A Cross-Sectional Survey on Musculoskeletal Pain Among Professional and Non-Professional Gamers in Saudi Arabia: Associations with Gaming Genre, Duration, and Ergonomic Factors

Introduction

Over the past five decades, the electronic gaming industry has rapidly expanded, becoming a significant cultural and economic force worldwide. Since the launch of early consoles like the Atari 2600 in 1977, gaming has transformed into a pervasive form of entertainment and competition.¹ However, alongside these advancements, concerns about potential negative health outcomes—particularly regarding musculoskeletal (MSK) health—have emerged. Increasing evidence suggests that prolonged gaming sessions, combined with poor ergonomics and sedentary behavior, are associated with a high burden of MSK pain across ages and levels of play.²

Consistent with this, a recent review found that most studies identify gaming as associated with MSK complaints.³ International data likewise show high rates of 77.8% MSK pain in gamers.⁴ In line with the global picture, in Saudi Arabia, a recent survey reported MSK pain in 86.2% of competitive gamers.⁵

Gamers commonly experience MSK pain in the neck, lower back, shoulders, upper back, and wrists/hands. This pain is associated with prolonged static postures such as forward-head posture, repetitive movements like mouse clicks and keystrokes, and poor ergonomics related to monitor and desk height, which can aggravate the risk of strain and injury.⁶ Additionally, personal characteristics such as gender and age seem to influence susceptibility to MSK pain. Female gamers, for instance, tend to report higher pain rates, potentially due to biological, psychosocial, and ergonomic factors.^5,7 Moreover, extended gaming duration has been linked to increased MSK pain in both genders.^8,9 Age and lifestyle factors, such as sedentary behaviors common among older adults and individuals in advanced educational or occupational roles, may further exacerbate the risk of MSK pain.^2,10

In addition to personal factors, specific gaming-related variables also play a critical role in the development of MSK pain. For instance, a recent study of smartphone-based play-to-earn gamers showed high rates of MSK disorders, suggesting that both the gaming platform and purpose can influence risk.¹¹ Competitive status may affect MSK pain risk, with professional gamers experiencing greater strain due to longer and more structured training routines.⁵ In contrast, non-professional gamers typically have lower exposure. Studies highlight that structured training in esports increases MSK risk, supporting the need to assess differences between gamer subgroups to develop tailored ergonomic and preventive strategies.⁸ Moreover, device type has emerged as a key determinant, with desktop and laptop users frequently reporting lower back pain, while smartphone and tablet users more commonly experience neck and shoulder discomfort due to poor posture.³ Virtual reality (VR) gaming also presents unique ergonomic challenges; prolonged standing and repetitive head and neck movements in VR environments have been linked to higher rates of lower back and neck pain.^12,13 When considering game genres, certain types—such as puzzle games—may contribute to localized MSK discomfort due to prolonged fine motor engagement and static posture requirements.¹⁴ Such genres often require sustained hand positioning or mouse use, which can stress specific muscle groups and joints.Recent literature highlights how repetitive fine motor activities, particularly in puzzle games, can lead to tendinopathy and localized pain. In contrast, motion-controlled and sports-racing games have been associated with shoulder and upper limb strain due to their repetitive and forceful movement demands.¹⁵

Given the growing popularity of gaming and accumulating evidence of its potential health impacts, a more detailed understanding of MSK pain contributors among gamers is warranted. Previous research has largely focused on isolated factors and specific populations,^5,8,10 leaving gaps in our understanding of how personal characteristics and gaming habits interact to affect MSK outcomes. This issue is particularly relevant in Saudi Arabia, where gaming has expanded rapidly and national policy has made esports a strategic priority; growth and governance are being actively steered to position the Kingdom as a global hub,¹⁶ yet the health implications remain under-investigated. To address this gap, the current study investigated the prevalence and locations of MSK pain among Saudi gamers and examined its predictors, focusing on how demographic and gaming-related variables—such as game genre, device type, gaming duration, and professional gaming status—contributed to pain outcomes. We hypothesized that certain variables, particularly professional gaming status and specific game genres, would significantly predict higher MSK pain prevalence due to prolonged exposure, repetitive movements, and inadequate ergonomic conditions. We further hypothesized that the neck and upper limbs would demonstrate greater pain prevalence compared to other body regions, given their continuous involvement in common gaming activities.

