March 26, 2021 • 39 mins
Esports Phyiotherapist and all-round gaming superhero Violeta Ivanova talks to us about the benefits of health support for esports professionals.
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Episode Transcript
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James Crow (00:00):
Hi, everybody, thanks so much for coming back
(00:01):
to the Posture Stars podcast.
It's James here again. And todaywe're going to be speaking to
Violeta Ivanova who's aphysiotherapist working in
eSports. Hello, Violeta.
Violeta Ivanova (00:11):
Hi, thank you for having me.
James Crow (00:13):
Thanks so much for coming on. I've been really
looking forward to speaking toyou. I've heard a lot of stuff
going on on the internet abouthow you're helping people in
eSports, and I've a particularinterest in playing computer
games myself. So it's right upmy street. So what are you doing
at the moment with eSports?
Violeta Ivanova (00:30):
So I'm working as a physical performance coach
for Roots Gaming, the Finnih CS:GO team. So we're working
on trying to get the basics,right, the ergonomics, the nut
ition, sleep, and then furthermoving into exercising and try
ng to get the in-game performnce increased from having
(00:53):
hysical interventions.
James Crow (00:55):
Wow. So they're getting the full package, and
they're getting really welllooked after. If these were a
cow that you could eat, they'dbe the most massaged cow on the
planet.
Violeta Ivanova (01:04):
I should hope so!
James Crow (01:06):
I was thinking earlier, gaming now is so
popular, it's become morelucrative in many ways than
film. And I think gaming isbringing in more money than film
at the moment, is that right?
Violeta Ivanova (01:17):
Yeah, I think so. Especially during the last
year, and now that we'recontinuing with the whole COVID
situation worldwide. There'sonly as many marathons on
Netflix you can do before yourun out of options that you're
interested in. And I think whenit comes to film, and watching
TV series, or TV, in general,it's a very passive kind of
(01:41):
content consumption, which getsboring really quickly. Like you
get through the binge, and thenyou have nothing else to do. And
after, maybe a month, for thereally hardcore people, it's
gonna become a bit boring. Sogaming comes into place, because
it's interactive. So you get allthe dopamine from the
(02:04):
gamification mechanics includedin games, it's fun, it's social,
for the most part. And it's alot more rewarding than just
sitting and watching something.
James Crow (02:17):
Totally, I always say, if your screen hasn't got a
mouse attached to it one way oranother, then it's broken. It's
no use to you, you need to beinteracting with technology
nowadays, rather than sittingpassively. And you know, there's
great stuff to watch on Netflixand Amazon and all those shows,
but there's nothing that canbeat playing with your friends
and playing onlineinteractively. But what worries
me is that a lot of people arespending all day maybe at work
(02:39):
or at college, and then they'respending all their evenings
playing games, and they're notlooking after themselves
physically. And that's, I guess,where you come in.
Violeta Ivanova (02:46):
Yeah. And I think in the last couple years,
as well, there has been a bigrise in exergaming or exercise
games, which use all thebenefits on gaming, but they
make you move around.A few yearsago, we had the whole Wii
situation but now it's even morewith Nintendo Switch. I think
(03:10):
you guys in the UK area, soldout completely on the Ring Fit
Adventure hardware, that wasquite fun to watch before the
second lockdown, or third orwhatever number you guys are on
now.
James Crow (03:23):
We've lost count!
Violeta Ivanova (03:26):
Yeah, and then with the development of VR, Beat
Sabre has been massivelysuccessful. So there is
definitely a move towardsgetting gamers more physically
involved in playing. But I doagree that a lot of gaming done
is very sedentary, and you losevery quickly track of time. And
(03:51):
then it predisposes for biggerrisks. And part of what I do,
and why I do it, is that I wantto help gamers, and especially
on the professional level, to beable to play as long as
possible, because it issomething that they've chosen as
a profession. So I'd like tomake sure that they can do it
(04:13):
for as long as possible, butalso as safely as possible.
James Crow (04:17):
So this is a real challenge for gaming, isn't it
because when I work with officeworkers at the moment, people
working from home in particular,we use queues to get them
moving. We use break timers, weuse cognitive tricks to get them
to pay attention to themselveswhilst they're paying attention
to the screen. Whereas whenyou're in a game, you are
completely lost in the game andvery unlikely to want after 20
(04:39):
minutes, something to bereminding you to get up and move
and stretch. It's just not gonnawork.
Violeta Ivanova (04:45):
Yeah, it's a lot easier to lose track of
time. And there's a lot morefocus being involved when you're
playing a game, well as comparedto office work. And I think the
challenge is to make sure thatplayers know that while you're
playing or performing it, it'sokay to not pay that much
(05:05):
attention. And that might soundvery controversial. But when
when players compete, I don'twant them to think about
anything else but getting thatwin. And I understand that
there's a lot of focus beinginvolved in that. So this is the
only thing I want them to thinkabout. After the match is done,
then we can think about "Okay,now we have 5 minutes, 10
(05:29):
minutes, 20 minutes before thenext game, what can we do within
that time", because 10 minutesis still quite a good amount of
time to do some physical,physical work. So what can we do
within within that time that wehave to make sure that you can
perform as good within the nextgame when you have to win again.
(05:52):
So this is kind of how we'resplitting it. in office work,
you would have the 20 minutes or30 minutes that you can get up
at any point and still do yourjob. In gaming, we do it so that
if a match is 30 to 40 minutes,then we take the stretching or
posture adjustment right afterthat, and then they can go back
(06:14):
to playing. And then within thenext break, there would be more
physical activity. There will beone alternative for those
playing at home. Or if you'renot competing on the match kind
of system (06:26):
Every time you die, and you have to wait for
respawn, you can do some squats,you can do some stretching, you
can do a couple jumps, and thenget back into the game. Because
in some games that could stretchinto quite a while for just
doing nothing and waiting, likeLeague of Legends is one of
them. If you die a lot, you willwait a lot for respawn. So I
(06:49):
like to tell my players that bythe end of this, you're either
going to be a better player andnot die as much, or you're going
to be better physically. And inmy opinion, it's a win-win.
James Crow (07:00):
Yeah, so definitely a win-win if they can play
better and take the time to lookafter themselves as well. In
terms of peripherals andinterfaces. I've always been a
PC gamer, as long as PC gameshave been around. So whenever I
think about posture for eSports,I always think about keyboards
and mice. Is that stillpredominant?
Violeta Ivanova (07:18):
Yeah, that would be the case in the
majority of the gaming.
James Crow (07:23):
How do people choose a good keyboard what is a good
keyboard that would help themergonomically?
Violeta Ivanova (07:28):
It's really hard to say and it is definitely
a rabbit hole that I went down.
When I was writing my thesis oncarpal tunnel syndrome and
esport, your wrist ergonomicsplay a really big part in how
much stress is your hand goingto be under. There is no right
solution. In this case, becausegaming peripherals are quite
(07:51):
different from office ones. Inthe sense that the buttons are
higher, if you get somethinglike typical mechanical gaming
keyboard, the buttons will behigher or taller than the
standard office keyboard, you'remore likely not going to have a
wrist rest on them, you're morelikely not going to have it a
(08:14):
very ergonomically adjustedoffice setting. So most gamers
will play at home where theyhave designed their desk based
on mostly aesthetics rather thanfunction. And there's nothing
really that we can do aboutthat. So it's more the
(08:34):
intervention comes in the timesthat they can get out rather
than while they're using theperipherals. Something that
could be adjusted is more whenit comes to mouse usage in terms
of grip styles or higher-endperformance. A lot of players
are utilising a claw grip, whichcan put a lot more stress on the
(08:55):
wrist. And what I found duringmy thesis was that the longer
distance travelled with themouse hand, led to a higher
chance for developing symptomslike burning in the fingers or
in the hand, which is notnecessarily a risk for carpal
tunnel syndrome. But it tells usthat there is something that we
(09:16):
can do about alleviating that.
So in this sense, I haveinstructed my players to if you
if you like using claw gripwhile you compete, that's fine,
do it. But most of the othertime, try to use a more relaxed
palm grip which is not going tostress out your rest as much.
