A tennis player's arm transforming into a bone structure highlighting bone density, illustrating arm asymmetry in tennis.

Tennis Elbow Myths Busted: The Truth About Arm Asymmetry & Bone Health

Beau Callahan in Health & Wellness December 2025 • 4 min read.

"Is your tennis swing setting you up for injury? Uncover the science behind arm strength, bone density, and how to balance your game for a lifetime of play."

Tennis, a sport celebrated for its blend of strategy, agility, and power, often demands more from one side of the body than the other. This inherent asymmetry, while crucial for generating forceful serves and precise volleys, can lead to imbalances that affect bone health and overall athletic longevity. Understanding how this uneven strain impacts the body is essential for players of all levels.

The repetitive nature of tennis strokes, where one arm consistently bears the brunt of the action, can cause significant differences in bone mineral content (BMC) between the dominant and non-dominant arms. This adaptation, governed by Wolff's Law, suggests that bone tissue responds to mechanical stress by increasing mass and density in the areas subjected to higher loads. While this adaptation can enhance performance, it also raises questions about potential long-term risks associated with such pronounced asymmetry.

Recent research has delved into the extent of these bone mineral content asymmetries in tennis players, examining factors like gender, age, and starting age to understand their influence on bone adaptation. By exploring the science behind these imbalances, athletes and coaches can make informed decisions about training regimens, injury prevention strategies, and overall health management.

Why Does Tennis Create Arm Imbalances?

A tennis player's arm transforming into a bone structure highlighting bone density, illustrating arm asymmetry in tennis.

The unilateral nature of tennis inherently favors one side of the body, leading to significant strength and bone density differences between the dominant and non-dominant arms. Each powerful serve and forehand swing places substantial stress on the dominant arm, prompting adaptive changes in bone structure and muscle mass. This process, known as lateralization, is a natural consequence of the sport’s demands.

Wolff's Law explains that bone tissue adapts to the loads it experiences. In tennis players, the dominant arm is subjected to far greater mechanical loading than the non-dominant arm. This leads to increased bone mass and size in the dominant arm, a phenomenon that researchers can quantify by measuring bone mineral content (BMC).

Increased Bone Density: The dominant arm experiences higher bone mineral content due to repetitive stress.
Muscle Mass Adaptation: Muscles in the dominant arm adapt to generate more power and withstand greater forces.
Risk of Imbalance: Significant asymmetry can lead to injury if not managed properly through balanced training.

While this adaptation is beneficial for performance, the long-term effects of such pronounced asymmetry need careful consideration. Understanding these changes enables players and coaches to implement strategies that mitigate potential risks and promote balanced athletic development.

What's Next for Tennis Players and Bone Health?

While this study highlights the impact of sex, chronological age and starting age on upper extremity asymmetry, one important variable remains: training volume. More studies are required to fully understand the effects of intensity and repetition of playing tennis, to better prepare athletes for tennis playing as they get older.

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This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1080/02640414.2018.1537173, Alternate LINK

Title: Upper Extremity Bone Mineral Content Asymmetries In Tennis Players: A Systematic Review And Meta-Analysis

Subject: Physical Therapy, Sports Therapy and Rehabilitation

Journal: Journal of Sports Sciences

Publisher: Informa UK Limited

Authors: Laurent Chapelle, Nikki Rommers, Peter Clarys, Eva D’Hondt, Jan Taeymans

Published: 2018-10-25

Everything You Need To Know

Why do tennis players often develop imbalances in their arms?

Tennis involves repetitive, one-sided movements like serving and hitting forehands, which place significantly more stress on the dominant arm. This unilateral action leads to a process called lateralization, where the dominant arm adapts by increasing muscle mass and bone mineral content (BMC) to handle the higher loads, while the non-dominant arm experiences less stress and adapts differently.

What is Wolff's Law, and how does it relate to bone density in tennis players?

Wolff's Law explains how bones adapt to the stress they endure. In tennis, the dominant arm experiences greater mechanical loading due to repetitive motions. As a result, the bone tissue in the dominant arm responds by increasing bone mass and density. This adaptation is measurable through bone mineral content (BMC) assessments, showing a higher BMC in the dominant arm compared to the non-dominant arm.

What are the implications of having increased bone mineral content in the dominant arm for tennis players?

The increased bone mineral content (BMC) and muscle mass in the dominant arm are beneficial for generating power and withstanding the forces during tennis strokes. However, significant asymmetry between the arms can lead to potential risks if not managed properly. This imbalance can increase the risk of injury and affect long-term athletic development. Therefore, balanced training regimens are crucial to mitigate these potential issues.

Besides sex and age, what other factors influence arm asymmetry in tennis players, and what further research is needed?

Current research shows that factors such as sex, chronological age, and starting age influence upper extremity asymmetry in tennis players. However, training volume is another important variable that needs consideration. Further studies are required to fully understand how the intensity and repetition of playing tennis impact bone health and adaptation in athletes, especially as they age. This information is crucial to prepare athletes for tennis throughout their lifespan.

What strategies can tennis players and coaches implement to address arm imbalances and promote balanced athletic development?

Strategies include incorporating exercises that target the non-dominant side to balance muscle strength and bone density. Cross-training activities that promote overall body strength and stability can also help. Coaches and trainers should monitor players for signs of overuse injuries and address imbalances early on. Regular bone mineral content (BMC) assessments can provide valuable insights into bone health and guide training adjustments.