Materials and Methods

Research Design and Sampling

This analytic cross-sectional descriptive study was carried out using a self-administered web-based questionnaire designed with Microsoft Forms between February and April 2024. The study included adult gamers (≥18 years) in Saudi Arabia, both professional and recreational gamers of all genders. Individuals with a history of fractures in the past six months, pre-existing medical conditions, surgical history, physical disabilities, or cognitive impairments were excluded from the study.

Professional gamers were defined as individuals officially registered with the Saudi Esports Federation who compete for awards and monetary prizes. While non-professional gamers participated in gaming purely for leisure without any formal competitive affiliation.

A non-probability convenience sampling method was employed, and the required sample size was determined to be 384 participants based on OpenEpi, ensuring a 5% margin of error at a 95% confidence level.

Participants were invited through Email and WhatsApp. Professional gamers were contacted using information obtained from the Saudi Esports Federation (SEF) registry, while non-professional gamers were invited through the dissemination of the questionnaire via social media platforms.

Data Collection Tool

Data were collected through an online questionnaire comprising two primary components. The first component centered on demographic information and gaming characteristics. Participants provided background data such as age, gender, education level, occupation, and marital status. The frequency of electronic gaming per week, average daily gaming time, registration with the SEF, participation in local or national tournaments, the types or genres of electronic games played, and the devices used for gaming (eg, smartphones, consoles, or PCs). To ensure content validity, the survey was reviewed by three experts in musculoskeletal health and gaming behavior and piloted with five participants to assess clarity, flow, and the functionality of branching logic. Professional gamers reported both competitive and recreational game genres to reflect their full range of gaming activity.

The second component of the questionnaire featured the Extended Nordic Musculoskeletal Questionnaire (NMQ-E), utilized to assess MSK pain. The Arabic version of the NMQ-E was employed in this study, with prior permission obtained from the original authors.¹⁷ The NMQ-E assessed musculoskeletal pain across nine anatomical regions: neck, upper back, lower back, shoulder, elbow, hand/wrist, hip, knee, and ankle/foot.¹⁸ A body map diagram was included to assist participants in accurately identifying pain locations. The questionnaire measured pain prevalence at four points in time: lifetime, annual, monthly, and point prevalence, while also examining the consequences of pain, such as interference with work, healthcare visits, medication use, absenteeism, and hospitalization. Response options were binary (“yes” or “no”). The NMQ-E has demonstrated robust reliability and validity in evaluating musculoskeletal symptoms and their consequences.¹⁸ The Arabic version has also shown strong content and construct validity, along with high test-retest reliability.¹⁸ Furthermore, lifetime prevalence responses were numerically coded (1 for “Yes,” 0 for “No”) to compute a total score that reflects the number of painful body sites.

Statistical Analysis

Statistical analysis was conducted using SPSS software (version 27.0). Descriptive results are presented as means ± standard deviation (SD) and in percentages. For the association analysis, body regions with a prevalence of MSK pain of 20% or higher—specifically the neck, upper back, lower back, shoulders, and wrists/hands—were selected for further examination. The associations among categorical variables, including gender, device type, prize gains, and types of games played, were evaluated using Pearson’s chi-square test (X²). The effect size was measured using Cramér’s V Phi coefficient (φ) for categorical associations and interpreted according to established guidelines. Where associations were identified, odds ratios (OR) with 95% confidence intervals (CI) were calculated. Eta was used to assess the relationship between categorical and interval variables, with interpretation based on conventional cutoffs reported in the literature.¹⁹ Binary logistic regression analysis was conducted to determine the predictive value of the selected demographic and gaming-related factors on MSK pain outcomes, adjusting for potential confounders. Three models were conducted for each body region: Model 1 (unadjusted) analyzed each predictor individually without covariate adjustment; Model 2 (age- and gender-adjusted) included only age and gender as predictors to assess their independent effects; and Model 3 (fully adjusted) simultaneously included all predictors—age, gender, gaming exposure, device type, and game genres—within a multivariable model. In these models, age was treated as a continuous variable, and gender was entered as a binary categorical variable (male = 0, female = 1). Relevant demographic and gaming-related variables were entered into the multivariable regression model to examine their associations with musculoskeletal pain. A subgroup comparison between professional and non-professional male gamers was conducted to account for gender confounding, as all professional gamers in the sample were male and gender was identified as a significant predictor of MSK pain. The significance level was set at a p-value of <0.05.

