An observational human study investigating the effect of anabolic androgenic steroid use on the transcriptome of skeletal muscle and whole blood using RNA-Seq.

BACKGROUND: The effects of Anabolic Androgenic Steroids (AAS) are largely illustrated through Androgen Receptor induced gene transcription, yet RNA-Seq has yet to be conducted on human whole blood and skeletal muscle. Investigating the transcriptional signature of AAS in blood may aid AAS detection and in muscle further understanding of AAS induced hypertrophy. METHODS: Males aged 20-42 were recruited and sampled once: sedentary controls (C), resistance trained lifters (RT) and resistance trained current AAS users (RT-AS) who ceased exposure ≤ 2 or ≥ 10 weeks prior to sampling. RT-AS were sampled twice as Returning Participants (RP) if AAS usage ceased for ≥ 18 weeks. RNA was extracted from whole blood and trapezius muscle samples. RNA libraries were sequenced twice, for validation purposes, on the DNBSEQ-G400RS with either standard or CoolMPS PE100 reagents following MGI protocols. Genes were considered differentially expressed with FDR < 0.05 and a 1.2- fold change. RESULTS: Cross-comparison of both standard reagent whole blood (N = 55: C = 7, RT = 20, RT-AS ≤ 2 = 14, RT-AS ≥ 10 = 10, RP = 4; N = 46: C = 6, RT = 17, RT-AS ≤ 2 = 12, RT-AS ≥ 10 = 8, RP = 3) sequencing datasets, showed that no genes or gene sets/pathways were differentially expressed between time points for RP or between group comparisons of RT-AS ≤ 2 vs. C, RT, or RT-AS ≥ 10. Cross-comparison of both muscle (N = 51, C = 5, RT = 17, RT-AS ≤ 2 = 15, RT-AS ≥ 10 = 11, RP = 3) sequencing (one standard & one CoolMPS reagent) datasets, showed one gene, CHRDL1, which has atrophying potential, was upregulated in RP visit two. In both muscle sequencing datasets, nine differentially expressed genes, overlapped with RT-AS ≤ 2 vs. RT and RT-AS ≤ 2 vs. C, but were not differentially expressed with RT vs. C, possibly suggesting they are from acute doping alone. No genes seemed to be differentially expressed in muscle after the long-term cessation of AAS, whereas a previous study found long term proteomic changes. CONCLUSION: A whole blood transcriptional signature of AAS doping was not identified. However, RNA-Seq of muscle has identified numerous differentially expressed genes with known impacts on hypertrophic processes that may further our understanding on AAS induced hypertrophy. Differences in training regimens in participant groupings may have influenced results. Future studies should focus on longitudinal sampling pre, during and post-AAS exposure to better control for confounding variables.

The MMAAS Project: An Observational Human Study Investigating the Effect of Anabolic Androgenic Steroid Use on Gene Expression and the Molecular Mechanism of Muscle Memory.

OBJECTIVE: It remains unknown whether myonuclei remain elevated post anabolic-androgenic steroid (AAS) usage in humans. Limited data exist on AAS-induced changes in gene expression. DESIGN: Cross-sectional/longitudinal. SETTING: University. PARTICIPANTS: Fifty-six men aged 20 to 42 years. INDEPENDENT VARIABLES: Non-resistance-trained (C) or resistance-trained (RT), RT currently using AAS (RT-AS), of which if AAS usage ceased for ≥18 weeks resampled as Returning Participants (RP) or RT previously using AAS (PREV). MAIN OUTCOME MEASURES: Myonuclei per fiber and cross-sectional area (CSA) of trapezius muscle fibers. RESULTS: There were no significant differences between C (n = 5), RT (n = 15), RT-AS (n = 17), and PREV (n = 6) for myonuclei per fiber. Three of 5 returning participants (RP1-3) were biopsied twice. Before visit 1, RP1 ceased AAS usage 34 weeks before, RP2 and RP3 ceased AAS usage ≤2 weeks before, and all had 28 weeks between visits. Fiber CSA decreased for RP1 and RP2 between visits (7566 vs 6629 µm 2 ; 7854 vs 5677 µm 2 ) while myonuclei per fiber remained similar (3.5 vs 3.4; 2.5 vs 2.6). Respectively, these values increased for RP3 between visits (7167 vs 7889 µm 2 ; 2.6 vs 3.3). CONCLUSIONS: This cohort of past AAS users did not have elevated myonuclei per fiber values, unlike previous research, but reported AAS usage was much lower. Training and AAS usage history also varied widely among participants. Comparable myonuclei per fiber numbers despite decrements in fiber CSA postexposure adheres with the muscle memory mechanism, but there is variation in usage relative to sampling date and low numbers of returning participants.

