OSTEITIS PUBIS

BACKGROUND

Osteitis pubis is a painful overuse injury of the groin that usually occurs in the running and kicking athlete e.g; soccer, football, ice-skating, long distance running. Occasionally it can occur during pregnancy or during child-birth. It affects an area at the front of the pelvis known as the pubic symphysis joint, at which a chronic inflammatory process occurs. Symptoms are usually of an insidious onset, over a period of weeks to months. Although it is not uncommon for there to be a specific event. The athlete usually describes pain at the beginning and end of a training session or game. As the injury progresses, the athlete often describes a loss of power or acceleration.

ANATOMY

The pubic symphysis joint is a fibro-cartilagenous joint at the front of the pelvis, it is bound and held together by strong ligaments with only minimal movement occurring.
It is believed that overactive abdominal and/or adductor muscles plus an asymmetrical load such as that which occurs with kicking may cause a shearing force at the pubic symphysis joint. This in turn may cause micro-trauma to the bone, and an inflammatory response that begins to erode the joint margins, which is then followed by a slow healing process. Often there is an associated adductor tendinopathy (‘wear and tear’ of the groin muscles) where they insert into the pubic symphysis joint, or a ‘sportsmans’ hernia.

Osteitis pubis can often be initially diagnosed by your Physiotherapist based on a clinical history and tests, palpation and direct pressure over the pubic bone is usually very painful. This diagnosis can be confirmed with an X-Ray showing an erosion or widening of the pubis symphysis, a bone-scan with increased take up or ‘hot spots’ at the pubic symphysis, or an MRI showing boney oedema.

TREATMENT and MANAGMENT

Treatment often varies depending on the stage of the injury process. It usually requires a period of rest, activity modification and some time away from sport.

Specific exercises are necessary for retraining stabilisation of the pelvis, the focus is on deep core and gluteal muscles, to try to reduce the overactivity of the superficial abdominals and adductors that place the shearing force on the bone. You will need to consult your Physiotherapist for these unique exercises. Clinical pilates with a Physiotherapist can also be an effective way of rehabilitation.

Return to sport can be a lengthy process. Usually this begins with less stressful activities such as cycling or swimming with a pool buoy, then once pain permits straight line running is commenced, and eventually into sport-specific training and games.

Non-steroidal anti-inflammatory medication can help with the healing process, if the pain does not settle with prolonged rest (and often it doesn’t) some Sports Physicians and Orthopaedic surgeons will consider cortico-steroid injections. In particularly recalcitrant cases of greater than 18 months to 2 years, some surgeons will consider operating.

Choi H, McCartney M, Best TM. Treatment of osteitis pubis and osteomyelitis of the pubic symphysis in athletes: a systematic review. Br J Sports Med. Sep 30 2008

Radic R, Annear P. Use of pubic symphysis curettage for treatment-resistant osteitis pubis in athletes. Am J Sports Med. Jan 2008;36(1):122-8

http://emedicine.medscape.com/article/308384-overview