(09:38):
Addressing something like mousesize is also good. If you have
really big hands you shouldn'tbe using a mouse that is way too
small for you. Because that isjust awkward for your wrist
position. But in the end of theday in terms of performance,
players know and trust theirperipheral so I wouldn't want to
(09:59):
change that too much, but ratherwhat else we can do to help with
that.
James Crow (10:04):
Oh, I get you, I get you. So they've got their
favourite mouse and they get thebest performance from it. And no
matter what you said in terms ofmusculoskeletal risk, you're
unlikely to change their mind onusing that product. I like to
mitigate my risk because I workat a keyboard, and I also play
lots of games. So I use, it'scalled a Contour Unimouse, have
you come across these? So I canswitch between an upright grip
(10:28):
and a near horizontal grip aswell. And so playing first
person I'll have the morehorizontal, and if I'm doing
office tasks I'll do the morevertical. Do you think that's a
good idea?
Violeta Ivanova (10:37):
Yeah, I think so. We're kind of doing the most
of the time versus some of thetime. And that would also apply
for any kind of postureadjustment or ergonomic
adjustment that you want, mostof the time, to be doing things
correctly, or as correctly asyou can. And then some of the
time, which would be the timethat you are competing, you're
(10:59):
performing, you have otherpriorities, then your posture,
then, in this sense, just do ithowever you feel comfortable,
whatever you're used to. Andwith time, the "most of the
time" will become "all of thetime", but it takes a long time
to to get used to having adifferent posture or a different
(11:23):
grip. So we are working on 80%versus 20% in terms of
peripheral usage. And it's a lotmore attainable, in my opinion,
for players. And it's a goodconversation starter. And it
won't it won't hinderperformance because every time
(11:44):
you approach a professionaleSports athlete and you say
"hey, I can help you with this,this and that". And all they can
hear is "okay, so you're gonnatake me out of practice, or
you're gonna change somethingabout the way I do things. I
don't like it because I want towin". It's like no, we want
people to win, it's justeverything else we can do to
(12:06):
help them. It's going to helpwith more winnings in the
future.
James Crow (12:11):
It's difficult to persuade them to pay attention
to improving their form. They'drather be just there in the
moment, making the small winsand winning that way. Wow.
difficult. It's a difficultsell, isn't it, but I'm sure the
companies that employ you seethe benefit. When I started
gaming, we used to play a game,this is back in the 80's, and we
used to play a game called DailyThompson's decathlon which
(12:32):
involves hammering your keyboardas fast as you can with two
digit fingers, or using acompetition pro joystick and
thrashing it from left to rightfor about 10 minutes at a time.
And I ended up in later lifesuffering from repetitive strain
injury which I've sinceovercome. But I blame Daley
Thompson personally. So if he'sstill out there and listening,
(12:53):
"Daley Thompson, it's your faultto answer for!"
Violeta Ivanova (12:59):
Gaming is nothing new. And competitive, or
in some cases, obsessive gamingis also nothing new. The parents
who are mad at their kidsplaying Fortniyr nowadays, were
probably the same ones who intheir childhood, were completely
obsessed over playing Mario. Andspending late nights just
hammering that thumb into thecontroller. And their parents
(13:24):
who were mad at them then, wereprobably the kids in their
childhood who had wrist painfrom using a Rubik's Cube too
much. Because that was also athing about carpal tunnel
syndrome in in the past, whenRubik's Cube became the new
mania, everyone was doing it allthe time, everywhere. There's
(13:47):
nothing new about people playingsomething that they enjoy for
long hours in a day. It's justhow we can support them in that.
James Crow (13:56):
Maybe all those parents are getting fed up
because they want to use thescreen and play something more
sedate like Valheim or somethingthemselves.
Violeta Ivanova (14:03):
Maybe they should play with their kids.
James Crow (14:05):
Well, maybe maybe they should. I have a I have a
young kid and he's always reallykeen to play with me, but I'm
keeping him away from computergames and screen time until he's
older. Because I know howaddictive it was when I was
younger. I was particularly goodat sports at junior school until
we got a Commodore 64. And thenI was really good at Rambo! In
(14:26):
fact, I was the third best inBritain on Rambo on the
Commodore 64 in 1986. Andpersonally, I think I was first
best but the department I sentmy score to were delayed in
printing it. So that man who gotfirst best on Rambo in 1986 I'm
coming after you, I'm gonna beatyou. He's out there somewhere. I
guess people also they like toget the hands busy. They use
(14:48):
fidget spinners and all sorts ofstuff like that nowadays as
well. What's going to happen asVR takes over? Are we likely to
see less and less keyboard andmouse use? VR is becoming really
popular at the moment this year.
How's that going to work witheSports?
Violeta Ivanova (15:04):
There is already VR being used in
simulator racing, as far as Iknow, or at least is very
popular in something likeFormula One eSports or rally
games. In Finland, they'retrying to build a whole VR
eSports League, but I'm not sureyet what kind of games are
(15:25):
involved there, I think it hasits uses, definitely, I think
we're gonna see a lot moredevelopment from the sorts of
something like Half Life Alyx,that was a really good example
on what you can do in terms offirst person shooter in a VR
setting. So I think we need towork more on the peripherals. A
(15:47):
lot of gamers have been askingfor an omnidirectional
treadmill. Just that experience.
I think before we get to that,we might see more broken TV
screens, which is always thecase when something new comes
up. But I personally think it'svery exciting. This is still
pandemic time. And I don't thinkit's getting away anytime soon.
(16:10):
And it's probably not going tobe the last one that's going to
make everybody stay at home. SoVR offers quite unique
possibilities for entertainment,but also for movement. Games
like Beat Sabre have been reallygreat in terms of movement, but
also, at least I follow a lot ofrehabilitation scene. So for
(16:31):
rehabilitation, VR has beenamazing. We've seen cases of
burn victims that have hadreduced amount of medication
because they use VR treatment.
And it has shown that it'sreducing their pain. And a lot
of chronic pain patients alsorespond very positively to VR
(16:56):
treatments or games, orsomething along those lines.
Even if it's just a virtualtrip, somewhere. We've seen a
lot of elderly homes also adoptthese kind of virtual travels,
virtual explorations. I believepersonally, it's a myth that
elderly people are too afraid oftechnology. At least in my
(17:19):
experience, they really enjoy itbecause it's something new and
fun. And they're very eager touse that. So in that sphere,
it's very well developing. Andwe're seeing a lot of assistive
aids to come with it, which willeventually transfer into the
(17:39):
more traditional gaming. Sowe'll get to see eventually, the
omnidirectional treadmill andall the gun attachments for
first person shooters for VR.
James Crow (17:51):
I can't wait.
Personally, I can't wait. Iwonder with regards to elderly
people and what you were saying,that that they're not really
afraid of the technology. That'smy experience, too. There's a
bit of a meme out there that oldpeople are afraid of new
technology. But I think whatpeople are seeing is that, yes,
some older people are afraid ofnew technology. But they're also
(18:11):
afraid of any change. Whereasgenerally older people embrace
change, and are quite lookingforward to new activities. So I
think that's misguided, thatgeneralisation
Violeta Ivanova (18:24):
And I wish I could see more of healthcare
professionals embracingtechnology as well, because
there is the, I don't know if Ishould call it disconnection.
But it is widely considered assomething that we shouldn't
really focus on, until weactually have to focus on it.
But by that point, it's been 20years and somebody else has been
(18:47):
using new technologies to helpothers for all this time. At
least on my behalf. I try tokeep up with what's coming out.
Even if it's something that hasnot been necessarily backed by
solid amount of science, I wouldlike to try it out. And I would
like to offer it to my clientsand to my patients. Because what
(19:12):
we're doing now, what we'reoffering, is treatment, which
is, the most typical would beyou got to see a physio they
give you a piece of paper with aprogramme and tell you "see you
in two weeks and do theseexercises at home." Most of the
time people don't do it and theprogramme ends up in the back of
a drawer and they come back intwo weeks. They're like "yeah,
(19:33):
of course I've done it." When infact you can see that they have
no idea what exercises we'retalking about. So using
gamification, using technologiesto help motivate them through
that process and to make it morefun, that can definitely show
much better results in therehabilitation process. Because
(19:54):
you can't expect somebody to go,in some cases we have might take
even 6 months to 12 months.
