Esports has come a long way from what it was before. We have seen the evolution of esports from brand partnerships to athletes collaborating with esports brands. Though what about the health and wellness? Where does that come into play, and how staying active and healthy helps players improve? My interview with Jordan Tsai, the physical therapist for Cloud 9, Evil Geniuses, Team Liquid, TSM, and the London Spitfire gives an insight of how staying active can cause better performance.

Thank you for coming to this really cool interview. Tell us a bit about your professional background and how you ended up in the world of esports?

Jordan: Thanks for having me. I got started shortly after school, I graduated with my doctorate in physical therapy in 2018. Right away, I got introduced to Cloud 9 through another work associate. I knew coming out of school I wanted to work in esports. Gaming has been a passion in my life, my cousins had the original Nintendo, so I grew up playing all those old games. After I graduated, I decided that gaming is such a passion of mine that I wanted to find a way to tie my career with that aspect. I was already into esports in terms of watching professional StarCraft and shortly got introduced to professional League by working with Cloud 9, mainly because I was working with their LCS team. I was very into watching competitive esports because I’ve always liked sports as well, for me it was that fusion of competitive gameplay with gaming which is what I like to do. It was really cool players play games at such a high level.

Looking into the research, there is not a lot of support for the health and wellness of gamers especially at the professional level. The industry booming in terms of money and revenue coming into it and awareness, but I think that the health care side has been slower to catch up. What I found out was that they would only bring physical therapist only when someone was hurt, they'd rehab and then leave. The goal is to help players understand that if this is your career and if you want to keep doing this for more than ten years, you have to allow your body to keep up with the demand.

We see so many players retiring early because they can’t play at the level they used to play. What are some key differences with traditional sports and esports. Can you explain what are these differences?

Jordan: The physical demand is very different, they’re not running or jumping. We are seeing that getting closer in terms of the demand because a lot of these professional organizations are also adding training programs in addition to structuring the health care side. A lot of these teams are bringing in professional trainers that are making these players workout. When they start doing physical training on top of everything else, you are also going to see new injuries. Someone who has never exercised before gets signed by a pro team and are required to exercise 5 days a week, there is a potential for injury because they are not conditioned. They are not ready to jump full into a lot of workouts, and sometimes you will see form issues. In the long term, it is really good because now that a player has been in the system for a year or two they are used to working-out regularly, you find that their endurance in gaming is much better, their reaction time should be better based on research, they are stronger, they have less pain, and they have fewer injuries. A lot of it is just a result of being overall healthier. I think the biggest difference is obviously the physical demand, but that gap is closing.

The similarities are actually more interesting. Both traditional sports and esports require these players to function at 100 percent when they are in game regardless of how tired or exhausted, they are. League of Legends is a good example. When you play a full series, you are playing up to five games in a row, that fifth game both teams are neck and neck and winner take all, that is exhausting and to still be able to function at 100 percent mentally and still be able to keep your mechanics that is really hard. It is quite the same effect that we are seeing in other sports where you have to bring in the entire staff. Most of the teams have a sports psychologist, a nutritionist, personal trainers, physical therapy, their sleep is planned out. They are really trying to look at the entire athlete as a whole and treat them as such. It is not that time anymore where you just solo queue for ten hours and expect to be the best in the world.

You have talked about how you helped players in preventing injuries, making sure they are staying healthy. What do you do you to teach these players?

Jordan: I don’t want to say prevent, because there is nothing that can prevent an injury, but you can minimize the risk of developing certain injuries by having good posture. Good posture is just having good alignment. I am a big believer in movement, creating improve mobility which is actually how you minimize injury. You want to be able to move through full range. Although I stress with a lot of players that you want to think about posture, it is more to be aware of that when you are in bad posture. I never tell these pro players that when they are on stage in the middle of a baron fight, that the last thing I want them going through their head, at that point that is not going to make a different, I want you to focus on the game. But the stuff you can focus outside of the game like when you are at home in between scrims sessions or watching YouTube, think about having good posture.

