Osteitis pubis

I have written this article for my good friend Anthony Walsh who still thinks he should have played for Richmond in the AFL (Australian Football) league. Of course at the ripe old age of “48” he also thinks like a 23 year old and according to my wife (his long time friend) still acts 25 years old. It seems the poor old chap has developed Osteitis Pubis. While he is still a very fit, very good looking athlete that many girls still lust after (and my stock broker) it seems he has developed this affliction which in all honesty is not that uncommon. However, it can be quite painful, annoying and certainly limits his ability to still pull the chicks when doing his beach sprints without getting his hair too messed up. So……. The pubic symphysis is the midline cartilaginous joint uniting the superior rami of the left and right pubic bones. It is positioned to the anterior of the bladder. In other words it is where your pelvic bones come together and are joined by what is known as fibro-cartilage. The fibro-cartilaginous disk is reinforced by a series of ligaments. These ligaments cling to the fibro-cartilaginous disk to the point that the fibers seem to intertwine with it. There are two main ligaments which are superior and inferior. These are the ligaments that provide the most stability at this point. While there are many causes why osteitis pubis can occur such as surgery, pregnancy, child birth and major trauma, today we are looking at athletic events such as running, soccer and in Anthony’s case football codes of all descriptions. AFL does seem to have their fair share of this type of injury. This is because the professional athletes are playing more often, are on slightly harder surfaces and are also faster, and kick further than they did 10 years ago. Osteitis pubis is known as an inflammatory disorder and the symptoms can include loss of flexibility in the groin region, a dull aching pain in the groin and for some a severe sharp stabbing pain when activities such as running, kicking, and quick change of direction takes place. While the following, (exercising on too hard a surface, coming back from a long rest period into a hard session, using ill-fitted foot wear, too high intensity or too long intense sessions can be causes), there are also some bio-mechanical issues such as faulty foot and body mechanics, unusual gait issues, muscular imbalances, and some believe leg length differences. Also tight muscles in the hip, groin and gluts can be a contributor. The best way to diagnose this injury is via a “CT” scan as it will be the most visual. Traditional x-rays may show up irregularity and widening of the pubic symphysis however a CT scan will be your best option, along with the symptoms that you may be experiencing to ascertain whether you have this disorder. The CT scan can also be used if your doctor decides to treat this by injecting the pubic symphysis with a corticosteroid. While there is the traditional treatment of osteitis pubis, such as anti-inflammatory medications, stretching, and strengthening of the stabilizing muscles, some recent research in Argentina (some of the extract here) used glucose and lidocaine injections (“prolotherapy”, or regenerative injection therapy) to try and restart the healing process and generate new connective tissue in 72 elite athletes with chronic groin/abdominal pain who had failed a conservative treatment trial. They treated the athletes with monthly injections to ligament attachments on the pubis. Their pain had lasted an average of 11 months, ranging from 3–60 months. The average number of treatments received was 3, ranging from 1–6. Their pain improved by 82%. Six athletes did not improve, and the remaining 66 returned to unrestricted sport in an average of 3 months. Some surgery techniques have been tried such as a wedge but these have had a poor success rate.
Try these normal techniques to see if they can assist. Avoid activities which place large amounts of stress through the groin area, stop running, completing abdominal work, kicking footballs, and anything that involves a quick change of direction. Avoid these activities so your body has time to recover on its own. This type of tissue takes a long time to heal as it has a limited blood supply. A graduated flexibility, core stability and strengthening program guided by a good sports physiotherapist are essential to enable you to get back to your normal exercise routines. It will take some time, so be patient.
By: John Hart
Master’s In Education” (Disability/Rehab) Newcastle University Australia
“Grad Cert Education” Newcastle University Australia
“Diploma Fitness/Recreation”
“Diploma of Sport and Recreation”
“Cert 4 Personal Training”
“Level 1 Strength and Conditioning Coach”
Member of ASCA (Australian Strength and Conditioning Association)

References:
1. Koulouris G. (2008). “Imaging review of groin pain in elite athletes: an anatomic approach to imaging findings.”. AJR Am J Roentgenol. 191 (4): 962–972.
2. Zoga AC, Kavanagh EC, Omar IM, Morrison WB, Koulouris G, Lopez H, Chaabra A, Domesek J, Meyers WC. (2008). “Athletic pubalgia and the “sports hernia”: MRI imaging findings.”. Radiology. 247 (3): 797–807. (Topol GA, Reeves KD: Regenerative injection of elite athletes with career-altering chronic groin pain who fail conservative treatment: a consecutive case series. Am J Phys Med Rehabilitation 2008;87;890-902)

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