Integrating Transwomen and Female Athletes with Differences of Sex Development (DSD) into Elite Competition: The FIMS 2021 Consensus Statement.

Sport is historically designated by the binary categorization of male and female that conflicts with modern society. Sport's governing bodies should consider reviewing rules determining the eligibility of athletes in the female category as there may be lasting advantages of previously high testosterone concentrations for transwomen athletes and currently high testosterone concentrations in differences in sex development (DSD) athletes. The use of serum testosterone concentrations to regulate the inclusion of such athletes into the elite female category is currently the objective biomarker that is supported by most available scientific literature, but it has limitations due to the lack of sports performance data before, during or after testosterone suppression. Innovative research studies are needed to identify other biomarkers of testosterone sensitivity/responsiveness, including molecular tools to determine the functional status of androgen receptors. The scientific community also needs to conduct longitudinal studies with specific control groups to generate the biological and sports performance data for individual sports to inform the fair inclusion or exclusion of these athletes. Eligibility of each athlete to a sport-specific policy needs to be based on peer-reviewed scientific evidence made available to policymakers from all scientific communities. However, even the most evidence-based regulations are unlikely to eliminate all differences in performance between cisgender women with and without DSD and transwomen athletes. Any remaining advantage held by transwomen or DSD women could be considered as part of the athlete's unique makeup.

Sport and exercise genomics: the FIMS 2019 consensus statement update.

Rapid advances in technologies in the field of genomics such as high throughput DNA sequencing, big data processing by machine learning algorithms and gene-editing techniques are expected to make precision medicine and gene-therapy a greater reality. However, this development will raise many important new issues, including ethical, moral, social and privacy issues. The field of exercise genomics has also advanced by incorporating these innovative technologies. There is therefore an urgent need for guiding references for sport and exercise genomics to allow the necessary advancements in this field of sport and exercise medicine, while protecting athletes from any invasion of privacy and misuse of their genomic information. Here, we update a previous consensus and develop a guiding reference for sport and exercise genomics based on a SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis. This SWOT analysis and the developed guiding reference highlight the need for scientists/clinicians to be well-versed in ethics and data protection policy to advance sport and exercise genomics without compromising the privacy of athletes and the efforts of international sports federations. Conducting research based on the present guiding reference will mitigate to a great extent the risks brought about by inappropriate use of genomic information and allow further development of sport and exercise genomics in accordance with best ethical standards and international data protection principles and policies. This guiding reference should regularly be updated on the basis of new information emerging from the area of sport and exercise medicine as well as from the developments and challenges in genomics of health and disease in general in order to best protect the athletes, patients and all other relevant stakeholders.

A systematic review of shoulder injury prevalence, proportion, rate, type, onset, severity, mechanism and risk factors in female artistic gymnasts.

OBJECTIVES: Systematically review shoulder injury prevalence, proportion, rate, type, onset, severity, mechanism, risk factors in female artistic gymnasts. METHODS: PubMed, Web of Science, Scopus, Cochrane Library were searched on 7/01/2017. Original studies reporting data for female artistic gymnasts only, of any age or level were included. Quality assessment was undertaken using Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. RESULTS: Fifteen observational studies were included. Thirteen were poor/fair quality. Shoulder injury prevalence (0%-86.9%) was higher in international (29.2%) versus national (20%) gymnasts. As a proportion of all injuries, shoulder injuries made up 4.2%-7.5%. Rates (0.35-5.7/1000 athlete exposures) were greater during practice (5.0/1000) than competition (2.4/1000). Multidirectional instability (33.8%, 37.7%) and musculotendinous injury (26.6%-90.9%) were the most common injury. In four studies 66.2%-100% of total shoulder injuries were acute onset. Most (59.3%) shoulder injuries were minor, 7.4% required surgery and 80% caused symptoms post-retirement. Asymmetric bars were the most frequent mechanism of shoulder injury. One study reported excessive shoulder stretching, hyperlaxity and instability as significant (p < 0.001) potential risk factors. CONCLUSIONS: Shoulder injuries are a problem among female artistic gymnasts. Interventional studies reporting age and competition level-specific data may guide prevention strategy implementation.

