Digital gaming, musculoskeletal, and related health hazards among adolescents and young adults

Digital games have become an important part of leisure activities in the daily lives of adolescents and young adults.[1] There exist several types of games for various age groups and genders.[2] In recent years, increased exposure and access to digital games (e-sports and Wii) have attracted more adolescents and young adults to gaming. Adolescents and young adults are vulnerable to excessive use of digital games when they use gaming as escapism to relieve stress from the real world.[3] The excessive use of these games can also be associated with several physical and psychological health problems.[4] Prolonged sitting with poor posture and fine motor strain associated with digital gaming makes musculoskeletal symptoms as one of the most common physical health hazards.[5–8] These musculoskeletal symptoms of gaming have also been found to be associated directly or indirectly with other health hazards like sleep issues,[9] fatigue and obesity,[10] headaches, anxiety,[4] stress,[4] digital eye strain[11], and epilepsy.[12] However, literature on the association between gaming and physical health hazards among adolescents and young adults is relatively scarce. To provide a broader overview, a generalized search was performed using search terms “health hazard” or “musculoskeletal” and “gaming.”[8] It gave us two broad domains: 1. gaming and musculoskeletal hazard and 2. gaming and other related physical health hazards. GAMING AND MUSCULOSKELETAL HAZARDS Musculoskeletal pain is one of the common musculoskeletal hazards associated with gaming in adolescents and youth.[8] Nintendo gaming system has been found to be associated with a wide pattern of musculoskeletal hazards ranging from tendinitis of the thumb, hand, wrist, and elbow (nintendinitis or nintendonitis) to palmar ulceration (ulcerative nintendinitis) due to repetitive micro-trauma. Further, the motion-sensitive Wii remote was associated with traumatic injuries that were confined mainly to the upper extremities (hand lacerations and bruising), face (periorbital hematomas), and neck.[13] Despite musculoskeletal pain being a significant concern associated with gaming among adolescents and young people, very few studies could be identified to draw meaningful conclusions. Excessive gaming for more than 5 h a day increased musculoskeletal symptoms among adolescents aged 13–18 years. Further, escape motives were associated with the musculoskeletal symptoms, suggesting that those playing for longer hours were more likely to report such symptoms.[13] A cluster analysis among adolescents highlighted more cases of musculoskeletal discomfort among problematic clusters with longer gaming times and higher risk for gaming disorder. Preliminary findings suggested pathological musculoskeletal changes in the hands and wrists of adolescents who played games for more extended periods.[14] In another study, addiction to online games, gender (girls), and education (higher) emerged as important predictors of neck discomfort and pain.[15] Gaming for more than 3 h per day, without rest breaks, was common among office workers, and there was an exacerbation of office work pain in most circumstances through strain superposition.[16] While excessive gaming time has some association with musculoskeletal hazard, no association has been reported with game types (single player vs multiplayer).[13] Mixed evidence emerged from the recent scoping review regarding the musculoskeletal pain associated with gaming.[17] Among the three included studies, one restricted its finding only to descriptive statistics; the other showed a weak association, while no association between gaming and musculoskeletal pain was reported in the other study. Another significant concern associated with gaming is the prevalence of musculoskeletal pain in e-sports. According to a recent study, four in every ten e-sports athletes reported pain, with back, neck, and shoulders being the most common pain sites reported.[8] GAMING AND OTHER RELATED PHYSICAL HEALTH HAZARDS Excessive video game use over a prolonged duration poses strain in the visual system resulting in headaches, dizziness, and in some cases, nausea and vomiting.[18] Prolonged near-term adaptation (blurred vision, difficulty in focusing, and headache), issues related to dry eye syndrome (irritation/burning sensation, ocular fatigue, discomfort, photosensitivity), and exacerbation of pre-existing vision problems (hyperopia, myopia, astigmatism, and adaptive disorders) were observed commonly along with symptoms due to poor posture and prolonged immobilization (such as neck pain, tension headache, and other atypical musculoskeletal pain) while gaming.[19] Precipitation of seizures due to rapid change of on-screen patterns (Nintendo epilepsy), auditory hallucinations (Nintendo hallucination), enuresis, and encopresis were observed in Nintendo gaming system.[20] Gaming duration was found to be associated with overweight and increase in food intake (mostly junk)[18] and problematic gaming behavior with fatigue, sleep disturbances, depression, and anxiety symptoms.[21] Contrastingly, a weak association between gaming and body mass index was reported among adolescents from a scoping review.[17] Overall, preliminary evidence suggested a negative association between increasing video game playing hours with general health status.[17] Overall, it identified existing evidence and their limitations to support the link between gaming pattern, gaming type, musculoskeletal, and related health hazards. There are very few studies with mixed evidence limiting our ability to draw conclusions about gaming and musculoskeletal and related health concerns in adolescents and young adults. Different games and gaming consoles have different issues reported, and there was no information on pain intensity. To the best of our knowledge, no investigations have utilized longitudinal design among adolescents. Variations in methodologies, study populations, sample sizes, sampling techniques, assessment, reporting (non-validated tools), and operational definitions could be attributed to this inconclusive evidence. Musculoskeletal hazards are common and multifactorial in adolescence. Future studies should focus on developing standard methodologies and tools and account for other contextual factors like (family history, schoolbag carrying, playing, work tasks, rest position between classes and works) while determining its association with gaming among adolescents and young adults. Given the diversity of interrelated health hazards associated with gaming, a comprehensive and holistic approach is required to collaborate with various health professionals to improve gaming practice. The sedentary nature and repetitive micro-trauma associated with gaming promote musculoskeletal injury along with the obesogenic environment and non-communicable diseases. The utility of prosocial digital games to enhance healthy behaviors and reduce health hazards must be explored. Such strategies should focus on promoting healthy use of technology and enhancing awareness and management of musculoskeletal and related health hazards to enable adolescents and young people to their positive transition to healthier adults. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.