Ethical Considerations

This study complies with the Declaration of Helsinki. All participants provided informed consent at the start of the survey, ensuring confidentiality and security. The study received ethical approval from the Institutional Review Board at Princess Nourah Bint Abdulrahman University, which was granted (IRB: 24–0490).

Results

In this study, a total of 641 individuals were approached, with 593 participants included in the analysis. The remaining 48 respondents were excluded for various reasons: 14 chose not to participate, 9 were disqualified due to age, 15 had a history of musculoskeletal injuries in the past six months, 7 had undergone recent surgeries, and 3 did not engage in electronic gaming (Figure 1).

Figure 1 Flow Chart of Inclusion and Exclusion of the Study.

Demographics

The current study involved 593 participants, the majority of whom were male (71.3%), with an average age of 25.70± (8.980) years. Most participants primarily resided in the Central Region (65.3%). As illustrated in Table 1, a significant portion of the participants held a bachelor’s degree (67.8%), with half identifying as students (50.4%), and a large majority being single (80.8%).

Table 1 Demographics and Gaming Behavior

The study also explored the characteristics of the gamers. Among the participants, 43.7% reported involvement in local or national tournaments, while 30.9% indicated they had won prizes. Additionally, 37.4% were registered with the Saudi Esports Federation as members of a team. When it came to preferred gaming devices, most players (33.4%) used personal computers. In terms of input devices, a substantial number of gamers (55.3%) favored controllers. Notably, 58.2% of players reported gaming for more than four hours each day, with the average gaming duration among participants being 4.83±2.07 hours. Moreover, First Person Shooters (FPS) are the most popular genre (65.1%). This is followed by Competitive (33.7%) and Sports/Racing (33.1%). Role-Playing Games (RPGs) and Card/Board also show notable popularity (28.3% and 28.2%, respectively). (Table 1).

Prevalence and Consequences of Musculoskeletal Pain

The majority of study participants reported experiencing MSK pain in at least one body region, specifically 78.2%, with a higher prevalence observed among females (86.47%) compared to males (74.95%). The most frequently affected areas of MSK pain over a lifetime included the neck (49.4%), lower back (40.0%), shoulder (29.7%), upper back (25.3%), and hand/wrist (24.5%). The neck also had the longest duration of reported pain, averaging 4.6 years, followed closely by the shoulder and lower back, both with an average duration of 4.4 years (Table 2). Participants reported a range of affected body regions due to MSK pain, varying from one to nine, with the majority experiencing pain in either one (22.3%) or two (18.5%) regions.

Table 2 Prevalence of Musculoskeletal Pain by Period for Each Region

Table 3 illustrates the impact of MSK pain among participants. While hospitalization rates due to musculoskeletal pain were relatively low, knee pain was the most frequently reported at 8.8%, followed closely by elbow pain at 8.3%. The effect of musculoskeletal pain on activity and participation was particularly significant for ankle and foot pain (52.3%), followed by knee pain (49.5%) and neck pain (43.9%). Additionally, the interference of pain with daily living activities was notably reported for neck pain (33.9%), knee pain (30.1%), and ankle/foot pain (29.2%). Visits to healthcare practitioners (HCPs) due to MSK pain were predominantly associated with ankle/foot issues (29.2%), neck problems (23.8%), and knee pain (20.3%). Furthermore, the need for medication to manage MSK pain was most linked to ankle/foot pain (29.2%), neck pain (26.7%), and hip pain (25.7%).

Table 3 Prevalence of Musculoskeletal Pain Consequences for Each Region

The Association Between Musculoskeletal Pain and Personal or Gaming Factors

Correlation analysis between pain location and participant demographics uncovered several statistically significant associations (Table 4).