Intended Hydration Strategies and Knowledge of Exercise-Associated Hyponatraemia in Marathon Runners: A Questionnaire-Based Study.

CONTEXT: Exercise-associated hyponatremia (EAH) is a potentially fatal condition that can be prevented by avoiding excessive fluid intake. Running has become more popular in recent years, so it is important to assess the safety of runners' hydration strategies. OBJECTIVE: (1) To explore the intended hydration strategies of a sample of marathon runners before the 2014 London Marathon, (2) to examine their sources of information and knowledge about fluid intake and their understanding of EAH, and (3) to compare these findings with the results of a similar study carried out before the 2010 London Marathon. DESIGN: Cross-sectional study. SETTING: The 2014 London Marathon. PATIENTS OR OTHER PARTICIPANTS: A total of 298 runners (148 males, 150 females), 0.83% of all race finishers. MAIN OUTCOME MEASURE(S): Planned frequency, type, and volume of hydration; sources of information about appropriate drinking; and understanding of hyponatremia were explored. Comparisons were made with data collected from a sample of participants at the 2010 London Marathon. Data relating to the 2014 cohort are presented in descriptive form. Comparisons of the 2010 and 2014 cohorts were conducted using parametric and nonparametric methods. RESULTS: A total of 48.7% of the 2014 cohort listed drinking to thirst as the most important factor affecting their hydration strategy during the race. This compared with 25.3% of runners from the 2010 cohort and represented an increase (χ2 = 29.1, P = .001); 5.8% of the 2014 cohort planned on drinking more than 3.5 L, compared with 12% of the 2010 cohort (χ2 = 4.310, P = .038). CONCLUSIONS: The number of sampled individuals using thirst to guide hydration strategies in the 2014 London Marathon increased from 2010. However, more than half of the 2014 cohort was not planning to drink to thirst. Runners still need to be educated about the risks of overdrinking as they continue to demonstrate a lack of knowledge and understanding.

Testing Gait with Ankle-Foot Orthoses in Children with Cerebral Palsy by Using Functional Mixed-Effects Analysis of Variance.

Existing statistical methods extract insufficient information from 3-dimensional gait data, rendering clinical interpretation of impaired movement patterns sub-optimal. We propose an alternative approach based on functional data analysis that may be worthy of exploration. We apply this to gait data analysis using repeated-measurements data from children with cerebral palsy who had been prescribed fixed ankle-foot orthoses as an example. We analyze entire gait curves by means of a new functional F test with comparison to multiple pointwise F tests and also to the traditional method - univariate repeated-measurements analysis of variance of joint angle minima and maxima. The new test maintains the nominal significance level and can be adapted to test hypotheses for specific phases of the gait cycle. The main findings indicate that ankle-foot orthoses exert significant effects on coronal and sagittal plane ankle rotation; and both sagittal and horizontal plane foot rotation. The functional F test provided further information for the stance and swing phases. Differences between the results of the different statistical approaches are discussed, concluding that the novel method has potential utility and is worthy of validation through larger scale patient and clinician engagement to determine whether it is preferable to the traditional approach.

Microfracture produces inferior outcomes to other cartilage repair techniques in chondral injuries in the paediatric knee.

INTRODUCTION: Chondral injuries are becoming increasingly common in the paediatric knee. First line surgical therapy is usually microfracture (MF), but the emergence of alternative techniques raises the question of what is the optimal treatment in paediatric patients. SOURCES OF DATA: A comprehensive search of PubMed, OVID, Web of Science, SportDiscus and Cochrane databases was performed using the key words 'autologous chondrocyte implantation, MF, mosaicplasty, juvenile, paediatric'. AREAS OF AGREEMENT: Each technique demonstrated a significant post-surgical improvement in clinical outcome scores. However, MF demonstrated poorer outcomes in larger lesions (>3 cm(2)) and shorter durability. AREA OF CONTROVERSY: The quality of the available literature is poor, and there is a lack of comparative trials. GROWING POINTS: The impact of defect characteristics, mechanism of injury and concomitant surgeries should be investigated. AREAS TIMELY FOR DEVELOPING RESEARCH: Appropriately powered randomized controlled trials with suitably long follow up and condition-specific outcome measures should compare different techniques against each other and placebo.

Gluteal muscle activation during the isometric phase of squatting exercises with and without a Swiss ball.

