The pelvis is made up of two bones, which join together at the front of the pelvis, forming the pubic symphisis, and at the back, together with the sacral bones forming the Sacro-iliac Joint (SIJ) (See picture). The two parts of the pelvic bones that meet is usually quite rigid, but there is a degree of movement, especially during lower limb actions.
Osteitis Pubis is a type of repetitive injury to this pubic symphisis. There is normally a combination of inflammation as well as tissue damage, thereby causing groin pain. Although it is most commonly an overuse syndrome, there are cases of this occurring due to specific traumatic incident.
What causes Osteitis Pubis?
The primary cause of this condition is due to poor muscle balance within several regions. The pelvis itself is a hub of attachments for muscles, originating from the lumbar, within the pelvis, as well as the hip. It is the sensitive balance of these muscles that plays an important role in whether an athlete will be susceptible to the condition. Muscular imbalance will result in increased forces going through the pubic symphysis during activities such as walking, running as well as sprinting; hence damaging the tissues.
Other factors that may cause Osteitis Pubis include:
- Inappropriate training intensity/technique
- Poor lower limb biomechanics (eg, foot pronation)
- Poor shoe wear
- No warm ups
- Joint stiffness
Signs and Symptoms of Osteitis Pubis
Patients suffering from this syndrome, typically develops pain in the groin gradually overtime. This pain may be felt on one or both sides of the groin. Typically the pain is felt when the patient squeezes their legs together (adduction), or by moving their legs away from the midline (abduction) . As the condition becomes more severe, the patient is unable to return to sport, and simple palpation of the groin may elicit intense pain.
An x-ray of the pelvis may be taken, which may show several indications. The first is an irregularity of the pubic symphisis, which is due to bony degradations over time. The second is the presence of calcification within the adductor tendon. Another sign that may be present is the reduction in the width of the pubic symphysis.
Treatments of Osteitis Pubis
Osteitis Pubis has been known to become an ongoing problem without proper management. An assessment by a qualified physiotherapist is highly recommended. They can diagnose the problem, but more importantly, identify areas that are the root cause of the problem. Treatments are then targeted at these factors, so that maximum recovery may be achieved.
Typically, rest is the first treatment in the initial stage. Further movements may cause aggravation to the area and impede healing. This may also involve walking with crutches if severe. Ignoring this phase will be detrimental to the prognosis. Ice as well as anti-inflammatory medications are also advised during this stage.
The next stage would only proceed once the pain has reduced. This involves a series of exercises to increase the flexibility and strength of the muscles surrounding the pelvic region. Exercises to target the core strength are also advised to ensure stability within the lumbo-pelvic region. Further exercises that are sports-specific, must also be prescribed, to ensure the athlete has a smooth transition to full training and subsequently match fit.
Some treatments that your physiotherapist at Physiohealth may use include:
- Massage (soft and deep tissue)
- Dry needling
- Joint mobilisation
- Prescription as well as teaching correct usage of crutches
- Prescription of correct orthotics/footwear advice
- Stretches (muscular and neural)
- Strengthening (Open kinetic chain, closed kinetic chain, functional and sports-specific)
- Core stability exercises (pilates)
- Correcting training technique as well as prescribing the right intensity to exercise
- Planning a return to sport timeline
To summarise, it is important that you are assessed by a qualified physiotherapists, as only they can identify the factors that are causing the problem, AND treat the problem effectively, thereby getting you back to your sporting commitments quickly!