Los Angeles doctor Levi Harrison specializes in sports-related upper extremity and shoulder injuries as well as hand rehabilitation. The orthopedic surgeon treats athletes across traditional sports like tennis, golf, and baseball, but he’s also established the country’s first esports-focused practice. In fact, he coined (and two years ago trademarked) the term “esports doctor.”

The lifelong gamer decided early on in his career that he wanted to focus on video game injuries, which has dovetailed nicely with the growth of esports into a legitimate entertainment industry.

Now his LA practice is made up of one-third esports and gaming clientele, many of which are referred by other doctors or gamers from around the country and across the globe.

According to research firm Newzoo, the global esports audience will reach 380 million this year (mostly millennials and Gen Z, the demographic that most brands and advertisers covet). Case in point, Newzoo forecasts brands will contribute $694 million (or 77%) of the $905.6 million global esports economy in 2018. Peter Warman, CEO of Newzoo, projects esports revenues will reach $1.4 billion by 2020.

With millions of dollars up for grabs at esports tournaments (the International awarded $24 million to “Dota 2” teams last year for just one event), making sure professional gamers remain healthy has become important for team owners – a growing number of which are now wholly owned or include investments from traditional sports teams like the Yankees, Patriots, 76ers, Lakers, and Dodgers.

Not only are traditional sports teams investing in esports, they’re also offering professional video game players the same type of access to nutritionists, psychologists, trainers, and medical staff that pro athletes receive.

“When it comes to esports players, the brain is the first instrument players use to strategize, and the second instrument is the body, using your hands, wrists, elbows, and arms,” Harrison said. “Teams today are starting to have more medical staff beyond coaches and gaming coordinators. Having a medical professional who’s been a gamer and understands the body as well as the ergonomics of gaming is important to not only win, but to play for a long time.”

Harrison said this recent shift is helping spread the message that being proactive about gaming responsibly can prevent injuries down the road – and that’s something that crosses over from pros to regular kids who play a lot.

“There are specific injuries we see in the gaming community, and that I see in my practice, including pain in the hands, wrists, elbows, knees, feet, and neck,” Harrison explained. “Repetitive motion or stress injures from overplaying are common. Tendinitis in the wrist, fingers, or elbows (like tennis elbow or golfer’s elbow or carpel tunnel or rotator cuff tendinitis).”

One injury you won’t find in any traditional sport is “gamer’s thumb,” which Harrison called an interesting pathology caused by the locking of the thumb and trigger finger. It’s rare, but in the worst cases gamers can’t bend or extend their thumb because it’s spent so many hours holding a console controller.

Professional gamers play anywhere from eight to 16 hours every day. Many live in team gaming houses and play with teammates on strict, routine schedules, whether they’re in competition or preparing to enter one. And with many esport seasons running almost year-long, there’s not the built-in off-season that many traditional pro athletes enjoy to rest and recuperate for the next year.

Another factor that impacts pro gamers is the short lifespan of the hand-eye coordination that’s required to compete at the highest level. Harrison said a pro career can span from 16 to 23 years of age, if a player is really consistent and hasn’t been injured.

“Your body and eyes can only take it for so long,” Harrison said. “By the time they turn 23 or 24, they’re a relic in this industry. And there are always 20 younger people waiting behind them to take their roster spot.”

It’s for these reasons that Harrison focuses on the whole athlete when working with a patient.

“We go through a whole diatribe of other issues, including posture, eye health for eye fatigue and strain, their mental status as it relates to depression or anxiety about injury or job security,” Harrison said. “The hand is part of it, but I treat the athlete from a whole body and mind perspective.”

Anyone who’s watched “Counter-Strike: Global Offensive” players practice or compete will see pros hunched in front of the PC screen with their eyes almost touching the monitor, which is a method players have told Harrison allows for more accurate aiming in the first-person shooter game.

The long-term effects of doing this for so many hours a day for so many years has yet to be studied, given the still nascent premise of esports. Harrison is studying the data he collects from players internally, and using his own research to design equipment that he hopes will help players game longer.

“Gaming console controllers and mouses aren’t ergonomically well-balanced for the amount of time professionals spend playing,” Harrison said. “I’m working on my own patents right now for equipment that’s specifically geared for gamers.”

Harrison is working on a device gamers can use to exercise their hand, and he’s had talks with companies who make controllers to potentially apply his own research and findings to future controllers targeting pro gamers.

One thing that separates professional sports from esports is that players often don’t disclose injuries to teams for fear of being replaced, according to Harrison.

“My client list has always been pretty high because of word-of-mouth, trust, and confidentiality,” Harrison said. “They’re aware if they come to me in LA, I’m not going to put this on social media and talk about who was in my office. There’s so much secrecy involved because of how much money is at stake. In esports only a few people know about injuries – coach, player, and parents – sometimes the team owners don’t even know.”