Table 4 Association of Pain Location and Sample Characteristics

Gender was significantly associated with MSK pain. For neck pain, a significant association and large effect size was observed (χ²=15.973, df=1, p<0.001, V=0.16); with males had lower odds (OR = 0.478, 95% CI [0.332, 0.689]). A similar pattern was observed for wrist/hand pain, with a significant association (χ²=12.053, df=1, p=0.001; V=0.14). Males had lower odds of experiencing wrist/hand pain (OR=0.500, 95% CI 0.337–0.724). Additionally, shoulder pain showed a significant association with sex and a moderate effect size, with females more likely than males to report shoulder pain (χ²=39.317, df=1, p<0.002; V=0.13).

When evaluating the impact of age on MSK pain, the results indicate a moderate relationship between age and pain in the shoulder and lower back, with Eta values of 0.374 and 0.313, respectively. A weak-to-moderate relationship was identified between age and neck pain, reflected by an Eta value of 0.291. Furthermore, a relatively weak relationship was noted between age and pain in the upper back, hands, upper limbs, and back, with Eta values of 0.235, 0.264, 0.254, and 0.268, respectively.

In addition, significant associations were found between MSK pain and gaming-related variables. The type of device used was associated with shoulder pain (X² = 22.386, df = 1, p <0.001, V = 0.19). Prizes won demonstrated a moderate association with neck pain (X² = 9.959, df = 1, p =0.002, V = 0.13) and a strong association with shoulder pain (X² = 22.386, df = 1, p <0.001, V = 0.19). Moreover, neck and upper limb pain exhibited a moderate correlation with prizes won (X² = 6.709, df = 1, p =0.010, V = 0.10).

To investigate the association between daily gaming hours and pain experienced in different body regions, Eta values were computed to evaluate the strength of these relationships. The findings indicated various levels of correlation, with the strongest associations identified for wrist and hand pain, as well as combined neck and upper limb pain, both showing an Eta value of 0.396. In contrast, lower back and shoulder pain demonstrated weaker correlations.

The Association Between Musculoskeletal Pain and Game Type/Genre

The correlation analysis examining the relationship between pain location and game type uncovered several significant findings. Puzzle games were notably linked to various pain regions, with the exception of wrist and hand pain. In contrast, sports and racing games displayed significant correlations with pain in the shoulder and upper back. However, no significant associations were identified between any pain regions and virtual reality (VR), role-playing games (RPG), massively multiplayer online (MMO), or competitive game types (Table 5).

Table 5 Associations Between Pain Location and Game Type/Genre Played

Regression Analysis

Binary logistic regression identified predictors of MSK pain across five regions. In unadjusted Model 1 analyses, female sex was associated with higher odds of neck, shoulder, wrist/hand, and lower-back pain, while age showed region-specific effects.

In the age- and gender-adjusted models (Model 2), female gender remained significantly associated with pain in the neck (OR = 2.06, 95% CI: 1.43–2.98, p < 0.001), shoulder (OR = 3.23, 95% CI: 2.18–4.77, p < 0.001), wrist/hand (OR = 2.02, 95% CI: 1.36–3.00, p < 0.001), and lower back (OR = 1.75, 95% CI: 1.22–2.51, p = 0.003). Gender was not significantly associated with upper back pain (p = 0.544). Age was a significant predictor of shoulder pain (OR = 1.06, 95% CI: 1.04–1.08, p < 0.001), and a borderline association was observed for lower back pain (OR = 1.02, 95% CI: 1.00–1.04, p = 0.051). No significant association was found between age and pain in the neck, upper back, or wrist/hand regions. Model 2 results are presented in Table 6.

Table 6 Age- and Gender-Adjusted Logistic Regression Results for Predictors of Musculoskeletal Pain Across Body Regions

In the fully adjusted models (Model 3), which included all demographic variables, gaming exposure, and game genres, gender and age remained significantly associated with MSK pain in several regions. Female participants had higher odds of reporting pain in the neck (OR = 2.080, p = 0.002), shoulders (OR = 2.426, p < 0.001), upper back (OR = 2.426, p = 0.001), and lower back (OR = 1.787, p = 0.014) compared to males. Increasing age was also associated with higher odds of pain in the shoulders (OR = 1.047, p < 0.001). No significant associations were found between device type (eg, laptop, PlayStation), tool used (eg, keyboard/mouse, touch), or average gaming hours per day and pain in any of the examined regions.

