking about esports um so if there's anyone that's interested there's a new world that's out here and you get to create and build whatever you want um when you have the passion for it so we're going to talk about some health concerns and so typically when you say oh we're talking about um health and wellness for gamers everyone almost everyone says oh what do you do just treat carpal tunnel and it really makes me angry um but i take a breath and i understand that a lot of people just aren't educated about it and it's it's not an ignorance on their part um it's just people don't really know so these are some of the topics that we are going to talk about mental health is huge and so typically when i am speaking about overall well-being or healthy digital lifestyles i really put mental health up top this is pre pandemic before mental health became its own crisis in its own pandemic and when we talk about mental health in esports there's negative and positive sides so our very first year of our team our nba 2k team they had a sports psychologist and if you look at the professional industry of esports a lot of the professional teams they may have one medical professional and it's usually a sports psychologist and so um we are starting to see that slowly shift to where they are expanding um their medical team but when we talk about mental health i take it all back to cognitive wellness everything sifters around cognitive wellness i think when you talk about a gamer um although they're sitting and they're playing and you don't really see them exercising their heart rate gets up just as high as a professional athlete on a basketball court or a football field when they are actually in game play and so when we talk about kind of these positive benefits of sports psychology if you can imagine this is a person usually at their home playing alone and then they get into a professional league and so now they're immediately on a team when they've never been on the team sport before they've never been in the spotlight they've never been on the stage in front of tens of thousands of people you can imagine how that all just kind of can come crashing down on someone and so a lot of the sports psychologists is just like we doing traditional sports talking about focus and attention um visualization really talking about how you get in the zone but not go past the zone and how to be a team player and how teamwork happens and so that's a lot of what happens initially when they come when you come on to a team this other important piece is the social emotional benefits of gaming and this is where it goes down actually into the youth and so what we are seeing a lot in elementary and middle school is gaming being brought into the curriculum whether that's minecraft whether it's roblox it's really kind of those strategy games um but the social emotional benefits and the connectedness that happens with gaming especially during the pandemic you people are getting on their headsets and they were talking to people all day every day more socialization than they ever would and so what some of the early research has shown is that for the youth who game they actually have better social skills than kids who don't they have better hand-eye coordination problem-solving skills and so there really are some great benefits to gaming now on the flip side of that of course there's the negative connotation that can come around the mental health of gaming and professional esports and depression anxiety are certainly the top two um and then the social isolation again people are used to being at home um by themselves playing this game and so they may not be going out publicly or engaging with their community and so this is some of the negative parts of mental health gaming disorder is really a controversial topic um in in the gaming space i know it came out as an icd code um and that really met the community with an uproar because we feel like the gaming disorder the the definition is really um quite strict and really robust not to say that gaming disorder doesn't happen we have seen a lot of gaming disorder when we do see it coming out of the asia market um but overall gaming disorder we really don't put too much um talk or speak into just because i don't really feel that it's gotten its fair shake um because we don't really know the esports in the gaming industry this is one thing this is the second most important thing this is what i learned a lot and so typically in our sports medicine fellowship we're not really doing much about vision unless we're talking about concussion um but we never talked well i didn't hear about computer vision syndrome or digital eye strain and so this was something that was new to me and i made sure that with our pre-participation physical we had an ophthalmologist there to do a really good eye exam if you can imagine professional gamers are sitting and looking at their screen 10 to 16 hours a day that's their practice time imagine all of that blue light that is coming from that screen the glare the eye fatigue your ancillary your skin your ciliary muscles get weak and they start to have a glare come over them you get dry eye you start to do more blinking vision is really really big we all actually need to um check ourselves about digital eye stream before the pandemic corporate america workers were usually working on computers seven to eight hours a day um through the pandemic we all have found ourselves more on computer screens just like today and so everything that we're talking about from a gaming perspective really flips over to what everyone in the world is really going through right now is just really talking about healthy digital lifestyles one thing we can do to try to avoid this computer vision syndrome this digital eye strain is the 2020 rule if you take nothing else away from this conversation today i want you to remember the 2020 rule because you can pass this one to your patients pass it on to yourself um and it's every 20 minutes you look 20 feet away for 20 seconds and so i usually will tell people you know you can pace out 20 feet if you want but you post something