Osteitis pubis (OP) is a common overuse injury characterised by inflammation and tissue damage to the pelvis at the pubic symphysis, resulting in groin pain. The two halves of the pelvis are joined by a disc of cartilage at the front of the body, forming the pubic symphysis. Several muscles of the abdomen and groin attach at this point and contract quite forcefully during some exercise, causing them to pull at their insertion into the bone. Repeated stress placed on the pubic symphysis can lead to inflammation and irritation.
Causes of Injury
Osteitis pubis is predominantly caused by repetitive contraction of the muscles that attach to the pubic symphysis, resulting in excessive stress on this joint. This causes trauma to the joint and tissues surrounding it. Sports or activities involving prolonged running, kicking, rapid direction change or excessive abdominal muscle use, are commonly associated with development of Osteitis Pubis. Examples of such sports include football, soccer, long-distance running and dancing.
- There are a number of factors that could increase a person’s risk of developing Osteitis Pubis, including:
- Muscular imbalances in the hip region and, in particular, weakness of the core muscles, gluteals and adductors (inner thigh muscles) and overactivity or tightness of the hip flexors, hamstrings or abdominal muscles.
- Biomechanical abnormalities, such as flat feet, poor posture and/or poor walking or running mechanics.
- Exercising on hard or uneven surfaces.
- Poor footwear
- Inadequate warm up and cool down
- Rapid increase in training intensity, duration or frequency
- Insufficient rehabilitation following a groin muscle (adductor) injury.
Signs and Symptoms
- Pain and tenderness in the groin region that may vary from a dull ache to a sharp pain.
- Pain most commonly located in the front and centre of the pubic bone
- Generally gradual onset
- Difficulty or aggravation of pain with standing on one leg
- Pain with contraction of certain muscles, particularly the hip adductors (inner thigh muscles) as with squeezing the legs together.
- Aggravation of pain with activities such as running, kicking or sit-ups
- Altered walking pattern or a limp
- Sporting performance compromised due to difficulty with running, kicking and changing direction
Immediate Treatment/ Management
Treatment for Osteitis Pubis should be commenced as early as possible and is aimed at reducing pain symptoms and inflammation, correcting any underlying abnormalities and achieving a gradual return to full activity.
Physiotherapy treatment can assist in ensuring a faster recovery and the best outcome and may include:
- Rest from aggravating activities
- Ice or heat application
- Manual techniques, including massage, dry needling and joint mobilisation to restore range of movement in the hip, lower back and sacral joints.
- Development and progression of a specialised home exercise program aimed at improving core stability, strengthening weak muscles (particularly hip adductors and gluteals) and stretching tight muscles.
- Correction of underlying biomechanical abnormalities
- Education and advice regarding activity modification, gradual return to activity when appropriate and correction of technique.
Return to Sport/Activity
A gradual return to sport and slow progression is essential in avoiding further overload and recurrence of injury. Premature return to sport is the most common reason for poor long-term outcome. It can take 3-4 months of appropriate rehabilitation before a full return to sport is achieved and possibly longer if the condition is left untreated.
For persistent cases of Osteitis Pubis there are two types of injections that may be recommended. These are cortisone and prolotherapy. Surgery is only considered as a last resort, generally in cases lasting longer than 6 months. Depending on the choice of surgery, which varies widely, it is likely to be a season ending operation.