Several game genres were significantly associated with MSK pain. Puzzle games were a consistent predictor, associated with increased odds of pain in the neck (OR = 1.189, p = 0.008), shoulders (OR = 2.459, p < 0.001), and lower back (OR = 1.839, p = 0.009). Participants who frequently played first-person shooter (FPS) games had higher odds of reporting wrist and hand pain (OR = 1.920, p = 0.010). Likewise, sports/racing games were significantly associated with both upper back pain (OR = 1.627, p = 0.026) and lower back pain (OR = 1.532, p = 0.035). Conversely, engagement with fighting games was associated with lower odds of pain in the shoulders (OR = 0.441, p = 0.010). Notably, VR games were associated with a reduced likelihood of neck pain (OR = 0.364, p = 0.004), potentially reflecting different physical demands compared to sedentary gaming styles. Other genres such as strategy, simulation, role-playing, MMO, and platformers did not show significant associations with pain in any region (Table 7).

Table 7 Binary Logistic Regression Models for Predictors of Gamers’ Musculoskeletal Pain

Comparison of Pain Locations and Consequences Between Professional and Non-Professional Male Gamers

Table 8 compares the prevalence of MSK pain between professional and non-professional gamers across various body regions. The statistical analysis showed no significant differences between the two groups regarding the number of pain sites or specific pain locations. A chi-square test was utilized to compare the prevalence of MSK pain in five key body regions. Among these areas, upper back pain revealed no statistically significant difference between professional and non-professional male gamers (X² = 0.656, df = 1, p =0.418), with a negligible effect size (φ = 0.04) and similar odds of experiencing pain (OR = 0.871, 95% CI [0.624, 1.216]).

Table 8 Comparison Between Professional and Non-Professional Gamers

In contrast, significant associations were noted in the other body regions assessed. Neck pain was found to be more prevalent among non-professional gamers than their professional counterparts (X² = 5.666, df = 1, p =0.017), with a small effect size (φ = 0.12) and lower odds for professionals (OR = 0.771, 95% CI [0.524, 1.136]). A similar trend was identified for shoulder pain, which was significantly higher in non-professional gamers (X² = 8.343, df = 1, p =0.004) and demonstrated a moderate effect size (φ = 0.14). Professionals exhibited lower odds of experiencing shoulder pain (OR = 0.588, 95% CI [0.377, 0.916]). Additionally, lower back pain was less prevalent among professionals compared to non-professionals, with a significant difference (X² = 6.718, df = 1, p =0.010), a small effect size (φ = 0.13), and reduced odds of pain (OR = 0.714, 95% CI [0.552, 0.923]). Conversely, wrist and hand pain was significantly more common among professional gamers (X² = 4.036, df = 1, p =0.045), with a small effect size (φ = 0.10) and increased odds of experiencing pain compared to non-professionals (OR = 1.482, 95% CI [1.004, 2.186]).

Discussion

This study explored the prevalence and predictors of MSK pain among gamers, with particular attention to pain locations and how demographic and gaming-related factors contributed to these outcomes. A majority of participants reported experiencing MSK pain in at least one area of their body, with the neck, lower back, shoulders, upper back, and wrists/hands being the most commonly affected regions. Neck pain was identified as the most disruptive to daily activities, followed by lower back and wrist/hand pain—areas that are crucial for mobility and everyday tasks. Although hospitalizations were relatively rare, they were most frequently associated with lower back pain, followed by neck and shoulder pain. Interestingly, professional gamers were significantly less likely to report neck, shoulder, and lower back pain, although wrist/hand pain was more prevalent in this group. No significant differences were observed between groups for upper back pain.