on the wall or on the floor that's 20 feet away that you've already measured sometimes i'll tell people to set a reminder set your alarm when you know you're going to be in a long work day or if you're gaming for a long time set an alarm every 20 minutes of course during game play no one's going to do this but for practice and practice sessions every 20 minutes look 20 feet away from the screen for 20 seconds and what that does it actually resets um your eye and it resets the ciliary muscles so that you don't have as much fatigue some other things that we can do gaming glasses do they work yes how well do they work i'm not for sure um so there's still a lot of research that needs to be done on gaming glasses i actually have a pair of glasses that i went to the optometrist for that are blue light blocking glasses and without a prescription it's just because i know it's on the computer screen so much so there are different qualities of gaming glasses so many different brands so that's one thing if you're going to be educating your um especially if you have a younger a younger patient i maybe will recommend i mean you can get a pair for five dollars online or you can get a really nice pair four hundred dollars but do they work to help block some of the blue light yes how much i'm not sure um the other thing you can do is you hold the object further away so instead of being so close on your phone or having your computer so close make sure your objects are further away myopia is a huge problem that we're seeing worldwide the world health organization actually has a full um program dedicated to myopia we are seeing a huge increase in that in singapore they have kids that it was interesting some of their statistics that the kids under the age of one and how many hours a day that they have screen time um and so myopia is really a big deal internationally some of the muscle skeletal things that we see again it is not carpal tunnel that jumps out and so let that be a takeaway also um it's very interesting you can imagine just your setup now and how you are and your typically throughout the workday you're on the computer you're typing you're doing your notes or if you are gaming um and you're on your pc or your controller it can bring about different musculoskeletal um issues so this upper cross syndrome that was something that was new to me it's physical therapy really uses this word um a lot in this diagnosis a lot um and we'll show a photo of that when we're talking about neck and back if you can imagine sitting in this chair for 10 to 12 hours a day and you don't really get up that much you're going to have neck pain and low back pain we see some spondylosis we see a lot of lower lumbar reticulopathy from prolonged sitting from the wrist it's very interesting um we see a lot of ecu tendonitis we've seen some tfcc so depending on the type of gameplay that you're doing if you're on a pc um usually with your left hand you're doing a lot of movement a lateral motion and so you're getting a lot of irritation overuse so what we see in gaming is really tendinopathies a lot of overuse syndromes hopefully we are starting to hit those a little bit before um they become an itis uh and just a little bit of a symptom before they actually become a true diagnosis we can see a lot of intersection syndrome when you imagine just in the mouse and seeing a lot of intersection syndrome gaming thumb is decrements tinocenovitis or texting thumb or selfie thumb um and then a lot of cmcoa and so when we are talking about professional gamers and professional esports athletes unfortunately they retire around the age of 22 to 25. that is a very short lifespan and it's usually from overuse injuries burnout fatigue you know versus we see professional athletes that really focus on their recovery or focus on their rehab or how to sustain longer game play and so right now it's really about education for your gamers that are coming into the office and really for esports teams and organizations you know that you don't see naomi osaka out on a tennis court hitting balls for 12 hours a day so why would you have to game and practice for 12 hours a day on the screen actually nyit came out with a really nice research article um that even a six minute break in between your gaming a six minute walk in between your gaming actually helps to improve your play and so we need to tell people start to um take breaks don't game as long usually after about five hours of gaming your performance starts to go down so gaming longer does not equal better play this is also something that's very specific for esports and so when we talk about keybinds or grips it's really kind of going to like performance art medicine um and when you talk about the performing arts you need to know what type of instrument your patient plays so that you know the very specific hand motions or neck motions if they're playing a violin or if they're on the guitar so it's almost similar to performance art where you really have to know what game you're and you don't have to be familiar with the game you know i have some pages coming i don't know what they're talking about i say well show me what your setup is um and so you see i didn't just misspell some just type some random words here on the screen this wasd so if you look down at your computer screen or if you look at this photo you see the hand placement usually it's the left hand um whether the person's right or left hand is usually the left hand and you will place your middle finger on the w key and so on the w a s d and that's really the keys that you use depending on what game that you're playing to like join attack move or to move your your avatar around so it's a very common key bind so you can imagine and also hitting the shift button so you're getting a lot of overuse here on this ulnar side doing motions like this if you're on the controller like you see on the left side if you have a traditional grip like it is up top versus on the bottom can you see how his finger is kind of this claw grip on the controller just imagine how much the eip is working if you're moving it all around