Chinese esports player Jian "Uzi" Zi-hao was more than a star "League of Legends" competitor. His team built its entire strategy around his abilities, funneling resources to him and teammate Shi "Ming" Sen-Ming so the duo could carry the squad to victory. Over his career, he earned more than $500,000 in tournament prize money, according to esports earnings data.

Yet in 2020, Jian announced his retirement, his storied career cut short by chronic wrist and arm injuries. He was 25 years old—still several years younger than the typical retirement age in most traditional professional sports, a gap that reflects how demanding top-level competitive gaming is on relatively young bodies.

Video games have a reputation for keeping people glued to the couch. But for those who compete against the best players in the world, gaming can be surprisingly physically and mentally taxing.

The strain of 'climbing the ladder'

The best esports players often have grinding schedules. They are expected to practice regularly, participate in scrimmages, and compete in official matches. Even at the recreational level, players cite the mental toll of playing for hours a day, every day, to hone their skills and "climb the ladder." Many top professionals spend even longer hours in team practice facilities than recreational players do grinding ranked matches alone.

A 2021 study of Portuguese esports players found that 37% experienced anxiety and depression, and 45% experienced sleep disturbances. The most common physical injuries in esports generally fall into two categories: eye problems and musculoskeletal issues.

Prolonged screen time leads to a range of vision problems in gamers, from common eye fatigue to a decreased ability to focus. Screen light also appears to contribute to sleep disturbances by disrupting the release of melatonin, the hormone that helps regulate the sleep-wake cycle.

Many esports players—professional or otherwise—also battle hand and wrist pain. Repetitive button-pressing causes injuries such as carpal tunnel syndrome, tendonitis, and "gamer's thumb," which arises from overuse or irritation of the tendons around the thumb and wrist. Many of these overuse injuries are also familiar to assembly-line workers, whose jobs involve similarly repetitive movements—an overlap that has allowed occupational health research to inform esports care.

Back injuries are another concern. Players can remain seated for three or more hours without a break, and prolonged sitting takes a toll on the lower back and spine.

The sedentary nature of esports has also been linked to a lesser-known—sometimes fatal—condition called deep vein thrombosis: a blood clot, often in the leg, that can become life-threatening if it travels to the lungs. In 2011, British gamer Chris Staniforth—who would play for as long as 12 hours at a time—died of the condition.

Preventative measures

As more esports injury research has been published, more treatment and prevention strategies have emerged.

Top esports teams now employ physical therapists, performance psychologists, athletic trainers, and even massage therapists to optimize player performance and recovery—an investment that makes financial sense for organizations whose results depend on keeping star players healthy and competing.

Teams often incorporate group exercise activities to build rapport among players and reduce injury risk. During competition, proper positioning of the spine and limbs has become an essential prevention strategy. Choosing a chair that encourages an upright posture can reduce pain and injury risk, especially when combined with an exercise program focused on functional strength, mobility, and stretching of the upper limbs.

Looking to the stage

When esports began gaining mainstream popularity in the 1990s and early 2000s, its proponents were eager to draw comparisons to traditional athletic competition. The parallels helped establish esports' legitimacy and gave non-gamers a familiar framework for understanding the competition.

As esports became a big business and a lucrative career path, players and teams hired a web of support staff—trainers, coaches, and therapists—that mirrored the structure of professional sports. In this vein, much esports injury research has drawn from the training methods of traditional sports.

However, as a scholar of exercise science, I believe injury treatment and prevention strategies could be further improved by seeing esports competitors as more like musicians and dancers than football or basketball players.

Performance optimization and injury research on professional performing artists has existed for centuries and represents a valuable, untapped resource. The physical and mental stresses of musical performance have much in common with esports competition: long stretches of sitting; small, dexterous hand movements; and performing without real-time input from a coach.

For example, biomechanics research has found similar patterns of forearm muscle fatigue among esports players and piano players. However, no studies to date have directly compared the two groups.

What if research interest in joint hypermobility or hand size among performing artists were translated to esports populations? Could popular piano warm-up exercises be effective for esports athletes who use keyboards?

Even research on sports like car racing might offer valuable insights. As with gamers, many people overlook how physically demanding car racing can be—including sitting for extended periods.

Prevention and rehabilitation techniques continue to improve. Even Jian, who retired in 2020, returned to play) for a few splits, or partial seasons, in 2022 and 2023.

In July 2023, "League of Legends" star Lee "Faker" Sang-hyeok was relegated to the bench due to cubital tunnel syndrome, an injury that emerges from arm and hand overuse.

Through a treatment plan that included changing his gaming posture and intensive physical therapy, Lee returned to play just a month later. He went on to win three consecutive world championships, with his support team helping prevent injury recurrence throughout each season.

Thanks to his rehabilitation, Lee's fans will be able to follow his hunt for a fourth "League of Legends" World Championship, which kicks off in October 2026 in the United States.

Sienna Cinti assisted with the research and writing of this article.

Erica D. Henn, Assistant Professor of Kinesiology and Exercise Science, Temple University

This article is republished from The Conversation under a Creative Commons license. This story was originally featured on Fortune.com.