The popularity of electronic sports (e-sports) has skyrocketed over the past decade [1], [2]. E-sports competitions now attract over 450 million viewers globally and generate more than $25 billion in revenue [3]. They offer salaries on par with traditional sports and have been accepted as an official medal event for the Asian Games and Olympic Games in 2022 and 2024, respectively [4]. While there is ongoing debate regarding whether e-sports should be considered traditional sports or merely recreational activities [5], [6], [7], some e-sports modalities should be considered a genuine sport. For example, e-cycling (or virtual cycling) constitutes real athletic performance [8]. Furthermore, contrary to the argument of the sedentary nature of some modalities, which would not classify them as sports modalities (despite modalities recognized as traditional sports such as chess and poker][9], e-sports require intense concentration, rapid motor skills, and mental agility, integrating technology and media while fostering social engagement [10], [11], [12]. In addition, although it involves sitting, energy expenditure could exceed 1.6 Metabolic Equivalents of Task (METs) and include rapid hand movement and reaction time [13], [14].

A clear distinction must be established between e-games (digital entertainment experiences encompassing casual and narrative-driven play) and e-sports (structured competitive gaming with professionalized rules and institutional oversight). The Olympic E-sports Games illustrate this divide by featuring only digitally adapted physical sports – such as cycling and shooting – while excluding commercially dominant yet non-federated titles. E-sports comprises different game genres, played competitively in controlled environments, between two or more competitors [2]. These games are accessible on multiple platforms (e.g., computer, mobile, console, or tablet) [15] and encompass different modalities. While the Olympic Esports Games prioritize digitized physical sports, genres like First-Person Shooters (FPS) and Multiplayer Online Battle Arena (MOBA) remain pillars of global e-sports, and are the most consolidated in computer platforms [2], [7],[16]. FPS games demand quick responses and hand-eye coordination, while MOBA games require cognitive skills like memory, strategy, and reaction time [17].

Professional e-sports players dedicate significant time to practice and training, leading to significant physical demands [13], [14], [18]. These include prolonged sitting, continuous use of electronic equipment, and repetitive movements. Notably, professionals perform a high volume of actions (500–600 per minute) and practice for extended periods (5–10 hours daily) before competitions [19]. A typical e-sports season involves weekly competitions, team matches, individual practice sessions, and multiple training days focused on improving mechanical or technical skills [20].

Musculoskeletal pain in the shoulders, spine (neck and lower back), wrists, and hands has been reported among e-sports players [21]. The sedentary nature of e-sports, coupled with excessive playing time without breaks, can negatively impact physical and psychological health [22]. While the World Health Organization (WHO) recommends breaks every 2–3 hours to minimize pain risks [21], [23], knowledge about the specific physical demands of e-sports and injury management remains limited [20], and concerns about the health effects of extensive video game play are rising [24].

There is limited evidence on the prevalence of musculoskeletal pain among e-sports players. The limited number of studies has critical limitations, and the current evidence is insufficient to draw definitive conclusions regarding musculoskeletal pain and associated factors in this population [25]. For example, studies measured a few associated variables or used only descriptive statistics, and only one study included professional players [19], [26]. Thus, more studies to assess prevalence, incidence, and associated behavioral factors on specific musculoskeletal conditions across e-sports games and across levels of performance are needed [20]. To address this gap, this study aimed to describe the prevalence of musculoskeletal pain and its associated factors among Brazilian e-sports players.