How to Fix Wrist Pain with Typing – Ultimate Keyboard Ergonomics Guide


If you’ve made it here you may have some discomfort or pain at your wrist after a long day of office work or gaming. Or maybe even both. Or you might be feeling some discomfort while you are working and want to make sure you fix it so it doesn’t get worse and prevent you from being able to continue working. If this is you, you are in the right place.


I’m Dr. Matthew Hwu a Physical Therapist who has been working with the olympians of desk work (esports athletes) for the past 8 years and have helped more than 2500 individuals resolve their wrist pain associated with excessive keyboard and mouse use. In gaming and esports players perform 10-15 movements per second (500-800 actions per minute) regularly practice esports-related skills for 5 to 10 hours per day.  Esports load is nearly triple the 8000 to 11 000 keystrokes (130-180 actions per minute) of office workers, who are already at increased risk of upper extremity pain. This is why it is important for us to consider our environment and keyboard ergonomics to minimize the risk of it contributing to our pain. This is a full guide on keyboard ergonomics so you can make some initial changes for better wrist health.


I want to remind you if you have some wrist pain, we do have a free wrist pain guide which provides you specific exercises based on where you are feeling your pain, which you can check out here



Hand And Wrist Position with the Keyboard

Hand & wrist position is important to consider when using the keyboard. Similar to how we want to think about posture the goal with the keyboard setup is to try to find a “neutral” position of the wrist. This is the position of the wrist in which there is the least amount of stress on the supporting muscles & tissues based on how muscles function (the work best at certain muscle lengths). Here is how you can setup in neutral.




When looking at the wrist from a “top-down” view you should do your best to avoid being in a position where the wrist is tilting too much to the left or right. Too much tilt to the left and this can cause some compressive stress at the pinky side of the wrist or irritate the pinky sided muscles. Too much tilt to the right and it can lead to increased use of muscles on the thumb side of our wrist. Split keyboards can often help with this as it allows the keyboard to move to a more natural position with respect to our shoulders so our wrists do not have to compensate (more on this later). We see these tilted positions occur for several reasons:


  1. Keyboard does not allow for neutral wrist (flat design)
  2. Keyboard is tilted to optimize for space and gaming
  3. Certain binds or keys are pressed more frequently on the keyboard which leads to certain movement patterns requiring the tilt (ex: alot of pinky sided keyboard pressing or spacebar pressing)
  4. Limitations in desk space
  5. Many more (if i missed something let me know in the comments!)

When we tilt our wrist in either direction, the muscles on that side of the wrist are often shortened. As I mentioned earlier muscles function better at certain lengths (research shows about 1.2x of the length allows for the muscle to generate the most overall force, this is known as the length tension relationship). This could lead to the tissues becoming fatigued more easily and tendons becoming irritated from repeated load or stress.

1HP RX: Start by looking at your wrist position. If your keyboard does not allow you to do this, IT IS OKAY. Wrist position is only one part of our ergonomics and overall physical health. I will explain more later.



Similarly when we look at the wrist in from a side-view, we should be avoiding excessive amounts of extension. This means bending the wrist up towards the ceiling. We can get away with around 10-15 degrees of extension as there is a natural amount that needs to occur in order for the muscles at our forearm to work well. Again this is based on the length-tension relationship of the muscles described above. In the research it has shown when there is more overall extension >20-30° the muscles on the top side of the forearm require more exertion to activate. This again can lead to earlier fatigue (less endurance) of these muscles and irritation of the tissues can develop. We have seen this extended position occur for several reasons:

  1. No palm / wrist support utilized
  2. Limited desk space leading to awkward position of the keyboard (elevated on a monitor stand) 
  3. Skinny individuals who have less forearm bulk often require more overall wrist extension
  4. Elevated arm-rests 
  5. Desk being too low compared to elbow position

1HP Rx: Try your best to keep your wrist in neutral to 10-15 degrees of extension. This can reduce the stress on the wrist & hand


This is one of the most common questions we get. I think all keyboards will and should have ergonomic features since they can only benefit health and performance. This answer may surprise you but in most cases, they aren’t necessary. I will provide some context as to why, there is nuance to consider in this response. Ergonomic keyboards typically focus on allowing some level of adjustability to help the wrist stay in a more neutral position. This might mean


  1. The ability to tent, especially for split keyboards which allows the thumb side of the each half to tilt upwards
  2. Adjustability stands to modify tilt in extension or flexion. 
  3. Palm & wrist support integration
  4. Key placement and design to minimize distance traveled for fingers
  5. Keyboard macros to minimize actions or strokes per unit time
  6. Modified heights & width of the keyboard


The goal with these features is again to help the wrist stay in a more neutral position and limit the overall amount of stress on the muscles of the forearm and hand while typing. But one should realize if you perform 500 strokes per minute, the stress will always go somewhere. Often those who develop wrist pain or pain with typing type so much that even with the REDUCTION of stress will not reduce the potential irritation of the tissues at the wrist and hand. They might also not have the muscular endurance to handle the repeated stress over time. 