so it's really about knowing um the key binds not so common are on the right side are the ijkl buttons it's really the wasd but also the different grips that you use on the mouse is it a palm grip is it a claw grip or a fingertip grip so when you're talking about esports medicine it is imperative that you learn what your patient is doing what kind of setup they have is a controller or a pc how do they grip the mouse what's their key bind so you can have a really idea where to focus your your exam so this is upper cross syndrome so you can see the cross here where they kind of have the upper back muscles crossing over with the tight pecs and so you're in this forward posture which is terrible the neck muscles their flexors are are weaker and then you have your mid back muscles because you are so hunched over you're not really engaged in your rhomboids or your serratus interior and so from this terrible posture you can start to get this upper cross syndrome this is treated um very well with physical therapy and you see on the right i am in it i'm not really a gamer um but you can see it's a really bad posture this is the approved posture so when you talk about ergonomics it's really important from your workstation at home to people's gaming stations that you make sure that you have a neutral spine your feet are flat on the floor although not in this picture um your elbows are to your side and so in my gaming chair i've set this up to where i have a very good posture here and this chair goes all the way back it comes forward so you get a quality gaming chair that really can make the difference and so if you have a patient who is an avid gamer or they are really um grinding to make it to a professional level then you want to make sure that they have quality um seating it they can be very expensive and so if it's a casual gamer just making sure they have a nice chair just like a regular chair that has some support dr mario says this is good um these are very very simple things to do to talk to your patients and so this is just like any other injury that may come into your office any other symptom upper extremity you really need to know your upper extremity anatomy anatomy really well when you're talking about esports and gaming yes low back lower extremity we do that a lot but when you really are getting into the fine details of the upper extremity you can give your patients an exercise prescription um sometimes they need to go to hand therapy but these are some very simple things that you can do uh to give them their and their patient instructions their post-visit instructions to say hey before you start the game make sure you do a warm-up you wouldn't let any of your athletic teams get on the field or get on the court without warming up you just don't do that you know that increases injury so when you're gaming you need to have a proper warm-up and a proper cooldown and so these are very basic that you can tell anyone they don't need to work with the therapist to know this this is a one of our athletic trainers here with the washington wizards who does a lot of who does a lot of the esports talks with me and so that's carlos in the pitcher and doing some very gentle neck stretching this kind of middle and right pitcher that's kind of the turtle when you stick your neck out really far oh it feels good go ahead and get that stretch here in the anterior neck and then pulling your neck back to give it that double chin so that's really engaging the posterior and anterior muscles so this is a beautiful neck stretch this always feels so good you should be doing this too maybe in the middle of clinic or while you're listening to these long lectures um just again reminding yourself that you need to be stretching we are everyone is now sitting much more wrist and forearm stretching um this is key and so even just now you haven't gained well maybe you have game today i haven't game today um but i've been on my computer a lot so even enjoying this you feel that really good stretch these are very simple things that you know how to do you know how to show your patient you can give them a thera-band if you want um while they're in clinic to say take home and start to do some of these very simple stretching exercises finger stretching it looks weird but you certainly want to make sure that you're getting a really good stretch on all of your muscles here and all of your fingers because this is what's doing most of the work when we talk about ergonomics and and really a good setup for gamers you know there's a lot of elbow issues that come um a lot of lateral epicondylosis just from mousing so much and it's usually all right-sided i said even people are left-handed when they game they usually are mousing with their right and doing the wsd keys with the left and so we'll see a lot of either hypertrophy of the forearm muscles some lateral epicondylosis certainly some olecranon bursitis just from sitting and rubbing their elbow either in a gaming chair on their desk just an improper setup i mean so those are some of the key sites to make sure that people are aware of very simple get a rubber band we tell people to do this all the time for various things all this information you already know you're just switching your brain over to say i'm now talking to a gamer about doing this um and so doing some simple stretches with the rubber band on the bottom this is a bucket of of rice to do some strengthening exercises with the wrist to do some strengthening exercises of the fingers so nothing fancy nothing sophisticated or expensive everyone can do these techniques at home to make sure that they are preparing themselves for a gaming session this is absolutely needed you know when you sit for a long period of time your hamstrings shorten you can have some low back pain and so making sure that you are stretching forward stretching out your hamstrings your quads doing this figure four stretch to really get those glutes really well such a good stretch but for people who are seated for a prolonged period of time they need to be doing the stretching before during and after we also want to encourage