Posture, injury prevention that improves performance indirectly because it doesn’t actually make you a better player, it allows you to play more games and get better repetitions without the distraction of injuring yourself or pain. If you stay healthy you get better practice overall, because when you are in scrim sessions practicing with your team, you don’t have to worry about your wrist hurting. The direct performance improvements are more so from good habits. Something that I stress with teams and it is more common now; is how do you structure practice? Back in the day, it would just be teams grinding for hours and then they would do their film review, by their sixth game, they are exhausted. Now, what they do is they will play a game, do review, giving themselves time to analyze the situation, and learn from it but it also gives their body a break. Structuring your practice is really important in how you can maximize your improvement in each game, rather than just running through games and learning what you should have learned afterwards. It is really important for teams and organizations to understand that structuring practice is vital in terms of how you actually perform and how you improve.

This is something esports can take from traditional sports. Traditional sports have learned this along time ago, that the best way to get better at something it is not to play multiple fake games. For example, football, you don’t see teams go on the football field every day and play fake games, that is not how you get better. They work on drills, they break practice into specific sequences; running, catching the ball, etc. It is difficult in League because I don’t think the tools are there yet. Though other games like CSGO or Valorant, aim lab is a great way to break practice into something specific that you can work on. It is interesting how teams break practice into specific versus scrimmage.

What can your average player do before a game starts?

Jordan: For League, because you are clicking so much with either your middle or index finger, what happens is that you overuse those tendons that run all the way into your forearm. One thing that would be good is what I call tendon lines moving your fingers through full range of motion because if you stay in this little tiny range of motion for hours what happens is that you start developing adhesions and it stiffens that joint up, stiffens up the tendons, the muscle. Afterwards or in between games you want to think about moving through full range again, it is almost like a minor stretch, you want to be stretching it in between.

What players can do is look at their shoulder position, this is kind of universal across all games, generally when you are at a computer your shoulders are hunch forward, your neck is hunch forward, you want to think of reversing those positions in between games or before games. A good stretch would be putting your hands behind your head and bring your elbows back and get a really good chest stretch, the peck minor or the inside part of your chest actually pulls on your shoulder blades and pulls your shoulder blades forward. Getting that to stretch is the first step in trying to get your shoulders back, and your back straight, and also helps with your neck position. I would follow this with scapular squeezes where you bring your shoulder blades together behind you and squeeze those muscles between your shoulders blades. The big takeaway is to find the position you stay in and try to reverse it, that is the easiest way I could describe it.

The neck position, the forward head position is very common easiest thing to do is a chin tuck. You’re bringing your chin towards your neck and then bringing your head straight backwards, it looks like you are creating a double chin. It strengthens the small muscles in your neck called the upper deep neck flexers and stretched the upper cervical. You want to be consistent, get into a habit. If you are queuing up, there is always that load time or champ select, that is your time to be doing stretches. It not only keeps your body fresh and preventing those injuries, it also almost becomes a ritual. In the psychology world, that is really important. Because if you are having a little checklist of things you do before you go in the game, it is going to make every single game feel like you’re getting ready for the competition. You should listen to your body! That is the first thing you should do, is listen to what your body is telling you. If you are starting to cramp and having pain, that is not an indication to wind wheel your wrist and keep playing, your body is actually telling you to stop, so it is important to be aware of those signals.

Is there certain equipment players can use, are gaming chairs really that useful?

Jordan: Yeah absolutely, this is really important because ergonomics or the proper set up of your environment is basically going to determine how much you're using the rest of your body. If you are set up perfectly, what you trying to do is create efficiency for body, you are trying to put yourself in a position where you have to use the least amount of muscles to be active, to hold yourself in a good position. If you are setup incorrectly, let’s say your keyboard is too low or your chair is too high, you are creating additional stress on different structures and, over time, that is what causes those overuse injuries. Generally, what you want to think is matching your equipment to your body. If you sit in your chair and pretend to have really good posture everything should then match that. If your desk, is low maybe raise your desk up or lower your chair.

