Groin Pain in Athletes – What is Osteitis Pubis?

Osteitis pubis is a condition in which inflammation occurs in the groin area where the right and left pelvis articulate with each other. The pelvises are structures that connect our body to our legs, protect the organs in the abdomen and groin, and provide support to the muscles. Each pelvis is actually formed by the fusion of three different bones called the ilium, ischium and pubis. The part at the front of the groin is the pubis. In the joint between the two pubis, there is a cartilage tissue called the symphysis pubis. With the stress or damage of this joint for various reasons, the symphysis pubis cartilage and nearby muscle and connective tissue may become edematous. This problem is called osteitis pubis.

Osteitis Pubis Symptoms

Pain in the lower abdomen and groin is the main symptom. Anteriorly, the junction of the pubic bones may be sensitive to pressure. Usually, the pain comes on gradually. Although it is dependent on the activity at first, it can be continuous later on. It can even make it difficult to stand up and walk. Pain in the inner thigh may be unilateral or bilateral. A massing sound or sensation may come from the groin while sitting, getting up, turning in bed or walking.

Who Happens?

It can be seen in physically active people such as football players, long-distance runners, roller skaters, and martial artists. It can also occur with the stretching and straining of the muscles in the groin area during prolonged labor in women. Direct traumas and surgeries affecting this area can also cause osteitis pubis. Disorder of the sacroiliac joints that connect the pelvis with the spine posteriorly may also be associated with osteitis pubis. In people with leg length inequality, the symphysis pubis may be forced accordingly.

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Diagnosis

If you suspect osteitis pubis, you can be examined by a physical therapy and rehabilitation doctor. Diagnosis is made as a result of questioning the complaints and physical examination. In some cases, X-ray, ultrasonography, MRI, computed tomography, scintigraphy (technetium-99m bone scan), blood and urine analysis may be required to exclude other possible diseases and confirm the diagnosis. On the X-ray, enlargement of the symphysis pubis, the adjacent bone and even wear and hardening (sclerosis) can be observed. MRI imaging can show edema and inflammation. Inguinal hernia (inguinal hernia), gynecological diseases (pelvic inflammatory disease, etc.), prostate infection are some of the problems that can be confused with osteitis pubis.

In the microbial infection of the symphysis pubis, there may be symptoms such as fever, redness, swelling, and increased levels of infection in the blood, as well as pain. In case of suspected infection, it may be necessary to take a sample (aspiration) from the area related to the needle. Spread of infection to the bone (osteomyelitis) is a serious problem.

Treatment

The treatment of osteitis pubis is mainly rest. It is usually a problem caused by activities such as excessive running or jumping. Movements that increase pain should be stopped. If the movements are continued despite the pain, the injury may increase and the event may become chronic, and recovery may become difficult. Cold application is also an effective method to relieve edema and pain in that area. An ice pack wrapped in a thin towel can be applied for 15-20 minutes. It can be repeated every 3-4 hours. Pain medications may be prescribed for short periods of time.

After the acute period has passed, exercises to strengthen the abdominal and groin muscles, and stretch the hip (adductor) muscles can help recovery.

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Manual therapy, cortisone injections (corticosteroid injections), prolotherapy methods can also be preferred for treatment.

Full recovery and return to previous activities may take 2-3 months or longer. During the recovery period, athletes can try alternative programs to maintain their form. For example, a football player with osteitis pubis may focus on swimming during this period.

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