No-one's gonna follow a piece ofpaper for 6 to 12 months every
single day. It's not motivating.
It's not fun. And there's otherways to do it. So why not offer
that? Rehabilitation doesn'thave to be a chore. Being
(20:15):
healthy shouldn't be a chore toanybody.
James Crow (20:18):
With virtual reality, is there a
musculoskeletal risk, do youthink, in wearing extra weight
attached to the front of thehead?
Violeta Ivanova (20:27):
There has not been any any confirmation or any
issues with people using thateven if we're talking arthritis.
cases, it's not really relatedto the weight of the device
itself. If anything, it helpspeople move, which improves
their wellbeing afterwards.
musculoskeletal conditions,something like arthritis will go
(20:50):
worse, the less you move, so wewant people who have arthritis
to keep moving and to be active.
So in this sense, the benefitswill overcome the the negatives.
James Crow (21:03):
Gabe Newell of Steam was recently talking about brain
computer interfaces (BCI). Andhe was talking about our limbs
as being, I remember this wrongI only briefly looked at it, but
it was talking about our limbsbeing our meat peripherals. And
that our brain computerinterface won't need these so
much. That actually we'll getbetter sensory appreciation from
(21:26):
the brain computer interfacethan we would from our own
visual system, as an example.
Which kind of tends towards methinking, well, people are going
to be moving less if they usingbrain computer interfaces. Is
that something that's risen inyour arena? Or is that still too
fresh to contemplate?
Violeta Ivanova (21:43):
I have heard kind of similar things from
eSports players along the linesof "why would we need a physio
if we sit all day, and we usecognitive performance to play
games." But truth is, even ifyou get a computer in your
brain, you're not chopping offyour head to work independently.
So you still need the rest ofyour body to function. Because
(22:06):
we're not anywhere nearfunctioning only in the cloud,
as humans. So I would say that,yes, maybe for performance
purposes, you will get morebenefits from only using the
brain computer that you getHowever, for the rest of your
body to function, and for thatbrain computer to keep
functioning, you need the otherparts. So you'll have to move
(22:30):
anyway, in terms of if you wantto do better cognitive
performance, you need to alsohave physical health to achieve
that, because that will supportit. If you have poor physical
health, your cognitiveperformance will go down as
well, because you don't justfunction as the head. You also
have the rest of your bodyattached to it.
James Crow (22:50):
This is great news, everybody. For everybody, all of
you sat there listening to this,you're not just a head, you have
got a body attached, so makesure you look after it. And
yeah, that's probably news to alot of people Violetea. Very
cerebral people will oftenforget to look after themselves
physically. And the downside isthat they perform less well
cerebrally. And there is scienceto back that up. Although there
(23:11):
is a school of philosophy thatsuggests that we're all just
brains in vats and don't havebodies at all. So then that
means that Gabe Newell's braincomputer interface is a brain in
a vat in a brain in a vat. Andthe argument gets slightly
confusing. So maybe maybe we'rebrains in vats in the brain in
the vat in the brain in the vat,talking about brains in vats, I
don't know,
Violeta Ivanova (23:31):
I would tell them to talk to a psychosomatic
therapist because they mighthave something else to say,
because that is also part ofwhat physiotherapists do. Part
of it is psychosomaticphysiotherapy, in which to
really simplify it, the usualtreatment we do is for people
who have lost the connectionbetween their mind and their
(23:55):
body.
James Crow (23:55):
We need more of those, we need more of those
because where I am in thenorthwest of England, I'm not
alone in wandering mindlessaround the streets. Okay, well,
I guess I'd better bring up myfirst question, which we've
talked very much about eSportsand how you help, which is
really useful. So my firstquestion that I ask all of my
(24:16):
podcast guests is "Violetta,what is posture posture?"
Violeta Ivanova (24:21):
Posture is how you are as a human, within a
certain space. There is no rightposture, there is no wrong
posture. There is no brokenposture that needs fixing. It's
how you are and you can improveyourself, as with anything, but
there is nothing inherentlywrong with it.
James Crow (24:42):
I've worked with a lot of people with possible
problems, and some of them arenature and some of them are
nurture. And for someone to sayyou've got bad posture is a real
kick in the teeth to thosepeople. So to hear that posture
is movement within a continuum,then I think that's a really
good thing. How do you helppeople with their posture?
Violeta Ivanova (25:01):
I think you hit a really good spot there before
telling somebody that they havea bad posture or that something
needs fixing, actually does moreharm than helps anybody.
Because, the same as you'rewaiting in a waiting room before
seeing a doctor and seeing apicture with a red low back will
(25:24):
cause you to have more low backpain than you had before,
telling somebody that somethingwith them is wrong, it's going
to bring even worse symptoms andless motivation to get better
afterwards. So the way we helppeople, at least in Finland,
(25:45):
physiotherapists are therapists,we do a very holistic approach,
meaning that we have theknowledge, but we also ask
people what they prefer. Solet's say somebody loves to
swim, we can say, "Okay, let'sjust apply all the knowledge
(26:05):
that we have, as part of yourswimming programme or as Aqua
therapy", or if somebody likesnature, then we say, "Okay,
let's do the activitiesoutdoors." If it's possible,
somewhere in a forest. We do avery combined approach depending
on what is needed. So let's saysomebody has issues with pain,
(26:27):
which is the usual case in whichpeople would come to us, and if
that is looking like it'sstemming from poor posture, then
we try to alleviate that throughexercising, through
strengthening muscles andstructures, and to really help
the person get better habits intheir life, which will continue
(26:51):
that progress that we want tosee. And eventually their
symptoms will lessen. And ifit's something more acute, of
course, we have other methodslike kinesio typing, and in some
cases, manual mobilizations.
However it's a lot moredifficult, when in order for
someone to get better, you needthem to actually do it
(27:12):
themselves. So we're going awayfrom all the manual therapies
and procedure based therapy inFinland, and more towards
empowering people and motivatingthem to take better care of
themselves.
James Crow (27:26):
Definitely the right way to be doing it. Although I
am a bit scared. As you saidearlier, it was minus 17 degrees
centigrade in Finland. And ifyou are encouraging people to go
swimming outdoors, you might notsee much more of them after
that, that might be the end ofthem.
Violeta Ivanova (27:42):
Actually, ice swimming is really popular here.
People do it. There arecertainly benefits, particularly
in neurological clients. I'veheard a lot of patients with,
let's say, MS (muscularsclerosis). That or Parkinson's,
that say that colder water helpsthem and they use it as part of
(28:02):
the rehabilitation. Some peoplewould go, at least once a week,
go to some ice swimming spot,and then they feel a lot better.
Or if we have Aqua therapy, theywould they would feel a lot
better if the water is a bitcooler for them because it helps
their normally overexcited neurosystem to be a bit more calm. So
(28:23):
then they could do activities abit more fluently.
James Crow (28:26):
When I go surfing in the North Sea., i'ts always when
I fill up my most alive ,whenthe water is absolutely freezing
cold. It really wakes you up.
Okay, so fantastic. You've told
Violeta Ivanova (28:35):
Keep changing positions. It's something that
me what do you think posture isand how you help with posture.
So I have a final question whichI like to ask, which is "For
ur listeners right now, if thre was one thing that they could
do to improve their posture, wat would that
James Crow (28:48):
Yeah, you heard it here. Everybody get get out of
people who try to sell ergonomicsolutions, they really hate
physios for saying that. Butwhatever you're using, whether
your chair or if you've beenstanding for long periods of
you're at home, at the office,or anywhere else, just keep
changing your position becauseit like mentioned earlier, it's
(29:10):
not the sitting that is going tocause your symptoms. It's the
sitting for too long. And itwill happen the same way as if
you're standing for too long. Sothere is not necessarily an eas
solution. A quick tip would bjust keep changing pos
tions and keep moving aro nd.
