Ergonomic keyboard for RSI: what helps (and when voice typing wins)

If you’re dealing with RSI or wrist pain, buying an “ergonomic keyboard” is often the first suggestion you’ll hear.

Sometimes it helps a lot. Sometimes it doesn’t — and you end up with an expensive keyboard and the same pain.

This post is our attempt to make the decision less random by combining:

what the ergonomics literature says about keyboard geometry, and
what people actually report in real-world threads,
plus a pragmatic alternative: reduce keystroke volume with voice typing.

Not medical advice. RSI symptoms can overlap with other issues. If you have persistent pain, numbness, or weakness, get medical advice.

TL;DR

“Ergonomic keyboard” is not one thing. The most evidence-backed geometry changes are split, tenting, and negative tilt, because they move wrists/forearms closer to neutral positions in lab studies (Marklin & Simoneau, 2004).
Split keyboard configurations reduced wrist ulnar deviation (a commonly cited risk factor) without obvious typing-efficiency differences across tested configurations in one study of experienced users (Marklin & Simoneau, 2001).
The scientific literature is clear about a limitation: we don’t have enough randomized trials to make strong claims that alternative keyboards prevent or treat musculoskeletal disorders for everyone (Marklin & Simoneau, 2004).
If your pain is primarily volume-related, the fastest lever is often typing less. Dictation can reduce upper‑extremity workload in some tasks, but it shifts some load to your voice (Juul‑Kristensen et al., 2004; Olson et al., 2004).

What “ergonomic” usually means (in practice)

Most mainstream keyboards force:

wrists into some ulnar deviation and extension,
forearms into pronation,
shoulders into a narrower posture than many people naturally prefer.

Alternative keyboard designs try to change one or more of those angles.

In a review of experimental data, Marklin & Simoneau summarize how split geometry, negative slope, and tenting affect wrist/forearm posture and note the need for randomized trials before strong health recommendations (Marklin & Simoneau, 2004).

What features are most worth paying for?

1) A split keyboard (or at least split geometry)

The core idea: bring your hands to shoulder width and reduce wrist deviation.

A study on split keyboard setup configurations found multiple split configurations resulted in less ulnar deviation vs a conventional setup (Marklin & Simoneau, 2001).

Practical tip: if you buy a split keyboard, experiment with:

the separation distance (closer vs shoulder width),
the opening angle,
and whether your elbows/shoulders feel relaxed at rest.

2) Tenting (tilting the halves up)

Tenting primarily targets forearm pronation. In the review, tenting the keyboard halves is described as effective for reducing pronation in experimental studies (Marklin & Simoneau, 2004).

Practical tip: tenting is one of those features that feels weird for a day, then “normal” — but only if your desk height and chair allow your elbows to stay comfortable.

3) Negative tilt (front edge higher, back edge lower)

Negative tilt targets wrist extension. The review notes wrist extension can be reduced toward neutral using a negative slope configuration (with the wrist rest sloping with the keyboard) in experimental data (Marklin & Simoneau, 2004).

Practical tip: a wrist rest isn’t automatically good. The goal is neutral posture, not “more padding”.

Why keyboards sometimes don’t solve RSI

Two common failure modes:

You improved posture, but kept the same typing volume.
You swapped one stressor for another (e.g., reaching for a mouse, heavy key force, awkward shortcuts, long uninterrupted sessions).

That’s why RSI is usually addressed with a bundle of changes:

keyboard geometry
pointing device choice
workstation setup
break schedule
and (often) workload management

The “typing less” alternative: voice typing

If your job is email, docs, tickets, or long-form writing, a keyboard can only get so “comfortable” — you’re still producing thousands of keystrokes per day.

Speech recognition is attractive because it can reduce upper‑extremity workload for some tasks, though the workload shifts (some increases in voice-related muscle activity were observed in a lab study comparing speech recognition vs keyboard/mouse work) (Juul‑Kristensen et al., 2004).

And there’s a real tradeoff: a case series described muscle tension dysphonia after heavy speech recognition use in RSI patients (Olson et al., 2004).

Our practical advice is “hybrid, not purity”:

Dictate drafts (reduce keystrokes)
Edit precisely (keyboard is faster for corrections)
Take microbreaks (reduce continuous load)

If you want an evidence-backed microbreak schedule: /blog/microbreaks-for-typing.
If you want the full dictation-for-RSI deep dive: /blog/voice-typing-for-rsi.

Where Voice Type fits

Voice Type is an on-device dictation app for macOS designed for people who dictate frequently:

system-wide dictation (any app)
hold-to-dictate hotkey (hold → speak → release)
on-device processing (audio stays on your Mac)

If RSI is your main driver, start here: /solutions/rsi.

Real-world threads (worth skimming)

Community threads aren’t medical evidence, but they’re useful for:

seeing which keyboards people stick with long-term,
learning what “annoyances” show up after week 2,
and getting setup ideas (tenting angles, key switches, desk height, etc.).
Reddit: “Low-profile ergonomic keyboard suggestions for RSI?” (r/ErgoMechKeyboards)
Hacker News: “Down the ergonomic keyboard rabbit hole” (HN thread)
Hacker News: “Glove80 Ergonomic Keyboard” (HN thread)

Sources

Alternative keyboard design features review: Marklin & Simoneau, 2004 (PubMed)
Split keyboard configuration and wrist angles: Marklin & Simoneau, 2001 (PubMed)
Split keyboard research history: Rempel, 2008 (PubMed)
Speech recognition workload shift: Juul‑Kristensen et al., 2004 (PubMed)
Voice strain case series: Olson et al., 2004 (PubMed)
Community: r/ErgoMechKeyboards thread, HN thread, HN thread

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