Treatment of ASIS Flexor Tendon Strain

Initial Management

The initial treatment for 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, as recommended by the American College of Rheumatology 1, 2
NSAIDs are recommended as first-line pharmacological treatment for pain and inflammation, with consideration of cardiovascular, gastrointestinal, and renal risks when prescribing, according to the European League Against Rheumatism 3, 4
Continuous NSAID treatment may be considered if symptoms persist, as suggested by the American College of Rheumatology 5
Ice/cold therapy can be applied to reduce local inflammation in the acute phase, as recommended by the European League Against Rheumatism 4

Local corticosteroid injection can be considered for persistent pain despite NSAID treatment, with injections directed to the local site of musculoskeletal inflammation, as recommended by the American College of Rheumatology 6, 1
Caution should be taken to avoid direct injection into the tendon itself to prevent tendon rupture, as warned by the American College of Rheumatology 1

Physical therapy is strongly recommended once acute pain begins to subside, with a focus on gentle range of motion exercises and progressive strengthening, as recommended by the American College of Rheumatology 7, 1
Active supervised exercises are preferred over passive interventions, and land-based exercises are conditionally recommended over aquatic therapy, according to the American College of Rheumatology 1, 7
Progressive resistance training for hip flexors can be implemented in the intermediate phase of rehabilitation, as suggested by the European League Against Rheumatism 4

Patient-reported pain levels, clinical assessment of strength and range of motion, and functional testing specific to patient's activities can be used to monitor progress, as recommended by the European League Against Rheumatism 8, 4
Referral to a sports medicine specialist or orthopedic surgeon may be considered if symptoms worsen or fail to improve after 4-6 weeks of appropriate treatment, as suggested by the European League Against Rheumatism 8

A maintenance strengthening program for hip flexors and core muscles can be implemented to prevent recurrence, as recommended by the European League Against Rheumatism 4
Proper warm-up before athletic activities can also help prevent recurrence, as suggested by the European League Against Rheumatism 4