Exercises for Gamer's Elbow

Do you spend hours at a time playing your favorite video game? Are you starting to notice that your arm and elbow are becoming sore? You may be experiencing discomfort from something called "Gamer's Elbow". Luckily, there are ways to treat this condition and get back to gaming in comfort! Keep reading for more information.

Otherwise known as lateral epicondylalgia; Gamer's Elbow is quite similar to "Tennis Elbow", but more specifically refers to pain that occurs from using the mouse. This injury commonly occurs in gamers due to their heavy use of the mouse and keyboard. This blog will outline the risk factors for the development of Gamer's Elbow, the basic anatomy and processes that occur and management strategies to get you back to full function.

eSports athletes are susceptible to developing mouse elbow

WHAT IS GAMER'S ELBOW?
Gamer's elbow occurs when the rate of destruction of tissue in the forearm exceeds the rate of healing. This could be due to heavy use through excessive contraction and relaxation or sustained contraction over a long period of time without adequate rest. Essentially, Gamer's elbow is due to an imbalance that occurs in the tissues that develops into a cycle of pain and further wear and tear.

Mouse elbow pain

Injuries of this nature affect the extensor tendons in the forearm. These muscles control the fingers and wrist by opening the hand and bending the wrist back. It might sound peculiar that the tendons in the back of the hand and wrist would be affected when holding the mouse involves more of a closed grip. We will explain this in more detail below.

HOW DOES IT DEVELOP?
This can primarily develop through overuse of the mouse, joysticks, and or prolonged use of the keyboard. The reason is simple but might not be obvious at first: the wrist extensor muscles are required to lift up our fingers to type or press mouse buttons. This upward lift exceeds the downward pull of gravity and therefore requires more force than pushing down. If there is a high volume of this contraction, an imbalance can occur. This imbalance concerns overuse of the wrist extensors while the wrist and finger flexors are not as active.

The imbalance is only the start of the negative cycle however. If there is a high volume of repetitive extension of the fingers without appropriate lengthening and shortening of the tissue in the forearm, collagen breakdown will occur. Collagen is the protein that acts as the glue and structural support in tendons (and bones, skin, organs etc).

Collagen breakdown in the tendon - fibres start to look less parallel in their orientation

WHAT ARE THE SYMPTOMS?

• Pain in the elbow on the outside aspect
• Pain with lifting the wrist and hand back
• Pain with forming a fist
• Loss of strength with activities such as gripping or holding the mouse

Pain site of mouse elbow

WHAT ARE THE CONTRIBUTING FACTORS?
There are a few things that should be considered in the development of Gamer's elbow:

• Lack of movement to lengthen muscles in the forearm
• Lack of stretching and resting, eg. prolonged periods of gaming
• Excessive wrist use instead of shoulder rotation
  
  

  Excessive use of the wrist can overload the muscles in the forearm

• There are several types of mouse grip that can affect the tendons and muscles differently
  
  

  The different types of mouse grip

1. Palm Grip:
PROS:

• Improved stability due to extra contact
• Reduced tendon stress

CONS:

• Can increase stress on wrist for fast, twitchy movements
• Reduced overall movement of fingers

2. Claw Grip:
PROS:

• Improved response due to fingers in primed position
• Thumb and ring/pinky finger can aid with fine mouse adjustments

CONS:

• Increased stress on finger tendons
• Fatigue onset might be quicker due to higher activation of muscles

3. Fingertip Grip:
PROS:

• Thumb and ring/pinky finger can aid with fine control
• Reduced tendon stress

CONS:

• Reduced fine mouse control - little mouse contact with palm
• More inconsistent due to having the least contact points with mouse

HOW CAN I MANAGE MY SYMPTOMS AT HOME?
Having a reliable and consistent routine of stretches, strengthening and strategies is the key to managing symptoms. Below is an outline of basic stretches and strengthening exercises that can be used:

Opening and closing the hand ensures mobility of the tendons

Wrist curls to ensure equal strength of flexors and extensors of the wrist with Dumbbell

Pictures of wrist extensionexercises with a Dumbbell

Prayer and reverse prayer wrist stretching

Here are some strategies that can be implemented to help prevent the onset of pain. These preventative strategies are best utilised in combination with the exercises above.

A wrist rest helps to reduce the angle of extension and reduce loading

It is important to note that mouse elbow does not only affect the hand that uses the mouse. Either wrist that is stuck in a prolonged position is susceptible. In fact, in some cases the hand that uses the keyboard - usually the left hand - can also succumb to pain. Utilisation of a wrist rest can help to reduce the prolonged angle of extension and reduce tension in the wrist extensor tendons.

Keeping the wrist neutral and pivoting from the elbow ensures decreased wrist strain

As mentioned earlier, excessive use of the wrist can cause overloading of the forearm musculature. By keeping the wrist in neutral and instead using the elbow and shoulder to pivot, the strain on the wrist can be reduced.

HOW CAN PHYSIOPHI HELP?

• Exercise Therapy: We can provide a battery of exercises as well as strategies to combat the symptoms of mouse elbow. There are also exercises to help with specific demands that certain games can have on the body.
• Massage Therapy: Can be very useful in the short-term and long-term phases of management. Release work on the extensors and flexors of the wrist and hand can begin the "reset" process and dramatically reduce pain in the elbow.
  
  

  Release work to reduce tension on the muscles of the forearm

• Advice and Education: Preventative strategies can be tailored to individual setups as well as playstyles. We understand that every game is different and that different genres place different demands on the body.

DISCLAIMER
At Physiophi, we have an avid enthusiasm for eSports and gaming, as well as every injury that the general population can suffer with in this ever-growing industry. Early identification of the injuries associated with gaming and subsequent management is essential to prolonging and improving your gaming experience. If your elbow pain is not improving, book in an appointment with us to regain the ability to play at maximum capacity.

PLEASE CONTACT US ON: (07) 3172 4332 TO HAVE A CHAT WITH OUR FRIENDLY STAFF OR SIMPLY BOOK ONLINE ON: WWW.PHYSIOPHI.COM.AU

REFERENCES

1. Bisset, L. M., & Vicenzino, B. (2015). Physiotherapy management of lateral epicondylalgia. J Physiother, 61(4), 174-181. https://doi.org/10.1016/j.jphys.2015.07.015
2. Karanasios, S., Tsamasiotis, G. K., Michopoulos, K., Sakellari, V., &Gioftsos, G. (2021). Clinical effectiveness of shockwave therapy in lateral elbow tendinopathy: systematic review and meta-analysis. Clin Rehabil, 2692155211006860. https://doi.org/10.1177/02692155211006860
3. Landesa-Martínez, L., &Leirós-Rodríguez, R. (2021). Physiotherapy treatment of lateral epicondylitis: A systematic review. J Back MusculoskeletRehabil. https://doi.org/10.3233/BMR-210053
4. Luk, J. K., Tsang, R. C., & Leung, H. B. (2014). Lateral epicondylalgia: midlife crisis of a tendon. Hong Kong Med J, 20(2), 145-151. https://doi.org/10.12809/hkmj134110
5. Yoon, S. Y., Kim, Y. W., Shin, I. S., Kang, S., Moon, H. I., & Lee, S. C. (2021). The Beneficial Effects of Eccentric Exercise in the Management of Lateral Elbow Tendinopathy: A Systematic Review and Meta-Analysis. J Clin Med, 10(17). https://doi.org/10.3390/jcm10173968