Repetitive Wrist Strain Injury in Gaming

Author: pivotalphysio

Hello, my name is Etienne Fafard and I am in my last year of my Masters of Science in Physical Therapy at the University of Alberta. Currently, I am on placement at Pivotal’s Northgate clinic with Sunny Deol and Meghan Guydash as my instructors. Typically, this profession will attract those who enjoy sports (take a quick gander at the other blog posts if you already haven’t!), and I am no exception to this! However, in this blog I will be writing on something else I enjoy; video gaming. And more specifically on the most common injury seen in competitive gaming, and a quick guide on how to prevent it.

A little context

The world of esports has developed and grown into a $1.5 billion industry, with over 200 million viewers. Just one of the more popular games, “League of Legends”, drew an audience of 60 million for its World Championships last year, with a total of $4.5 million on the line for the players. To put that in perspective, last year the Stanley Cup Finals had 7 million viewers, and the NBA Finals was watched by an average of 31 million viewers. Almost all of the world’s top gamers now play on sponsored teams, and as the industry and competition have increased, so have the support staff. This includes coaches, data analysts, managers, personal chefs, and yup, you guessed it, physical therapists.

The number one most common injury with gamers

While many outside the world of those who follow competitive gaming would scoff at the idea of a gamer getting injured, it can, and has happened. The #1 most common injury seen in both professional and casual gamers is a repetitive wrist strain injury.

Clacking keys; mashing button; quick clicks; precise sweeping gestures with a mouse; and running joysticks in precise patterns. The mechanical motions of playing video games are inherently quick and repetitive, and both aspects are common in developing wrist tenosynovitis. This is because our muscles have a limited amount of endurance and they become fatigued over time. Without proper rest, the tendons begin to develop tiny tears, then these tears become inflamed. The longer we play, the less chance we give our bodies a natural response to heal, thus resulting in more tears and inflammation. Symptoms of this wrist injury generally include:

  • Pain with grasping/gripping/clenching/wringing or other wrist movements
  • Swelling, warmth, and redness
  • Soreness, aching, or tenderness in the hand/wrist/forearm

How do we prevent it?

  1. Ergonomics
  2. Appropriate Sitting Posture
  3. Rest
  4. Stretching
  5. Strengthing Exercises

Making sure that your gaming setup is rigged to have optimized posture is the first line of defence for preventing injury. Ergonomics simply refers to having our bodies exposed to the least amount of stress and allowing our muscles to work more efficiently (aka: expending the least amount of energy needed). Here I will first discuss specific things that can be done to prevent wrist injuries, and then give a few general tips on overall posture.

Ergonomics: Arm-Rests

Have your arm-rests set so that your elbows are comfortably supported, which allows for the shoulders to be relaxed. We want our forearms to be parallel with the floor to ensure that there is not an excessive amount of pressure on any one part of the forearm. This typically means that your elbows will be bent from 90-100degrees. This can:

  • reduce the amount of strain on the shoulders
  • help alleviate pressure on the forearms
  • set you up to having neutral wrists

If the armrests are too low, your shoulders and wrists get no support at all; if they are set too high, your shoulders become shrugged up and will not only create a risk of shoulder, wrist, or hand strain, but as well as neck stiffness.

Ergonomics: Mouse

Have the wrist as close to neutral as possible and limit the amount of extension (hand bending up). Placing a rolled-up towel underneath your wrist, or having a mouse pad with some kind of gel/foam support can aid in attaining a neutral wrist. In addition, finding the size of mouse that is the right fit will give a comfortable and ergonomically grip.

Here are the different kinds of mouse grips, listed in lowest to highest risk of injury based off of how much physical stress they create on our hand/forearm muscles; 1. Palm; 2. Fingertip; 3. Claw.

Bottom line: find and try to maintain that neutral alignment for your wrist, and use a palm grip.

Ergonomics: Keyboard

In the same fashion, we want our keyboard to give us a neutral wrist when gaming. With a traditional keyboard, our wrists are forced into a slight amount of ulnar deviation (hands pointed outward), our shoulders will be internally rotated, and typically we will have a focused amount of pressure on one point of the forearm. Ergonomic keyboards exist! They have wrist rests and more importantly the ability to lift or flatten the angle of the keyboard. Adjustability is great, as it allows the equipment to fit your body and help attain good posture. These keyboards are also created in a way where the keys aren’t laid out straight, but are converging in from both sides. This reduces both ulnar deviation and internal rotation.

Sitting Posture

  • Draw your chin slightly back like you are making a double chin
  • Bring your chest slightly forward and draw your shoulders back
  • Slightly arch your lower back, and scoot your butt all the way back into your seat
  • Avoid having your knees higher than your hips
  • Avoid crossing your legs
  • Keep your feet flat on the ground
  • Most importantly: change your posture often, staying in one position (even an optimal position) is perhaps the worst thing you can do and can create back pain later on


Take breaks! We need time to let our tendons/muscles recover. I would suggest setting a timer on your phone for every 45 minutes to an hour and taking a 5 to 10-minute break from gaming. If you happen to start to feel sore for more than a few days, rest completely. Take a break entirely from gaming for 1-3 days.


Stretch before you start playing, stretch during your short breaks, and stretch after you’re done playing. Stretching helps improve circulation, maintain proper range of motion, and provides relief to overused muscles. Here are some basic stretches that you can do.

Each stretch should be 3 repetitions, holding for 20 seconds each.

Strengthening Exercises

It may seem simple and somewhat trivial, but it is important to strengthen and condition our wrist, forearm and hand muscles. This will help offset muscle fatigue and decrease the total amount of load that our wrists take.

Each exercise should be approximately 3 sets of 15.

End Remarks

Although I’ve talked about the competitive gaming community, this blog post most definitely extends to anyone who enjoys playing video games less seriously and to those who work an office job. In any case, where you think that you may have sustained a wrist injury, it may be warranted to go seek out your physical therapist or doctor for an assessment. Physical Therapists can help you identify issues, deal with symptoms, and provide the appropriate treatment. You owe it to yourself to take care of your body; you’ll feel better and you will be able to game longer. Happy gaming everybody!

Written by Etienne Fafard MScPT
Physiotherapy Student


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DynaMed Plus [Internet]. Ipswich (MA): EBSCO Information Services. 1995 – . Record No. 114235, Medial epicondylitis; [updated 2016 Jul 15, cited place cited date here]; [about 9 screens]. Available from

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Woo E, White P, Lai C. (2015). Ergonomics Standards and Guidelines for Computer Workstation Design and the Impact on Users’ Health – A Review. Ergonomics, 59(3), 464-475.

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