(29:34):
time go and have a rest. I lovesit stand electric desks and I
use one of them every day. Isthat something that has any
benefits at all in eSports? Dopeople stand to play?
Violeta Ivanova (29:44):
I think most don't because it is still
something that is quiteexpensive to get. And usually
it's something that officeswould be equipped with, at least
in Finland, but what I'venoticed in more traditional
physiotherapy work is thatpeople who have sit-to-stand
desks, they either sit or theystand, they forget the whole
(30:07):
point that it can be adjusted.
And the idea of it is that youchange your position, like once
every couple of hours. Like Imentioned, if you stand for a
whole day, it's not gonna do youany better than if you sit all
day. Sit to stand desk is great,I think it's a really nice
possibility that you couldchange your position every once
in a while. If you don't haveaccess to a sit to stand desk
(30:29):
than having a normal desk, butsitting on something like an
exercise ball, or just having abalance cushion on your normal
chair can help you achieve thatmoving your position around and
weight shifting of your body,even when you're not entirely
changing your your posture likesitting to standing.
James Crow (30:52):
I guess that's what you're doing with your gaming
community, Violeta, is that theyare sitting, dedicated sitting
for the period of theircompetitive sport. And then
you're getting them to moveimmediately afterwards and
recover from from the downsideof being static and engrossed in
the game for so long.
Violeta Ivanova (31:10):
Yeah, you will be surprised what a couple of -
just stand up, shake your legsaround, do a little bit of
stretching, and maybe walkaround the house. If you have
stairs, go up and down like 5 to10 stairs and then get back into
the chair. It does improve yourfocus, it gives you a little bit
(31:30):
of change. Not only talkingabout a sitting ergonomics, but
also your environment (31:34):
having the same environment and the
same focus point for longperiods of time will get you're
really tired of it. So you wantto be able to change that
around, whether it's to look atsomething else, or to look
through the window. So we wantto keep that going, to have the
(31:57):
focus, then have a little bit ofshift of position on what your
eyes are seeing, to also helpwith the fatigue. And then get
back into the chair, do yourjob. And then you swap again.
James Crow (32:10):
So a lot of people will be sitting for a while and
then they'll stand but they'relooking at their phone and
scrolling through their phone,and the focal length of their
eyes isn't changing from onescreen to the next. Whereas
looking out of a window is agreat exercise and rest for your
eyeballs, which is really goodthing to do. Do you have your
eSports competitors work ontheir eyes as much as you work
on the rest of theirphysicality?
Violeta Ivanova (32:31):
I think in terms of eye health, the biggest
thing that we've been discussingis more to get a good amount of
sleep, to have appropriatelighting in the environment that
they're playing at. So theenvironmental ergonomics are a
big factor, especially inFinland, where the matches are
(32:51):
usually done with UK time. Sofor here, it's plus two hours.
So they will be pretty late inthe evenings. Something like 9
or 10pm. You also have theenvironment outside which in
winter, that means that there isabout two to three hours of
daylight in my area. And thensummertime it switches to the
(33:11):
point where the sun doesn't set.
So you really need to be able toinfluence your working
environment, and your sleepingenvironment.
James Crow (33:20):
So I'm hearing a really interesting theme that's
coming across in everything thatyou've mentioned, it's about
mobility and fluidity,physically. Also in terms of use
of peripherals and ergonomics,and of the environment, of the
light. Really, you aresuggesting mobility, in all
(33:41):
aspects of working and gaming aswell
Violeta Ivanova (33:44):
Yes the possibility to change your
environment and yoursurroundings. I think it's
especially important for notjust gamers ,who are mostly
focused at home, but also toanybody else who is working from
home. I think the part that thatgets people fatigued like ,
(34:05):
we're talking now about zoomfatigue and working from home
fatigue. You see the same thingevery single day. And that is
very tiring. If the only thingyou do is get from bed to your
desk and then back to the bed itcan get very monotonous pretty
quickly. So you can do so manythings, to just change around
(34:28):
your environment, without havingto change that much necessarily.
Lighting is one of them. Movinghow your monitor is positioned
is also one thing, because sureyou're looking at your monitor
the whole time, but your eyesalso see what's around it. So
changing out those things thatare behind your monitor or
(34:51):
around it can can really make adifference in how you feel
during the day and how tired youare at the end of it.
James Crow (34:59):
That's something I'd never considered, the stuff of
behind and around your monitor.
We're advising at the momentthat if people spend a quarter
or a third of their day on zoomor teams that they do their
teams and zooms standing. Andthen they do the rest of the
work sitting to get somevariability in. But I had never
considered changing what isgoing on behind the monitor, I
guess that's a new one on me.
(35:21):
Maybe people should have a fishtank behind their monitor, or I
guess people with dogs get a lotand cats get a lot of movement
going on.
Violeta Ivanova (35:28):
Yeah, that would be one option. Another one
that I would suggest would behaving a window behind your
computer monitor, I've seen alot of people have their window
behind their back, which in myopinion, is quite distracting.
Because if the sun is shining,it's going to shine straight to
your monitor and be a lot morestraining on your eyes, if you
(35:50):
need to look at it for half theday. Rather than that, just move
your monitor, if possible to bein front of your windows so that
your eyes have that visual breakwith the background. Having a
plant around you is alsobeneficial. It's not necessarily
going to clean your air, likemost people believe. You don't
(36:13):
live in a jungle, if you dogreat, but it gives you that
visual visual change. And it'ssomething that itself will
change as it grows. So it addsvalue to that. But also
different kinds of lightingbehind your monitor. I know some
gaming monitors have that led inthe back. During the day, you
(36:36):
can change it in differentcolours, not necessarily the
rainbow effect, I would notrecommend that but change it to
a different static colour, orduring the different times of
the day. That would be great.
Changing wall art if you can. Ifyou can't, then you can put it
on the side of your computer andjust keep changing them up every
(36:56):
couple of weeks. It just makesit new without having anything
necessarily new.
James Crow (37:05):
That sounds like a real good incentive for our
listeners to do a bit of movingstuff around on their desk,
after listening to this podcast.
In fact, turn us off right now.
Stop listening to this and getyour desk sorted and dust it as
well. If you're if your desk isanything like my desk at the
moment, believe me, it's notgood for the environment. I do I
do have plants on my desk, butthey are also covered in a layer
(37:25):
of dust. So maybe that's not sogood for my environment. I think
we do have the same one.
Violeta Ivanova (37:31):
Yeah, spider plants!
James Crow (37:33):
Yeah. Which which are supposed to be very good for
breathing quality. But ifthey've got half an inch of dust
on, like mine, then maybe that'sthat's not the case. I think I'm
gonna have to clean my plantsnow, thanks for this Violeta!
Violeta Ivanova (37:47):
There goes the rest of the day!
James Crow (37:50):
Stick it on the to do list.
Violeta Ivanova (37:52):
Actually, in the last year, house plants have
been just completely explodingin terms of market sales because
people are stuck at home. Sothey need something to do that
it's not involving computerscreens. So people have been
buying and buying house plants,which I think is great.
Gardening is definitely a nicehobby to have with all the
(38:14):
mental health benefits. And itcauses you to move around, which
is great. And now a lot ofpeople are transitioning into
growing different kinds ofvegetables and herbs, which is
also great. So yeah, get someplants around your computer, and
you're gonna feel really niceand refreshed.
James Crow (38:32):
Excellent, excellent advice. And if you can't get
them inside, then make sure toget a little bit of time outside
as well. Unless it's pitch blackand minus 17 degrees in which
case wrap up warm first, but doget outside. You've got to
haven't you.
Violeta Ivanova (38:46):
Yeah, you have to.
James Crow (38:47):
Okay, so I've enjoyed speaking with you
Violeta Ivanova, physiotherapistspecialising in eSports. That's
been really helpful. I'velearned loads of stuff from you
today. And I feel like I'mcompletely up to date now in
terms of physiotherapy andeSports. So I can pretend to
know lots about it, now, as aresult of doing this podcast,
and I hope our listeners feelmore educated as well. Thank you
(39:09):
so much for your time.
Violeta Ivanova (39:10):
Thank you for having me.
