Interview: Dr. David Amirrezvani discusses improving player health in esports

The health of esports athletes is a topic that doesn’t get much press outside of player retirements. Unfortunately, that is ultimately detrimental to the long-term health of the scene. At the Inven Global Esports Conference, we had a chance to sit down with Dr. David Amirrezvani, DPT, CSCS, and CEAS and chat about his efforts to change that in order to create a healthy ecosystem.

To learn more or to connect with Dr. Amirrezvani, head to his website at

GameCrate: In your talk today, you mentioned how there is more predictably in motion for esports players and that makes it easier to treat them. Would you liken that to a baseball pitcher and because of that similarity it’s easier to design exercises and routines for esports athletes?

Dr. Dave: It’s the perfect analogy. We know the exact types of movement these players will be doing, obviously specific to their esports, and those are the types of things we’re looking at from a biomechanical standpoint. We ask ourselves: How do we mitigate the effects of these movements from an injury prevention standpoint?

GC: You also mentioned that we need to do more than just wrist exercises to keep ourselves in shape. Can you quickly go over what muscles are being used when we’re sitting down and playing games?

Dr. Dave: Pretty much the whole body, which most people don’t consider. We have to use postural muscles, postural stabilizers, muscles of our core, lower back, and our hips to keep us upright. Sitting in an upright position isn’t the easiest thing to do, even outside of esports.

Even your knees and feet have to be in a certain position. It ties into a larger talk about ergonomics and optimizing that.

Team Liquid Impact on stage

GC: You also talked about how we don’t stop in esports and gaming. That we get caught in the struggle phase (see the below slide for the loop) and don’t stop creating a destructive loop. Can you expand on that?

Dr. Dave: It’s a unique quality—maybe not quality. An aspect of esports athletes where they have an ability to not take a break. They don’t self-regulate. A lot of that has to do with the accessibility of esports.

A traditional athlete in football needs a lot more than someone in esports: 21 other players, referees, a field, a ball, and organized competition. So even if I wanted to play football for six hours a day, no one is going to want to do that.

The nature of esports is that it’s readily available and there’s always people to play with. Therefore, we can get stuck in an instant gratification loop where we just don’t want to stop. I think that’s a bit of human nature. We can see that in gambling. You win or you lose. If you lose, you feel bad about it and you keep going so you can feel good which then creates that instant gratification loop.

That’s a big part of performance coaching in general. Taking a look at those things, dissecting them, and figuring out how to stop that from happening.

GC: With it being so accessible, do you think there needs to be safeguards? We’ve seen China experiment with this on their mobile phones.

Dr. Dave: That’s a tough thing to say. The last thing we want to do is prevent the next Yiliang “Doublelift” Peng from being exposed to League of Legends. These skills can be harnessed at a young age, but to your point, we need to make sure these kids aren’t getting burned out.

Doublelift holding up the 2019 Spring Split trophy

You put a kid in little league baseball at 7-years-old, by the time he gets to high school he’s going to hate baseball unless he’s a top college prospect. He’s never going to want to play it again because all of his time and energy was spent in baseball.

That’s something that, as esports continues to grow and becomes a viable career path, we need to make sure that these infrastructures are in place to make sure they’re not overdoing it. It could become a big issue.

GC: Another thing you mentioned was that it’s hard to know what to do because the scene is so young. What’s the hardest part of that? Is it that we just have to experiment with things in the beginning even though it could be detrimental to the early few?

Dr. Dave: No, nothing bad can come of it. The biggest limiting factor is accessibility. There are some organizations that are all for it and playing the long game. They’re trying to set themselves up for success 10-15 years out.

A lot of that is being gatekeeped, though. Many organizations don’t understand why it’s important to have individuals such as myself in their organizations. It can be frustrating and detrimental to everyone involved.

GC: Is there more crossover between traditional sports and esports than people may think?

Dr. Dave: Yes, there is a huge overlap, but I don’t want people to think that they’re the same because they are very different. There are a lot of similarities in the organizational structure, player management, sponsorships, and that type of stuff. It’s still very different, though.

