Hello fellow gamers – you are here because at one point in your gaming career you may have felt some low back pain preventing you from enjoying your league, CS:GO, PUBG, Destiny2 and now maybe Fortnite? Games.

Pain in general sucks but most of the time we ignore it and for the most part it can go away. But there is ALWAYS a reason why we have low back pain and it’s because of that reason that it RETURNS. Which sucks 🙁 The good thing is that I’m here Ü and I’ve been working with those in professional esports for the past two years and have been practicing as a Physical Therapist with an Orthopedic Clinical Specialist license for the past three years. Low back pain, ESPECIALLY for gamers, is easy to manage.

It is only when we ignore it for more than half a year that it becomes just a little more complicated. Today, you guys are going to learn a step-by-step approach on how to manage low back pain as a gamer but first…

TREATING THE CAUSE, NOT THE SOURCE

First I want to write about something I feel a lot of gamers do not understand mostly because I see it so much in the community. I get it though, marketing appeals to the quick fixes. Treating many of the pain conditions we suffer as gamers can indeed be quick – but it is generally more than just massaging the muscles or putting tape on our wrist/forearms/back or using a cold-pack at the end of every session. These are solutions which often address the source of the pain (for the low back it is commonly a muscle strain) -> so massage the muscle to allow it to relax.

Yes this will reduce pain, but what have we done to the actual CAUSE of the muscular strain? Nothing. Most of the time the CAUSE of low back pain is us sitting for extended periods of time, with shitty posture.

So we have to be able to step-back and look at the big picture sometimes so we can understand that things like massages, cold-pack, kinesiotape and even exercises may not completely resolve the pain issue. Because we are not addressing the root cause.

We have to improve our posture so the muscle can work optimally, take enough breaks to prevent strain AND also exercise to increase endurance of our muscles and prevent injury. We can utilize massage, ice, kinesiotape to facilitate RECOVERY from the strain of these sessions.

Okay, enough of my little soap box.

What causes low back pain? And what will you feel?

Low back pain is gaming is the second most common pain pattern in gaming and is most commonly the result of MUSCULAR STRAIN. As I mentioned earlier, the main reason for why we develop low back pain as gamer is because we are just sitting for too long (with poor posture).

This causes muscles in our lower back to be either overused or overstretched depending on how we sit (flexed vs. extended posture). Flexed is when our lower back and pelvis are rounded (picture on the right) which is how most of us sit. Extended is when our lower back and pelvis are arched (picture on the left). Some of us sit in this way to be closer to the screen.  So again, the muscles of our lower back (paraspinals/erector spinae) are the source of the pain, with prolonged sitting with poor posture being the CAUSE of the pain.

Typically we will feel aching in our lower back which will occur after a couple of hours into our gaming sessions – especially if we are playing for multiple days in a row.  You will feel it most commonly in the regions shown below

Three-Step Approach for Low Back Pain in Gaming

Alright – now for management of the low back pain. Our updated approach for management of pain in gaming is the POP approach which stands for… Prevention, Optimal Loading and Pain Management.

1. Prevention of low back pain in gaming

Prevention of low back pain in gaming means considering three things – posture, ergonomics and lifestyle design. It always comes back to these three things we have to take into consideration first.

Posture – putting our lower back in the neutral position. In between flexion and extension. I have written about this many times in a bunch of my articles, but I’ll write it again. Neutral is the position for our joints in which there is the least amount of stress on our supporting tissues. For the lower back and pelvis it means in between the flexed and extended positions. An easy way is to think of your lower back as a bucket of water and intending to keep it balanced.

Ergonomics: Optimizing ergonomics for our lower back utilizing our surroundings (chair, lumbar support and foot rest) to ensure we can sit with this optimal posture mentioned above. The quick tips we need to know are…

  1. Have a lumbar support to help maintain neutral position
  2. Keep our hips neutral and our feet supported as an elevated thigh can push us into the “flexed” position
  3. Having enough space for the chair to roll underneath the desk to prevent us from sitting in the “extended” position to get closer to the screen.

Here is quick gif by Caitlin which goes over the main points you need to know about your posture and ergonomics.

Lifestyle Design: This means making sure you know how long you are going to play as well as taking effective breaks. Know how long you are going to play (I will play for 1-2 hours before I take a break) and know what you are going to do during your break! Whether it be exercise, getting food or just walking around – it’s important for us to undo the stress of sitting for prolonged periods of time.

2. Optimal loading for Low back pain

Rest has been one of the most common ways we have approached addressing our injuries in the past and unfortunately – while it may provide temporarily relief. It again does not address the root cause of the issue and is only a temporary solution. I’m sure many of us have gone through the following cycle

Pain -> Take a 1-2 week break from gaming -> feels good for a couple days to weeks -> pain comes back

This approach of rest is OUTDATED, which is why I want to introduce you guys to the concept of optimal loading for recovery. Optimal loading means INSTEAD of resting completely as a solution for pain (or avoiding our activity completely) providing the APPROPRIATE AMOUNT OF STRESS to allow our tissues to adapt and get stronger.