Your mouse hand, you don’t want it to be totally flat, you want a 20 degrees incline, your arm should sit if you draw a line straight and then 20 degrees up. There are a lot of tools you could use. Obviously the adjustability on most chairs, the arm adjustment, the back readjustment, the seat height those are really good, but the biggest thing I wish more gaming chairs had would be the tilt. The ability to tilt the bottom of the seat forward or back, what studies have shown is if you have a slight tilt forward, it makes it a little hard for you to sit upright, but what it does it actually turns on more muscles. You get your abdominal muscles working just a little bit while you are playing and can help a lot with back pain. Reclining back is not quite as important for most competitive gamers, I know streamers may like to lay back, but it's really two different avenues; do you design a chair for comfort? Or do you design a chair for performance?

I think that’s where a lot of gaming chairs miss the mark – they are all design for comfort. Long story short, the biggest downside to gaming is that they don’t have enough adjustability. If you look at really high-end priced office chairs, that market has been much more involved in ergonomics than gaming has been, and I think they can learn a lot from that. There are some expensive desk chairs that have so many features that can make it perfectly fit for the human body. If you look at that list, [it] is double of most gaming chairs. I think they can learn a lot from that, but it isn’t the market right now because everyone wants a really cool looking chair, rather than looking at what’s optimal.

Before I get to my last question. What is your advice as an esports physical therapist?

Jordan: Based on the evidence, the most important form of exercise that you can do as a gamer is cardiovascular. I know everyone hates that, but cardio is the way because what they found in research is that if you have better cardiovascular performance; running, swimming, anything that gets your heart rate up and sustain its, has been shown to improve your reaction time, your memory, your pattern recognition, and your brain functions better.

Cardio is really not just for your heart, it’s about creating better oxygen balance on your bloodstream. If you look at elite cardiovascular athletes; marathon runners, swimmers, they actually have higher oxygen saturation in their blood, meaning in their blood, there is more oxygen available at any one time than someone who doesn’t exercise. What we found is that, if you are a gamer 90 percent of the time, your game is actually in your brain, it is much more mental than a traditional sport because is all about reaction time.

Secondary to that, you want to be working on exercise that trains the muscle that are probably weak, meaning if you are in a desk and your shoulders are hunch forward all the time, you are probably weak in your back and you are probably weak in your core. Stretching is really important obviously, you want to keep stretching in areas that feel tight, just reversing the position you are in.

Sleep is huge! There is a study that even sleeping six hours at night, people after 14 days tested as poorly on this cognitive test as someone who went 24-48 hours of no sleep. If you can get at least 8 hours of sleep, you are going to be functioning at a much higher level, that you won’t even notice it. Your brain will just be going faster.

Diet is really important, not as much direct correlation with gamers, but poor diet leads to other issues. If you are eating a lot of fatty foods, a lot of sugar, all that stuff, your odds of developing diabetes are much higher. In these conditions what they do is shrink your blood vessels making it harder for blood flow to get to place they need to go. This effect both your brain and your nerves and a common issue with gamers is nerve pain, so you are increasing the likelihood of developing nerve pain if you have poor diet. You will find that if you incorporate all of this stuff, your gameplay will be better because you will be able to play longer, you’ll have less pain and hopefully play better.

Awesome! All of this information has been amazing. To my last question, where can people learn more?

Jordan: I appreciate the shout out. I have a website is RespawnTherapy.com and an Instagram where I post regularly with exercise videos, how do to certain exercises, I put pathology like “Here is a common problem that gamers have” and I describe what it is, what causes it, and how do you treat it and that’s @respawn.therapy. Through my website, if you wanted to see me directly or wanted an evaluation, I do schedule, we can do stuff online if you are not in the LA area or I am happy to see people in-person in LA. That is what I do with most of the teams, I just drive to their facility and treat them there.

To pitch a little if Dignitas wants to talk, I’d be happy to have a chat about what benefit I can bring to the team and why it is important to stay on top.

I'd like to thank Jordan for taking the time to talk to me. For more information about his organization, visit the Respawn Therapy website here or follow them on Instagram.