Effects of age and starting age upon side asymmetry in the arms of veteran tennis players: a cross-sectional study



While tennis playing results in large bone strength benefits in the racquet arm of young players, the effects of tennis playing in old players have not been investigated. Large side asymmetries in bone strength were found in veteran players, which were more pronounced in men, younger players and childhood starters.


Regular tennis results in large racquet arm bone and muscle strength advantages; however, these effects have not been studied in old players. The non-racquet arm can act as an internal control for the exercising racquet arm without confounding factors, e.g. genotype. Therefore, veteran tennis player side asymmetries were examined to investigate age, sex and starting age effects on bone exercise benefits.


Peripheral quantitative computed tomography (pQCT) scans were taken at the radius, ulna and humerus mid-shaft and distal radius in both arms of 88 tennis players (51 males, 37 females; mean age 63.8 ± 11.8 years). Thirty-two players began playing in adulthood, thereby termed ‘old starters’; players were otherwise termed ‘young starters’.


Muscle size and bone strength were greater in the racquet arm; notably, distal radius bone mineral content (BMC) was 13 ± 10 % higher and humeral bone area 23 ± 12 % larger (both P < 0.001). Epiphyseal BMC asymmetry was not affected by age (P = 0.863) or sex (P = 0.954), but diaphyseal asymmetries were less pronounced in older players and women, particularly in the humerus where BMC, area and moment of resistance asymmetries were 28–34 % less in women (P < 0.01). Bone area and periosteal circumference asymmetries were smaller in old starters (all P < 0.01); most notably, no distal radius asymmetry was found in this group (0.4 ± 3.4 %).


Tennis participation is associated with large side asymmetries in muscle and bone strength in old age. Larger relative side asymmetries in men, younger players and young starters suggest a greater potential for exercise benefits to bone in these groups.

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Ireland, A., Maden-Wilkinson, T., Ganse, B. et al. Effects of age and starting age upon side asymmetry in the arms of veteran tennis players: a cross-sectional study. Osteoporos Int 25, 1389–1400 (2014). https://doi.org/10.1007/s00198-014-2617-5

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  • Ageing
  • BMD
  • Bone
  • Exercise
  • Muscle
  • pQCT