In esports, I think most people are in one of two camps right now: you either want everyone from traditional sports to understand esports and you’re shoving it down their throat so it can make sense to them or you want them to stay away completely.

People are very protective of esports, and rightfully so, the industry has built something very unique and unprecedented. We need to find a balance between the two. We need to be welcoming. Let’s not kick them to the curb and instead show them why they may enjoy esports.

Hyeon “EFFECT” Hwang retired after Stage 2 of Overwatch League due to personal issues

GC: Great points. I have a few questions about the more psychological side of things. Over the past year or so we’ve seen a lot of player retirements in the Overwatch League that cite mental health. Players have found these games as something that brings them joy and happiness and when they lose that joy they become depressed and even consider suicide in the most extreme cases. While our sample size is small, do you think this may become a recurring trend that we need to keep an eye on?

Dr. Dave: 100 percent. I think that ties back into the fact that we need more professionals in the space working on these types of issues. It’s not just the psychological aspect, it’s not just the physical aspect, it’s player development as a whole.

Let’s say a player has a wrist injury or a bout of depression that causes them to be unable to play. This player is now benched and if they haven’t sorted their problem by the end of the season, they could be released. Maybe the organization provides resources for this or maybe they don’t. Either way, the org can release the player and just pick up a fresh, young, and equally talented player to take their spot.

Then what happens? Life after esports is a huge issue right now and we’re only starting to see a few instances where top tier players are taking a backseat and going into an organizational role. Those are things that are important to talk about as well.

Players are being dropped left and right without a plan. It’s a big issue that needs to be addressed that ties into the whole picture.

GC: You didn’t mention it in your talk, but is substance abuse something we need to be worried about? Things like teenagers taking Ritalin to get them to the professional level.

Dr. Dave: Not yet. The conversation needs to be had, though. Thankfully, I think esports athletes are generally decent humans and don’t think about these types of things.

Fair play is a big thing we’ve been able to foster in esports, which I think is incredible, but I think that will change. I think people will begin to explore these types of options in order to find competitive advantages. It will absolutely be a problem in the near future.

GC: One aspect of esports is that professionals are more accessible than any other sport. Is that adding more to the stress they deal with?

Dr. Dave: Honestly, I joke about wanting to be Doublelift, but they have so much stress in their lives. Not only from a competitive standpoint, but also maintaining their personal brand, creating content, livestreaming, replying to DMs, photos, signing autographs, and traveling. All of that combined into one is really just a recipe for disaster.

I know I sound like a broken record, but the need for people like myself in this space is vital. We can help mitigate the impact of a lot of those things so it doesn’t spiral out of control. We want to put the fire out before it even starts.

GC: Do you think pros need to take a step back and remove some of that accessibility?

Dr. Dave: Absolutely, though it does depend on what your goals are. If you’re looking to only compete then take a step back. If you want to become a content creator after a year then you need to do it in order to build your brand. I don’t think it’s healthy to have both.

If we look at traditional sports again, a lot of famous athletes have people that represent them for these things. Many don’t even send out their own tweets. I think the time will come in esports when that’s the case, but I think players need to be very wary about how accessible they are.

GC: Last thing, do you have three basic tips for people to help them be healthier physically and mentally?

Dr. Dave: First and foremost, sleep. Sleep is underrated. We know it’s important, but if you don’t have an optimized pattern or good sleep hygiene, it’s hard to build a foundation. The implications of rest and recovery overnight are huge.

Reducing blue light exposure, having a bedtime routine, and similar things are helpful toward getting there.

Physical activity is huge and underrated in the gaming community. Set some easily attainable goals. Someone asked if they should start with 20 minutes for every hour. You don’t have to start there. Start with five minutes and build upon that. It’s not all or nothing.

Building those habits over time will really set yourself up for success.

GC: Any final thoughts you wish to share?

Dr. Dave: Just that these types of conversations are necessary to the growth of the industry. If the esports world, at all levels, starts to think about these things, they’ll be very thankful that they did.

Photo Credit: Lol Esports via Flickr, Robert Paul for Blizzard Entertainment, and Dr. David Amirrezvani