OBJECTIVES: Growing evidence supports hip muscle activation and strengthening exercise prescription to prevent and treat various lower limb injuries. Common prescriptions include single-legged and double-legged squatting, with and without a Swiss ball. We aimed to establish the effect of varying forms of squatting exercises on gluteal muscle activation. DESIGN AND SETTING: Observational laboratory study. PARTICIPANTS: Nineteen (11 male) healthy participants (28.4 +/- 2.7 years old) were compared using one-way repeated measures analysis of variance. MAIN OUTCOME MEASURES: Surface electromyography (EMG) measures of gluteus medius (GMed) and gluteus maximus (GMax) during the isometric phase of single-legged and double-legged squatting, with and without a Swiss ball. RESULTS: A greater percentage of maximal voluntary contraction (%MVC) during single-legged squatting was found compared to double-legged squatting for GMed (42 versus 9%MVC, p < 0.001) and GMax (35 versus 14%MVC, p < 0.001). Additionally, the Swiss ball increased GMax activity (42 versus 35%MVC, p = 0.026) and demonstrated a trend toward increased GMed activity (46 versus 42%MVC, p = 0.075) during the single-legged squat. CONCLUSIONS: These results indicate single-legged squatting may be more appropriate than double-legged squatting to facilitate strength gains of GMed and GMax. Additionally, the Swiss ball may be a useful adjunct to target gluteal muscle strengthening during single-legged squatting.

The effect of anti-pronation foot orthoses on hip and knee kinematics and muscle activity during a functional step-up task in healthy individuals: a laboratory study.

BACKGROUND: Greater frontal and transverse plane hip and knee motion, and delayed gluteus medius and vastus medialis oblique activation have frequently been identified in patellofemoral pain syndrome populations, whilst prefabricated anti-pronation foot orthoses have been reported to reduce symptoms. The aim of the study was to evaluate the effects of such orthoses on hip and knee kinematics, gluteal and vasti muscle activity, kinematic and electromyographic interactions alongside correlations with specific clinical measures. METHODS: Eighteen asymptomatic individuals (11 male 7 female) had measures taken of static foot posture and ankle range of motion. Hip muscle activity and kinematics were measured using electromyography and an active motion capture system during a step-up task. Order of testing with or without orthoses was determined using a coin toss. FINDINGS: Between condition paired t-tests indicated significantly reduced peak hip adduction angles (1.56°, P < 0.05) and significantly reduced knee internal rotation (1.3°, P < 0.05) in the orthoses condition. Reduced ankle dorsiflexion range of motion correlated with a reduction in hip adduction following the orthoses intervention (r = 0.59, P = 0.013). INTERPRETATION: The effects of prefabricated orthoses may be partially explained by kinematic alterations that occur proximal to the foot in the kinetic chain. These clinically and biomechanically relevant effects appear more evident in those with reduced underlying ankle motion. Further research is indicated using a symptomatic population to explore the clinical relevance of these observations.

A systematic review of resting left ventricular systolic and diastolic function and adaptation in elite weightlifters.

BACKGROUND: This review aims to establish what effect weightlifting has on the systolic and diastolic function of the left ventricular (LV). SOURCES OF DATA: PubMed; ISI Web of Knowledge; Cochrane Library and Ovid Medline were searched in February 2012 to find literature on the effect of weightlifting on the LV cardiac function. AREAS OF AGREEMENT: Stroke volume, posterior wall thickness and ventricular filling time and rate were seen to increase. A decrease in the resting heart rate was seen. AREAS OF CONTROVERSY: Blood pressure and LV morphological changes were equivocal. GROWING POINTS: Weightlifting causes recognizable functional change to the LV, some of these changes may confer benefits such as improvements in the systolic function. AREAS TIMELY FOR DEVELOPING RESEARCH: Discrepancies exist with regard to regional LV morphological change, as the evidence suggests the LV does not adapt in a homogenous manner. Attempts should be made to separate performance-enhancing drug users from those who compete drug free.

The effect of tumor necrosis factor-α antagonists on arterial stiffness in rheumatoid arthritis: a literature review.