James Crow (39:11):
Now everybody go on, go and clean your house plants.
Get out of here. Cheerio.
Hi, everybody, thanks so much for coming back
(00:01):
to the Posture Stars podcast.
It's James here again. And todaywe're going to be speaking to
Violeta Ivanova who's aphysiotherapist working in
eSports. Hello, Violeta.
Violeta Ivanova (00:11):
Hi, thank you for having me.
James Crow (00:13):
Thanks so much for coming on. I've been really
looking forward to speaking toyou. I've heard a lot of stuff
going on on the internet abouthow you're helping people in
eSports, and I've a particularinterest in playing computer
games myself. So it's right upmy street. So what are you doing
at the moment with eSports?
Violeta Ivanova (00:30):
So I'm working as a physical performance coach
for Roots Gaming, the Finnih CS:GO team. So we're working
on trying to get the basics,right, the ergonomics, the nut
ition, sleep, and then furthermoving into exercising and try
ng to get the in-game performnce increased from having
(00:53):
hysical interventions.
James Crow (00:55):
Wow. So they're getting the full package, and
they're getting really welllooked after. If these were a
cow that you could eat, they'dbe the most massaged cow on the
planet.
Violeta Ivanova (01:04):
I should hope so!
James Crow (01:06):
I was thinking earlier, gaming now is so
popular, it's become morelucrative in many ways than
film. And I think gaming isbringing in more money than film
at the moment, is that right?
Violeta Ivanova (01:17):
Yeah, I think so. Especially during the last
year, and now that we'recontinuing with the whole COVID
situation worldwide. There'sonly as many marathons on
Netflix you can do before yourun out of options that you're
interested in. And I think whenit comes to film, and watching
TV series, or TV, in general,it's a very passive kind of
(01:41):
content consumption, which getsboring really quickly. Like you
get through the binge, and thenyou have nothing else to do. And
after, maybe a month, for thereally hardcore people, it's
gonna become a bit boring. Sogaming comes into place, because
it's interactive. So you get allthe dopamine from the
(02:04):
gamification mechanics includedin games, it's fun, it's social,
for the most part. And it's alot more rewarding than just
sitting and watching something.
James Crow (02:17):
Totally, I always say, if your screen hasn't got a
mouse attached to it one way oranother, then it's broken. It's
no use to you, you need to beinteracting with technology
nowadays, rather than sittingpassively. And you know, there's
great stuff to watch on Netflixand Amazon and all those shows,
but there's nothing that canbeat playing with your friends
and playing onlineinteractively. But what worries
me is that a lot of people arespending all day maybe at work
(02:39):
or at college, and then they'respending all their evenings
playing games, and they're notlooking after themselves
physically. And that's, I guess,where you come in.
Violeta Ivanova (02:46):
Yeah. And I think in the last couple years,
as well, there has been a bigrise in exergaming or exercise
games, which use all thebenefits on gaming, but they
make you move around.A few yearsago, we had the whole Wii
situation but now it's even morewith Nintendo Switch. I think
(03:10):
you guys in the UK area, soldout completely on the Ring Fit
Adventure hardware, that wasquite fun to watch before the
second lockdown, or third orwhatever number you guys are on
now.
James Crow (03:23):
We've lost count!
Violeta Ivanova (03:26):
Yeah, and then with the development of VR, Beat
Sabre has been massivelysuccessful. So there is
definitely a move towardsgetting gamers more physically
involved in playing. But I doagree that a lot of gaming done
is very sedentary, and you losevery quickly track of time. And
(03:51):
then it predisposes for biggerrisks. And part of what I do,
and why I do it, is that I wantto help gamers, and especially
on the professional level, to beable to play as long as
possible, because it issomething that they've chosen as
a profession. So I'd like tomake sure that they can do it
(04:13):
for as long as possible, butalso as safely as possible.
James Crow (04:17):
So this is a real challenge for gaming, isn't it
because when I work with officeworkers at the moment, people
working from home in particular,we use queues to get them
moving. We use break timers, weuse cognitive tricks to get them
to pay attention to themselveswhilst they're paying attention
to the screen. Whereas whenyou're in a game, you are
completely lost in the game andvery unlikely to want after 20
(04:39):
minutes, something to bereminding you to get up and move
and stretch. It's just not gonnawork.
Violeta Ivanova (04:45):
Yeah, it's a lot easier to lose track of
time. And there's a lot morefocus being involved when you're
playing a game, well as comparedto office work. And I think the
challenge is to make sure thatplayers know that while you're
playing or performing it, it'sokay to not pay that much
(05:05):
attention. And that might soundvery controversial. But when
when players compete, I don'twant them to think about
anything else but getting thatwin. And I understand that
there's a lot of focus beinginvolved in that. So this is the
only thing I want them to thinkabout. After the match is done,
then we can think about "Okay,now we have 5 minutes, 10
(05:29):
minutes, 20 minutes before thenext game, what can we do within
that time", because 10 minutesis still quite a good amount of
time to do some physical,physical work. So what can we do
within within that time that wehave to make sure that you can
perform as good within the nextgame when you have to win again.
(05:52):
So this is kind of how we'resplitting it. in office work,
you would have the 20 minutes or30 minutes that you can get up
at any point and still do yourjob. In gaming, we do it so that
if a match is 30 to 40 minutes,then we take the stretching or
posture adjustment right afterthat, and then they can go back
(06:14):
to playing. And then within thenext break, there would be more
physical activity. There will beone alternative for those
playing at home. Or if you'renot competing on the match kind
of system (06:26):
Every time you die, and you have to wait for
respawn, you can do some squats,you can do some stretching, you
can do a couple jumps, and thenget back into the game. Because
in some games that could stretchinto quite a while for just
doing nothing and waiting, likeLeague of Legends is one of
them. If you die a lot, you willwait a lot for respawn. So I
(06:49):
like to tell my players that bythe end of this, you're either
going to be a better player andnot die as much, or you're going
to be better physically. And inmy opinion, it's a win-win.
James Crow (07:00):
Yeah, so definitely a win-win if they can play
better and take the time to lookafter themselves as well. In
terms of peripherals andinterfaces. I've always been a
PC gamer, as long as PC gameshave been around. So whenever I
think about posture for eSports,I always think about keyboards
and mice. Is that stillpredominant?
Violeta Ivanova (07:18):
Yeah, that would be the case in the
majority of the gaming.
James Crow (07:23):
How do people choose a good keyboard what is a good
keyboard that would help themergonomically?
Violeta Ivanova (07:28):
It's really hard to say and it is definitely
a rabbit hole that I went down.
When I was writing my thesis oncarpal tunnel syndrome and
esport, your wrist ergonomicsplay a really big part in how
much stress is your hand goingto be under. There is no right
solution. In this case, becausegaming peripherals are quite
(07:51):
different from office ones. Inthe sense that the buttons are
higher, if you get somethinglike typical mechanical gaming
keyboard, the buttons will behigher or taller than the
standard office keyboard, you'remore likely not going to have a
wrist rest on them, you're morelikely not going to have it a
(08:14):
very ergonomically adjustedoffice setting. So most gamers
will play at home where theyhave designed their desk based
on mostly aesthetics rather thanfunction. And there's nothing
really that we can do aboutthat. So it's more the
(08:34):
intervention comes in the timesthat they can get out rather
than while they're using theperipherals. Something that
could be adjusted is more whenit comes to mouse usage in terms
of grip styles or higher-endperformance. A lot of players
are utilising a claw grip, whichcan put a lot more stress on the
(08:55):
wrist. And what I found duringmy thesis was that the longer
distance travelled with themouse hand, led to a higher
chance for developing symptomslike burning in the fingers or
in the hand, which is notnecessarily a risk for carpal
tunnel syndrome. But it tells usthat there is something that we
(09:16):
can do about alleviating that.
So in this sense, I haveinstructed my players to if you
if you like using claw gripwhile you compete, that's fine,
do it. But most of the othertime, try to use a more relaxed
palm grip which is not going tostress out your rest as much.
