High Scores: “The Gamer’s Doctor” talks hand injuries, weed & respect

(Interview continued)

In terms of work and play injuries, gaming seems like the elephant in the room. Video games are so huge and so many people are playing them, and yet nobody’s talking about best practices for minimizing the negative impact on our bodies.

I posted my “Top 7 Rules for Gamers” to maintain hand and wrist health, and I got emails from all over the world about it. People were saying this is an issue that hasn’t been addressed before, and they were grateful for me actually talking about it.

You’ve talked about being amazed by competitive gamers who play for four, eight or 12 hours at a time, and how if you’re devoting that amount of time and getting paid to do it, it should be considered an e-sport.

It’s very presumptive that people treat it like this oddball thing. (Other doctors) are very dismissive, and I’ve always thought that was very judgmental and inappropriate. I’ve always looked at gamers, no matter how much a person games, as people. You have to respect patients regardless of their age or anything else, and gaming shouldn’t matter in that. And that includes if they smoke cannabis too. They’re human beings. That’s the way I run the practice.

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Some of the advice for preventing things like carpal tunnel syndrome seems like common sense. But from a practical standpoint, that’s not how many gamers act. What would the average person NOT know off the top of their heads about preventing repetitive stress injuries?

They may not know you should actually take time once every hour to just stretch your fingers. Make a fist, open your fist, and do that 20 times for one minute. Take each finger and massage it. After two hours of gaming, go to the kitchen or bathroom and run warm water over your hands and wrists. Heat increases the viscosity of any fluid, and we have fluid in our wrist and finger joints so it increases mobility and reactions per minute.

You say you’ve been treating more gaming-related injuries these days. Can you describe some of them? Are they all generally mild or do they have a range of severity?

All the severity depends on the chronicity, or how long they’ve had it. Is it a chronic or acute problem? Acute problems that I see are often associated with overuse syndrome on the hands and wrists. It’s called De Quervain syndrome (also known as gamer’s thumb — which results in pain, tenderness, swelling and decreased range of motion in the hands). The more common things I see are just overuse of the wrists, like ulnar deviation or the swelling of the metacarpophalangeal joints. That’s basically just going up and down, like when you’re clicking a mouse for hours at a computer.

How do you treat these injuries?

That’s initially just treated with a wrist splint, but overall I recommend changing gaming patterns. Secondly I give them an anti-inflammatory medication, third is acupuncture and fourth is injection of a steroid. The last possible thing, if everything else has failed, is surgery. But I’m an integrative holistic surgeon and I only operate, as much as I love to do it, as a last bastion. We rarely get there, though.

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Do you hear from other doctors about this?

One thing I can tell you is that I have often have other physicians calling me and saying, “I have a gamer here, what should I do?” And I just say, “Send them here.” It’s different when you’re in the culture and you’re seeing these people yourself.

You say you’re in the culture. Are you a gamer?

I’m not a huge gamer, but I play games with my nieces and nephews, so I do game. But what I want to remind the other physicians who call me from all over the U.S. is that they shouldn’t forget that these people aren’t simply gaming. They’re often playing other sports, like racket sports, or they may be weightlifters or doing other things that are not sedentary. A lot of times physicians make the assumption that all gamers are sedentary. That’s not true. They work — sometimes in factories, sometimes doing labor. Sometimes they have young kids they’re picking up all day. All these things matter. That’s why you have to treat the gamer like any another patient. Look at whole person, not just the gaming injury.

So why have so few doctors not addressed gamers specifically?

The (other doctors) just don’t know. Many don’t believe that gaming is that big of a deal. I definitely think part of it’s generational and part of it is institutionalized thinking that gaming is not that prevalent. But people are online and on their smartphones, and they’re doing it from all over the world.

Do you have any tips for cannabis-using gamers who might be more prone to being sedentary for long periods of time? Are there gaming-related injuries they could be more susceptible to?

There’s not a specific issue they’re more susceptible to, but there’s the possibility that if you’re smoking or eating cannabis you may have slower reaction time and also may play longer because you’re so relaxed. So instead of playing for three hours, you may play for five or six. You may also have increased numbing or pain in your hands and not be aware of it.

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That would seem to be the double-edged sword, since many people use cannabis for medical purposes.

That’s the benefit and the drawback. It could decrease the amount of inflammation and swelling and pain, but it may also cause (gamers) to not know they have these problems by masking them. It could decrease the progression of the inflammatory cascade. But I like talking about cases and research, not just anecdotal things. I’d like to see a double-blind study that addresses these issues.

Do you think motion-controlled games that don’t use physical controllers, like the Xbox Kinect or the Wii, can eliminate some of these issues since they free up your hands and body?

You’d think it would decrease the amount of pressure in your joints, your hand, your wrist, your elbow. You’re not using the console and not trying to hit all those actions per minute. You may get a cardiovascular workout, and that increases your physical endurance, so there are some pluses to that. The great thing is that you’re not stationary, so you’re not getting blood clots in your legs. You’re burning calories. Also it’s not the same amount of force and stress on your joints, fingers, wrists and elbows.

At the risk of reinforcing stereotypes, I think most stoner-gamers would be more inclined to play games that don’t require any movement beyond their hands and wrists. But I think there’s also a lot of people who haven’t come out as cannabis users yet, so it’s hard to generalize.

Cannabis users who are gamers should not be discriminated against or dismissed. We want to be inclusive on it, and what’s important to me is treating them. Keeping your ailments secret is never a good thing.

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Dr. Levi Harrison’s 7 tips for preventing gaming injuries

1. Take a five-minute break every 60 minutes to simply flex and extend your fingers. You can do this by making a full fist and then opening all your fingers widely for several repetitions (20 repetitions every 60 minutes). Setting a reminder on your phone is a great way to keep track.

2. Before gaming, immerse your hands and wrists in warm water for three to five minutes. The heat will be soothing to the joints. Also, heat reduces viscosity of the joint fluid, which may increase the flexibility of the wrist and agility of the fingers, hence your actions per minute.

3. Do gliding exercises on the wrist during a 60-second break. These exercises are designed to help stave off carpal tunnel syndrome symptoms which include hand numbness, tingling, pain, or decreased grip strength. (Video demonstration)

4. Do Nirschl exercises to help stretch out the extensor muscles of the elbow and wrist. This can help prevent “tennis elbow,” something not exclusive to tennis players and a real risk for active games. (Video demonstration)

5. Do blocking exercises when taking a break. These exercises greatly assist in the movement of the joints in your fingers and thumbs. (Video demonstration)

6. Massage your fingers, wrist and elbows regularly during the day, even when you are not gaming. This is especially important for the thumb, which is responsible for over 42 percent of all functional motion of your hand during gaming.

7. Shake out your hands, wrist and elbows during your break and throughout the day. This can be done during one of the 60-second breaks.