This guide is not a replacement for a physician, if you are experiencing any pain or injury please seek professional medical help.

Table of contents

1. Introduction
2. Why should you strech while gaming?
3. Mobility routine
4. Stretching routine
5. Upper Cross Syndrome
6. Posture correction routine
7. Good posture tips
8. Treat the cause, not just thet symptoms

1. Introduction

My name is Charlie, and I'm a gamer and software developer. I'm by no means a professional Physiotherapist but I have researched this topic and feel confident of merging my notes into one hopefully useful guide.

2. Why should you strech while gaming?

The human hand is designed for precise manipulation of objects, which means there is a fine degree of neuromuscular control. Fine motor control requires a complex interaction of numerous muscles and other soft tissues throughout the entire upper extremety. Despite the mechanical demands on the region, those soft tissues are not designed to handle large or repetitive force loads, such as those that happen while gaming (moving your mouse or typing). As a result, soft-tissue orthopedic disorders often result from repetitive overuse injuries.

RSI (Repetitive Strain Injuries) potentially damages your muscles, tendons, nerves and joints through repeated micro-trauma. The small size of those tissues in the wrist and hand also make them vulnerable to high or repetitive force loads.

Soft tissues in the hand are not designed to handle repetitive force loads -
Stretching and mobility exercises can help avoid issues in the area and encourage recovery.

3. Mobility routine

Mobility exercises help increase the production of synovial fluid, reducing friction between the articular cartilage of synovial joints during movement and reducing chances of injury and pain. They also increase blood pressure and body temperature, preparing the body for physical activity. For these reasons I recommend doing them before playing, for 30 to 60 seconds each. This should take you 5 minutes approximately.

1. Hand rotations. Start by interlacing the fingers. Begin rotating your hands around each other, starting slowly before increasing speed. It’s key to keep the movement as fluid as possible, keeping your fingers firmly connected and palms in contact with each other. Then, repeat the exercise rotating your hands to the opposite direction.

2. Hand waves. Start by interlacing the fingers, with your palms facing the ground and elbows out to the side. Begin the movement by flexing one of the wrists and letting it flow through the opposite wrist, all the way down to the elbows, making a “wave” motion. Remember to keep the movement as fluid as possible, keeping your fingers firmly connected.

3. Prayer stretch. Start by placing your hands together, around face level with your fingers straight pointing upwards. Keep your hands in contact with each other as you lower them with your elbows out to the side. Once you reach the end of your range, push your hands back up to face level and pull your elbows together. Repeat the exercise trying to increase your range of motion slightly with each repetition.

4. Inverted prayer stretch. Start with the back of your hands in contact with each other and your fingers pointing downwards. Pull your arms upwards flaring your elbows out. Once your wrists reach elbow height, push your elbows inwards in order to apply pressure between your hands. As with the prayer stretch, try to increase your range of motion slightly with each repetition.

5. Hang loose stretches. This stretch is named after the Hawaiian hang loose hand sign. Start by extending your thumb and pinky fingers, while bending the other middle three. Just simply begin to rotate your wrist back and forth, keeping that rotation going for the duration of the exercise.

4. Stretching routine

Stretching has many benefits, so let's mention some of them briefly:

1. Increases muscle flexibility.
2. Reduces the probability of injuries.
3. Improves recovery time.
4. Improves coordination of agonist-antagonist muscles.
5. Prevents muscle tightening after exercise.
6. Decreases the amount of lactic acid in muscles.

Since studies have shown that static stretching before phyisical activity, specially before warming up, may be detrimental (like this 2012 study), I'm going to advise you to practice the following routine only after playing. You're going to hold each stretch for 20 to 30 seconds. As with the mobility routine, this should take you 5 minutes approximately.

1. Wrist extension. Start by extending your arm in front of you at around shoulder level, with your palm facing up . Extend your hand back towards you, until you feel a slight stretch in the palm and forearm region.

2. Wrist flexion. Just as before, start by extending your arm in front of you at around shoulder level, with your palm facing down this time. Flex the hand towards you. You should feel a slight stretch on the opposite side of the forearm.

3. Fist stretch. Repeat the same process as with the last stretch, but this time with your fingers curled into a fist. This exercise will stretch the muscles in the back of your hand.

