Osteitis Pubis – Symptoms, Treatment, Exercises

If you’re suffering from osteitis pubis, you’re no stranger to pain and tenderness in the groin and lower pelvis. The pain and swelling can make everyday movements like walking or running difficult, so it’s important to learn how to manage and treat osteitis pubis effectively. 

But how long is rehabilitation? How do you treat osteitis pubis? Does osteitis pubis go away on its own? Learn everything you need to make a full recovery from this pubic bone stress injury. 

What is Osteitis Pubis? 

Osteitis pubis is a painful inflammation of the pubic symphysis, the joint where the left and right pubic bones meet in the front of the pelvis. This joint is made up of a cartilaginous disk and multiple layers of cartilage, as well as stabilising ligaments. 

Osteitis pubis is commonly found in sports people like distance runners and hockey players. It often happens as a result of repetitive stress or trauma in sports that require running, kicking, or abrupt changes in direction. 

What are the Symptoms of Osteitis Pubis?

what are the symptoms of osteitis pubis
symptoms of osteitis pubis

Osteitis pubis symptoms include: 

  • Pain in the groin area (that intensifies when coughing or sneezing) 
  • Increased pain during physical activity 
  • Stiffness or tightness in the lower belly or groin area
  • Decreased range of motion 
  • Tenderness over the pubic symphysis 
  • Swelling or bruising in the groin 

Causes: Why Does Osteitis Pubis Happen? 

Repetitive Stress and Overuse

Repetitive stress is one of the most common causes of osteitis pubis. Movements like running, kicking, or twisting can lead to overuse sports injuries when you do them a lot. Overuse means the pubic symphysis endures “microtrauma”, which is basically a minor injury that can lead to chronic pain when it’s not addressed. This is because the area keeps getting reinjured with movement. 

Sports Activities

Sports that involve quick changes of direction, sudden stops and starts, and high-impact movements can lead to this condition. These activities can put strain on the pelvis and its surrounding muscles. This strain causes inflammation that doesn’t go away because your movements will keep making it worse. 

Muscle Imbalances and Weaknesses 

Unbalanced muscles or muscle weakness in the pelvis can lead to osteitis pubis. When you’re doing an activity that places stress on the pelvis, the muscles should support and stabilise the bones and tendons. Weak or imbalanced muscles can’t do that, so your pubic symphysis can be injured much more quickly. 

Pregnancy and Childbirth

Hormonal changes during pregnancy and physical stress on the pelvis during childbirth can weaken the pelvis, the pubic symphysis joint, and its surrounding muscles, tendons, and ligaments. This could lead to chronic pain, even if you aren’t doing a lot of strenuous activity. 

Post-Surgical Complications 

Osteitis pubis may be a complication after pelvic or even lower abdominal surgery. Hernia repair operations, prostate surgeries, and other operations in the area can destabilise the pelvis. This can lead to chronic inflammation and groin pain. 

Biomechanical Factors 

Certain biomechanical factors can change how weight and force are distributed across the pelvis, which can cause imbalances, inflammation, and pain in the groin and surrounding areas. Certain conditions like hip joint problems, different leg lengths, and other physical factors can trigger this problem. 

How to Diagnose Osteitis Pubis 

Physical Examination 

Your physiotherapist will ask you about the symptoms you’re experiencing, including information about when they started and what kind of activities cause the pain to get worse. You’ll also have a physical examination, where the physiotherapist will ask you to move through a certain range of motion to assess your pain and check the area to see if it’s tender or swollen. 

Imaging Tests 

If your symptoms are severe, your physio may send you for imaging tests to get more insight into how best to treat you. These may include: 

  • X-rays: X-rays may not show abnormalities when the condition is in its early stages. However, as it progresses, X-rays can reveal issues like widening of the pubic symphysis, bone spurs, or other irregularities. 
  • MRI: An MRI can give your physiotherapist a more detailed understanding of the joint and the soft tissues surrounding it. This can help your physio rule out other possible causes of your groin pain. 
  • Bone Scan: In severe cases, your doctor may recommend a bone scan to get an idea of the level of inflammation in the pelvic area. 

What are the Treatments for Osteitis Pubis? 

what are the treatments for osteitis pubis
treatments for osteitis pubis

Osteitis pubis treatment focuses on reducing inflammation, alleviating pain, and speeding up healing. In most cases, non-surgical osteitis pubis self-treatment is enough to ease your pain and reduce inflammation. At-home treatment of osteitis pubis or groin pain includes: 

Rest 

The most important step is to rest from activities that cause pain or make the pain worse. Depending on the level of your pain, you may be able to get away with modifying your workout routine to focus on low-impact exercises. If you still experience pain, you may need to take a break from exercise and sports altogether. 

Hot and Cold Therapy 

Applying cold to the painful area can help reduce inflammation and ease your pain. On the other hand, applying heat can help to relax tight muscles in the area and improve blood flow, speeding up healing. 

Medication for Pain Relief 

Over-the-counter anti-inflammatories (aka, NSAIDS) can help you manage your osteitis pubis pain. In some cases, your doctor may recommend corticosteroid injections for reducing inflammation. 

Can Physical Therapy Help for Osteitis Pubis? 

Research shows that various forms of physical therapy can be effective at treating chronic osteitis pubis. Rehabilitation programs may include therapies like: 

These therapies can be effective in conjunction with a home exercise program designed to improve core stability, strengthen weak pelvic muscles, and improve flexibility. 

What Exercises Can Help With Osteitis Pubis? 

Incorporating osteitis pubis exercises into your daily routine can strengthen your pelvic muscles, stretch tight muscles, and maintain your range of motion. Try these strengthening exercises for osteitis pubis. 

