ASIS Stress Reaction in Female Basketball Player

Abstract

Background: A 19 year-old NCAA Division I female basketball player (188cm, 61kg) reported proximal Quadriceps femoris (Quad) and hip discomfort for several days in her right leg whilst running 300 meters. Initially, the injury presented with tightness in her right Quad and progressed to soreness with running. Patient’s soreness was directly over the Tensor fascia latae (TFL) and Sartorius region with painful straight leg raises and abduction on the affected side. She reported no popping, snapping, crunching, or pulling sensation and had no previous history of hip injury or pain. Differential Diagnosis: Hip flexor strain (Psoas major/minor), Tensor fascia latae strain, Adductor strain, Osteitis pubis, Avulsion fracture of the Anterior Superior Iliac Spine (ASIS), and lower abdominal muscle strain are examples of differential diagnoses that may occur with pain around the ASIS region. Treatment: Upon evaluation, patient was put on limited participation and progressed as tolerated in July 2017. The patient attended physical therapy once a week. She received dry needling to address painful myofascial trigger points that limited her Sartorius and TFL range of motion. She started an intensive Gluteal strengthening regime due to assessed Glute activation insufficiency. Instrument Assisted Soft Tissue Mobilization (IASTM) was also administered in an effort at improving muscle fiber alignment, reducing myofascial trigger points, and preventing buildup of proteins. The patient worked to improve her mobility, stability, and strength in her lower extremities bilaterally. The patient also underwent electrotherapy couple with cryotherapy post activity to modulate pain. The patient progressed and returned to play by the beginning of season in November 2017 with unlimited playing time. Uniqueness: Stress reactions on the ASIS are not common, especially with Sartorius complications. Sartorius avulsions off the ASIS are sometimes witnessed in young athletes because of osteological development. The ASIS is a pronounced, secure segment of the Ilium and thus it is uncommon for muscular avulsion at this boney prominence to occur. Conclusions: Clinicians should be informed and aware of the signs, symptoms, and differential diagnoses for a stress reaction on the ASIS due to the Sartorius. When encountering pain over the anterior hip region in a patient, a stress reaction of the ASIS must be a potential differential diagnosis especially when associated with Glute weakness, pain with straight leg raises and abduction of the affected leg. ASIS stress reactions may be effectively managed with conservative treatment of rest and cryotherapy with appropriate mobility and strengthening exercises. Knowledge and understanding of special tests and manual muscle testing can help to determine and differentiate diagnoses. Clinical Application: Clinically, these findings can be used to broaden a clinician’s differential diagnoses and better achieve positive patient outcomes. It also helps provide clinicians with a potential treatment framework in the event of an ASIS stress reaction.