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 What is it? Osteitis pubis is an inflammation of the pubic symphysis and surrounding muscle insertions. Also referred to as pubic bone stress injury, it occurs due to isolated or repetitive insult to the pubic symphysis and nearby structures.
Symptoms/Risks Risks for developing osteitis pubis include: Forces that occur during sports such as kicking, acceleration, deceleration, and direction changes can cause injury to this area (pubic symphysis). Other risk factors for this injury include: decreased hip range of motion, muscle tightness, weak adductor strength and previous injuries. The presenting symptoms of osteitis pubis can be almost any complaint about the groin or lower abdomen. Common complaints include the following: • Pain localized over the symphysis and radiating outward • Adductor pain or lower abdominal pain that then localizes to the pubic area • Pain exacerbated by activities such as running, pivoting on 1 leg, kicking, or pushing off to change direction, as well as by lying on the side • Pain occurring with walking, climbing stairs, coughing, or sneezing • A sensation of clicking or popping upon rising from a seated position, turning over in bed, or walking on uneven ground
Sports Medicine Evaluation & Treatment A sports medicine physician will review symptoms and perform specific exam maneuvers including: • Palpate the athlete’s pubic bone directly over the pubic symphysis; tenderness to touch is often noted at that point • Checking for inguinal hernia • Assessment of muscle weakness, especially in hip adductors or flexors • Gait assessment Depending on the results of the physical examination, the physician may order the following tests/imaging studies: Laboratory studies are not required to make the diagnosis, but some may be helpful in eliminating other causes, including the following: • Complete blood count (CBC) • Erythrocyte sedimentation rate (ESR) • Urinalysis Imaging studies that may be helpful include the following: • Plain radiography • Bone scan • MRI Treatment options include: • Rest • Heat/Ice application • Physical therapy (PT) Elements of therapy may include the following: - Avoidance of any exercise that may place stress on the pelvic ring - Dynamic stabilization techniques - Manipulation • Pharmacologic therapy • Surgery is rarely warranted for osteitis pubis and is generally reserved for failure of conservative management
Injury Prevention Prevention of osteitis pubis can be achieved by maintaining appropriate flexibility and strength. This can be achieved through: • Exercises for the hip flexors, hip adductors, lumbar stabilizers, and abdominal muscles • Hamstring and quadriceps exercises • Stretching (daily or more often) • Aquatic conditioning (except frog kicking) • Stair-stepping machines (as tolerated) • Sports-specific activities, with offending motions added last • Manipulation
Return to Play Athletes are advised to refrain from sporting activities for 3-6 months and then to return on a gradual supervised basis. AMSSM Member Authors References Category: Hip and Groin, [Back] |
