Osteitis pubis has unfortunately become a much more common injury in sports people, especially in the late teenage years. Whilst there are often a number of causes, there is usually a significant element of Bone Stress Reaction.
These problems will usually improve with rest, but commonly the pain returns when the player returns to full activity.
Individual assessment of the causes, and specifically tailored exercise programs are the gold standard for the management of these injuries.
These problems commonly need the involvement of the physiotherapist and sports medicine doctor.
Some of these injuries may also require surgery.
What is the cause?
The main cause is a build up of stress between your left and right pubic bones causing a stress reaction
This build up of stress can be caused by:
- Weakness of your gluteal (bottom) muscles
- Overactivity of your groin muscles
- Overactivity of your abdominal muscles
- Abnormal hip biomechanics
It is also common in sports (e.g. AFL, football/soccer) where player kick, and have sudden changes of direction, or favour one side of your body.
It has become more common in these sports as they have also involved increased amounts of running.
What will you feel?
This type of injury doesn’t usually get better as you warm up
- Often the pain takes a little while to come on, and then it can feel quiet sharp.
- Once you cool down it can remain painful.
- Your pubic bone may ache for several days and you will be stiff with movement around your pelvis
- It is most commonly felt on your pubic bone/groin, but can radiate into your groin muscles and hip on one side.
What should you do initially?
Follow the treatment:
- Rest – avoid exercise that will cause more pain
- Ice – every hour for 15-20 minutes on the painful area
- Compression – Skins, or a SIJ brace may take some pressure off the pubic bones
- Medicine – anti-inflammatory medication, i.e. Nurofen
Make an appointment to see a sports medicine doctor or physiotherapist for management advice.
What type of rehabilitation is best?
There is no one type of rehabilitation is best, however programs usually contain some or all of the following.
- Rest or relative rest from sport that makes the pain worse.
- A gradual planned return to sport
- Strengthening of the gluteal (bottom) and groin muscles
- Abdominal control exercises
- Cortisone injections
- Acupuncture and soft tissue release
- Surgical interventions (adductor release, wedge resection)
It depends on many factors such as; what type of sport you play, the severity of your pain, your age, the duration of the symptoms etc.
How long until you return to sport?
- This will depend on the severity of your symptoms and your physiotherapist’s and sports medicine doctor’s recommendations.
- This injury rarely gets better by itself with just rest.
- In severe cases this can involve up to 12 weeks rest, and then active physiotherapy and gradual guarded return to sport in 6 months.
- Or surgical intervention – approximately 10 weeks of rest and then strengthening and control exercises for a further 1-2 months before gradual return to sport.
For further information, see your local Lifecare practitioner. Click here to find your closest Lifecare clinic.
