Osteitis pubis (OP) is a common overuse injury characterised by inflammation and tissue damage to the pelvis at the pubic symphysis, resulting in groin pain. The two halves of the pelvis are joined by a disc of cartilage at the front of the body, forming the pubic symphysis. Several muscles of the abdomen and groin attach at this point and contract quite forcefully during some exercise, causing them to pull at their insertion into the bone. Repeated stress placed on the pubic symphysis can lead to inflammation and irritation. As such, OP is typically an “overuse” trauma.
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Typically found in the athletic patient, there is a multitude of causal factors that need to be considered when assessing OP. Some of the factors assessed include:
- Muscular imbalances in the hip region and, in particular, weakness of the deep abdominal muscles, gluteals and adductors (inner thigh muscles) and overactivity or tightness of the hip flexors, hamstrings or abdominal muscles.
- Biomechanical abnormalities, such as flat feet, poor posture and/or poor walking or running mechanics.
- Poor footwear
- Inadequate warm-up and cool down
- A rapid increase in training intensity, duration or frequency
- Insufficient rehabilitation following a groin muscle (adductor) injury.
There are several specialised orthopaedic tests used to confirm the diagnosis of OP and both x-rays and MRI can aid in confirmation of the diagnosis, particularly in chronic (long term) conditions.
The first option for the management of OP is a course of Physiotherapy. This will include activity modifications, manual techniques including massage, dry needling acupuncture and joint mobilisations and the development and progression of a specialised home or gym based rehabilitation program.
Depending upon other causal factors, biomechanical correction through custom made orthotics and footwear changes may be needed.
A gradual return to sport and slow progression is essential in avoiding further overload and recurrence of injury. Premature return to sport is the most common reason for poor long-term outcomes. It can take 3-4 months of appropriate rehabilitation before a full return to sport is achieved and possibly longer if the condition is left untreated.