(09:38):
Addressing something like mousesize is also good. If you have
really big hands you shouldn'tbe using a mouse that is way too
small for you. Because that isjust awkward for your wrist
position. But in the end of theday in terms of performance,
players know and trust theirperipheral so I wouldn't want to
(09:59):
change that too much, but ratherwhat else we can do to help with
that.
James Crow (10:04):
Oh, I get you, I get you. So they've got their
favourite mouse and they get thebest performance from it. And no
matter what you said in terms ofmusculoskeletal risk, you're
unlikely to change their mind onusing that product. I like to
mitigate my risk because I workat a keyboard, and I also play
lots of games. So I use, it'scalled a Contour Unimouse, have
you come across these? So I canswitch between an upright grip
(10:28):
and a near horizontal grip aswell. And so playing first
person I'll have the morehorizontal, and if I'm doing
office tasks I'll do the morevertical. Do you think that's a
good idea?
Violeta Ivanova (10:37):
Yeah, I think so. We're kind of doing the most
of the time versus some of thetime. And that would also apply
for any kind of postureadjustment or ergonomic
adjustment that you want, mostof the time, to be doing things
correctly, or as correctly asyou can. And then some of the
time, which would be the timethat you are competing, you're
(10:59):
performing, you have otherpriorities, then your posture,
then, in this sense, just do ithowever you feel comfortable,
whatever you're used to. Andwith time, the "most of the
time" will become "all of thetime", but it takes a long time
to to get used to having adifferent posture or a different
(11:23):
grip. So we are working on 80%versus 20% in terms of
peripheral usage. And it's a lotmore attainable, in my opinion,
for players. And it's a goodconversation starter. And it
won't it won't hinderperformance because every time
(11:44):
you approach a professionaleSports athlete and you say
"hey, I can help you with this,this and that". And all they can
hear is "okay, so you're gonnatake me out of practice, or
you're gonna change somethingabout the way I do things. I
don't like it because I want towin". It's like no, we want
people to win, it's justeverything else we can do to
(12:06):
help them. It's going to helpwith more winnings in the
future.
James Crow (12:11):
It's difficult to persuade them to pay attention
to improving their form. They'drather be just there in the
moment, making the small winsand winning that way. Wow.
difficult. It's a difficultsell, isn't it, but I'm sure the
companies that employ you seethe benefit. When I started
gaming, we used to play a game,this is back in the 80's, and we
used to play a game called DailyThompson's decathlon which
(12:32):
involves hammering your keyboardas fast as you can with two
digit fingers, or using acompetition pro joystick and
thrashing it from left to rightfor about 10 minutes at a time.
And I ended up in later lifesuffering from repetitive strain
injury which I've sinceovercome. But I blame Daley
Thompson personally. So if he'sstill out there and listening,
(12:53):
"Daley Thompson, it's your faultto answer for!"
Violeta Ivanova (12:59):
Gaming is nothing new. And competitive, or
in some cases, obsessive gamingis also nothing new. The parents
who are mad at their kidsplaying Fortniyr nowadays, were
probably the same ones who intheir childhood, were completely
obsessed over playing Mario. Andspending late nights just
hammering that thumb into thecontroller. And their parents
(13:24):
who were mad at them then, wereprobably the kids in their
childhood who had wrist painfrom using a Rubik's Cube too
much. Because that was also athing about carpal tunnel
syndrome in in the past, whenRubik's Cube became the new
mania, everyone was doing it allthe time, everywhere. There's
(13:47):
nothing new about people playingsomething that they enjoy for
long hours in a day. It's justhow we can support them in that.
James Crow (13:56):
Maybe all those parents are getting fed up
because they want to use thescreen and play something more
sedate like Valheim or somethingthemselves.
Violeta Ivanova (14:03):
Maybe they should play with their kids.
James Crow (14:05):
Well, maybe maybe they should. I have a I have a
young kid and he's always reallykeen to play with me, but I'm
keeping him away from computergames and screen time until he's
older. Because I know howaddictive it was when I was
younger. I was particularly goodat sports at junior school until
we got a Commodore 64. And thenI was really good at Rambo! In
(14:26):
fact, I was the third best inBritain on Rambo on the
Commodore 64 in 1986. Andpersonally, I think I was first
best but the department I sentmy score to were delayed in
printing it. So that man who gotfirst best on Rambo in 1986 I'm
coming after you, I'm gonna beatyou. He's out there somewhere. I
guess people also they like toget the hands busy. They use
(14:48):
fidget spinners and all sorts ofstuff like that nowadays as
well. What's going to happen asVR takes over? Are we likely to
see less and less keyboard andmouse use? VR is becoming really
popular at the moment this year.
How's that going to work witheSports?
Violeta Ivanova (15:04):
There is already VR being used in
simulator racing, as far as Iknow, or at least is very
popular in something likeFormula One eSports or rally
games. In Finland, they'retrying to build a whole VR
eSports League, but I'm not sureyet what kind of games are
(15:25):
involved there, I think it hasits uses, definitely, I think
we're gonna see a lot moredevelopment from the sorts of
something like Half Life Alyx,that was a really good example
on what you can do in terms offirst person shooter in a VR
setting. So I think we need towork more on the peripherals. A
(15:47):
lot of gamers have been askingfor an omnidirectional
treadmill. Just that experience.
I think before we get to that,we might see more broken TV
screens, which is always thecase when something new comes
up. But I personally think it'svery exciting. This is still
pandemic time. And I don't thinkit's getting away anytime soon.
(16:10):
And it's probably not going tobe the last one that's going to
make everybody stay at home. SoVR offers quite unique
possibilities for entertainment,but also for movement. Games
like Beat Sabre have been reallygreat in terms of movement, but
also, at least I follow a lot ofrehabilitation scene. So for
(16:31):
rehabilitation, VR has beenamazing. We've seen cases of
burn victims that have hadreduced amount of medication
because they use VR treatment.
And it has shown that it'sreducing their pain. And a lot
of chronic pain patients alsorespond very positively to VR
(16:56):
treatments or games, orsomething along those lines.
Even if it's just a virtualtrip, somewhere. We've seen a
lot of elderly homes also adoptthese kind of virtual travels,
virtual explorations. I believepersonally, it's a myth that
elderly people are too afraid oftechnology. At least in my
(17:19):
experience, they really enjoy itbecause it's something new and
fun. And they're very eager touse that. So in that sphere,
it's very well developing. Andwe're seeing a lot of assistive
aids to come with it, which willeventually transfer into the
(17:39):
more traditional gaming. Sowe'll get to see eventually, the
omnidirectional treadmill andall the gun attachments for
first person shooters for VR.
James Crow (17:51):
I can't wait.
Personally, I can't wait. Iwonder with regards to elderly
people and what you were saying,that that they're not really
afraid of the technology. That'smy experience, too. There's a
bit of a meme out there that oldpeople are afraid of new
technology. But I think whatpeople are seeing is that, yes,
some older people are afraid ofnew technology. But they're also
(18:11):
afraid of any change. Whereasgenerally older people embrace
change, and are quite lookingforward to new activities. So I
think that's misguided, thatgeneralisation
Violeta Ivanova (18:24):
And I wish I could see more of healthcare
professionals embracingtechnology as well, because
there is the, I don't know if Ishould call it disconnection.
But it is widely considered assomething that we shouldn't
really focus on, until weactually have to focus on it.
But by that point, it's been 20years and somebody else has been
(18:47):
using new technologies to helpothers for all this time. At
least on my behalf. I try tokeep up with what's coming out.
Even if it's something that hasnot been necessarily backed by
solid amount of science, I wouldlike to try it out. And I would
like to offer it to my clientsand to my patients. Because what
(19:12):
we're doing now, what we'reoffering, is treatment, which
is, the most typical would beyou got to see a physio they
give you a piece of paper with aprogramme and tell you "see you
in two weeks and do theseexercises at home." Most of the
time people don't do it and theprogramme ends up in the back of
a drawer and they come back intwo weeks. They're like "yeah,
(19:33):
of course I've done it." When infact you can see that they have
no idea what exercises we'retalking about. So using
gamification, using technologiesto help motivate them through
that process and to make it morefun, that can definitely show
much better results in therehabilitation process. Because
(19:54):
you can't expect somebody to go,in some cases we have might take
even 6 months to 12 months.