Exercise FTW

For us that means playing the RIGHT amount and doing things like EXERCISE to address weakness, stiffness, etc. contributing to our low back pain.

What EXERCISES YOU ASK? Specific ones based on how you sit (flexed or extended) – because each of these positions can cause certain muscles to be stiff, weak or have poor coordination. So see below for what exercise you need to do based on how you sit!

Flexion

Extension

 Hamstring Stretch Seated Low Back Stretch 
Prone Press-Ups  Psoas Stretch
 Seated Good Mornings Feet Supported Crunch
 Quadruped Alternating Arm Reaching  Plank with Abdominal Activation
 Pelvic Tilt with Active Shoulders Hip Thrust with Bridge

How long should I play?

As I said, it is more than just exercise – it is about playing the RIGHT AMOUNT OF TIME. What is the right amount of time for us? Pay attention…

It is how long we can play before the pain begins or gets worse! Listen to your body – especially if this is the first time you have been dealing with the injury! While pain does not directly correlate to the condition of your tissues – it is a good signal to let us know when we should think about taking a break or stopping. Let’s say you have some pain in your lower back – instead of avoiding playing altogether. You can play until you feel some discomfort (1-3 out of 10 on a scale of pain) at which you should consider taking a break before you aggravate/irritate your lower back tissues more.

For example: “I can play cs:go until I feel some discomfort in my lower back after 1-2 games”

So pay attention to how long you can play before you feel pain or your discomfort gets worse. This is important not only to track to see if you are doing better but also to treat that as your endurance limit for your lower back: The amount of time you can play before the tissues in your lower back become irritated aka your back is only able to handle X hours before the tissues become irritated. Knowing your endurance limit can allow you to plan around it but get better.

As you perform your exercises you will notice your endurance limit increasing! (aka overheating meter)

Pain Management – Temporary Relief with Heat, Ice and Meds

The last and final step is to provide temporary relief to your lower back and should be treated as short-term methods to reduce your lower back pain. Using these methods only will not address the root cause: Sitting too long with poor posture. That is why this is step three J

Here are some simple rules and tips you can follow in order to use heat, ice, medication or massage to temporarily alleviate your pain.

Important Disclaimer with Over-the-Counter Medication: Always talk to your pharmacist or MD to make sure you are able to take NSAIDs without any complications.

  Ice Heat Medication Massage
What? Cold Pack Hot Pack, Hot Shower Advil, Motrin As Needed
When? < 3 weeks > 3 weeks As Needed As Needed
How? Lying down on a cold pack for 10 minutes Hot shower or lying down on a hot pack for 10 minutes (with enough   layers between your skin and the hot pack) Every 4-6 hours as needed (More details from cleveland clinic) Self-Massage with Foam Roller (See below for description)
Why? Reduces pain through reduced nerve conduction speed (reduces sensation of pain) Relieves muscle spasms, increases blood flow, facilitates healing Pain Management only – does not address root cause Relieves muscle spasms, facilitates healing

 

THE BOTTOM LINE – THREE STEPS TO RESOLVE YOUR LOW BACK PAIN

Okay – You know what is causing your low back pain and the three step approach to address the cause and RESOLVE your pain.  I think the big question now is how long is it going to take for the low back pain to get better?

The general timeline is about 6 weeks for your low back pain to be completely resolved if you are diligent with the recommendations above. This is because it has been shown it takes up to 6 weeks of consistent exercise to improve our muscular strength/endurance. Realistically, it may improve in 1-2 weeks with better posture and improved coordination/control of our muscles.

So follow the three steps!

  1. Optimize your Posture, Ergonomics and Schedule
  2. Exercise to improve the endurance of your lower back muscles
  3. Manage your pain with heat, ice, medication

And most important of all realize…

We were not doing something correctly before which led to our pain. This means WE HAVE TO CHANGE OUR GAMING LIFESTYLE IN SOME WAY. The steps above help us identify what we have to change but also give us a plan to improve ourselves as gamers.

This is unless we fell off of our gaming chair and landed on our backs…that’s a trauma related injury. Check out my other article on what gamers need to know about injuries.

THANKS FOR READING!

Share this if you know someone who may need some help with their low back pain! Lets help our community live, game and replenish their low back HP ;). Until next time…

PLAY FOR LONGER, WITH LESS PAIN

Simple tips for the gaming community to prevent injuries, improve performance live a healthy lifestyle. Join some of your favorite pros in the 1HP horde to learn how to live well to game well.

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