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For more ideas on how to cope with osteitis pubis go to
coping skills
, chronic pain and
girdles and footwear
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| Anatomy back
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| The symphysis pubis is a fibrocartilaginous joint between the pubic rami.
In addition, the abdominal muscles (rectus abdominis and external and internal oblique muscles)
attach distally to the inguinal ligament, conjoined tendon, and pubic symphysis, whereas the
adductor muscles (pectineus, adductor longus, adductor brevis, adductor magnus, gracilis)
arise from the superior and inferior rami of the pubis.
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| Osteitis Pubis back |
Osteitis pubis is a painful non-infectious inflammatory condition that involves the pubic bone,
symphysis, surrounding muscle insertions and structures. Small avulsion fractures can also occur at the attachment
of the adductor tendons to the pubic bone as well as repetitive microtrauma or shearing forces to the pubic symphysis.
This microtrauma exceeds the dynamic capacity of tissue for hypertrophic remodeling, resulting in tissue degeneration.
Osteitis pubis is considered to be the most common inflammatory disease of the pubic symphysis. It is an overuse injury,
that is, it is caused by repeated trauma rather than a specific incident. Shear stress at the symphysis pubis can also
cause sacroiliac dysfunction in osteitis pubis if hip internal rotation is limited in either flexion or extension.
Osteitis Pubis is predominantly caused by repetitive contraction of the muscles that attach to the pubic bone and
the pubic symphysis. In sports, actions such as running, jumping, kicking and rapid changes of direction cause the
abdominal and groin muscles to exercise a pulling or traction force on the pubic bone, which in some cases can result
in excessive stresses.
In Australian football this risk is increased by repeated jarring of the pelvis caused when
players come down from the high leaps required by the game, by tackling from other players and the crossed
over kinetics of long distanced kicking, (crossed over kinetics occurs when the energy released by the momentum
of a movement has not expelled the forces generated but collides with the energy of another movement and due
to the pelvis being the center to absorb this kinetic energy manifests itself to release anomalous forces.)
Osteitis Pubis can be categorized into two main groups: Overload & biomechanical inefficiencies.
Overload (or training errors).
(168)
Other overload causes include.
Exercising on hard surfaces, like concrete.
Exercising on uneven ground.
Beginning an exercise program after a long lay-off period.
Increasing exercise intensity or duration too quickly.
Exercising in worn out or ill fitting shoes.
Go to girdles-and-footwear to read more.
Biomechanical Inefficiencies(168)
Faulty foot and body mechanics and gait disturbances.
Poor running or walking mechanics;
Tight, stiff muscles in the hips, groin and buttocks;
Muscular imbalances and
Leg length differences.
It is also associated with
urologic procedures and as a complication of various
obstetrical and gynaecological procedures including vaginal
deliveries. Increased ligamentous laxity or muscle imbalance
can act as a mechanism for the development of osteitis
pubis in athletes, this acquired laxity maybe a result of adductor
and/or gracilis dysfunction and act as a potential mechanism
for abnormal symphyseal motion and, hence, for the
development of traumatic osteitis pubis. The
incidence of osteitis pubis appears to be up to 5 times more
prevalent in males than in females.
| Osteitis pubis and pregnancy back |
| Damage can occur to the ligaments surrounding and bridging the pubic joint as a result of
repetitive stress or by falling, tripping, slipping and also from pelvic surgery and pregnancy. In childbirth it mainly
appears post partum caused by a degree of trauma during the birth. Particular movements or activities can cause
a slight but continual separation or shearing in the symphysis, which can erode the joint surfaces, causing lesions
and a kind of roughening in the area jointing the fibrocartilage and pubic bones that form the symphysis pubis.
Symptoms include one or more of the following; pain in the pubic area, hips, lower back and thighs.
X-rays taken during the early stages of osteitis pubis can be misleading, you may feel the pain
but the damage doesn't appear on the films, it is only as the process continues that later pictures
will show evidence of bony erosion at the ends of the pubic bones.
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| Symptoms of Osteitis Pubis
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| The symptoms of osteitis pubis can include:
Pain while climbing stairs, running, kicking, changing directions, or even during routine activities such as standing.
Pain when coughing, or sneezing.
Loss of flexibility in the groin region.
A dull aching pain in the groin. In more severe cases a sharp stabbing pain.
Difficulty in ambulation and the characteristic waddling gait.
A low grade fever.
Pain over the pubic symphysis with referred pain into the inguinal region and the groin.
An audible or palpable click over the symphysis might be detected during daily activities.
Muscular imbalances: Tight inner thigh and hamstring muscles and weak abdominal muscles can cause osteitis pubis.
Leg Length Discrepancy: If one leg is longer than the other, it could contribute to the problem.
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| Diagnosis
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Blood test.
Needle biopsy.
Pelvic X-rays can be normal early on, or there might be slight separation of the pubic bones with patchy sclerosis and irregular
cortical margins. X-rays will shows cysts and erosion of the pubic symphysis in advanced cases.
Bone scan will highlight advanced uptake at the pubis symphysis.
MRI will show the bone stress injury and swelling present.
The thoracolumbar junction, commonly refers pain to the groin. Subtle lumbar spine instabilities can cause
neural or joint irritation commonly refer pain to this area.
Associated pathologies, especially adductor or other tendon injuries from recurrent stretching and
tearing of the stabilizing anterior ligaments and adductor muscles.
The whole process usually occurs over a period of six to eight weeks, but symptoms can last as long as six
months or more. In severe and long standing cases surgery could be considered.
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Ways to Help back |
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Rest, it may even require the use of crutches if walking is painful.
Initial therapy you should use ice to reduce inflammation. Your Healthcare Professional might consider
the use of anti-inflammatory or injected corticosteroids.
Use moist heat: In chronic cases, heating the area before exercising can be helpful.
Physical Therapy. The aim being to restore flexibility around the pelvis and implement modalities to
control pain and inflammation.
Change shoes. Choose shoes with maximum shock absorption.
Get an orthotic device: You may need some type of lift in your shoe if you have a leg length discrepancy.
Avoid uneven terrain while symptomatic.
Painful symptoms may be reduced using a TENS machine.
Assess and improve lumbo-pelvic, hip and lower limb biomechanics.
Ultrasound and electrical stimulation are often very helpful.
Manipulation can be an option. If any SI dysfunction or pubic shearing occurs, manipulative therapy
can alleviate some pain and decrease the shearing force that is created across the pubic symphysis.
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Doctor's Role back |
| Healing is characterized by gradual reossification with complete restoration occurring after
many months. Because of its chronic nature, osteitis pubis is extremely frustrating for both patient and Doctor.
Ideally the Doctor should provide care, encouragement and support for patients with this problem, as well
as education regarding prevention. This will encourage a greater understanding and awareness
while improving overall outcomes.
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