John Mingione, 54, was in his living room, put on his Oculus headset and started playing a Star Wars game. He had given the virtual reality device to his son and was testing out a new game.
Soon he found himself in a fierce battle with a stormtrooper and was getting closer and closer to the edge of a cliff. Mingione lunged forward and suddenly felt himself falling, falling, over the edge, but the ground rose up much faster than he had anticipated. Bam! It turned out he hadn’t fallen off the cliff but had hit a beanbag in his living room and rolled over onto it, face down on the ground.
The house shook so badly when he fell that his wife and children ran in. They found Mingione lying on the floor in pain, pieces of remote controls and batteries scattered around him.
“I told them I was fine, but my knee was hurting,” Mingione said. “… When I fell, what stopped me was the ground, not my hands or anything.”
His knee and elbow swelled painfully and continued to hurt for about four weeks. He hasn’t touched a helmet or played any other game since: “I’m retired,” he said.
Mingione had better luck than a friend who wore a virtual reality headset during a virtual boxing match while his family watched. A family member told him, “You know you can kick, too,” and so his friend kicked the air as hard as he could, breaking his toe on a coffee table.
“You really have to be careful because you can’t see anything when you’re playing,” Mingione said.
Injuries are increasing
As the number of people using virtual reality headsets increases, so does the number of people injured when the virtual world crashes – literally – into the real world.
Sales of virtual reality headsets grew from $4.42 million in 2018 to $21.76 million last year and are expected to reach $27.26 million by 2028, according to Statista Market Insights, which also reported that more than 5.4 million units were sold in 2019 and more than 14 million are expected this year. The headsets cost anywhere from several hundred to several thousand dollars.
A study published last year found that only 125 incidents of VR-related injuries were reported to emergency rooms in 2017. By 2021, that number was estimated at 1,336, according to the study, using data from the National Electronic Injury Surveillance System, known as NEISS.
According to Melissa Kovacs, an associate professor of trauma research at Dignity Health Medical Group in Chandler, Arizona, and a co-author of the study, unofficial 2022 numbers she’s seen show a 100% increase since 2021 in VR-related emergency room visits, reflecting the surge in sales and use of the headsets.
She added that the number of injured is likely much higher than the NEISS figures because the NEISS figures only reflect people who went to emergency rooms, not those who went to doctors’ offices or emergency rooms or who treated their injuries at home.
“These injury numbers are small, but they are increasing quite alarmingly,” Kovacs said.
Daniel Cucher, a trauma surgeon who works with Kovacs at Dignity Health and a co-author of the study published last year, said that after trying one of the virtual reality headsets himself, he understood how people were getting injured. “It’s a physical engagement,” he said, and “they’re typically used in people’s living rooms, basements or enclosed spaces, where they’re prone to injury if they’re wildly flailing around with their headsets” and can’t see or feel the real world of walls, beanbags and chairs around them.
Fractures, lacerations, strains or sprains
According to the study, the most common VR-related injury, accounting for 30% of emergency room visits, was a fracture, followed by lacerations, at 18.6%, contusions at about 14%, and strains or sprains, which accounted for 10%, according to the data.
Young children, up to the age of 5, are most likely to injure their face, while those aged 6 to 18 are most likely to injure their hands or face. Adults, up to the age of 54, primarily injure their knees, fingers and wrists, while the majority of people over the age of 55 injure their upper torso and upper arm.
NEISS cases include: a 60-year-old man who bumped into an object, hit his chest against the wall, and suffered bruised ribs and dental pain; a 13-year-old boy who bumped into a table and lacerated his face; a 9-year-old child who dove and hit his face on a television stand, injuring his teeth and cutting his upper lip; and a 12-year-old child who was evaluated for a head injury after leaning on a virtual shelf that caused him to fall onto a real shelf.
Many VR-related injuries are caused by a direct blow or hitting a hard object, such as a wall, table or door frame, said Hilton Phillip Gottschalk, an orthopedic hand surgeon in Austin who has treated a number of people with such injuries.
When his son plays a virtual reality game called “Gorilla Tag,” Gottschalk says, he has no idea where walls, tables or couches are. When he hits something in the virtual game, he could easily hit a real object in the room with great force without even knowing it’s there.
“There is a certain percentage [of injuries] “These are falls due to dizziness, trips or whatever. But most of these falls are actually direct hits, direct contact. Hand hits the wall, hand hits the couch, hand hits the table,” Gottschalk said.
Bryce Gillespie, an orthopedic surgeon in Atlanta who specializes in hands and upper extremities, wrote in an email that the most common VR-related injuries he sees are finger fractures. Fortunately, most simply require a cast and not surgery, he wrote in an email.
“The injuries I’ve seen are typically among teenagers who are using virtual reality headsets to play video games” at home, Gillespie wrote. “They lose track of objects around them. Some trip over a table and land on their hands. Others simply turn around quickly and hit a doorjamb with their hands.”
Recently, he treated a 12-year-old boy who was playing a virtual reality game and hit his hand on a doorjamb while waving his arms to defend himself, breaking several fingers. And a 14-year-old boy came to him after he tripped over a coffee table, fell, and broke bones in his hand while playing a virtual reality sports game.
Headsets can be disorienting
Jennifer Weiss, chief of staff at Shriners Children’s Hospital in Honolulu, recently treated a 13-year-old boy who sprained his ankle and ended up in an inflatable cast even though he had set up his playset so there was nothing to trip over. “It wasn’t even that there was anything to trip over. It was just that his proprioception was weird,” she said, referring to the ability to sense where one’s body is in relation to the space around it. “He misjudged where the ground was.”
She knows the feeling, Weiss said. She recently made a virtual reality mockup of an operating room and said wearing the headset was disorienting.
“When I played with [the VR glasses] “It’s kind of like walking in the dark,” she said. “Even though there’s nothing to trip over, it’s just a different feeling of where your body is.”
Brian A. Janz, a plastic and reconstructive surgeon in Catonsville, Md., who specializes in hands and upper extremities, said the increase in VR-related injuries is similar to what happened a few years ago when people started buying hoverboards, two-wheeled, self-balancing scooters that people steer by leaning forward, backward, right or left.
A child would get one for Christmas and then adults would try it and get hurt. “I’ve seen injuries very similar to hoverboards, where parents and grandparents [are] “I tried virtual reality and then I got unsteady or had bad balance and fell and ended up spraining or breaking my wrist,” he said. With hoverboards, people eventually got used to using them and the number of injuries went down. The same thing is likely to happen with virtual reality, he said.
VR device manufacturers provide rules for safe use of their products, including using them in an open space and setting gameplay boundaries in the headset, so that the player does not venture into areas cluttered by real-world objects. If the user exceeds the boundaries, the device alerts them.
Kate McLaughlin, a spokeswoman for Meta, which makes a line of Quest virtual reality headsets, responded to questions about the injuries by pointing to the company’s safety guidelines. “This is our Meta Quest Safety Center, where we help educate people on how to stay safe when using Meta Quest products,” she wrote in an email.
Apple, which makes the Apple Vision Pro, also highlighted its safety guidelines and said its product “uses the most natural and intuitive inputs possible: the user’s eyes, hands, and voice,” Apple public relations manager Andrea Schubert wrote in an email. “Apple Vision Pro is a spatial computer that blends digital content with the physical world while allowing users to remain present and connected to others (users can see the world around them as soon as they pick up the device).”
In an ideal world, that might be true. “But let’s be honest,” Gottschalk said. “When you make a quick move, you don’t have time to react, right? If you’re close to that boundary and you make a quick maneuver, a quick hand movement, by the time you get that alert, it’s over. You’ve already done the damage.”
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