What is the treatment for an Anterior Superior Iliac Spine (ASIS) flexor tendon strain?

Treatment of ASIS Flexor Tendon Strain

The treatment for an Anterior Superior Iliac Spine (ASIS) flexor tendon strain should begin with rest and NSAIDs as first-line treatment, followed by progressive physical therapy with supervised exercises once pain begins to subside. 1

Initial Management

• Rest and Activity Modification: Initially restrict activities that cause pain, particularly those involving hip flexion or trunk rotation 2
• NSAIDs: Recommended as first-line pharmacological treatment for pain and inflammation 1
  • Consider continuous NSAID treatment if symptoms persist 1
  • Take into account cardiovascular, gastrointestinal, and renal risks when prescribing NSAIDs 1
• Ice/Cold Therapy: Apply to reduce local inflammation in the acute phase 1

Local Interventions

• Local Corticosteroid Injection: Consider for persistent pain despite NSAID treatment 1
  • Injections should be directed to the local site of musculoskeletal inflammation 1
  • Ultrasound guidance may improve accuracy when injecting near the ASIS 3
  • Caution: Avoid direct injection into the tendon itself to prevent tendon rupture 1

Physical Therapy and Rehabilitation

• Physical Therapy: Strongly recommended once acute pain begins to subside 1

  • Begin with gentle range of motion exercises and progress to strengthening 1
  • Active supervised exercises are preferred over passive interventions (massage, ultrasound, heat) 1
  • Land-based exercises are conditionally recommended over aquatic therapy 1

• Progressive Rehabilitation Protocol:

  1. Initial phase: Non-weight bearing exercises to maintain mobility 2
  2. Intermediate phase: Progressive resistance training for hip flexors 1
  3. Advanced phase: Sport-specific exercises and functional training 2

Special Considerations

• Adolescents: Be aware that ASIS injuries in adolescents may represent avulsion fractures rather than simple strains, especially in athletes 4

  • Type I: Sartorius avulsion (common in sprinting)
  • Type II: Tensor fascia lata avulsion (seen in rotational sports like baseball)

• Return to Activity: Gradual return based on:

  • Resolution of pain with activity 2
  • Restoration of strength (compared to unaffected side) 1
  • Normal functional movement patterns 1

Monitoring and Follow-up

• Monitor progress through:

  • Patient-reported pain levels 1
  • Clinical assessment of strength and range of motion 1
  • Functional testing specific to patient's activities 1

• If symptoms worsen or fail to improve after 4-6 weeks of appropriate treatment, consider:

  • Advanced imaging to rule out avulsion fracture or other pathology 5, 6
  • Referral to sports medicine specialist or orthopedic surgeon 1

Prevention of Recurrence

• Implement a maintenance strengthening program for hip flexors and core muscles 1
• Address any biomechanical issues that may have contributed to the initial injury 2
• Ensure proper warm-up before athletic activities 1