John Mingione stood in his living room, put on an Oculus headset and began playing a Star Wars game. Mr. Mingione, 54, had given his son the virtual-reality device as a gift and was trying out a new game.
Soon, he was caught up in a pitched battle with stormtroopers, getting closer and closer to the edge of a cliff. Mingione lunged forward and suddenly felt himself falling off the cliff, but the ground rose up much faster than he expected. Bang! In the end, instead of falling off the cliff, he crashed into an ottoman in the living room, flipped over it, and landed face-first on the floor.
The house shook violently when Mingione fell, so his wife and children rushed to his side and found him lying on the floor, shaking in pain, with pieces of the remote control and batteries scattered around him.
“I told them I was OK, but my knee hurt,” Mingione said. “When I fell, it wasn’t my hands or anything that stopped me, it was the floor.”
His knees and elbows were badly swollen and in pain for about four weeks. He hasn’t touched a headset or another game since. “I’m retired,” he said.
Mingione was luckier than a friend who was wearing a VR headset and taking part in a virtual boxing match with his family watching: “I know you can kick too,” one of the family members said, so the friend kicked as hard as he could into the air, smashing his toe on a coffee table and breaking it.
“You can’t see anything while you’re playing so you definitely have to be careful,” Mingione said.
Increase in number of injured
As the number of people using VR headsets increases, so does the number of people getting injured when the virtual world literally crashes into the real world.
According to Statista Market Insights, sales of virtual reality headsets increased from $4.42 million in 2018 to $21.76 million last year and are expected to reach $27.26 million by 2028. The company also reported that more than 5.4 million units were sold in 2019 and are projected to exceed 14 million this year. Headsets range in price from a few hundred to a few thousand dollars.
A study published last year found that just 125 VR-related injuries were reported to emergency rooms in 2017. Using data from the National Electronic Injury Surveillance System, known as NEISS, the study estimated that number will reach 1,336 by 2021.
Melissa Kovacs, an associate professor of trauma research at Dignity Health Medical Group in Chandler, Arizona, and co-author of the study, said unofficial numbers she’s seen for 2022 show a 100 percent increase in VR-related emergency room visits since 2021, reflecting increased sales and use of the headsets.
She added that the number of injuries is probably much higher than the NEISS figures because the NEISS figures only reflect people who went to emergency departments, not people who went to a doctor’s office or urgent care clinic or who dealt with injuries at home.
“The number of injuries is small, but it is increasing at an alarming rate,” Kovacs said.
Daniel Kuchar, a trauma surgeon who works with Kovacs at Dignity Health and co-authored a study published last year, said he tried a VR headset himself and understood how people could get hurt. “It’s a pretty physical engagement,” he said. “These are typically used in people’s living rooms or basements or enclosed spaces, where you’re more likely to get hurt if you go thrashing around with the headset on” because you can’t see or feel the real world around you, like walls, ottomans or chairs.
Fractures, lacerations, sprains
According to the study, the most common VR-related injuries were fractures, accounting for 30% of emergency room visits, followed by lacerations at 18.6%, contusions at about 14%, and sprains at 10%.
Children up to age 5 were most likely to have injuries to the face, while those aged 6 to 18 were most likely to have injuries to the hands and face. Adults up to age 54 primarily sustained injuries to the knees, fingers, and wrists, while most people aged 55 and over sustained injuries to the upper body and upper arms.
NEISS cases included a 60-year-old man who was struck by an object and slammed his chest into a wall, suffering bruised ribs and a sore tooth; a 13-year-old boy who was struck by a table and suffered a laceration to his face; a 9-year-old boy who dove and slammed his face into a TV stand, suffering damaged teeth and a cut to his upper lip; and a 12-year-old boy who leaned on a virtual shelf and fell onto a real shelf, requiring testing for a head injury.
Many VR-related injuries occur through direct impact or collision with a hard object such as a wall, table or door frame, said Hilton Philip Gottschalk, an Austin orthopedic surgeon who has treated many patients with such injuries.
Gottschalk said that when his son plays the VR game “Gorilla Tag,” he has no idea where the walls, tables or couches are, and when he hits something in the virtual game, he can easily hit it with too much force without realizing that the actual object in the room is there.
“At a certain rate [of injuries] “Some falls are due to dizziness or tripping, but most are direct blows, direct contact — a hand hitting a wall, hitting a couch, hitting a table,” Gottschalk said.
Bryce Gillespie, an Atlanta-based orthopedic surgeon who specializes in the hand and upper extremities, said in an email that the most common VR injury is a broken finger. The good news is that most injuries can be treated with a cast rather than surgery, he said.
“Many of the injuries I’ve seen are among teenage boys using VR headsets while gaming at home,” Gillespie wrote. “They lose sight of what’s around them. Some have tripped over tables and fallen onto their hands to the ground. Others have slammed their hands into doorframes simply by turning around too quickly.”
Recently, he treated a 12-year-old boy who broke multiple fingers after slamming his hand on a door frame while playing a VR game and swinging his arm in defense, and a 14-year-old boy came in after breaking his hand after tripping over a coffee table while playing a VR sports game.
Headsets can be disorienting
Jennifer Weiss, chief of staff at Shriners Hospitals for Children in Honolulu, recently treated a 13-year-old boy who sprained his ankle and ended up in an air cast. The boy sprained his ankle despite setting up for a game where he’d have no obstacles to bump into or trip over. “It wasn’t like there was anything to trip him over. It was just that his proprioception was off,” Weiss said, referring to his ability to sense where his body was in relation to the space around him. “He misjudged where the floor was.”
Weiss says she understands that feeling: She recently built a virtual reality model of an operating room, and found putting on the headset to be disorienting.
“When I’m playing [the VR glasses] “…It’s like walking in the dark,” she said. “You don’t have anything to trip over, but you have a different sense of where your body is.”
Brian A. Jantz, a plastic surgeon in Catonsville, Maryland, who specializes in the hand and upper extremities, said the rise in VR-related injuries is similar to what happened a few years ago when people started buying hoverboards, two-wheeled, self-balancing scooters that steer by leaning forward, backward, and side to side.
A child gets a hoverboard for Christmas, and then an adult tries it and gets hurt. “I’ve seen parents and grandparents get injuries that are very similar to what happens with a hoverboard. [are] “We’ve seen a lot of cases where people try VR, get unstable or lose their balance, fall, and end up with a sprained or broken wrist,” he said. With hoverboards, people eventually got used to riding them, and the number of injuries went down. The same thing is likely to happen with VR, he said.
VR device manufacturers enforce rules for using their products safely, such as using them in an obstacle-free space and setting play boundaries on the headset to ensure play does not extend into areas blocked by real-world objects, and the device will warn users when they go beyond the boundaries.
Kate McLaughlin, a spokeswoman for Meta, which makes the Quest line of VR headsets, responded to questions about the injuries by pointing to the company’s safety instructions: “This is our MetaQuest Safety Center, where we teach people how to stay safe when using MetaQuest products,” she said in an email.
Apple, which makes the Apple Vision Pro, also pointed to its safety guidelines, saying its product “uses the most natural and intuitive inputs possible: a user’s eyes, hands, and voice,” Andrea Schubert, Apple’s public relations manager, said in an email. “Apple Vision Pro is a spatial computer that allows users to stay present and connect with others while blending digital content with the physical world (users can see the world around them from the moment they put on the device).”
In an ideal world, that might be true, “but let’s be honest,” Gottschalk says, “when you’re moving fast, you don’t have time to react, right? You get close to the boundary, you move fast, you make a quick move with your hand, and by the time you get a warning, it’s over. You’ve already done the damage.”