everyone stand up stand up take a break in between each game depending on what what type of genre or what title they're playing that game could last three minutes or it could last 30 minutes and just saying after every game just stand up sleep this is huge um and everything kind of that we're talking about today for healthy digital lifestyles for esports medicine really falls under lifestyle medicine um all these things are what we talk about when giving someone a really good lifestyle medicine prescription but sleep is huge in the esports and gaming community there's not much of it um people are usually gaming and so we'll say well that's the gamer hour so usually gamers will go to bed late late early excuse me late night very early morning and then have a later afternoon but with all of the blue light that's coming it's impacting their sleep um and so we do know that when you don't have sleep when you sleep well you have quality sleep it's not necessarily about the quantity it's about the quality of sleep that when you have great rest it decreases your stress level you can perform better it decreases your risk of heart disease and stroke and when you think about these esports athletes they are sedentary it's a sedentary activity yes their heart is racing for certain things during gameplay but it's sedentary and so there is a risk of obesity um in the gaming community what we are starting to see so that narrative of it's a young boy overweight in his parents basement eating doritos and drinking a pop that's not we're shifting that narrative which is really great so what we're starting to see with streamers and some of the esports athletes they're showing their workouts they are actually making sure that they are healthy they're eating well they're talking about healthy snacks they're getting into the gym and so even with our nba 2k team we have them actually it's on their own they they shot basketball together three days a week we had them work out with our exercise performance person three days a week so getting in this exercise we know exercise helps you sleep and it helps you perform better the blue light and this is another thing of why maybe the game the blue light classes are good for people or if you have on your computer having a screen um a protector to block the blue light or even on your phone putting on a blue light filter these things are really important um we know that it decreases melatonin now it's going to throw your sleep pattern off when you don't sleep everyone's cranky but you also can't focus as well and you're not as rested your your stress level goes up a bit um it disrupts your internal body clock and so when we talk about especially for esports if you think about this just like any other traditional professional league they they play across the world they don't just play from city to city so some of these teams fly internationally the travel schedule is very demanding not much room in there for sleep or for travel and just like the nfl did a couple years ago about really being cognizant of the travel schedule sleep schedule like recovery schedule we are telling the esports tournament organizers you really need to be cognizant of that schedule sleep is so important and we know it makes it much more difficult to to learn and then when you have decreased melatonin it increases your hunger so now we're already talking about increasing obesity for a population that is sedentary so this blue light is not good y'all so get something to block your blue light if you haven't already um and so some things that we can do is really talking about a good sleep hygiene and so and i write a prescription for this for my patients usually we probably you all too um for your concussion um patients about a good sleep hygiene because we know sleep is impacted with that and their internal clock is off but sledding is setting a schedule when you're talking to a professional gamer it's hard for them to do but you still tell them um they need to set a sleep schedule get off of any device at least an hour before it's time for you to go to sleep um so that you're not getting so much stimulation and then i love to use a diffuser i tell everyone use a diffuser so about four hours before you know you want to start to go to sleep put in some eucalyptus some lavender and it really just permeates the air and it starts to get your body relaxed and starts to promote sleep these are very simple things to do if you don't have this on your prescription for your post-concussion patients you should and also if you have any gamers that are coming in nutrition is key and this is where i think you can make a big impact indifference when you are educating these gamers what is also very interesting in this esports world at this professional level there's not a pipeline of gaming like we have with aau basketball or pop warner football so they haven't come up in a system where they talk where we talk about nutrition and the importance of exercise and sleep they are just now getting this information they may be in their late teens early 20s they're just now talking about nutrition and why you should exercise and so with this younger generation starting to gain we now have the opportunity to capture them at a younger age and start to teach them the right things to do so that when they get older hopefully they would have adopted a healthier lifestyle and healthy lifestyle behaviors and so when you're talking about eye health i also put this in my patient instructions i already have it um as a dot phrase so that they can remember their eye health vitamin ace e it's how i tell them to remember it um and giving them some and some um foods that specifically have those vitamins these are all snackable most of these are snackable so instead of reaching for that potato chip maybe you have a lentil chip or maybe you already have some pre-cut strawberries so when you talk to gamers and their whole goal is about performance they just want to perform better gain better when you start to talk about the benefits of eye health and of brain health they kind of become shocked that they didn't