Episode 13 | Ask the Expert | Guests: Serena MacLeod – Sports Psychologist | Dr En Tam – GP and Esports Medicine Specialist
The image of a teenager in a darkened bedroom, gaming alone, is out of date. Esports is a multi-billion dollar global industry, growing by over 40% year on year, with professional players living and training together full-time, competing in front of millions of viewers, and retiring as young as 18. And the health implications – physical, psychological, and developmental – are only beginning to be understood.
In this episode of the London Bridge Sports Medicine podcast, Dr Ajai Seth is joined by Serena MacLeod, a sports and exercise psychologist specialising in esports, and Dr En Tam, a GP with a background in sports medicine and technology. Between them, they cover what esports actually is, who is playing it, and what the sports medicine world needs to start paying attention to.
What is esports – and how has it changed?
Esports refers to competitive electronic gaming – players and teams competing against each other in structured formats, from local grassroots tournaments to global professional leagues with prize pools in the millions. Games range from first-person shooters to multiplayer online battle arenas (MOBAs) like League of Legends, which currently has more active players than there are owners of the latest PlayStation console.
The defining shift from earlier gaming is complexity and collaboration. Modern esports titles demand second-by-second teamwork, deep strategic thinking, and reaction times that place professional players in the top 0.001% of the population in terms of hand-eye coordination and processing speed. A 30-minute League of Legends match might involve up to 5,000 mouse clicks from a single player. The cognitive and physical demands are significant.
Accessibility is also a defining feature. Unlike cricket, golf, or tennis – sports that require equipment, facilities, and expense – competitive gaming requires a computer, an internet connection, and time. This makes it one of the most socioeconomically inclusive competitive activities available, and a genuine community and outlet for people who might not fit into traditional sport.
The physical health risks
Professional and semi-professional gamers typically train for 10 to 14 hours a day. The physical consequences of this are significant and largely unaddressed by the existing healthcare system.
Musculoskeletal injuries
The most common physical complaints are lower back pain, scapular and shoulder pain, and wrist injuries – particularly repetitive strain injuries (RSI) and carpal tunnel syndrome. These are predictable consequences of sustained static posture combined with extremely high-volume repetitive fine motor movements. The ergonomic principles used in office environments apply here, but the demand is far greater: an office worker using a keyboard and mouse for eight hours experiences a fraction of the mechanical load of a competitive gamer doing the same for 12 to 14 hours.
Dr Tam notes that structured advice on injury prevention, strength training for the specific muscle groups involved in gaming, and ergonomic guidance is almost entirely absent outside the top professional teams. When players have sought help from GPs or other practitioners, they have frequently been told either that the problem does not sound serious or simply to play less – advice that is neither specific nor actionable for someone whose career depends on their performance.
Sedentary behaviour and metabolic health
The other significant physical health concern is the broader consequence of extreme sedentary behaviour: weight gain, early onset type 2 diabetes, cardiovascular risk. Professional gamers in the early years of esports notably retired not just with musculoskeletal injuries but with metabolic health conditions. Several have had to retire in their early twenties with diabetes.
This problem is compounded by the culture of “grinding” – the prevailing ethic in competitive gaming that more hours of practice equals better performance. Esports bars and training facilities often encourage players to stay at their stations as long as possible, with food and drink delivered to their chairs. The idea of taking breaks is actively stigmatised in some competitive environments, seen as falling behind competitors.
Dr Tam and Serena MacLeod both advocate for structured breaks, regular movement, and preventative health checks as standard practice for serious gamers – but acknowledge that without governing bodies and organisations mandating this, it is unlikely to be adopted widely.
The psychological considerations
Social connection vs. isolation
The social dimension of esports is frequently misunderstood. The assumption that gaming is isolating is challenged by the reality of modern competitive titles, which are fundamentally team-based and require constant communication, coordination, and trust between players. Many professional gamers identify the sense of community and belonging as the most positive aspect of their involvement in esports.
For certain populations – including individuals with autism, social anxiety, or physical disabilities that limit access to traditional sport – esports can provide a genuinely valuable social environment and competitive outlet. Serena MacLeod notes that her own interest in esports was partly motivated by seeing how gaming provided her brother, who was diagnosed with autism, with a meaningful social connection and shared passion.
Addiction and compulsive behaviour
Gaming disorder was formally recognised by the DSM-5 in 2018 as a diagnosable condition, with similarities to other compulsive and addictive behaviours. The reward mechanisms in competitive gaming – improving performance, achieving ranks, receiving social validation – are specifically designed to drive continued engagement. The fear of falling behind competitors if training stops adds another psychological pressure that makes stepping away difficult.
Serena MacLeod describes this as a particular challenge at the semi-professional level, where players do not yet have the support systems of a professional team but are training at near-professional intensity.
Fame, online abuse, and mental health at a young age
The mental health challenges unique to esports are substantial. Top professional players can accumulate millions of followers on social media and streaming platforms, with their performances – and their mistakes – scrutinised in real time. Online abuse is endemic. And many players reach this level of public exposure while still in their early or mid teens.
The youngest player earning millions in the sport is approximately 13. Managing fame, public pressure, and constant criticism at 13 – while also going through puberty – is a level of psychological demand that most adults would struggle with. Burnout is common. Transition out of the sport, typically between 18 and 25, is poorly supported: many players have not completed secondary education, have limited transferable qualifications, and no structured pathway into post-esports career.
South Korea, where esports infrastructure is most developed, has formalised support for career transition. In the UK and most of Western Europe, this does not yet exist.
What good support looks like
At the professional level, the leading teams have multidisciplinary support: performance psychologists, physiotherapists, nutritionists, and medical staff. The problem is that this support exists only at the very top of the pyramid. Below that, at the semi-professional and grassroots level where most players exist, structured support is almost entirely absent.
Both guests identify the same core needs:
- Structured training schedules that incorporate regular breaks, exercise, and recovery – not just gaming hours
- Ergonomic assessment specific to the demands of competitive gaming, not generic office guidance
- Strength and conditioning work targeting the muscles of the back, shoulder, and wrist that are most affected by gaming posture and repetitive movement
- Psychological support for emotional regulation, managing public pressure and online abuse, and building resilience
- Preventative health monitoring including regular checks for metabolic health, blood pressure, and weight – particularly important given the sedentary demands of the activity
- Career transition support for players leaving the professional scene at a young age
The bottom line
Esports is not a niche hobby. It is a global industry with tens of millions of active participants, a significant proportion of whom are young people training at intensities that would alarm any sports medicine practitioner if they appeared in a traditional sport context. The physical and psychological health implications are real, growing, and largely unaddressed by existing healthcare pathways.
If you are a gamer – recreational, semi-professional, or professional – the same principles that apply to any athlete apply to you: structured training, adequate rest, appropriate cross-training, and access to the right support when problems arise. The fact that your sport takes place at a desk does not make those needs any less real.
LBSM offers a dedicated esports medicine service for gamers at all levels, covering injury assessment and prevention, ergonomic advice, and performance support.
Serena MacLeod is a sports and exercise psychologist specialising in esports, working with players from grassroots to professional level on performance, emotional regulation, and wellbeing.
Dr En Tam is a GP with a background in medical education, sports medicine, and digital health, currently working at Livi.
To discuss esports-related health concerns or book an appointment with the LBSM team, visit lbsm.co.uk/booking
Listen to the full episode below ↓
