Why You Should Rethink Using Wrist Rests

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Disclaimer: I make ergonomic keyboards at taikohub.com.

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It is a bit troubling when I see wrist rests being so commonly accepted without much discussion. At least once a month I am asked what wrist rest I would recommend. But the first thought that comes to mind is that the question assumes that wrist rests are something that you actually want. Instead, wrist rests are quite controversial. There are specific circumstances where they might be helpful, but the risk for harm is real.

The problem with wrist rests is that putting your wrist on them increases pressure on the nerves and tendons of your wrist. The wrist contains an area called the carpal tunnel compartment where nerves and tendons run through. Note that the carpal tunnel compartment is an anatomic area and not to be confused with carpal tunnel syndrome, which is a medical condition due to median nerve irritation. This compartment is sensitive to increased pressure. While putting pressure every once in a while might not cause issues, doing this frequently or for long periods of time can result in carpal tunnel syndrome.

A cross section of the anatomic area known as the carpal tunnel compartment. Reproduced and adapted from Rodner C, Raissis A, Akelman E: Carpal tunnel syndrome. Orthopaedic Knowledge Online Journal. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2009; 7(5). Accessed September 2022.

You could avoid the issue by floating your hands above the keyboard when you type. But in that case, there’s no point in having a wrist rest.

The controversy comes in when we find ourselves habitually placing our wrists on sharp edges, such as desks or laptops. In this case, a soft wrist rest can help reduce the pressure. Although it’s worth considering whether it might be easier and better to just avoid sharp edges in the first place.

Sometimes people find wrist rests helpful for neck and shoulder discomfort. The caveat is that you’re offloading pressure from those areas onto your wrists. In the short run, you might find it helping your neck and shoulders without noticeable discomfort to your wrists. In the long run, the increased pressure can be harmful.

You probably have already guessed by this point, but I personally avoid wrist rests. I did actually try wrist rests at one point, because I like experimenting on myself. But I stopped after a week because they worsened the pain. That’s only a sample size of 1, so take it with a grain of salt, but even n = 1 can provide valuable information.

Instead of all the focus on wrist rests, I wish I saw more recommendations on healthy typing habits. Below is an interesting excerpt from the Canadian Centre for Occupation Health and Safety (CCOHS) summarizing recommendations from the U.S. Occupational Safety and Health Administration (OSHA).

• Your hands should move freely and be elevated above the wrist/palm rest while typing. When resting, the pad should contact the heel or palm of your hand, not your wrist. …If used, wrist/palm rests should be part of an ergonomically-coordinated computer workstation.
• Reduce bending of the wrists by adjusting other workstation components (chair, desk, keyboard) so the wrist can maintain an in-line, neutral posture.
• Match the wrist support to the width, height, and slope of the front edge of the keyboard (keeping in mind that the goal is to keep wrist postures as straight as possible).
• Provide wrist/palm supports that are fairly soft and rounded to minimize pressure on the wrist. The support should be at least 3.8 cm (1.5 inches) deep.
• For tasks that involve working with shoulders raised, elbows held out, arms held forward and wrists held up (as in typing, micro-electronics assembly, etc.), any means of reducing muscular tension is important in preventing musculoskeletal injuries.

The recommendations are interesting because they’re telling you to avoid using wrist rests, even when not typing, but if you do use it, they recommend soft and rounded wrist rests to minimize pressure.

I do something similar to the recommendations above. I aim to keep my hands floating above my keyboard and my wrists in a neutral position. Meaning the wrist is not flexed down or extended up. I also find my standing desk to be quite useful, because I can switch between sitting and standing to avoid fatiguing my back muscles. It also allows me to move the desk to a position where my elbows are flexed at 90 degrees and my shoulders aren’t hunched. Although not everyone has a standing desk. If your desk is unadjustable, an adjustable slide out keyboard tray can achieve the same effect.

An example of neutral sitting posture Reproduced and adapted from Busse, P. (2022, June 8). Workplace ergonomics: Tips for neutral posture. SFM Mutual Insurance. Accessed September 2022, from https://www.sfmic.com/workplace-ergonomics-for-neutral-posture.

Ultimately, wrist rests are a personal decision and should be considered carefully based on your circumstances. If in doubt, talk to your local MD, occupational therapist or physiotherapist.

On a personal note, my level of exercise tanked during the pandemic. This led to weak back muscles, meaning I couldn’t sit for long periods of time without hunching forward. I would compensate for the shift in center of gravity by putting pressure on my wrists. Physiotherapy and split keyboard with tenting was helpful enough to resolve things. But I still do physiotherapy exercises regularly to keep things at bay.

References

1. Government of Canada, C. C. for O. H. and S. (2022, August 18). Wrist Rests. Canadian Centre for Occupational Health and Safety. Retrieved August 18, 2022, from https://www.ccohs.ca/oshanswers/ergonomics/office/wrist.html

2. Keith MW, Masear V, Chung K, Maupin K, Andary M, Amadio PC, Barth RW, Watters WC 3rd, Goldberg MJ, Haralson RH 3rd, Turkelson CM, Wies JL. Diagnosis of carpal tunnel syndrome. J Am Acad Orthop Surg. 2009 Jun;17(6):389-96. doi: 10.5435/00124635-200906000-00007. PMID: 19474448; PMCID: PMC5175465.

3. Aboonq M. S. (2015). Pathophysiology of carpal tunnel syndrome. Neurosciences (Riyadh, Saudi Arabia), 20(1), 4–9.2022

4. Pidgeon, T. S., Faust, K., & Jennings, C. D. (2022, March). Carpal tunnel syndrome - symptoms and treatment - orthoinfo - AAOS. OrthoInfo. Retrieved August 28, 2022, from https://orthoinfo.aaos.org/en/diseases–conditions/carpal-tunnel-syndrome

5. Busse, P. (2022, June 8). Workplace ergonomics: Tips for neutral posture. SFM Mutual Insurance. Retrieved September 20, 2022, from https://www.sfmic.com/workplace-ergonomics-for-neutral-posture

Thanks to Avnit Grewal, MScOT, Victor Uong, BKin and Carlos Yu, MD for reading drafts of this.