These two reasons (how much you type & the endurance of your forearm/hand muscles) are the MOST common reasons why we see wrist pain occur for individuals that are on the PC frequently. It is not because the keyboard is designed in a way that will lead to the tissues becoming irritated. This is why ergonomic keyboards aren’t typically necessary. They can help but don’t address these underlying issues & problems.


Regardless, I will highlight how each of these features can reduce stress and why you might as well get an ergonomic keyboard since it allows it to better match to your individual physiology and desk setup. If you can reduce the risk of injury by 10% by having a more adjustable keyboard, might as well do it. But remember managing your schedule (how much you type) and strengthening your forearms are MORE important.


Split keyboards are a bit more prevalent nowadays, which I love. These types of keyboards can often help to maintain a better shoulder position. Instead of causing the shoulders to rotate inward, the keyboard can be utilized in a more neutral position of rotation. 

Keep in mind not all split keyboards are designed with gaming in mind. Some are, like the Kinesis & Dygma keyboards, but others might lack the highly responsive switches that people are comfortable with and decrease strain by virtue of the minimal force required to press them. There’s a learning curve required when switching keyboard styles, and certain positions of the right side of the keyboard might interfere with comfortable mouse movement. If you’ve had difficulty making your setup more specific to you, a split keyboard adds more points of adjustability and may be the ergonomic “boost” you’re looking for.

That’s not to say it’s impossible to have a good ergonomic setup with a standard keyboard; it’s absolutely possible. As I mentioned, if you don’t require much out of your hands throughout the day, maintain good stretching, strengthening, and break-taking habits, and don’t have any injury history, you may find the extra ergonomic benefits a split keyboard offers to be unnecessary (just remember that preventing an injury is easier than treating it!)




Split keyboards and other ergonomic variants now have the ability to tent meaning the angle of the inside of the keyboard can move up.  This controls the amount of wrist PRONATION and SUPINATION which affects the length and activity  of certain muscles along the forearm. The research shows how any reduction in the amount of pronation can be helpful in reducing the risk of shoulder, forearm and hand pain – even though it is a small amount.


For the nerds out there has been research recently that has shown differing results when it comes to wrist/hand strength with different positions of wrist rotation. It seems to indicate that despite having less ACTIVITY in the position, it does not mean the muscles work optimally in that position. But this is a more nuanced discussion that doesn’t really have much clinical benefits to us. 


1HP RX: The bottom line is  if you can tent your keyboard it can potentially help to reduce the risk of forearm and shoulder discomfort. It is my opinion that it is likely a roughly 5% reduction of risk as there are other factors to consider. It may matter more for those who use the PC or game upwards of 8-12 hours a day. 



A majority of keyboards often come with wrist rests however the compact profile keyboards which are popular within the gaming community often do not have a built in wrist rest. The function of a wrist rest is to reduce the amount of potential extension at the wrist and as mentioned above this can reduce the overall stress on the top side of the forearm due to the physiology of muscles.

1HP Rx: We do recommend most individuals try to have a wrist

rest for this reason however some individuals may not need it based on their individual morphology (those with larger forearm bulk typically have less relative extension as the tissue elevates the forearm and thumb muscle bulk may also reduce relative extension). 





Binds can also affect where stress is distributed for the muscles of the wrist and hand. If you use certain binds more frequently in game you are utilizing those muscles more frequently. How you move to press the keys is also important. If you tend to use your index finger more for certain buttons it can be a potential cause – this is more often for gaming in which certain buttons are constantly spammed.  


Ortholinear and other key orientations are also available as niche products within the keyboard ergonomic space that claim to reduce the overall strain in the hand as a result of the position of the keys and the potential for less overall distance traveled for the fingers. This in theory does make sense but there have not been any studies which have confirmed the benefit. Again one should ZOOM OUT to realize that these are minor differences in physical stress and addressing the larger contributors of

  1. Schedule management – cumulative key strokes per session. Making sure you take breaks to allow tissues to recover. Stretching between your natural work breaks as well (You can again reference our free wrist pain guide to learn the exact stretches and exercises you can do to target specific regions
  2. Build up the endurance of the muscles you use frequently (Check out the guide or this video to learn more)


You can have the perfect ergonomics and still develop wrist pain. This is because ergonomics is typically just a small component of your physical health. With most issues of the wrist and hand it is muscle endurance and how long you are typing. The distribution below represents the majority of cases we have seen with wrist pain in gamers and desk workers. There are absolutely cases in which keyboard  ergonomics have played a larger role but those are few and far between. In most cases the lower levels of physical activity, weakness in the forearm, schedule requiring significant amount of typing and keyboard use all lead to the development of wrist pain and wrist under preparation injuries (overuse injuries).

Hope this guide was helpful for you! If you have any questions feel free to reach out to us on twitter or any other platform. You can also join our email list if you want direct access to more content like this. Don’t forget to checkout the free wrist pain guide if you have current wrist pain!



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