4. Wrist supination. Start by putting your arm in front of you, locking your elbow into your body so your arm does not move. Turn the palm up, rotating it outwards with the assistance of the opposite hand.

5. Wrist pronation. Repeat the same process as before, but this time rotating the back side of your hand inwards with the assistance of the opposite hand.

6. Thumb extensor. Start by curling your fingers around your thumb into a fist. Continue with a downward movement of the hand. You can gently assist the movement with the other hand. You should feel a stretch in the thumb/wrist region.

5. Upper Cross Syndrome

This section includes a discussion of the Upper Cross Syndrome, one of the most common postural distortions in the cervical/thoracic region, specially in PC users. It is not considered an injury condition, as are the prior conditions mentioned. However, it can produce considerable stress on other tissues or structures and contribute to their dysfunction.

Because humans stand upright in a vertical gravity plane and the head is a heavy weight, we are susceptible to the distortion of a forward head posture. Chronic dysfunctional posture is the likely cause. This condition usually involves muscular distortion in the thoracic and cervical regions. When the head is positioned forward of the line of gravity, a tensile load is placed on the posterior cervical extensor muscles. These muscles keep the eyes looking straight ahead and prevent the head from falling forward. Even a slight degree of forward head posture increases stress on the posterior neck muscles.

In addition, there is an increased compressive load on the posterior vertebral arch structures. For every inch the head moves forward from its normal posture, the compressive load on the lower neck is approximately equal to that number times the weight of the head (e.g. 2 inches forward head posture equals two times the weight of the head).

Reasons your head and also your shoulders tilt forward are:

1. Due to weakened muscles, supposed to keep your head and shoulders in their neutral positions.
2. Due to overactive and tight muscles that are causing your head and shoulders to protrude forward.

Upper cross syndrome involves muscular distortion in the thoracic and cervical regions -
Some muscles are weak, while others are overactive and tight.

6. Posture correction routine

What we need to do to fix this is stretch the muscles that are tight, and strengthen the muscles that are weak, which has actually been shown in clinical studies (like this 2005 study) to be a very effective method in correcting the upper cross syndrome if properly implemented.

Tight muscles that we'll be stretching:

• Sternocleidomastoid (big muscle to the side of the neck)
• Anterior scalenes, levator scapulae and upper trapezius (side of the neck and upper back)
• Suboccipitals (four small paired muscles below the occipital bone, the back of your head)
• Pectoralis major/minor (your chest muscles)

Weakened muscles that we'll be strengthening::

• Deep cervical neck flexors (muscles that tuck your chin)
• Lower trapezius, rhomboids and serratus anterior (some of your back muscles)
todo: finish diagrams and writeup

7. Good posture tips

Here I am going to give you some easy to follow tips for each region of the body, so you can maintain proper posture while playing. To avoid muscle aches and fatigue, you should do the following:

• Neck: always keep your eyes straight ahead, avoiding twisting your neck as a neutral position. Your line of sight should match the top of the screen.
• Shoulders: always keep them relaxed. Avoid shrugging them.
• Arms: try not to keep your arms hanging in the air. This will add unnecesary tension to certain muscles and joints. Leave forearms supported and elbows locked against your body, mantaining an angle between 90 and 100 degrees.
• Wrists: they have to be relaxed and aligned with your forearms, avoiding deviations while in neutral position.
• Back: must mantain its natural curvature, keeping it against the back of your seat. Use a chair that provides support for the lower back.
• Hips: keep an angle between 90 to 100 degrees, with thighs parallel to the floor. Knees at 90 degrees.
• Feet: keep them on the floor. Remove items under your desk so your legs can be placed and moved comfortably. Using a footrest may be a good idea as well.

8. Treat the cause, not just the symptoms

Remember that, although treating symptoms may be necessary, we must determine what their causes are and treat them as well. It is important to know what is causing whatever problem we have, be it playing too much, death gripping our mouse, bad posture, etc. Many times we overcome a certain pain or injury through stretching, warming up, resting, but if we don't define what the causes were and we make the same mistakes again, problems will usually come back. So that's my final advice: remember to treat the cause, not just the symptoms.

You can always hit me up on Discord (haze#0666) or Twitter (@CharlieMaddex) if you have any questions!