know that there were specific foods that they could be eating to intentionally improve their vision and their brain health and so for brain health i tell them vitamin b bed and so i just usually break it down that way give them these um these options for food and talk about substituting at least one snack a day for one of these and at least then talking about a meal a day and slowly starting to introduce it that way so it's palatable to people this is very important especially for the pediatric population um and for adults too but really for the younger generation we know that kids need to be exercising at least 60 minutes of moderate to vigorous exercise a day um this pediatric inactivity triad is it is um endemic here in in the u.s and certainly across the world um i'm actually in working with um unesco on a program called fit for life and it's a 10-year program engaging youth and women really focus on the youth how to get them active um using digital strategies and healthy digital lifestyles and so we know that childhood obesity is up um kids are not going out and exercising and i tell parents all the time let your kids gain that's that's no problem as long as they're exercising put the controller down go outside and play and come back in um and so this is something we still need to be pushing and focusing we all know exercises medicine and especially in this younger population so let's go ahead and gain your life away as long as you've done your homework and you've gotten your exercise in for the day um and so these are just some simple things that we can tell them to do for adults of course 30 minutes a day it's harder to tell adults some time to go exercise than it is the kids or to get the buy-in from the parents of why the kids should be exercising but it is important not only for your health your physical health your mental health but also to improve your performance i did not create this slide which is why you see esports is is spelled uh incorrectly but i think this is a great photo of this multi-disciplinary team that we're used to working with in sports medicine and so this is very similar to the team that i was able to set up at medstar for our pre-participation physicals we had a sports medicine doctor we had orthopedic hands we had a hand surgeon an ophthalmologist a vision therapist exercise physiology uh sports performance we had our full research team there and our sports psychologist for six athletes but that's what we do for our other 15 professional basketball players why would we not do it for our six professional esports athletes and so just talking through all the things that we mentioned today um and nutritionist is on here it really is a multi-disciplinary effort right now world health organization has a brand new initiative called safe hearing and so again of most people who are gaming have the headphones on they're turned up really loud and so now we're trying to bring an ideology into the conversation and making sure that we have safe hearing now so that we can hear in the future um and so all these things come into the care of taking care of professional gamer and people are shocked to understand and to hear how much goes into it one other thing i just want to make sure to note is that gaming is accessible to everyone and i'm so proud of this slide i know it doesn't look so great i'm not the most tech person but to know that uh mount sinai new york nike actually sponsors um an adaptive esports team there are teams that um are paris and they use their uh sip straw um actually to move their their character and so when you talk to your younger patients or anyone who may not be the healthiest or the tallest or the biggest gaming is for everyone and so i always want to make sure that we know and that we are promoting adaptive esports um and accessibility because i think it's really important there's particular controllers and keyboards and mice that are adaptive and it's really impressive this is the handbook of esports medicine as dana mentioned i'm one of the co-editors i really have to give the credit to dr lindsey migliore who at the time was my resident at medstar health who is a huge gamer she's called the gamer doc and this was really her idea her baby and caitlyn mcgee who is a physical therapist here in the area um they really did a bulk of the writing the authorship but i was very honored to be one of the co-editors of handbook of esports medicine the first book of its kind and so if you are interested in esports this is not a plug for the book this is just really for learning um this is a great opportunity for you to learn more about esports medicine and just one other thing i'll share is when you have your your patients come in or they're with their parents and they're complaining about them gaming all the time you can now go to college on a scholarship for gaming and so in 2021 there was nine million dollars of scholarship money given to esports teams and over 150 universities and colleges in the us and so this is not a game no no pun really intended um this is really serious and so if you have someone who's interested um you should really promote and encourage them to keep gaming healthy gaming um because they can go to college there's so many different verticals and things that you can do within esports outside of just being a gamer but now you can go to college so that is a very quick overview of esports medicine um thanks dr tanji and uh i'm open to any questions i know dana we we may take some questions from the chat or you have some already yes thanks so much dr moore that was great um i'm sure we all including me learned a lot about the whole world of esports medicine all the different aspects of health that are involved and thanks for also touching on the importance of inclusion in sports including esports for everyone i'm putting a link in the chat right now that's for feedback if you could fill that out uh dr moore i do have a few questions the first one is how did you get involved with nba 2k and for anyone who's interested in getting involved with esports how do you recommend getting started i was voluntold i