Many gamers reported seeking healthcare services and using medications, indicating the chronic nature of pain in some cases. However, it is important to note that literature specifically investigating hospitalization, healthcare visits, and medication use in gamers is still scarce. In this study, gender, age, and certain game genres emerged as significant predictors of MSK pain.⁵

Gender emerged as a consistent risk factor, with female gamers significantly more likely to report pain in the neck, shoulders, upper back, and lower back. These findings align with broader literature noting gender-related differences in MSK pain, potentially influenced by physiological, ergonomic, or hormonal factors. This pattern is supported by Wijnhoven et al (2006), who linked higher MSK pain prevalence in females to hormonal, physiological, and psychosocial factors.²⁰ Similarly, Fathuldeen et al (2023) found that neck, lower back, and hands/wrists were the most painful regions for gamers, areas heavily engaged during gaming sessions.⁵ Cankurtaran et al (2022) further demonstrated that females, despite playing less than males, reported higher rates of head, hand/wrist, and back pain.²¹ Additionally, Arvidsson et al (2020) highlighted the role of psychosocial factors and ergonomics in MSK pain among females.⁷ Such patterns underscore the importance of incorporating gender-specific ergonomic education and targeted interventions. Nevertheless, further research is needed to clarify gender-specific risk factors, especially given the underrepresentation of female gamers. Age was positively associated with pain in the shoulders, indicating that even within a relatively young gaming population, age-related vulnerability exists and may compound ergonomic strain. This study’s findings agree with Lindberg et al (2020), who suggested that older adults often maintain poor ergonomics during work and leisure activities, which, combined with age-related physiological changes and sedentary habits, may increase MSK susceptibility.²

Beyond demographic influences, gameplay genre emerged as an important determinant of MSK pain. In addition to personal factors, specific gaming-related variables—particularly game genre—were associated with MSK pain in several body regions. Puzzle, FPS, and sports/racing games showed significant associations with pain in the neck, lower back, and wrists/hands, highlighting the potential impact of specific game genres on physical strain. Virtual reality (VR) gaming stood out, with participants reporting considerable neck and lower back pain, likely due to prolonged standing and head movements. Gregory et al (2008) found that standing for two hours without rest could result in lower back pain.¹² Furthermore, Tyrrell et al (2018) linked VR gameplay to excessive neck and head motion, which may aggravate pre-existing conditions.¹³ Puzzle games were a consistent predictor across multiple regions, while sports/racing and FPS games were also associated with specific pain areas, such as lower back and wrist/hand. Conversely, fighting games were associated with lower odds of shoulder and upper back pain.

These findings emphasize the importance of considering game genre as a central factor when evaluating MSK pain risk among gamers. Puzzle games, FPS, and sports/racing genres showed consistent associations with pain in multiple body regions, underscoring the need for genre-specific prevention strategies. Ergonomic interventions that address prolonged static postures, repetitive inputs, and device use—tailored to common patterns within specific game genres—may help reduce MSK burden in gaming populations.^15,22,23 This highlights the need for genre-specific ergonomic guidelines, as certain game mechanics may place disproportionate strain on the musculoskeletal system.

In addition to game genre, the type of device and the ergonomics of its use also played a critical role in shaping MSK outcomes. Although device type initially showed a significant association with shoulder and wrist/hand pain in the bivariate analysis, this relationship did not remain significant after adjusting for covariates in the regression models. This suggests that device type may not independently contribute to MSK pain risk, but instead may be confounded by other factors such as gender, game genre, or input method. This interpretation is supported by Gholami et al (2025), who found high rates of MSK disorders among smartphone-based play-to-earn gamers, indicating that both platform and gaming motivation can influence musculoskeletal outcomes.¹¹ However, overall, the device appeared to outweigh the game genre in determining MSK pain risks. Alnuman et al (2022) concluded that device type was a critical factor in MSK pain prevalence, a conclusion supported by our findings.²²

While the regression models suggest device type may not independently drive MSK pain, ergonomics related to device use remain a decisive factor. Consistent with Geer et al (2023), poor posture, long gaming hours, and sleep disruption significantly exacerbate MSK pain risk. Taken together, these findings support the need for ergonomic training, adaptive seating, and scheduled breaks, particularly in high-risk device contexts.²³ Alnuman et al (2022) also found higher pain rates among gamers compared to non-gamers, particularly in the upper body, reinforcing the impact of device-specific strain patterns observed in the current study.²² Tholl et al (2022) identified smartphones and tablets as common contributors to neck and shoulder pain due to hunched postures.³ While these device-specific patterns were noted, the adjusted regression model suggests that device type alone may not be an independent predictor of MSK pain. Despite these observations, research on device-specific MSK pain patterns remains limited.