BACKGROUND: There is evidence that patients with rheumatoid arthritis (RA) have a higher arterial stiffness than their age-matched healthy counterparts and thus have a higher cardiovascular risk. Under National Institute for Clinical Excellence guidelines, tumor necrosis factor-α (TNF-α) antagonists are indicated clinically in patients with severe active rheumatoid disease. TNF-α antagonists have been found to reduce inflammatory markers in RA; however, it is debatable if they have favorable effects on the cardiovascular system. This review evaluates the effect of TNF-α antagonists on arterial stiffness, a predictor of cardiovascular disease, in RA patients. SEARCH STRATEGY: A search of Ovid MEDLINE and ISI Web of Knowledge databases was conducted to identify studies into the effect of TNF-α antagonists on arterial stiffness in RA patients. Eight studies matching the search criteria were included for analysis. FINDINGS: Two methods were used to assess arterial stiffness: pulse wave velocity and augmentation index. Despite inconsistencies in augmentation index values, aortic pulse wave velocity in all but one study was significantly reduced following TNF-α antagonist treatment. Most studies had methodological limitations, including inadequate sample size, nonblinding of those involved in the measurements, and inadequate inclusion/exclusion criteria. Variation in results could be due to the use of different TNF-α antagonists, different outcome measures being used, and differences in follow-up. CONCLUSIONS: The balance of evidence suggests that TNF-α antagonists may have a beneficial effect on arterial stiffness and therefore cardiovascular risk. However, larger more robust longer term studies are warranted to confirm recent findings.

Coronal plane hip muscle activation in football code athletes with chronic adductor groin strain injury during standing hip flexion.

BACKGROUND: Groin pain arising from adductor muscle injury is common amongst football code athletes and can result in significant time lost from sporting participation. The associated motor control deficits are not well understood. AIMS: The aim of this study was to better understand the coronal plane muscle activation patterns associated with chronic adductor injury. METHODOLOGY: Measures of muscle activation at various stages of the standing hip flexion manoeuvre were made with surface electromyography and motion capture in 9 male football code subjects with chronic adductor injury, and 9 matched controls. RESULTS: The gluteus medius to adductor longus activation ratio was significantly reduced in subjects with groin pain when the injured leg was either moving (F = 64.3, p < 0.001) or in stance phase (F = 32.4, p < 0.001) when compared to activity-matched uninjured subjects, equating to a difference varying between 20 and 40% depending on phase of movement. These differences were particularly due to decreased abductor muscle activation. No significant differences between the uninjured and injured side of patients was found. CONCLUSION: Football code athletes with groin pain exhibit significantly altered coronal plane muscle activation with comparison to uninjured subjects. These findings need to be taken into account when planning rehabilitation for these athletes.

Motion analysis as an outcome measure for hip arthroplasty.

We review the available literature on the use of motion analysis as an outcome measure following total hip arthroplasty. Several studies have investigated spatio-temporal parameters of gait, kinematics, kinetics and electromyographic outputs following hip arthroplasty. We undertook to review all these studies to evaluate the value of motion analysis as an outcome measure. The search of the literature yielded eight studies. Motion analysis demonstrates functional improvement in patients post-operatively, but the values of the variables measured do not reach the same levels as control subjects. Motion analysis does not show much difference post-operatively between patients operated on by different technique or incision. Furthermore, motion analysis can identify subtle functional limitations which may not be detectable with conventional outcome measures.

The effect of eccentric and concentric calf muscle training on Achilles tendon stiffness.

OBJECTIVE: To compare in vivo effects of eccentric and concentric calf muscle training on Achilles tendon stiffness, in subjects without tendinopathy. METHODS: Thirty-eight recreational athletes completed 6 weeks eccentric (6 males, 13 females, 21.6 ± 2.2 years) or concentric training (8 males, 11 females, 21.1 ± 2.0 years). Achilles tendon stiffness, tendon modulus and single-leg jump height were measured before and after intervention. Exercise adherence was recorded using a diary. RESULTS: All data are reported as mean ± SD. Groups were matched for height and weight but the eccentric training group were more active at baseline (P < 0.05). Tendon stiffness was higher in the eccentrically trained group at baseline compared to the concentrically trained group (20.9 ± 7.3 N/mm v 13.38 ± 4.66 N/mm; P = 0.001) and decreased significantly after eccentric training (to 17.2 ( ± 5.9) N/mm (P = 0.035)). There was no stiffness change in the concentric group (P = 0.405). Stiffness modulus showed similar changes to stiffness. An inverse correlation was found between initial, and subsequent, reduction in stiffness (r = -0.66). Jump height did not change and no correlation between stiffness change and adherence was observed in either group (r = 0.01). CONCLUSIONS: Six weeks of eccentric training can alter Achilles tendon stiffness while a matched concentric programme shows no similar effects. Studies in patients with Achilles tendinopathy are warranted.

