Updated: Jul 26, 2019
Hi Everyone, the topic for this week’s blog is osteitis pubis (OP).
Also known as pubic symphysitis, osteitis pubis is inflammation of the pubic symphysis, a piece of fibrocartilage that sits between the two pubic bones at the front of our pelvis. It is a common overuse injury that affects the pubic bone and the muscles and tendons that attach onto it.
OP is most commonly seen in athletes who put a lot of stress through their pelvis with activities that involve a repetitive scissoring action of the legs. This can include running, AFL, soccer, hockey and track athletes and is also highly associated with other conditions of the pelvis and hip.
The pubic symphysis is a cartilaginous joint that connects the two pubic bones from each hip together, these bones are also the attachment site for several of our pelvic ligaments and muscles.
Although it is technically a joint, it is unlike other joints in the body, such as the shoulder and hip, as it is not designed to create movement.
Its main role is to transfer weight from the upper body to the legs during walking or running and for separation in women during child birth.
Osteitis pubis specifically is an inflammation of the pubic symphysis and the attachment sites of the gracilis, adductor longus, adductor brevis and rectus abdominus muscles.
Together these muscles are there to provide stability to the pelvis and their main action is adduction of the hip (the movement of a limb or other part towards the midline of the body or towards another part.)
The main cause of OP is instability of the pelvic bones which places stress on the pubic symphysis. The instability is aggravated when asymmetrical loads are placed through the pelvis when standing on one leg, i.e. running or kicking activities. These activities are normally well accommodated in the normal "stable" athlete but with poor lumbopelvic control the additional forces place excessive stress through the muscles, ligaments and the joint itself.This results in subtle shifting through the pubic bones and symphysis which over time creates microtrauma and an inflammatory response in the direct area.
As mentioned above this condition is seen most commonly in athletes who, repetitively, put a high load through their hip region when in a single leg stance. It is seen even more so in athletes who when in single leg stance are required to use their opposite leg to kick, such as in soccer and AFL. In these extreme positions the muscles of the hip don’t have the stability needed to support the pelvis and results in excessive movement through the pubic symphysis.
Symptoms of osteitis pubis can include:
· Pain in the adductor (groin) muscles
· Pain on activity that is relieved with rest
· An increase in pain through the groin area during and after activity
· Significant pain the morning after engaging in the aggravating activity
· Inability to reach full pace or kick long distances
· Sharp pain with lateral movements
· Sometimes pain may refer into the lower back or posterior thigh.
Conservative management is the preferred method of treatment for OP initially and most patients will find this will be successful in managing their pain and return to sport however, in more serious cases, surgery to the area may be needed for full relief.
The most important stage of treatment, in order to resolve the condition, is a period of rest from the aggravating activity. The minimum period of rest is 3 weeks and may be longer depending on the severity of the symptoms. This period of rest is critical to ensure you are pain free prior to beginning your rehabilitation program. From here a specific reconditioning program is required to address the factors that led to overload of the pubic symphysis in the first place and is broken into 3 phases.
· Address muscle tightness or increased tone using soft tissue release and dry needling
· Stretching program for the affected muscles such as the adductor group, hip flexors and hamstrings
· Use of ice or NSAIDs to manage pain along with adjunctive therapies such as ultrasound and taping to reduce inflammation
· Continue to address muscle tightness or increased tone using soft tissue release and dry needling
· Functional strength program that targets lumbopelvic control and core strength as well as adductor strengthening exercises.
· Return to run program (target distance followed by intensity)
· Sport specific drills for the patient
· Dynamic and agility exercises
Osteitis pubis can be a particularly painful and debilitating condition for any athlete and prevention of its onset is paramount as the rehabilitation time can be extensive. Not only will prevention exercise minimise the risk of it developing but will also enhance the athletes lumbopelvic (core) stability and subsequent performance. So, three tips to reduce the risk of OP arising are:
1. Lumbopelvic control and core stability are essential to provide the pelvis with the stability needed to prevent this from occurring in the first place. Exercises should focus on gluteus medius and minimus, pelvic floor and transverse abdominus strengthening.
2. Ensure you stretch your adductor (groin) muscles before and after sport.
3. If you experience an unexplained pain in the groin area, consult your physio, chiro or massage therapist as early as possible.
So that’s a brief overview of what osteitis pubis is and how it occurs. If you have questions or comments, feel free to e-mail us at firstname.lastname@example.org and we will happily answer them for you.
If you are suffering with groin pain and want relief today, call us on (08) 9486 8653 and we will arrange an appointment for you.