Osteitis Pubis is a painful overuse condition that affects the groin. It was first described by Legueue and Rochet in 1923. It affects an area at the front of the pelvis known as the ‘Pubic Symphysis’. The Pubic Symphysis is a cartilaginous (made from fibrocartilage) joint, that is tightly bound by very strong ligaments. This means that only a limited amount of movement is allowed at this joint.
The exact mechanism of the development of Osteitis Pubis remains unclear. Several theories have been proposed, including the overuse of the abdominal muscles that attach to the pelvis causing microtrauma to the bone, excessive shearing forces on the Pubic Symphysis caused by powerful kicking or repeated movements, or even instability of the Sacro Iliac joint at the back of the pelvis resulting in abnormalities at the Pubic Symphysis.
Osteitis Pubis is most common in sports where a large shearing force goes across the Pubic Symphysis. This occurs during kicking activities, ice skating and dance. The excessive forces overstrain the Pubic Symphysis and cause an inflammatory response. Others who tend to have a high risk of developing Osteitis Pubis include those with rheumatological diseases and expectant mothers.
SIGNS AND SYMPTOMS
Osteitis Pubis causes pain during and after exertion, which is often combined with tenderness to touch at the Pubic Symphysis area. Typically, this pain may radiate up to the lower abdomen or down to the groin region. In many cases the patient is unable to localize the pain, which may move around the pelvic region.
It is therefore important that all cases of persistent groin pain are referred to a doctor who can carry out a full assessment and make a differential diagnosis by excluding other conditions that may be potentially more serious.
The clinical signs and history of the patient are usually sufficient to raise the suspicion of Osteitis Pubis, but diagnostic investigations can confirm this condition. Plain x-rays can be useful. The patient may be asked to stand on one leg for these so called ‘stork views’.
The x-rays are able to see widening or erosion at the Pubic Symphysis which is indicative of Osteitis Pubis. MRI scans may also be helpful as they clearly depict bone stress reactions and inflammatory changes in the tendons that attach to the pelvis. However, in the case of athletes and those who undertake a high level of sporting activity MRI findings may show bruising of the Pubic bone even in those who have no symptoms.
TREATMENT
This injury is better prevented than treated, however, early treatment is best. Unfortunately very deep, and therefore painful massage is normally quite effective. “Core” strengthening exercises have shown to be beneficial. If left untreated surgery may be required. At Sport Medicine Massage we have a realtime ultrasound to help you ensure you have effective core functionality.
Get on to it early and you have a better chance…
If you like my posts don’t forget to subscribe