Although he’s worked with hundreds of esports athletes from around the globe since opening his solo practice in Los Angeles in 2007, only two patients were willing to go on the record for this story. Even retired players from the big esports titles like “League of Legends,” “CS:GO,” and “Dota 2” don’t want to talk about the injuries professional video gaming has caused them.

Nick Scolari was one of Harrison’s original patients. After playing games since age seven and running a successful YouTube channel, repetitive stress caused him to develop wrist tendinitis in both hands.

“I went from being able to game aggressively at high levels in real-time strategy games to not being able to lift a water bottle, put on a shirt, or drive a car,” Scolari explained.

His original physician gave him a wrist brace and told him to go home and rest, but because he also had atrophy in his shoulders and pecs, it didn’t get better.

“I looked up local specialists in LA and found Dr. Levi and it was a complete 360,” Scolari said. “He was more proactive with exercises and stretches that targeted the supporting areas. I had serious injuries in my shoulder from playing football and track and field. He looked at my upper extremities and pectoral injury, so he was able to give stretches and exercises for the other problems that were compounding my issues. No surgery was needed. And after several months, I was able to game again.”

These days, the 29-year-old Los Angeleno creates one or two “Total War: Warhammer” videos a day and streams on Twitch three or four times a week. He’s even been able to get back into jujitsu.

“The protocol for gamers is similar to individuals working on computers all day long,” Scolari said. “I used to sit for four or five hours at a time and my posture was terrible. Whenever you can, stand up and shake out your shoulders and do light stretching so you don’t get inflamed across your body.”

Harrison actually created a series of YouTube videos to educate all gamers about the importance of stretching, taking breaks, and increasing circulation to prevent potential injuries from gaming too much. He teamed up with professional “Osu” player Remco Merkestijn on several videos for his YouTube channel, which has over 45,000 followers and over 5.5 million video views. He’s also on Twitch regularly (@drleviharrison).

Unfortunately, Merkestijn, the 26-year-old music rhythm gamer, didn’t heed some of the messages in those videos himself. After playing “Osu” for six to 12 hours a day over 10 years, he frayed a tendon in his left hand – the result of consistent strain over a long period of time.

“That’s why awareness is so important,” Merkestijn said. “If I had practiced what I preached better, I likely wouldn’t have had that issue. Anything that feels unusual, not even pain, but discomfort, is a sign you’re straining something you shouldn’t be straining. Stretches will strengthen what you already have, and help prevent anything back from occurring in the future.”

Those videos do have an impact on gamers, as well as pros. Harrison attended the grand opening of LA-based Team Liquid’s Alienware Training Center last month and he said several players came up to him and thanked him for putting together the informational videos that lay out exercise routines for specific games.

“Health is a very unsexy subject, in general. And Dr. Levi brings a genuine message to awareness,” Merkestijn added.

Caitlin McGee, a physical therapist in Washington, D.C. who specializes in gaming and esports clients at 1HP Gaming, has seen a significant increase in awareness, attention, and interest on the part of players and teams when it comes to injury prevention, healthy lifestyles, and injury management.

Along with Los Angeles-based physical therapist Matt Hwu, 1HP Gaming started out primarily working with players one-on-one, but now also does team assessments and work onsite at tournaments like the Intel Extreme Masters.

“Our primary goal is to prevent the need for surgery to address an injury in the first place by incorporating ergonomics, exercise, and nutrition management,” McGee said. “For the most part, the kinds of repetitive stress injuries that we see in esports are best addressed with physical therapy and don’t require surgery. The kinds of cases we refer to surgeons usually involve either traumatic injuries or a patient ignoring and mismanaging an injury for a prolonged period of time.”

“I’ve found that players who do customized stretches for the game they play and their style of play will have fewer injuries and can play longer during the day, if they have a coordinated fitness and nutritional program,” Harrison said.

Harrison does practice what he preaches. A gamer his entire life, he only plays two to three hours a week now. And he sticks with PC games like “Overwatch,” “CS:GO,” and “Call of Duty,” preferring the mouse-and-keyboard set-up to the controller.

“I can’t play longer because of how my hands are affected when operating,” Harrison explained. “I need to be steady with the scalpel. And I do the exercises I created to make sure my hands, and body, are in good shape.”

Harrison sees a future where health will become even more important in esports. There are ongoing discussions for video gaming to become part of the upcoming Olympic Games as early as Japan. And with the NFL, MLS, NASCAR, Formula One, FIFA, and NBA all actively involved with esports today, the line between traditional sports and competitive gaming will only continue to blur.