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This article first appeared in the 91�㽶��Ƶ Magazine’s 2020 winter edition and represents practice prior to the COVID-19 pandemic.

There is a type of athlete who doesn’t dribble, kick or catch a ball but rather succeeds through hand-eye coordination and wields a controller or computer keyboard. They’re esports athletes, and their focus is expert-level competitive video gaming. And while esports athletes have been around for a while, research on providing medical care to these athletes is still evolving.

West Virginia School of Osteopathic Medicine (91�㽶��Ƶ) alumnus Dominic King, D.O., is conducting research on these athletes through the Cleveland Clinic, where he completed a residency and fellowship and has been a sports medicine physician for more than five years. He now serves as the director of the Esports Medicine Program and the manager of Orthopaedic Informatics.

“We started to witness the swell of popularity of esports internationally and a substantially large population of competitive video gamers in the U.S.,” the 91�㽶��Ƶ Class of 2011 graduate said. “We started tossing around the concept that these people aren’t your typical athletes, but they are skilled and that skill can cause injury. Most people probably think of a kid sitting on a couch playing a video game, but what we do at the Cleveland Clinic is focus on esports athletes’ health, wellness and performance and how we can help them compete at an elite level in a safe way.”

The term esports, or electronic sports, refers to competitive video games played either one-on-one or in teams. Many of the health issues commonly found among esports athletes are overuse injuries such as neck strain, eye strain, upper-shoulder strain, and tendonitis of the wrists or elbows. While many sports medicine physicians can treat these common diagnoses, King is interested in health education for the athletes.

“These are relatively younger athletes who don’t have cardiovascular diseases, but we can still intervene and educate this group on health outcomes. We want to take a closer look at their fitness and nutrition. If we approach these competitors as athletes, then nutrition, strength and conditioning are what is going to keep them healthy. Competitive video gamers are going to have to train like professional athletes,” he said.

King and his team studied esports athletes at the University of Akron. They wanted to identify the psychomotor and neurocognitive skills metrics on which esports athletes rely compared to athletes in other sports. The team used proprietary software to compare similar age and gender matches, ultimately finding that esports athletes outperformed traditional athletes in psychomotor and neurocognitive performance. The athletes studied spent an average of two and a half to five hours a day training five to seven days a week.

The research findings have opened up dialogue about how esports athletes can be healthier and improve their skills.

Jamie Nickell is a collegiate esports athlete at Concord University in Athens, W.Va. The graphic design major has been involved with the program since its inception more than two years ago. Concord University was the first higher education institution in West Virginia to have an esports program.

Nickell, who has been involved with esports since 2013, said he is aware of overuse injuries among athletes and has incorporated ways to combat them into his weekly practice.

“We have ‘hard’ practice days where we sit and play against other teams for a few hours without breaks, but then the next day will be a type of cool-off day where we relax and go over film from the previous day,” said Nickell, who is captain of the Call of Duty varsity roster. “I realized this was much easier on myself and the rest of the team so we weren’t straining our brains and bodies each day to the max, but we can still grow as a team and get better.”

He said his team practices between 10 and 20 hours a week, depending on competition scheduling.

Nickell’s parents, Dawn and Jason Thomas, work at 91�㽶��Ƶ. Dawn is the school’s student recruitment events coordinator, and she said that working at a medical school has made her aware that her son could face health risks.

“Most people don’t think that sitting and playing video games would lead to any real injuries. Jamie always played video games, even as a young child. I’ve read that playing video games causes aggression, depression and violence, so I was always aware of his behavior,” she said. “As a parent, I’m glad that there is research and more available information to better educate esports athletes. A lot of people tend to think that you’re unhealthy if you’re sitting around playing video games all day, and you could be if you’re not educated on lifestyle habits. I am glad that Dr. King is bringing awareness to athletes and their parents about possible injuries.”

King said that graduating from an osteopathic medical school allows him to share manipulative techniques to combat overuse in athletes.

“Osteopathic physicians meeting with esports athletes is like peanut butter and jelly,” he said. “Our training allows us to evaluate ergonomics, critically examine the athlete during play and create a whole-body-focused treatment plan to improve their structure, function and overall well-being.”

As an osteopathic physician, King can educate athletes on counterstrain tender points, muscle energy techniques and ligament stretches.

“I always felt confident in the skills I received from 91�㽶��Ƶ. It’s interesting to think about learning osteopathic medicine 10 years ago and working at the Cleveland Clinic in this newer field. When you couple excellent osteopathic training with the post-medical school training at the Cleveland Clinic, you have the best combination a physician could ask for,” King said.

King spoke on the topic of esports athletes at the annual Osteopathic Medical Education conference hosted by the American Osteopathic Association in October 2019 in Baltimore. He also spoke at the Joint Commission on Sports Medicine and Science’s annual meeting in Minneapolis at the end of February.

Nickell and King agree that esports athletes don’t necessarily receive the same recognition as traditional athletes, but both said that increasing numbers of people are aware these athletes are more than just young people playing in casual gaming sessions.

“We think that in some ways we may be able to improve the population health of young adults playing video games,” King said. “We want esports athletes to certainly come to us if they sprain their wrists, but we also want to help them live healthier lives.”