Osteitis Pubis

Do you experience mild to sharp pain in the lower back and abdomen area while performing regular physical activities like walking, running or standing up from a sitting position? You may be suffering from an overuse injury called Osteitis Pubis. Read on to find out about this condition, its etiology, symptoms, how it is diagnosed and what its treatment options are.

What is Osteitis Pubis?

Also called Pubic Symphysitis, it is a noninfectious overuse injury that causes inflammation of the lower pelvis and tissue damage. Individuals with this kind of injury experience pain around the pubic symphysis (joint of the two pubic bones). Osteitis pubis also causes groin pain.

Osteitis Pubis Image Source: wikimedia

Osteitis Pubis Incidence

The prevalence of this injury among athletes and sportsmen ranges between 0.5% and 6.2%. Various different sports are associated with the condition, but sports activities like football, soccer, rugby and ice hockey pose a greater risk of Osteitis Pubis. As per statistics, an increase in the physical demands of sportspersons is a major cause of this type of overuse injury.

Osteitis Pubis Causes

The exact causes for this condition are still not known. However, it is an overuse injury occurring due to prolonged and repetitive activities that put strain one the pubic symphysis. This injury commonly affects athletes and is typically caused by running, biking, cycling and kicking. Osteitis Pubis can result from various sports activities that involve running, such as:

• Athletics
• Football
• Hockey

Excessive contraction of the abdominal muscle (like during repetitive sit-ups) may also lead to this kind of injury. Following insufficient rehabilitation for some other injury, like adductor tendinopathy can cause Osteitis Pubis.

Other principal causes of this disorder include:

• During Pregnancy or after childbirth
• Gynecologic surgery
• Urologic surgery
• Major trauma
• Repeated minor trauma
• Rheumatologic disorders

Osteitis Pubis Signs and Symptoms

People suffering from this condition generally experience severe pain in the groin area, which gradually develops over time. The pain can occur on one as well as both sides of groin. One may also experience pain at the front parts of the hips and in lower abdomen. The pain can be felt when one very firmly touches the pubic bone located in front of the pelvis.

Squeezing both the legs together and moving the injured leg away from the body’s midline may also increase the pain. The pain can also aggravate when one participates in various physical activities such as kicking, running and cycling.

In case of less severe instances of the injury, the symptoms may include stiffness and mild ache in the groin area that increase when one rests after some activity like kicking and running (especially if it involves change of direction). In the initial stages of this condition, the inflammation associated with it tends to increase with activity. Patients also experience pain when carrying weight, moving sideways or standing up after sitting for a long period of time.

With the progression of the condition, an individual suffers from increasing pain during activity. Sometimes, the severe pain even affects the performance of the patient. In some cases, a sufferer may even limp due to extreme pain.

Osteitis Pubis Prevention

It is possible to prevent this overuse injury. Following are some of the precautionary measures that one can take to avoid developing Osteitis Pubis:

Warming Up properly

One should warm up properly before taking part in some kind of physical activity as it prepares the body for the activity. A proper warm up prepares the lungs, heart, joints, muscles as well as the mind of a person for strenuous activity.

Avoiding activities that trigger pain

It is advisable to avoid participating in activities that are more likely to increase the pain and discomfort. One has to give special attention to understand which particular exercises worsen his or her pain.

Resting

If a person experiences mild pain in the lower back or abdomen area, he or she should take rest to cure the pain. Mild pain in those specific areas can be an early symptom of Osteitis Pubis. Due to this reason, it is better to treat the condition before it can reach an advanced stage.

Stretching and strengthening

Stretching exercises help to keep the muscles around the groin and hips in proper shape. It also increases flexibility of the muscles and gives them strength to perform various activities. Performing strengthening exercises with exercise balls and abdominal exercises are very useful for this purpose.

Using right footwear

Wearing good shoes is very important for avoiding various types of pain as they keep the knees and hips of an individual in a stable shape. Proper shoes also provide support and cushioning to the legs and knees while walking or running.

Osteitis Pubis Tests and Diagnosis

A physiotherapist generally performs a thorough objective and subjective examination to diagnose this injury. In some cases, various diagnostic tests such as bone scan, x-ray, CT scan and MRI can also be used for diagnosing and assessing its severity.

Radiographic Features

Various diagnostic tests involving radiology are used for diagnosing Osteitis Pubis. These involve:

X-Ray

X-ray findings help to detect any joint irregularity, subchondral erosive change and sclerosis that may eventually cause ankylosis. However, the findings do not become apparent until four weeks after the initial appearance of the symptoms.

MRI

MRI is useful for determining if the patient has parasymphyseal bone marrow edema. During the initial stages, the MRI results may also display the presence of peripubic soft-tissue oedema and Symphyseal fluid.

Bone Scan

The reports of bone scan may display negative results but they may show intense signal uptake by the pubis symphysis.