No-one's gonna follow a piece ofpaper for 6 to 12 months every
single day. It's not motivating.
It's not fun. And there's otherways to do it. So why not offer
that? Rehabilitation doesn'thave to be a chore. Being
(20:15):
healthy shouldn't be a chore toanybody.
James Crow (20:18):
With virtual reality, is there a
musculoskeletal risk, do youthink, in wearing extra weight
attached to the front of thehead?
Violeta Ivanova (20:27):
There has not been any any confirmation or any
issues with people using thateven if we're talking arthritis.
cases, it's not really relatedto the weight of the device
itself. If anything, it helpspeople move, which improves
their wellbeing afterwards.
musculoskeletal conditions,something like arthritis will go
(20:50):
worse, the less you move, so wewant people who have arthritis
to keep moving and to be active.
So in this sense, the benefitswill overcome the the negatives.
James Crow (21:03):
Gabe Newell of Steam was recently talking about brain
computer interfaces (BCI). Andhe was talking about our limbs
as being, I remember this wrongI only briefly looked at it, but
it was talking about our limbsbeing our meat peripherals. And
that our brain computerinterface won't need these so
much. That actually we'll getbetter sensory appreciation from
(21:26):
the brain computer interfacethan we would from our own
visual system, as an example.
Which kind of tends towards methinking, well, people are going
to be moving less if they usingbrain computer interfaces. Is
that something that's risen inyour arena? Or is that still too
fresh to contemplate?
Violeta Ivanova (21:43):
I have heard kind of similar things from
eSports players along the linesof "why would we need a physio
if we sit all day, and we usecognitive performance to play
games." But truth is, even ifyou get a computer in your
brain, you're not chopping offyour head to work independently.
So you still need the rest ofyour body to function. Because
(22:06):
we're not anywhere nearfunctioning only in the cloud,
as humans. So I would say that,yes, maybe for performance
purposes, you will get morebenefits from only using the
brain computer that you getHowever, for the rest of your
body to function, and for thatbrain computer to keep
functioning, you need the otherparts. So you'll have to move
(22:30):
anyway, in terms of if you wantto do better cognitive
performance, you need to alsohave physical health to achieve
that, because that will supportit. If you have poor physical
health, your cognitiveperformance will go down as
well, because you don't justfunction as the head. You also
have the rest of your bodyattached to it.
James Crow (22:50):
This is great news, everybody. For everybody, all of
you sat there listening to this,you're not just a head, you have
got a body attached, so makesure you look after it. And
yeah, that's probably news to alot of people Violetea. Very
cerebral people will oftenforget to look after themselves
physically. And the downside isthat they perform less well
cerebrally. And there is scienceto back that up. Although there
(23:11):
is a school of philosophy thatsuggests that we're all just
brains in vats and don't havebodies at all. So then that
means that Gabe Newell's braincomputer interface is a brain in
a vat in a brain in a vat. Andthe argument gets slightly
confusing. So maybe maybe we'rebrains in vats in the brain in
the vat in the brain in the vat,talking about brains in vats, I
don't know,
Violeta Ivanova (23:31):
I would tell them to talk to a psychosomatic
therapist because they mighthave something else to say,
because that is also part ofwhat physiotherapists do. Part
of it is psychosomaticphysiotherapy, in which to
really simplify it, the usualtreatment we do is for people
who have lost the connectionbetween their mind and their
(23:55):
body.
James Crow (23:55):
We need more of those, we need more of those
because where I am in thenorthwest of England, I'm not
alone in wandering mindlessaround the streets. Okay, well,
I guess I'd better bring up myfirst question, which we've
talked very much about eSportsand how you help, which is
really useful. So my firstquestion that I ask all of my
(24:16):
podcast guests is "Violetta,what is posture posture?"
Violeta Ivanova (24:21):
Posture is how you are as a human, within a
certain space. There is no rightposture, there is no wrong
posture. There is no brokenposture that needs fixing. It's
how you are and you can improveyourself, as with anything, but
there is nothing inherentlywrong with it.
James Crow (24:42):
I've worked with a lot of people with possible
problems, and some of them arenature and some of them are
nurture. And for someone to sayyou've got bad posture is a real
kick in the teeth to thosepeople. So to hear that posture
is movement within a continuum,then I think that's a really
good thing. How do you helppeople with their posture?
Violeta Ivanova (25:01):
I think you hit a really good spot there before
telling somebody that they havea bad posture or that something
needs fixing, actually does moreharm than helps anybody.
Because, the same as you'rewaiting in a waiting room before
seeing a doctor and seeing apicture with a red low back will
(25:24):
cause you to have more low backpain than you had before,
telling somebody that somethingwith them is wrong, it's going
to bring even worse symptoms andless motivation to get better
afterwards. So the way we helppeople, at least in Finland,
(25:45):
physiotherapists are therapists,we do a very holistic approach,
meaning that we have theknowledge, but we also ask
people what they prefer. Solet's say somebody loves to
swim, we can say, "Okay, let'sjust apply all the knowledge
(26:05):
that we have, as part of yourswimming programme or as Aqua
therapy", or if somebody likesnature, then we say, "Okay,
let's do the activitiesoutdoors." If it's possible,
somewhere in a forest. We do avery combined approach depending
on what is needed. So let's saysomebody has issues with pain,
(26:27):
which is the usual case in whichpeople would come to us, and if
that is looking like it'sstemming from poor posture, then
we try to alleviate that throughexercising, through
strengthening muscles andstructures, and to really help
the person get better habits intheir life, which will continue
(26:51):
that progress that we want tosee. And eventually their
symptoms will lessen. And ifit's something more acute, of
course, we have other methodslike kinesio typing, and in some
cases, manual mobilizations.
However it's a lot moredifficult, when in order for
someone to get better, you needthem to actually do it
(27:12):
themselves. So we're going awayfrom all the manual therapies
and procedure based therapy inFinland, and more towards
empowering people and motivatingthem to take better care of
themselves.
James Crow (27:26):
Definitely the right way to be doing it. Although I
am a bit scared. As you saidearlier, it was minus 17 degrees
centigrade in Finland. And ifyou are encouraging people to go
swimming outdoors, you might notsee much more of them after
that, that might be the end ofthem.
Violeta Ivanova (27:42):
Actually, ice swimming is really popular here.
People do it. There arecertainly benefits, particularly
in neurological clients. I'veheard a lot of patients with,
let's say, MS (muscularsclerosis). That or Parkinson's,
that say that colder water helpsthem and they use it as part of
(28:02):
the rehabilitation. Some peoplewould go, at least once a week,
go to some ice swimming spot,and then they feel a lot better.
Or if we have Aqua therapy, theywould they would feel a lot
better if the water is a bitcooler for them because it helps
their normally overexcited neurosystem to be a bit more calm. So
(28:23):
then they could do activities abit more fluently.
James Crow (28:26):
When I go surfing in the North Sea., i'ts always when
I fill up my most alive ,whenthe water is absolutely freezing
cold. It really wakes you up.
Okay, so fantastic. You've told
Violeta Ivanova (28:35):
Keep changing positions. It's something that
me what do you think posture isand how you help with posture.
So I have a final question whichI like to ask, which is "For
ur listeners right now, if thre was one thing that they could
do to improve their posture, wat would that
James Crow (28:48):
Yeah, you heard it here. Everybody get get out of
people who try to sell ergonomicsolutions, they really hate
physios for saying that. Butwhatever you're using, whether
your chair or if you've beenstanding for long periods of
you're at home, at the office,or anywhere else, just keep
changing your position becauseit like mentioned earlier, it's
(29:10):
not the sitting that is going tocause your symptoms. It's the
sitting for too long. And itwill happen the same way as if
you're standing for too long. Sothere is not necessarily an eas
solution. A quick tip would bjust keep changing pos
tions and keep moving aro nd.
(29:34):
time go and have a rest. I lovesit stand electric desks and I
use one of them every day. Isthat something that has any
benefits at all in eSports? Dopeople stand to play?
