Osteitis pubis is an overuse injury of the pubic symphysis (anterior pelvic joint). It may present as an inflammatory or degenerative condition. It is seen as an injury to athletes across different sports and may often be a cause of chronic groin pain.
Symptoms may include:
• Groin pain, intermittent dull ache that is poorly localized, groin stiffness in the morning after training, playing or exercise.
• Sharp pain on aggravating movements such as sprinting or changing direction quickly.
• Low abdominal pain or hip pain (can also refer to the scrotum in males)
Causes of this condition are still debatable and may include:
• increased shear forces on the pubic symphysis from running, twisting, changing direction at speed
• pelvic and deep/ lower abdominal muscle imbalances
• increased speed of football competitions
• increased training and playing volumes
• increased speed of direction changes while running
A qualified APA Sports Physiotherapist or Sports Physician using thorough assessment and clinical tests can make a diagnosis of osteitis pubis. Referral for diagnostic tests such as X-Ray, CT scans or bone scans are sometimes required and may assist in this process.
• Initial period of rest and address the inflammation of the pubic symphysis and muscle attachments.
• Massage and muscle release of any groin or pelvic muscle guarding.
• Address any relevant abnormal hip, lumbar spine or pelvic biomechanics.
• Improve control and strength of the muscles that attach to the pelvis.
• Start gradual progression of functional activities that do not aggravate groin pain eg: swimming (with pool buoy), cycling, and straight line running.
It should be noted that rehabilitation may be slow and recurrences may occur when:
• Poor player compliance to rehabilitation guidelines.
• Start exercising too soon, ignoring pain.
• Inadequate core stability and control of pelvic /groin muscles before resuming running drills.
This chronic groin injury requires early diagnosis and appropriate management by an APA Sports Physiotherapist. This should allow the player to resume sport within a suitable time frame and reduce the frustration of injury recurrence and chronic pain.