What is the best course of management for a 19-year-old active duty male with a 1-day history of left hip pain, likely due to a sprain/strain or overuse injury, after participating in an Army Combat Fitness Test (ACFT) competition, with symptoms including pain during weight-bearing activities and mild pain at rest?

Management of Acute Hip Strain/Overuse Injury in Young Active Duty Service Member

This 19-year-old active duty male with acute hip strain from deadlifting should receive conservative management with relative rest, NSAIDs for pain control, ice application, and progressive physical therapy, with return to full activity guided by symptom resolution over 2-6 weeks. 1

Immediate Management (First 48-72 Hours)

Initial treatment should consist of rest, ice, compression, and NSAID therapy to address the acute muscle strain injury. 1 This patient's presentation—pain onset during eccentric loading (deadlift), worsening with continued activity, and 5/10 pain with weight-bearing—is classic for muscle strain involving the hip flexors or abductor complex. 1

• Pain control: Continue NSAIDs (upgrade from acetaminophen) for anti-inflammatory effect 1
• Ice application: 15-20 minutes every 2-3 hours for the first 48-72 hours 1
• Activity modification: Avoid aggravating activities (heavy lifting, running, dragging) but maintain light mobility 1
• Weight-bearing as tolerated: Full ROM with 5/5 strength supports early mobilization rather than strict rest 1

Diagnostic Considerations

No additional imaging is needed at this time given the clinical presentation, mechanism of injury, negative hip-specific tests (FABER, Patrick's), full ROM, and normal strength. 2, 3

When to Consider Further Workup:

• If pain persists beyond 2 weeks: Consider AP pelvis and lateral hip radiographs to exclude stress fracture, avulsion injury, or other bony pathology 2, 3
• If symptoms worsen or fail to improve by 2-3 weeks: MRI without contrast may be indicated to evaluate for muscle/tendon tears, labral pathology, or occult fracture 2, 1
• Red flags requiring immediate imaging: Inability to bear weight, severe pain at rest, fever, or progressive neurologic symptoms 4

Important Pitfall:

The AAOS guidelines highlight that initial radiographs can miss occult hip fractures, particularly in younger patients with high-energy mechanisms. 2 However, this patient's ability to complete the 2-mile run, full ROM, and 5/5 strength make fracture extremely unlikely. If pain persists or worsens over 48-72 hours, reconsider imaging. 2

Progressive Rehabilitation Protocol

Physical therapy should be initiated as pain and swelling subside to restore flexibility and strength. 1

Week 1-2:

• Gentle stretching of hip flexors, abductors, and external rotators 1
• Isometric strengthening exercises 1
• Avoid eccentric loading and high-impact activities 1

Week 2-4:

• Progressive resistance training as tolerated 1
• Gradual return to functional movements (squats, lunges) 1
• Sport-specific training can begin when pain-free with basic movements 1

Week 4-6:

• Return to full duty activities when pain-free with all movements 1
• Ensure adequate warm-up before intense exercise to prevent reinjury 1

Return to Duty Criteria

The patient can return to full ACFT training when:

• Pain-free with all hip movements including deep squatting and running 1
• Full strength restored (already present in this case) 1
• No pain with eccentric loading (deadlift simulation) 1
• Able to perform sport-specific movements without compensation 1

Prevention Strategies

To prevent recurrence, counsel on:

• Adequate warm-up before intense exercise, particularly before maximal lifts 1
• Avoiding excessive fatigue during training—this injury occurred on the 3rd rep of deadlifts after already completing other events 1
• Progressive loading rather than maximal efforts when fatigued 1
• Proper lifting mechanics with emphasis on hip hinge patterns 1

Expected Outcome

The long-term outcome after muscle strain injury is usually excellent, and complications are few. 1 Most acute muscle strains resolve within 2-6 weeks with conservative management. 1 This patient's young age, high baseline fitness, full ROM, and normal strength are favorable prognostic indicators.

Follow-Up Plan

• Reassess in 1 week: Evaluate pain improvement, ensure compliance with activity modification 1
• Reassess in 2-3 weeks: If not improving, consider radiographs and formal physical therapy referral 2, 1
• Consider MRI at 4-6 weeks: Only if symptoms persist despite conservative management 2, 1