was volunteered by my hospital and you know um you know when talking with um dr brandie wade at uc davis when i would told her how to take care of this video gaming team it's really talking about i could have potentially blocked my blessing there to say oh i don't want to do this i just said yes i was volunteered to do it and i think and i asked why me um and i think because of of my background with um you know pm and r and sports and brain injury and really lifestyle medicine how can you get involved so that's very interesting at the professional level um in 2019 i was the only team position for a professional esports team in the u.s currently we have dr lindsey mcleod who's a director of player performance for evil geniuses which is a professional team for the other professional teams they really have a sports psychologist or a director of player performance they have not quite gotten there yet to understand that you need a team position you need an athletic trainer you need all these people it's interesting because most of the owners of these professional esports teams are owners of traditional professional teams you put the value and you invest in the product the product are the athletes um so at a professional level it's still really hard to get some experience i would say start to get in some research because that is really an area that is starting to grow there's an international journal of esports medicine um there are a couple other journals that are out there nyit uc irvine they are really pumping out a lot of the research in the u.s um from that perspective it's hard to break in right now and so it's kind of if you if you know a gamer someone that's streaming then maybe you can start to get on their stream and talk about healthy gaming or talk about hey you should do this um because the professional bubble hasn't burst just yet and we have a related question from cong kong he said it can you talk more about coverage of esports including training room sideline compensation yeah so um for me for with my hospital um there wasn't really any compensation because it was just kind of we take care of all these professional teams but um outside of this me with an nba 2k league i i don't know what the compensation is because like i said right now it's either um exercise like physiology like performance based people uh or sports psychologists that are really on the medical team and it's really just a person of one and a lot of times um but what is the sideline coverage like so i had no idea like i told you what nba 2k was so i flew across the country from dc to las vegas to a tournament and because i said well if i'm taking care of these players i need to know what the hell do they do and so i actually went to a live esports event um and then of course in the pandemic cam we actually just had one on behalf of global esports federation in singapore and it's just live um and i found myself yelling at the screams like pick up the ball pick up the dribble like and and so i think if you are wanting to get into esports a great way to do that is with sports titles so whether that's fifa um nba 2k madden so at least you know the sport and now you're kind of going into the electronic version of that versus picking up and talking about league of legends or dota 2. uh so if you want to kind of slowly kind of dip your toe in i think it's easier to start with some of the sport specific um games but we have a we have a long way to go it starts by having talks like this um that we can hopefully then be on the main stage talking about esports medicine that would be great and we have a also related question from edwin he says as far as the pre-participation physicals go for esports what would you recommend adding slash changing on the current high school forms anything physically that we should look out for or keep an eye out for yeah i think this is when you really focus in on your upper extremity physical exam i think that's key um if you have the opportunity to have a vision therapist there with you to really do some very quick high-level um testing that would be great um because you don't need necessarily the orthopedic hand surge i mean we were just being extra but i said let me just bring everyone to the table that i think would really fit this team but from like a high school um pre-participation physical i would focus on upper extremity your upper extremity exam i think vision we absolutely need to be checking um in a mental health screen another question from edwin any data on issues with virtual reality gaming so i'm not um too sure about any issues so far we that's still kind of in its infancy people might kill me for saying that in that world but what we are starting to see um and what we saw in the in the olympics um this past year was active esports what we're calling virtual esports and so it was just a demonstration um actually in august at the commonwealth um games which is the third largest sporting event in the world behind the olympics and world cup the commonwealth games 74 countries and territories that is in um the uk in august and actually the global esports federation was putting on a commonwealth esports championship so we're going to start to see that more but i like the vr ar world because now we're talking about active esports or virtual esports so now we get exercise and activity and gaming all in one so it's kind of doing a full circle talking about more of a healthy digital lifestyle another question from hong kong any advice for college students on their school's e-sport team looking for national accreditation things like listing under the school athletic department with the associated funding etc yeah so collegiate esports is is is interesting it's not a sanctioned sport by the ncaa which means that title ix is not in existence and so 90 plus percent of the scholarships have gone to um men and not women and so uh i think some schools are trying to fight to get it sanctioned as a sport either they have their own esports team or clubs so there is something called nace national athletic collegiate esports um which is really uh the really big body