Australian athletes who play kicking and/or running sports, such as Australian rules football (AFL), soccer and distance running, are particularly vulnerable to osteitis pubis.[1] According to researchers from the Australian Institute of Sports, approximately 44.8% of elite AFL players will experience groin pain sometime during their careers.[2] More men are diagnosed with this condition compared to females.[3]
Osteitis pubis can sometimes be challenging to identify as it often occurs in combination with other conditions, such as hip impingement and groin strains. Additionally, how it develops has yet to be fully determined. More research is being conducted to find further efficient ways of diagnosing and managing this condition.
What is osteitis pubis?
Osteitis pubis is a condition that commonly occurs in young athletes which causes pubic and groin pain. This condition occurs when the rectus abdominis (abdominal) and adductor (groin) muscles that attach to the pubic symphysis (where the two pelvic bones meet) become inflamed from overuse.
What are the symptoms of osteitis pubis?
The main symptoms of osteitis pubis include pain at the front of the pelvis, which can radiate outwards. Other symptoms include inflammation and tenderness of the front of the pelvis, with people experiencing a clicking or popping sensation when shifting positions.
Common symptoms of osteitis pubis
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Pain at the centre of the pelvis
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Pain at the lower parts of the abdomen
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Increase in pain while running, kicking and change of direction
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Pain during walking and stair climbing
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Pain when lying on your side
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Clicking or popping sensation when shifting positions
What causes osteitis pubis?
The most common cause of osteitis pubis is repeated stress on the pelvis. It typically occurs in athletes. Sports such as soccer, tennis, netball and running are the most common causes; however, osteitis pubis may arise during or after pregnancy.
Common conditions of osteitis pubis
Sports that increase the risk of osteitis pubis
High-intensity sports requiring a lot of leg movements and changing direction can result in repetitive stress and excessive pressure on the pubic symphysis resulting in inflammation.
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Soccer
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Hockey
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Tennis
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Football
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Long-distance running
Various factors can cause osteitis pubis, and some of them might be causing your problems. It is best to get checked by a medical professional to give you advice and appropriate treatment.
How is osteitis pubis diagnosed?
Osteitis pubis can cause mobility issues and prevent you from doing things that you love to do.
There are several options available when it comes to diagnosing your groin pain as osteitis pubis. One of the more common and most recommended by Australian GPs is an assessment from a physiotherapist.
Physiotherapists are highly qualified health professionals that diagnose and treat joint problems such as osteitis pubis.
The assessment process starts with a consultation, where your physiotherapist will ask you several questions related to your injury and pain. The more information you can provide, the easier it will be for the physiotherapist to accurately diagnose.
After establishing an understanding of the background of your condition, your physiotherapist will perform a physical assessment to determine what injury or problem is causing your groin pain and rule out other conditions.
The initial evaluation typically lasts for about 30 to 60 minutes. Your physiotherapist will then create a specific treatment plan based on your assessment to help you recover from injury.
From here, your physiotherapist will explain your treatment program.
This will include:
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Strategies to manage the pain and to prevent worsening of the condition
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Number of treatment sessions
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Home exercises
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Timeline of your total recovery
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Advice and recommendations.
How is osteitis pubis treated?
Osteitis pubis can be inconvenient and comes with painful symptoms that affect the quality of your life. Pain can render you inactive for weeks or months, resulting in deconditioning and other secondary complications if left untreated.
There are several options when it comes to treating osteitis pubis. One of the more common and the treatment option referred to by Australian GPs the most frequently is physiotherapy.
Osteitis pubis is something that physiotherapists see in the clinic quite often, and the process of treating it is straightforward. Once the physiotherapist has completed the initial assessment, they will formulate an effective treatment plan.
A combination of treatment protocols such as pain therapy, stability exercises and conditioning will be given to you by your physiotherapist.
Your treatment for osteitis pubis will focus on decreasing your pain, improving your mobility and gradually introducing you to your pre-injured state.
