Athletes and physically active individuals who participate in activities, exercises, and sports that involve kicking, pivoting, and/or shifting directions can develop pelvis overuse injury of the pubic symphysis/joint at the front of the pelvis known as osteitis pubis. Can recognizing the symptoms and causes help in treatment and prevention?
Osteitis Pubis Injury
Osteitis pubis is the inflammation of the joint that connects the pelvic bones, called the pelvic symphysis, and the structures around it. The pubic symphysis is a joint in front of and below the bladder. It holds the two sides of the pelvis together in the front. The pubis symphysis has very little motion, but when abnormal or continued stress is placed on the joint, groin and pelvic pain can present. An osteitis pubis injury is a common overuse injury in physically active individuals and athletes but can also occur as the result of physical trauma, pregnancy, and/or childbirth.
Symptoms
The most common symptom is pain over the front of the pelvis. The pain is most often felt in the center, but one side may be more painful than the other. The pain typically radiates/spreads outward. Other signs and symptoms include: (Patrick Gomella, Patrick Mufarrij. 2017)
Lower abdominal pain in the center of the pelvis
Limping
Hip and/or leg weakness
Difficulty climbing stairs
Pain when walking, running, and/or shifting directions
Clicking or popping sounds with movement or when shifting directions
Pain when lying down on the side
Pain when sneezing or coughing
Osteitis pubis can be confused with other injuries, including a groin strain/groin pull, a direct inguinal hernia, ilioinguinal neuralgia, or a pelvic stress fracture.
Causes
An osteitis pubis injury usually occurs when the symphysis joint is exposed to excessive, continued, directional stress and overuse of the hip and leg muscles. Causes include: (Patrick Gomella, Patrick Mufarrij. 2017)
Sports activities
Exercising
Pregnancy and childbirth
Pelvic injury like a severe fall
Diagnosis
The injury is diagnosed based on a physical examination and imaging tests. Other tests may be used to rule out other possible causes.
The physical exam will involve manipulation of the hip to place tension on the rectus abdominis trunk muscle and adductor thigh muscle groups.
Pain during the manipulation is a common sign of the condition.
Individuals may be asked to walk to look for irregularities in gait patterns or to see if symptoms occur with certain movements.
X-rays will typically reveal joint irregularities as well as sclerosis/thickening of the pubic symphysis.
Magnetic resonance imaging – MRI may reveal joint and surrounding bone inflammation.
Some cases will show no signs of injury on an X-ray or MRI.
Treatment
Effective treatment can take several months or longer. Because inflammation is the underlying cause of symptoms, the treatment will often involve: (Tricia Beatty. 2012)
Rest
Allows the acute inflammation to subside.
During recovery, sleeping flat on the back may be recommended to reduce pain.
Ice and Heat Applications
Ice packs help reduce inflammation.
The heat helps ease pain after the initial swelling has gone down.
Physical Therapy
Physical therapy can be extremely helpful in treating the condition to help regain strength and flexibility. (Alessio Giai Via, et al., 2019)
Anti-inflammatory Medication
Over-the-counter nonsteroidal anti-inflammatory medications – NSAIDs like ibuprofen and naproxen can reduce pain and inflammation.
Assistive Walking Devices
If the symptoms are severe, crutches or a cane may be recommended to reduce stress on the pelvis.
Cortisone
There have been attempts to treat the condition with cortisone injections, but the evidence supporting its use is limited and needs further research. (Alessio Giai Via, et al., 2019)
Prognosis
Once diagnosed, the prognosis for full recovery is optimal but can take time. It can take some individuals six months or more to return to pre-injury level of function, but most return by around three months. If conservative treatment fails to provide relief after six months, surgery could be recommended. (Michael Dirkx, Christopher Vitale. 2023)
Sports Injuries Rehabilitation
References
Gomella, P., & Mufarrij, P. (2017). Osteitis pubis: A rare cause of suprapubic pain. Reviews in urology, 19(3), 156–163. https://doi.org/10.3909/riu0767
Beatty T. (2012). Osteitis pubis in athletes. Current sports medicine reports, 11(2), 96–98. https://doi.org/10.1249/JSR.0b013e318249c32b
Via, A. G., Frizziero, A., Finotti, P., Oliva, F., Randelli, F., & Maffulli, N. (2018). Management of osteitis pubis in athletes: rehabilitation and return to training – a review of the most recent literature. Open access journal of sports medicine, 10, 1–10. https://doi.org/10.2147/OAJSM.S155077
Dirkx M, Vitale C. Osteitis Pubis. [Updated 2022 Dec 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556168/
Pain along the pelvis and groin region is known as osteitis pubis. Osteitis pubis develops through the inflammation of the pubic symphysis, or the joints of the major pelvic bones found at the front of the pelvis.
