Osteitis pubis is a very common condition we see in our office because of the large number of thletes we see. The most common are probably “footy players” or Australian Rules Football, runners and soccer players. Repetitive stress and micro trauma to the pubic symphysis region (where the left and right pubic bones come together at the front of the body,) is thought to be the main cause of osteitis pubis or “OP,” however some OP injuries can originate from one specific trauma.
What Causes Osteitis Pubis
Sports that involve kicking, jumping and running are all activities that involve rapid changes in direction. These fast movements and changes in direction exert excessive forces on the pubic bones. A pulling force is exerted at the area where the abdominal and groin muscles attach and as a result of this excessive stress, tissue damage and inflammation result. Inflammation can lead to changes in the bone such as hardening of the tissue or increased density of the bone, which can be seen on x-rays. The medical term for this is sclerosis. It is understandable then how an athlete afflicted with OP would become incapable of sustained athletic activity. It is important to diagnose this condition in its early stages before it progresses and causes damage and erosion at the pubic symphysis.
Australian Rules Football players are repeatedly tackling, kicking and running, and jumping up and coming down. This repetitive impact excessively jars the pelvis. Pain usually arises when performing the kicking motion. Tight adductor and hamstring muscles along with weak abdominal muscles can also contribute to osteitis pubis.
What Are the Symptoms of Osteitis Pubis?
Most sufferers of osteitis pubis have pain over the pubic region with accompanying symptoms into the lower abdominals, groin region, insides of the thighs, hips and sometimes the testicles. The groin becomes tight and inflexible. Leg movements against resistance can become painful, specifically adduction, or movements towards the centre line of the body.
Factors contributing To Osteitis Pubis
For some reason the incidence of osteitis pubis has markedly increased over the last 10 years. Some reasons for this may be:
Excessive Loading on the Pubic Bones and Muscles from:
- Increased training and playing demands on the players
- Increasing exercise intensity or duration too quickly
- Increased hardness of the playing surfaces
- Increase in size and strength of the athletes
Biomechanical Contributing Factors:
- Poor gait mechanics of walking and running
- Restricted mobility of the pelvic girdle, abdominal and leg muscles
- Functional or anatomical leg length discrepancies
- Musculo-skeletal imbalances (scoliosis or muscle imbalances)
Treatment of Osteitis Pubis
Rest and Ice:If the injury is acute or has just happened, the first thing to do is rest and ice the injury. If the athlete continues with training or playing, this further movement will aggravate the injury, potentially furthering the damage to the tissues and prolong the recovery time.
Restrict Movement: Limit the amount of movement and activity until the inflammation and pain are reduced or gone.
A frozen bag of peas or some crushed ice are two simple effective ways to begin icing. Anything frozen or cold will work. It is important to note however, to not apply the ice directly to the skin, this can cause an “ice burn” to the skin. Use a damp towel or cloth as a barrier between your skin and the ice. As a basic guide, alternate the ice every 15-20 minutes for the first few days for a couple of hours at a time. This is just a guide, once you speak to your medical practitioner for a complete examination and consultation, they will be able to give you more specific instructions once your condition has been thoroughly assessed and diagnosed. Using ice and resting an injured area is never a bad approach in the initial stages.
Chiropractic Care for Osteitis Pubis
Chiropractic focuses on improving the mechanics and function of the joints. This is usually accomplished through low force, safe and effective spinal adjustments. In our practice we use multi-thrust instrument adjusting along with other specific instrumentation for complimentary soft tissue rehabilitation of the injured area. Response time can vary between individuals depending on the severity and nature of the specific injury. Initial care is focused on stabilising and strengthening the anatomical regions and any areas of articular dysfunction.
Preventing Osteitis Pubis
These are some simple steps to help minimise the potential effects of high velocity kicking and running sports.
- Try to train on level playing surfaces
- Train on grass as often as possible
- Proper warm up and cool down for preparing the body for activity and recovery
- Proper rest and recovery after heavy training and competitive sessions
- Strength training and stretching to continually maintain the athletic resilience for your sport
- Proper footwear for support and spinal biomechanics
This article is meant as a guide and a general overview of osteitis pubis, it is not meant to substitute for a thorough examination or medical advice from a qualified health care professional. Consult your chiropractor or other provider for specific advice regarding your particular individual health needs.