Depending on the severity of your osteitis pubis, a physiotherapist may provide you with a combination of the following types of treatments:
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Advice and Education - Professional advice and information that you can use at home to help you recover faster.
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Manual Therapy - Hands-on treatment technique used by your physiotherapist to improve your joint mobility and decrease pain.
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Lumbopelvic Stabilisation Exercises - Exercise techniques to increase the stability of your low back and pelvic joint to maximise recovery and improve functions.
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Ultrasound Therapy - Sound waves penetrate deeper structures of the body to stimulate soft tissue healing and increase blood circulation.
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Therapeutic Exercises - Corrective exercises to treat impairments in your muscles and joints.
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Stretching Exercises - Involves stretching of lower body muscles to improve soft tissue extensibility and increase your range of motion.
Physiotherapy treatment can last for about 30 to 60 minutes. Most patients can feel the difference in just a single session.
Next step: Creating a treatment plan made for you
Your physiotherapist will create a detailed treatment plan based on your condition and lifestyle to allow you to return to your normal activities as soon as possible.
Self-care for osteitis pubis
If you think you have osteitis pubis, here are the best things you can do and avoid.
Things to do:
- Rest
Osteitis pubis is an overuse injury. Resting for a few days can help relieve the stress around the joint area and facilitate optimal recovery.
- Heat or Cold compress
Use a hot compress to help you decrease pain and increase blood circulation in the area. Apply the hot compress for at least 20 minutes.
Alternatively, if there is a significant presence of swelling, apply an ice compress to manage the symptoms of inflammation and decrease pain. Apply a cold compress for 10 to 15 minutes.
Things to avoid:
- Avoid high impact activities
Take a break from sports for a couple of weeks and let the inflammation subside before engaging in high impact activities.
Do I need a specialist or surgery?
Surgery for osteitis pubis is rarely done, except if all conservative efforts have failed.
An X-ray or MRI may be ordered if fractures or malignancy are suspected of being the cause of your condition and will help to rule out another diagnosis.
Your doctor may give you anti-inflammatory drugs to help you manage the pain and symptoms of osteitis pubis.
Additionally, your GP may refer you to physiotherapy for proper management and further assessment.
What is the recovery time / prognosis for osteitis pubis?
Ultimately, recovery time is dependent on being proactive and seeking professional treatment and the severity of your groin pain and injury.
In most cases, osteitis pubis can resolve with rest and conservative interventions. However, it takes an average of 7 to 9 months to achieve full recovery, especially if it is left untreated.
Important factors in recovery include:
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Sticking to your rehabilitation program and regularly exercising
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Resuming your sports activity gradually
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Paying attention to pain, and resting as necessary.
Can osteitis pubis be prevented?
Prevention is always better than a cure, however sometimes these things happen and we have little control over them. If you already have osteitis pubis, you will find that these tips are still helpful in managing symptoms and improving your pain.
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Strengthening exercises - An optimised training approach can prevent various injuries. Strengthening the hip muscles, lower back, abdominals, hamstrings, and quadriceps can effectively reduce the stress on the lower body’s joints.
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Stretching - Stretching of lower body muscles can improve range of motion and make your tendons more resilient to stretch.
Outlook and the main takeaways
Osteitis pubis is a frustrating condition that can affect the quality of your life for a long time. It is an overuse injury resulting from repetitive stress on the groin area.
Rest and commitment to rehabilitation is the key in treating osteitis pubis. Book a physiotherapy consultation today and have your condition assessed by movement experts.
Anatomy of the pelvis and pubic symphysis
The pubic symphysis is located in front of the pelvis, just between the adjacent hyaline cartilages of the pubis. The pubic symphysis is a joint that connects the two bones of the pelvis during activity.
Different lower-body muscles are attached near the pubic symphysis and adjacent structures of the pelvis. Repeated high impact stress produced by these tendons such as during kicking, acceleration or abrupt change in direction causes chronic overloading of the pubic symphysis resulting in injury.