Site of maximum neovascularisation correlates with the site of pain in recalcitrant mid-tendon Achilles tendinopathy.

BACKGROUND: Neovascularisation is associated with pain in Achilles tendinopathy (AT). The anatomical relationship between ultrasound (US)-defined indicators of tendinopathy and clinically determined pain sites has not been investigated. PURPOSE: To measure the spatial correlation between the sites of maximum palpated tenderness, site of patient-indicated pain, maximum US-determined neovascularisation and maximum antero-posterior tendon thickness in patients with chronic recalcitrant AT (CRAT). METHODS: A custom-designed measuring apparatus and clinical examination were used to measure the sites of maximum tenderness and subjectively defined pain on 29 tendons from patients diagnosed with mid-tendon CRAT. All tendons had been previously non-responsive to eccentric loading. Maximal neovascularisation and tendon thickness were measured by US scanning in conjunction with the measuring device. RESULTS: A significant association exists between clinically determined pain and neovascularisation (r = 0.85, p < 0.001), patient reported pain (r = 0.91, p < 0.001), maximal tendon thickness (r = 0.91, p < 0.001), maximal thickness and maximal neovascularisation (r = 0.86, p < 0.001). CONCLUSION: Sites of subjectively defined pain, clinically palpated tenderness, tendon thickness and neovascularisation are anatomically associated. Palpation can be reliably used as a clinical guide when planning interventions in patients with CRAT.

The short-term effects of high volume image guided injections in resistant non-insertional Achilles tendinopathy.

We investigated neovascularisation, tendon thickness and clinical function in chronic resistant Achilles tendinopathy following high volume image guided injections (HVIGI). The subjects involved 11 athletes (mean age 43.5 years+/-11.6, range 22-59) with resistant tendinopathy of the main body of the Achilles tendon for a mean of 51.4 months (+/-55.56, range 4-144) who failed to improve with an eccentric loading program (mean 11.8 months+/-2.6, range 8-16). The morphological features, neovascularisation and maximal tendon thickness were assessed with power Doppler ultrasound. Clinical function was measured with the Victorian Institute of Sports Assessment-Achilles tendon (VISA-A) questionnaire. All the tendinopathic Achilles tendons were injected with 10 mL of 0.5% bupivacaine hydrochloride, 25 mg of hydrocortisone acetate, and 40 mL of 0.9% NaCl saline solution under real time ultrasound guidance. All outcome measures were recorded at baseline and after a short-term follow-up (mean 2.9 weeks, range 2-4). The results showed a statistically significant difference between baseline and 3-week follow-up in all the outcome measures after HVIGI. The grade of neovascularisation reduced (3-1.1, p=0.003), the maximal tendon diameter decreased (8.7-7.6 mm, p<0.001), and the VISA-A scores improved (46.3-84.1, p<0.001). In conclusion, HVIGI for resistant tendinopathy of the main body of the Achilles tendon is effective to improve symptoms, reduce neovascularisation, and decrease maximal tendon thickness at short-term follow-up.

The relationship between hip rotation range of movement and low back pain prevalence in amateur golfers: an observational study.

OBJECTIVE: To investigate whether amateur golfers with self-reported low back pain have reduced hip rotation compared to asymptomatic controls. DESIGN: Observational case-control study. SETTING: Data collection took place at 2 amateur golf clubs in southern England. PARTICIPANTS: On initial contact, all participants completed a screening questionnaire used to allocate participants into LBP (n=28) and control groups (n=36). LBP group were found to be heavier than controls (t=2.242, 95% CI 0.763-13.332) but were matched for age, height, handedness, handicap, rounds played per week and years of play. MAIN OUTCOME MEASURES: Primary outcome measures were lead and non-lead hip medial and lateral rotation in 0 degrees of flexion as measured by inclinometer. Secondary measures included inter and intra-rater reliability. RESULTS: The LBP group had significantly reduced lead hip passive (LBP 21.14+/-10.17 degrees; controls 31.06+/-8.06 degrees, t=-4.228, 95% CI -14.621--5.205) and lead hip active medial rotation (LBP 21.46+/-10.01; controls 28.06+/-7.49 degrees, t=-2.908, 95% CI -11.147--2.036) compared to controls. No between group differences were found in non-lead hips or any passive or active lateral rotation measures. CONCLUSION: Although there is lack of causality between LBP and hip rotation, the deficit in lead leg medial hip rotation in amateur golfers who suffer LBP may be relevant for screening or treatment selection.