Violeta Ivanova (29:44):
I think most don't because it is still
something that is quiteexpensive to get. And usually
it's something that officeswould be equipped with, at least
in Finland, but what I'venoticed in more traditional
physiotherapy work is thatpeople who have sit-to-stand
desks, they either sit or theystand, they forget the whole
(30:07):
point that it can be adjusted.
And the idea of it is that youchange your position, like once
every couple of hours. Like Imentioned, if you stand for a
whole day, it's not gonna do youany better than if you sit all
day. Sit to stand desk is great,I think it's a really nice
possibility that you couldchange your position every once
in a while. If you don't haveaccess to a sit to stand desk
(30:29):
than having a normal desk, butsitting on something like an
exercise ball, or just having abalance cushion on your normal
chair can help you achieve thatmoving your position around and
weight shifting of your body,even when you're not entirely
changing your your posture likesitting to standing.
James Crow (30:52):
I guess that's what you're doing with your gaming
community, Violeta, is that theyare sitting, dedicated sitting
for the period of theircompetitive sport. And then
you're getting them to moveimmediately afterwards and
recover from from the downsideof being static and engrossed in
the game for so long.
Violeta Ivanova (31:10):
Yeah, you will be surprised what a couple of -
just stand up, shake your legsaround, do a little bit of
stretching, and maybe walkaround the house. If you have
stairs, go up and down like 5 to10 stairs and then get back into
the chair. It does improve yourfocus, it gives you a little bit
(31:30):
of change. Not only talkingabout a sitting ergonomics, but
also your environment (31:34):
having the same environment and the
same focus point for longperiods of time will get you're
really tired of it. So you wantto be able to change that
around, whether it's to look atsomething else, or to look
through the window. So we wantto keep that going, to have the
(31:57):
focus, then have a little bit ofshift of position on what your
eyes are seeing, to also helpwith the fatigue. And then get
back into the chair, do yourjob. And then you swap again.
James Crow (32:10):
So a lot of people will be sitting for a while and
then they'll stand but they'relooking at their phone and
scrolling through their phone,and the focal length of their
eyes isn't changing from onescreen to the next. Whereas
looking out of a window is agreat exercise and rest for your
eyeballs, which is really goodthing to do. Do you have your
eSports competitors work ontheir eyes as much as you work
on the rest of theirphysicality?
Violeta Ivanova (32:31):
I think in terms of eye health, the biggest
thing that we've been discussingis more to get a good amount of
sleep, to have appropriatelighting in the environment that
they're playing at. So theenvironmental ergonomics are a
big factor, especially inFinland, where the matches are
(32:51):
usually done with UK time. Sofor here, it's plus two hours.
So they will be pretty late inthe evenings. Something like 9
or 10pm. You also have theenvironment outside which in
winter, that means that there isabout two to three hours of
daylight in my area. And thensummertime it switches to the
(33:11):
point where the sun doesn't set.
So you really need to be able toinfluence your working
environment, and your sleepingenvironment.
James Crow (33:20):
So I'm hearing a really interesting theme that's
coming across in everything thatyou've mentioned, it's about
mobility and fluidity,physically. Also in terms of use
of peripherals and ergonomics,and of the environment, of the
light. Really, you aresuggesting mobility, in all
(33:41):
aspects of working and gaming aswell
Violeta Ivanova (33:44):
Yes the possibility to change your
environment and yoursurroundings. I think it's
especially important for notjust gamers ,who are mostly
focused at home, but also toanybody else who is working from
home. I think the part that thatgets people fatigued like ,
(34:05):
we're talking now about zoomfatigue and working from home
fatigue. You see the same thingevery single day. And that is
very tiring. If the only thingyou do is get from bed to your
desk and then back to the bed itcan get very monotonous pretty
quickly. So you can do so manythings, to just change around
(34:28):
your environment, without havingto change that much necessarily.
Lighting is one of them. Movinghow your monitor is positioned
is also one thing, because sureyou're looking at your monitor
the whole time, but your eyesalso see what's around it. So
changing out those things thatare behind your monitor or
(34:51):
around it can can really make adifference in how you feel
during the day and how tired youare at the end of it.
James Crow (34:59):
That's something I'd never considered, the stuff of
behind and around your monitor.
We're advising at the momentthat if people spend a quarter
or a third of their day on zoomor teams that they do their
teams and zooms standing. Andthen they do the rest of the
work sitting to get somevariability in. But I had never
considered changing what isgoing on behind the monitor, I
guess that's a new one on me.
(35:21):
Maybe people should have a fishtank behind their monitor, or I
guess people with dogs get a lotand cats get a lot of movement
going on.
Violeta Ivanova (35:28):
Yeah, that would be one option. Another one
that I would suggest would behaving a window behind your
computer monitor, I've seen alot of people have their window
behind their back, which in myopinion, is quite distracting.
Because if the sun is shining,it's going to shine straight to
your monitor and be a lot morestraining on your eyes, if you
(35:50):
need to look at it for half theday. Rather than that, just move
your monitor, if possible to bein front of your windows so that
your eyes have that visual breakwith the background. Having a
plant around you is alsobeneficial. It's not necessarily
going to clean your air, likemost people believe. You don't
(36:13):
live in a jungle, if you dogreat, but it gives you that
visual visual change. And it'ssomething that itself will
change as it grows. So it addsvalue to that. But also
different kinds of lightingbehind your monitor. I know some
gaming monitors have that led inthe back. During the day, you
(36:36):
can change it in differentcolours, not necessarily the
rainbow effect, I would notrecommend that but change it to
a different static colour, orduring the different times of
the day. That would be great.
Changing wall art if you can. Ifyou can't, then you can put it
on the side of your computer andjust keep changing them up every
(36:56):
couple of weeks. It just makesit new without having anything
necessarily new.
James Crow (37:05):
That sounds like a real good incentive for our
listeners to do a bit of movingstuff around on their desk,
after listening to this podcast.
In fact, turn us off right now.
Stop listening to this and getyour desk sorted and dust it as
well. If you're if your desk isanything like my desk at the
moment, believe me, it's notgood for the environment. I do I
do have plants on my desk, butthey are also covered in a layer
(37:25):
of dust. So maybe that's not sogood for my environment. I think
we do have the same one.
Violeta Ivanova (37:31):
Yeah, spider plants!
James Crow (37:33):
Yeah. Which which are supposed to be very good for
breathing quality. But ifthey've got half an inch of dust
on, like mine, then maybe that'sthat's not the case. I think I'm
gonna have to clean my plantsnow, thanks for this Violeta!
Violeta Ivanova (37:47):
There goes the rest of the day!
James Crow (37:50):
Stick it on the to do list.
Violeta Ivanova (37:52):
Actually, in the last year, house plants have
been just completely explodingin terms of market sales because
people are stuck at home. Sothey need something to do that
it's not involving computerscreens. So people have been
buying and buying house plants,which I think is great.
Gardening is definitely a nicehobby to have with all the
(38:14):
mental health benefits. And itcauses you to move around, which
is great. And now a lot ofpeople are transitioning into
growing different kinds ofvegetables and herbs, which is
also great. So yeah, get someplants around your computer, and
you're gonna feel really niceand refreshed.
James Crow (38:32):
Excellent, excellent advice. And if you can't get
them inside, then make sure toget a little bit of time outside
as well. Unless it's pitch blackand minus 17 degrees in which
case wrap up warm first, but doget outside. You've got to
haven't you.
Violeta Ivanova (38:46):
Yeah, you have to.
James Crow (38:47):
Okay, so I've enjoyed speaking with you
Violeta Ivanova, physiotherapistspecialising in eSports. That's
been really helpful. I'velearned loads of stuff from you
today. And I feel like I'mcompletely up to date now in
terms of physiotherapy andeSports. So I can pretend to
know lots about it, now, as aresult of doing this podcast,
and I hope our listeners feelmore educated as well. Thank you
(39:09):
so much for your time.
Violeta Ivanova (39:10):
Thank you for having me.
James Crow (39:11):
Now everybody go on, go and clean your house plants.
Get out of here. Cheerio.
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