Avoid Injury in VR Esports with Proper Body Positioning

by David Amirrezvani, DPT, CSCS, CEAS

As the popularity of esports continues to rise, the pain and injuries associated with gaming increase across the board. Pain in the lower back, neck, shoulders, elbows, wrists, knees, etc., are becoming all too common, especially among those who participate in both recreational and competitive VR. VR is a full body esport which exposes athletes to a unique injury risk. As a result, the demand for experts and specialists in the fields of physical therapy, sports performance, and injury prevention are at an all-time high. There is a need within the industry for increased awareness and education of athletes and coaches, in order to foster sustainable growth in esports and gaming as a whole.

In traditional sports, maintaining the overall health of athletes and injury prevention are key.  Esports are no exception. One of the biggest differences between “traditional esports” and VR esports is the physical nature in which competition takes place. While traditional esports athletes maintain a static, seated position with primarily repetitive movements of the upper extremities (mouse/keyboard/controller), VR esports requires movement of the entire body. The more moving parts, the higher the risk of injury becomes. VR esports are also unique because athletes are removed from their physical environment, and therefore have a decreased awareness of how their body is positioned. Combine these factors with a highly competitive environment and hours of practice/gameplay, and the risk for potentially career-ending injuries becomes even greater!

A comprehensive understanding of the fields of biomechanics, kinesiology, and ergonomics as well as their application to esports provides necessary insight into how the body can and should move within the context of VR. Outlined below are just a few of the common “do’s and don’ts” specific to VR athletes.

Reduce Knee Pain

Squatting is one of the most functional movements that human beings perform. It also happens to be a movement that is often associated with knee pain. The image on the left (below) demonstrates an exaggerated version of a poor squat, while the image on the right depicts ideal foot, knee and hip positioning when squatting during VR. The most common mistake is leading with the knees!

Athletes should sit back with the hips (as if to sit in a chair) so that the pressure of your body weight is placed through the heels, rather than the midfoot or forefoot, while simultaneously keeping the chest lifted.

The angle of the shins will become much more upright so that the knees are not going beyond the toes. Pressure in the heels allows for better activation of the glutes, and less force on the knees, and less force on the knees = less risk for knee pain!

Assessing squat positioning from the front is also important in order to ensure that the knees and hips continue to maintain an optimal position. While keeping pressure through the heels is essential, separating the knees to prevent a “knee valgus” is also key.

A knee valgus is defined asthe uncontrolled inward movement of the knees during dynamic activity, such as a squat or lunge. A dynamic knee valgus is often the result of instability or poor glute activation, which can result in significant knee pain or injury with repetitive poor biomechanics.

Maintain Optimal Posture

An upper cross posture is characterized by having a forward head with rounded shoulders, which is often found among gamers across all esports secondary to poor postural endurance and ergonomics. Prolonged upper cross positioning can lead to a variety of overuse issues and strains including neck, upper back, and shoulder pain associated with competitive play.

Maintaining a neutral posture with the shoulders down and back and the head in an upright position is key for decreasing compressive forces in the spine, and strain on the shoulders. Think about increasing the distance between the ears and the tips of the shoulders!

Additionally, being mindful of neck/shoulder positioning is essential to maintaining optimal posture during squatting/lunging.


Activity modification is the first place to start if experiencing any type of pain or discomfort associated with movement, including VR esports. If symptoms continue to persist, it is imperative that you see a Doctor of Physical Therapy to ensure optimal mechanics and implement strategies for injury prevention. They would be able to provide you with a combination of treatments including manual therapy, ergonomic assessment, strength and conditioning, as well as specific mobility and stability exercises to not only treat your pain, but keep it away!

About the Author:

Dr. Dave has been a lifelong gamer and traditional athlete. He combined his love of esports and sports medicine with a Doctor of Physical Therapy degree from NY University. Dr. Dave provides consulting for esports organizations and can be reached via his website.

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