Hip Adductor Stretch

hip adductor stretch

Purpose: To stretch the inner thigh muscles and relieve tension. 

Step-by-Step Instructions

  1. Sit with your knees bent and place the soles of your feet together.
  2. Hold your knees or feet with your hands for stability. 
  3. Gently press your knees out and towards the floor. 
  4. Hold the stretch for 20 to 30 seconds. 
  5. Repeat the stretch 2 to 3 times. 

Hip Flexor Stretch

hip flexor stretch

Purpose: To stretch the muscles at the front of the hip. 

Step-by-Step Instructions

  1. Start in a kneeling position with one knee on the ground and the other foot on the ground. 
  2. There should be a 90-degree angle between your legs, and between each leg and the ground. 
  3. Gently push your hips forward until you feel a stretch in the front of the hip on the kneeling side.
  4. Hold for between 20 and 30 seconds. 
  5. Switch sides. 
  6. Repeat 2 to 3 times on each side. 

Hip Hike

hip hike

Purpose: To strengthen the muscles around the hip and improve pelvic stability. 

Step-by-Step Instructions

  1. Stand on the edge of a step or solid platform with one foot firmly planted on the step and the other foot hanging off the side. 
  2. Keep your supporting leg straight and maintain level hips. 
  3. Lower the hanging leg toward the ground by dropping your hip. 
  4. Lift the hanging leg by raising your hip toward your rib cage. 
  5. Keep your torso upright and avoid leaning to either side during the exercise. 
  6. Hold the position for 1 to 2 seconds at the top, then slowly lower it back down.
  7. Repeat this motion 10 to 15 times for each side. 

Glute Bridge

glute bridge

Purpose: To strengthen the gluteal muscles and stabilise the pelvis. 

Step-by-Step Instructions

  1. Lie down on your back, bend your knees, and keep your feet flat on the ground, spaced hip-width apart. 
  2. Raise your hips towards the ceiling, engaging your glute muscles at the highest point. 
  3. Hold this position for 2 to 3 seconds before gently lowering your hips back to the floor. 
  4. Repeat this movement 10 to 15 times. 

How to Prevent Osteitis Pubis 

You can prevent osteitis pubis with some careful and mindful changes to your training. 

Gradually Increase the Intensity of Physical Activity 

Rapidly increasing your intensity or frequency of physical training can place excess strain on the pubic symphysis. This can lead to inflammation and groin pain, especially if your body doesn’t have enough time to rest in between exercise sessions. Avoid this by paying close attention to: 

  • Progressive Overload: Gradually increase the duration, frequency, or intensity of your workouts over time and allow enough time for your body to adapt to each new level. 
  • Rest and Recovery: Incorporate rest days into your training schedule to allow your body to adapt and repair. At least one full rest day and one day of “active recovery” per week is optimal. 
  • Listen to Your Body: Pay attention to any signs of pain or discomfort in the groin or pelvic area. If you feel pain, adapt your activity to avoid it. Be sure to maintain good form in whatever you do. 

Proper Warm-Up and Cool-Down 

Failing to warm up means your muscles won’t be ready for the level of activity you’re going to put them through, which could lead to sore, tight muscles in the pelvis. Cooling down is necessary to flush out lactic acid and reduce muscle stiffness. 

  • Warm-Up Routine: Spend at least 10 to 15 minutes warming up before doing intense physical activity. Include dynamic stretches, some light cardio, and sport-specific drills to warm up your range of motion. 
  • Cool-Down Routine: When you’re done, spend 10 to 15 minutes cooling down. Include static stretches and light aerobic activity to bring your heart rate down gradually and safely. 
  • Stretching Focus: Stretch the hip flexors, adductors, hamstrings, and other muscles around the pelvis to maintain flexibility and reduce the chance of stiffness that could cause pelvic or groin pain. 

Cross-Training 

Engage in a variety of exercises to avoid repetitive strain on specific muscle groups. Incorporate low-impact activities like swimming, cycling, and strength training to balance the load on your pelvis and lower body. This variety reduces the risk of overuse injuries that can lead to osteitis pubis. 

Flexibility Training 

Stretch regularly to maintain flexibility in your hip, groin, and lower back muscles. Focus on stretches that target the hip flexors, hamstrings, and adductors. Improved flexibility helps reduce tension around the pelvic area, lowering the risk of inflammation. 

Prioritise Rest 

Make sure you get enough rest between workouts to allow your body to recover. Overtraining without resting properly in between increases the likelihood of developing osteitis pubis. Listen to your body and take breaks when you feel discomfort or fatigue. 

Maintain a Healthy Weight 

Keep your body weight within a healthy range to reduce the stress on your pelvic region. Excess weight places additional pressure on your joints and muscles. A balanced diet combined with regular physical activity can help you achieve and maintain a healthy weight, decreasing the risk of osteitis pubis.

Osteitis Pubis FAQs

It may take several weeks to months for the pain and inflammation to subside completely. However, recovery time for osteitis pubis can vary depending on the severity of the condition and individual factors.

Yes, osteitis pubis can cause testicular pain as the inflammation and referred pain from the pubic symphysis may extend to the surrounding areas, including the testicles.

Osteitis pubis can sometimes cause frequent urination if the inflammation affects nearby structures, such as the bladder. However, frequent urination is not a common symptom and should be evaluated by a healthcare professional to rule out other causes.

With proper treatment and preventive measures, most people fully recover from osteitis pubis. However, it can return through reinjury, so it’s important to take extra care to prevent it from coming back.

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