A condition that is commonly associated with the athletic population, osteitis pubis is a term more recently referred to as pubic bone stress response. The condition involves the anterior aspect of the pelvis, at the site where the two pubic bones join (pubic symphysis), and the surrounding muscles and ligaments. It is thought to be caused by an overload or repetitive strain of the pubic symphysis resulting in a bony stress reaction of the adjacent bones.
Osteitis pubis has a reported incidence of up to 7% in athletic populations and may occur more frequently in sports that involve sprinting, cutting and kicking such as soccer and AFL. Pain is commonly experienced at the anterior aspect of the groin, directly over the pubic symphysis, through the medial thigh muscles and/or the lower abdominal muscles.
The location of pain may be present on one or both sides of the groin. Symptoms are typically aggravated by activities involving change of direction, kicking, hip adduction and when attempting abdominal exercises.
The condition normally follows a continuum where pain is mild and intermittent initially and then progresses to more constant pain. End stage osteitis pubis is typified by erosion of the pubic bone at the pubic symphysis and the formation of bone spurs.
Diagnosis of osteitis pubis by a physiotherapist is based on the history of symptoms and a thorough physical examination including location of pain and assessment of aggravating factors. Radiographic imaging may be recommended to provide additional confirmation of the condition.
As the etiology of groin pain can be complex, assessment by a physiotherapist is important as pain in this area may also be related to muscle strains, sportman’s hernias, stress fractures, infections, referral from the spine or hip joint injuries. If left untreated or misdiagnosed, osteitis pubis can lead to long term groin pain.
Based on the physical examination and biomechanical findings, your Physica physiotherapist can develop an individual rehabilitation program directed to your specific needs and goals. Rehabilitation for osteitis pubis may involve a period of initial rest, reduced high level loading, medications to reduce the severity of pain and manual therapy to address muscle imbalances.
Conservative management is the first line of rehabilitation with the main focus being on the control and strength of the pelvis, back and hips. Rehabilitation back to full function can take a period of weeks to months, depending on the individual and the stage of the condition.