The pubic symphysis is a thin joint which generally provides very minimal motion. The joint retains the two sides of the pelvis together in the front, where they connect�at the sacrum in the rear side of the pelvis.
Osteitis Pubis Symptoms
Osteitis pubis is commonly characterized by pain in the front of the pelvis. Other causes of pelvic pain, such as a strain or a sprain, are frequently confused and diagnosed as osteitis pubis. While many patients report painful symptoms on one side, the�pain�typically occurs in the middle of the pelvis. Other symptoms of osteitis pubis include limping and weakness.
Osteitis Pubis Causes
For some patients, the pubic symphysis itself can become irritated and inflamed, causing the well-known symptoms of osteitis pubis. Other common causes of osteitis pubis comprise of: sports injuries, particularly from football, hockey, and soccer; pregnancy; gynecologic or abdominal surgical interventions; and trauma or injury from accidents.
�
Osteitis pubis is known as the inflammation of the pubis symphysis which causes various degrees of lower abdominal, pelvic, and groin pain. Symptoms of osteitis pubis include pain and discomfort in the region of the pelvis when engaging in physical activities, and loss of flexibility. A variety of causes, including sports injuries, can cause osteitis pubis. Fortunately, rest alone can help treat this painful health issue.
Dr. Alex Jimenez D.C., C.C.S.T.
Osteitis Pubis Diagnosis
Diagnosis of osteitis pubis generally involves x-rays which demonstrate an irregular pubic symphysis with sclerotic, or thick, bone borders as a result of chronic inflammation. An MRI test is generally not required, however, it will help demonstrate the inflammation of the bone and the joint.
Additional tests may be performed to ensure there’s no infection in the bone which could also be causing symptoms similar to osteitis pubis. This complication is more of a concern for those patients who have had recent surgery or for those who are more prone to suffer from infections.
Osteitis Pubis Management
The most recommended treatment for osteitis pubis is rest. Since inflammation is the problem, the human body often only requires the joint to rest in order to heal correctly. Other treatment, however, consists of:
Rest
An essential treatment for osteitis pubis is rest as this will permit the intense inflammation in the pelvis and groin to subside. For many patients, rest alone is the only treatment necessary for their�osteitis pubis. If the pain is severe, crutches or a cane may provide additional assistance.
Ice and Heat
Ice packs and heating pads are among the most commonly used remedies for inflammation. Make sure to follow the instructions of your healthcare professional before utilizing ice and heat for your osteitis pubis symptoms.
Chiropractic Care
Chiropractic care is a well-known, alternative treatment option for osteitis pubis. A doctor of chiropractic, or chiropractor, will utilize a variety of treatment methods and techniques, to help restore strength, mobility, and flexibility while rest is needed to subside the painful symptoms. Chiropractic care can also help correct any spinal misalignments which may be causing additional pain and discomfort for the patient.
Drugs and/or Medications
Nonsteroidal anti-inflammatory drugs and/or medications, commonly referred to as NSAIDs, are frequent prescriptions provided for patients with hip pain brought on by problems like arthritis, bursitis, and tendonitis.
Treatment of osteitis pubis may take some time to completely relieve the painful symptoms. The use of drugs and/or medications is demonstrated to be better than the other treatment options listed above, although attempts to heal osteitis pubis with cortisone injections have been tested.
Surgical interventions are generally not necessary for patients with osteitis pubis.�The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at�915-850-0900�.
Curated by Dr. Alex Jimenez
Additional Topics: Acute Back Pain
Back pain�is the most prevalent cause of disability worldwide and the second most common reason for doctor office visits, outnumbered only by upper-respiratory infections. Approximately 80 percent of the population will experience back pain at least once throughout their life. The spine is a complex structure made up of bones, joints, ligaments, and muscles, among other soft tissues. Because of this, injuries and/or aggravated conditions, such as�herniated discs, can eventually lead to symptoms of back pain. Sports injuries or automobile accident injuries are often the most frequent cause of back pain, however, sometimes the simplest of movements can have painful results. Fortunately, alternative treatment options, such as chiropractic care, can help ease back pain through the use of spinal adjustments and manual manipulations, ultimately improving pain relief.
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