Osteitis pubis is an overuse injury characterised by tissue damage and inflammation to the pelvis at the site where the two pubic bones join (pubic symphysis), resulting in groin pain.
What causes Osteitis pubis?
Osteitis pubis is usually an overuse injury, which commonly occurs due to repetitive or prolonged activities placing strain on the pubic symphysis. This typically occurs due to repetitive running, kicking or change of direction activities. It is commonly seen in running sports such as football, hockey and athletics (particularly marathon runners).
One of the main causes is instability of the pelvic bones and in particular the pubic symphysis.
The instability is aggravated when asymmetrical loads are placed through the pelvis such as when running or kicking. These activities are normally well accommodated in the normal “stable” athlete but with poor lumbopelvic control the additional forces are uncontrollable and will cause injury.
Patients may also develop osteitis pubis due to excessive abdominal muscle contraction (such as during repetitive sit ups) or following inadequate rehabilitation of other injuries, such as adductor tendinopathy.
What are the symptoms of Osteitis pubis?
Patients with osteitis pubis typically experience groin pain that develops gradually overtime. Pain may be experienced on one or both sides of the groin. Pain can sometimes also be experienced in the lower abdominals or at the front of the hips. Patients usually experience pain on firmly touching the pubic bone at the front of the pelvis.
Pain may also increase when squeezing the legs together or when moving the affected leg away from the midline of the body (abduction). Pain is usually aggravated by exercise such as running, kicking, performing sit-ups or change of direction activities.
In less severe cases of osteitis pubis, patients may only experience an ache or stiffness in the groin that increases upon rest following activity. These activities typically include running (particularly involving change of direction) and kicking. The pain associated with osteitis pubis may also warm up with activity in the initial stages of the condition.
As the condition progresses, patients may experience symptoms that increase during activity and affect performance. In severe cases the patient may be unable to continue the activity and may limp or ‘waddle’ as a result of the pain.
How is Osteitis pubis diagnosed?
Diagnosis of Osteitis Pubis is initially done by a Physiotherapist with a series of questions about how the pain came on and what are the aggravating factors, followed by a detailed physical examination.
Athletes with Osteitis Pubis usually experience pain over the front of the pelvis with referred pain into the groin. They also are acutely tender when touching or palpating the pubic symphysis and the bones either side.
Resisted muscle contraction and stretching of the groin muscles and hip flexors will cause pain. Coughing, sneezing and performing a sit up will also often reproduce pain.
Further investigations such as an X-ray, bone scan, MRI or CT scan may be required to assist with diagnosis and assess the severity of the condition. If this is necessary we can refer you on to our network of Sports Physicians to arrange an appropriate investigation.
How do you treat Osteitis pubis?
Most people with osteitis pubis heal well with appropriate physiotherapy. The success rate of treatment is largely dictated by compliance to the rehab program though. One of the key components is that you rest sufficiently from ANY activity that increases your pain until you are symptom free. This will almost certainly entail a cessation of running and kicking.
By avoiding these activities, the body can begin the healing process in the absence of further tissue damage. Once you can perform these activities pain-free a gradual return to these activities is indicated provided there is no increase in groin symptoms. Activities which do not cause pain or an increase in symptoms are usually encouraged during the rehabilitation period to maintain fitness. This may include stationary cycling or swimming with a pull buoy.
Ignoring symptoms or adopting a ‘no pain, no gain’ attitude is likely to lead to the condition becoming chronic and requiring an extensive period of rehabilitation.
Ice therapy and anti-inflammatory medication can significantly reduce the inflammation and pain associated with osteitis pubis. Simply resting and taking anti-inflammatories alone however, will not completely resolve the condition unless it is accompanied by appropriate exercise program to address any weakness and asymmetries that lead to its onset.
Your Leading Edge Physiotherapist will provide you with a graduated flexibility, core stability and strengthening program which is essential to the rehabilitation of anyone with Osteitis Pubis. Their detailed assessment will determine which factors have contributed to the development of your osteitis pubis and will use this information to correct these factors is essential to ensure an optimal outcome. Without this, the symptoms are most likely to recur upon resumption of the aggravating activity.
Once pain permits, light straight-line running drills may commence. This will progress to the implementation of progressive acceleration and deceleration running drills, as well as change of direction drills before returning to match play. These progressions should be carefully monitored by the treating physiotherapist for any aggravation of symptoms.
How long will it take to get better?
Osteitis pubis can often be a difficult injury to rehabilitate. However, with appropriate physiotherapy and management of activity levels, most patients can return to normal function in a number of weeks. In more severe cases (particularly in those patients who have had their symptoms for a long period of time) rehabilitation may take significantly longer, often lasting 6 months or more before a successful return to sport can occur. Early physiotherapy treatment is therefore vital to hasten recovery in all patients with this condition.
I think I have Osteitis pubis, what do I do right now?
To help your injury resolve as fast as possible avoid aggravating activities such as running and kicking. Recovery is easier if you stop irritating your groin pain.