Similar to the current study, several investigations have highlighted high rates of MSK pain among professional gamers, particularly affecting the neck, shoulders, and lower back. Lindberg et al (2020) reported that 42.6% of Danish esports athletes experienced MSK pain, while DiFrancisco-Donoghue et al (2019) observed analogous trends among collegiate players.^2,24 Goh et al (2023) corroborated these risks in a systematic review; however, none of these studies included non-professional gamers for comparison.¹

In contrast to earlier research, our findings revealed significant differences in the prevalence of pain across various regions. Non-professional gamers were more likely to report neck, shoulder, and lower back pain, whereas wrist and hand pain were more prevalent among professional gamers. Notably, upper back pain showed no significant differences between the two groups. These results diverge from those of Reeves et al (2024), who found no distinctions in MSK disorder indicators between professional and casual gamers, suggesting that the interplay between professionalization, ergonomics, and pain is complex and merits further study.²⁵ The current findings suggest that while competitive status may influence pain in specific areas, other factors—such as prolonged sitting, poor ergonomics, and repetitive strain—are likely significant contributors for all types of gamers.⁹ It is important to recognize that the gender distribution differed between the professional and non-professional groups in our sample, which may have influenced our comparisons. Future research should adopt stratified or matched designs to more effectively isolate the effects of gender and professional status on musculoskeletal outcomes. These findings highlight the need for tailored prevention strategies that consider both gaming roles and ergonomic risks, ensuring support for musculoskeletal health regardless of professional status. The clinical implications are significant, as early identification and intervention for at-risk gamers could help mitigate long-term musculoskeletal issues and enhance functional outcomes.

Recognizing that both professional and casual gamers are vulnerable to MSK disorders highlights the importance of health promotion programs, workplace-style ergonomic education, and early screening in gaming populations. This is particularly critical in the Saudi Arabian context, where gaming is rapidly expanding as both a leisure activity and a professional pursuit. Cultural factors—such as prolonged sedentary behavior, preferences for indoor leisure, and evolving health-seeking behaviors—may uniquely influence both pain prevalence and healthcare utilization among Saudi gamers. These contextual elements enhance the applicability of the findings regionally, while also providing a valuable perspective for global comparisons in gaming-related MSK research.

While this study provides important insights into the relationship between gaming behaviors and MSK pain among Saudi gamers, several methodological considerations warrant attention. Its cross-sectional design limits causal inference, and reliance on self-reported data may introduce recall or reporting biases. Future studies would benefit from longitudinal designs to assess causality, the incorporation of objective ergonomic/postural measures, and consideration of cumulative exposure (total years of gaming). Furthermore, objectively assessing pain severity, functional disability, and comorbidities such as sleep disturbance or sedentary lifestyle could add critical clinical relevance. Given the underrepresentation of female gamers and the rapid growth of e-sports in Saudi Arabia, further gender-sensitive and culturally contextualized research is warranted. Additionally, the observed differences between professional and non-professional gamers must be interpreted with caution, as gender imbalance across groups likely influenced prevalence patterns. The use of convenience sampling and exclusion of individuals with prior injuries may limit generalizability. Cultural factors unique to the Saudi context, such as gaming preferences and health-seeking behavior, merit further exploration. Future research would benefit from incorporating comparative experimental designs with control variables to enable stronger causal interpretation.

Conclusions

This study revealed a notable prevalence of MSK pain among gamers in Saudi Arabia, with the most commonly affected areas being the neck, lower back, shoulders, upper back, and wrists/hands. Pain occurrence was influenced by various factors, including gender, age, and game genres. Notably, puzzle, FPS, and sports-racing games were associated with heightened discomfort levels, while virtual reality gaming was significantly linked to neck pain. These findings underscore that MSK disorders are common among gamers and that individual characteristics and genre-specific demands are critical predictors, supporting the need for ergonomic education and gender-sensitive prevention programs. While the study offers valuable insights, its reliance on a young, culturally specific sample and self-reported data limits generalizability, highlighting the need for future work with diverse populations and objective clinical measures. Future research should adopt longitudinal and interventional designs to test ergonomic strategies and better establish causal relationships. In conclusion, this study emphasizes the widespread incidence of MSK pain among gamers and the importance of culturally contextualized, evidence-based approaches to prevention and intervention.