Osteitis pubis is a pathological process involving degenerative changes to the pubic bone and the pubic synthesis.
The most recent theory behind the development of osteitis pubis is that the condition is a stress injury caused by the shearing forces across the bone at the edges of the pubic synthesis. These shearing forces are generated through twisting, turning and kicking movements.
This shearing causes wear to the bone and leads to the development of cysts, osteophyte (bony spur) development, widening of the anterior margins of the symphysis and a moth eaten appearance of the pubic synthesis on x-ray.
Osteitis pubis is an overuse injury caused through repetitive strain through the pelvis. It is common in football, hockey or in distance runners. As with most degenerative progresses osteitis pubis comes on gradually over time. It may start with an ache and then progresses over time to a potentially debilitating condition where playing sports becomes impossible because of pain.
Signs and symptoms of osteitis pubis include:
- Insidious onset of groin pain.
- Pain aggravated by exercise especially twisting/turning movements or kicking.
- A decrease in sports performance is noticed by the athlete and their coach.
- Pain on resisted adduction (squeezing the legs together).
- Pain on other special tests performed by your physiotherapist.
Ignoring the symptoms will only lead to your condition becoming chronic. Once chronic your symptoms will take a lot longer to settle down and you run the risk of creating a permanent condition that will never completely go away.
Traditionally the treatment of osteoitis pubis has been one of rest. The problem with this is on the resumption of activity the pain tends to come right back. Previously osteitis pubis required a period of around 10 months rest from sports, now with improved treatment techniques this time has been reduced to approximately 6 months.
Modern physiotherapy treatment consists of:
- Rest from aggravating activities, this will include: running, especially running with directional changes, jumping, kicking and sit ups. Once symptoms decrease with these activities a gradual return to sport program can be started.
- Development of a specific strengthening program to provide support to the joints and prevent reoccurrence in symptoms.
- Mobilising and manipulating the lumbar spine.
- Massage and stretches to release tight muscles.
- Neural stretches.