Osteitis Pubis Differential Diagnosis

Certain conditions are characterized by symptoms similar to those of Osteitis Pubis. These include:

• Sacroiliac Joint Injury (Si Joint Injury)
• Pubic Osteomyelitis
• Stress Fracture
• Groin Strain
• Pelvic Fracture
• Muscle Contusions
• Tendon Injuries
• Acetabular Labral Tears
• Bursitis
• Rheumatologic Disorders
• Chronic Symphyseal Injury

Physicians must ensure that the symptoms complained about by patients are not the result of any of these disorders.

Osteitis Pubis Treatment and Management

Physiotherapy is the best treatment option for people suffering from this kind of injury. However, the success of the treatment depends on the severity of the symptoms present and how patients react to treatment. Sufferers are always asked to take sufficient amount of rest to reduce the pain. In some severe cases, patients may even be asked to use crutches while waking so that the pubic bones and symphysis do not suffer any further damage. This helps to speed up the healing process. The treatment options for this condition include:

Rest

Resting is the most important aspect in the treatment of Osteitis Pubis as it allows the severe inflammation to subside. In many cases, rest is the only treatment one requires to completely cure the pain resulting from the injury. Sufferers may also use crutches or cane if experiencing extreme pain. If prolonged rest is unable to cure the inflammation, doctors may consider other treatment options like corticosteroid injections.

Heat and Ice Application

Heat pads and ice packs are most commonly used for treating inflammation. One should consult a doctor to find out whether ice treatment or heat treatment is best for a patient and how long the treatment should last.

Physical Therapy

This kind of treatment can cure the inflammation resulting from Osteitis Pubis. Different modalities are used by physical therapists for regaining mobility and increasing strength of patients that help them carry out all the normal everyday activities without experiencing pain. Physical therapy and massage treatment are very helpful for maintaining the strength and flexibility of an injured leg.

Anti-Inflammatory Medication

There are numerous nonsteroidal anti-inflammatory medications (NSAIDs) such as Ibuprofen that are often prescribed to Osteitis Pubis patients, especially those who suffer from hip pain due to various problems including Bursitis, Arthritis and Tendonitis.

Drugs and Injections

Anti-inflammatory medications do not work in cases where the injury has already damaged the bone. Doctors generally treat such Osteitis Pubis patients with intravenous Bisphosphonates or Biphosphates. Rheumatology consultants usually prescribe this drug for treating Osteoporosis. Biphosphates bind to the bone surface permanently and decelerate the bone-eroding cells or osteoclasts. This makes it possible for the bone-building cells or osteoblasts to work more efficiently. The symptoms of Osteitis Pubis generally start to reduce within a month of administering this injection. In some cases, however, a patient requires further injections.

Osteitis Pubis Surgery

If the condition does not respond well to any of the traditional treatments within twelve months, a doctor may recommend a surgical approach. A surgeon restores stability of the damaged leg fixing screws and a plate across the joint. Patients require crutches for the first three weeks after surgery. One is not allowed to return to sports until after three months.

Osteitis Pubis Complications

There are very few reports of any complications of this condition. The major complication may be caused due to the muscle tightness that leads to muscle-tendon injury. Various biomechanical errors causing the injury are corrected and a patient is given flexibility-training for preventing this complication. Erosion of bone is an important complication that occurs if in case of misdiagnosed Osteomyelitis. This kind of complication requires considerable recovery time.

Osteitis Pubis Prognosis

Osteitis Pubis may often take very long time to reach the stage of complete recovery. However, the prognosis or outcome is generally favorable with proper management and physiotherapy. In most cases, patients are able to return to their normal life and participate in all normal activities like walking, running and cycling after a few weeks or months. In more severe cases of the condition, rehabilitation takes much longer and patients may require around six months for achieving full recovery.

Osteitis Pubis and Pregnancy

The ligaments bridging and surrounding the pubic joint can suffer damage very easily due to the secretion of the Relaxin hormone before childbirth for softening the pelvic ligaments during labor. The ligaments can suffer serious injury if a woman falls, trips and slips repetitively during this time. Osteitis Pubis may also occur in women post pregnancy or postpartum period as the ligaments still remain soft. The Relaxin hormone disappears gradually after childbirth allowing the ligaments to become strong again. In some cases, however, the weakness of the ligaments remains and the women experience a continuous shearing in the pelvic ligaments, where they are attached to joint surfaces, while stepping up a step or carrying a baby. Common symptoms of this condition include pain in the hips, knees, pubic area, thighs and lower back.

Osteitis Pubis Vs Sports Hernia

Athletic Pubalgia or Sports Hernia is a soft tissue injury seen in sportsmen. This type of groin injury is often confused with Osteitis Pubis as both the conditions cause similar pain. Osteitis Pubis causes pain in the pubic symphysis that can be referred to the hip, lower abdomen and groin. The repetitive trauma and mechanisms of injury of this condition are similar to those of a Sports Hernia. Physicians distinguish between these two injuries by x-ray.

Osteitis Pubis is serious injury of the pubic symphysis or pubis symphysis causing mild to severe pain and tissue damage of the lower pelvis. Early treatment is necessary for curing the inflammation completely and making it possible for the patient to participate in sports and other physical activities. Individuals with advanced cases of this injury require longer healing time.