for most of the colleges that offer scholarships that also may be a great place for anyone who wants to volunteer um to tap into and email them i i spoke at their conference in 2019 so kind of all this stuff pre-pandemic um when people were meeting in person now we are back to meeting but i think that might be a great place to start with the you know volunteer like we do every for everything else in sports medicine we're always doing volunteer coverage and so this is a way for you to kind of get in maybe with your collegiate team there's a huge um high school league called play versus or play vs which um has a lot of high school teams that are around so just like friday night football you can be covering your esports team do they really need you there who knows but it's really about having a presence and starting to show that we are there um and starting to do some education and awareness and so that would be a great place to start actually that was a lot of resources we might need a list later sure we got a couple more questions that came in one is from adrian how do you recommend starting a wellness program for our local university esports team or maybe even our local high school team i've read this population might be initially resistant to care how would you recommend overcoming this um it's about fun and so you can't you can't take the fun out of games in esports i think that's the biggest thing to take away when you're talking about healthy digital lifestyles you still have to talk about the fun in it you have to let them know you're not coming to shut them down not coming to have them eat um cucumbers and carrots but it's really about education like i said before this is there's no pipeline for for gaming so they haven't had that training that younger kids have had in different sports um i think it's so a lot of for the college level if it's a club team or even for their esports team um it's usually a professor from the school and so some of the schools you know they have their own sites up if it's really a team versus a club sport um so i would recommend getting a contact or finding the contact information for the coach and just talking about can i come in and give a talk or can i do a zoom talk to your players about what they can be doing to level up to make their game play better and that's really how i brought it to our athletes and luckily out of our six players three had played in high school or college like traditional sports so they kind of got it but it's just really about how i can make you perform better because that's really at the end of the day what it's about and then you can kind of brace it that way and related to playing better we have a question from jair it like in most competitive sports there's always those looking for that competitive edge can you speak on some of the pharmacologic agents legal and illegal that might be used in the esports world any discussion or need for possible drug screening obviously difficult to do without any governing body yeah and that's it there is no governing body for esports um and the esports community doesn't want one and so that's the what i have found and i am learning is that the esports community they are very true they are genuine they are authentic and they don't want you bringing in anything that's not authentic to them or to the space and so there isn't a governing body this has been a huge topic of debate globally um about drug screening what i can tell you is that a large percent of the gamers become positive for stimulants so ritalin is huge i mean the stimulants are really big in the um professional esports realm it is a quiet topic that's not spoken about it's a drug of abuse so stimulants are certainly a drug of abuse caffeine is a drug of abuse um energy drinks are one of the biggest sponsors and promoters so i never promote um the energy drinks if you want to do caffeine let's get quality coffee let's do green tea let's find some other natural way some dark chocolate throw those things in to make sure you can still get your caffeine boost um but i never really promote the energy drinks and that's something i don't think we should be promoting either um it's just not safe for for this population for anyone but certainly there is a underground um well-known fact that stimulants are drugs of abuse and i'm gonna combine my question with the last question that i see here from hamilton um so his is do you see any significant differences in pathology with different gaming genres like first person shooters versus racing versus fighting games and then mine was do you have you seen i guess more injuries with certain uh consoles versus others the research is lacking so i don't have an answer that but these are great research projects and i certainly because we see a lot of overuse that's really what we are seeing from a musculoskeletal standpoint and so that's now we're talking about doing an ultrasound um and let's do a you know pre-season ultrasound and postseason ultrasound and use a target and we did some research about quality of life studies um with our team so this is where the research can happen this is where you should be trying to jump on it and talk to some of your attendings and say hey can we do this project most of us we're all getting ultrasound training um we know how to look at tendons um nerves really well so we're talking about ulnar neuritis carpal tunnel um those kind of things and so i don't the research doesn't show just yet because there's not much that has been that has been done on that um with regards to is there a certain genre that's showing more to nanopathy or some of the path activities than the other all right so hamilton that's your next research project hamilton [Laughter] yeah we've gone through uh all our questions there's a lot of interest uh i certainly learned a lot in this so thank you so much um we have yes more fantastic talk thank you so much thank you awesome thank you all for having me thank you dr tanji my mentor i love you i'm i am because of you so thank you and dana thank you for inviting me thank you all right everyone have a good night bye