In this article, you will find everything you need to know about osteitis pubis and the most effective ways to treat it, including an advanced treatment called Prolotherapy.
Osteitis pubis is a condition characterized by pelvic pain, often seen in athletes. It can affect your performance and daily activities, but understanding the symptoms, causes, and treatment options can help you return to peak activity.
Key Takeaways
- Osteitis pubis involves inflammation or stress-related changes in the pubic symphysis and surrounding muscles, especially in athletes of high-impact sports.
- Diagnosis includes imaging techniques such as X-rays and MRI along with physical tests; non-surgical management is often effective, with only 5-10% of cases requiring surgery.
- Prevention involves proper training, pelvic muscle strengthening, flexibility exercises, and avoiding excessive stress on the pubic symphysis.
Understanding Osteitis Pubis
Osteitis pubis is caused by stress or inflammation of the pubic symphysis and surrounding musculature, leading to groin or lower abdominal pain. It may result from chronic tendinosis due to repetitive use of the anterior pelvic muscles and abnormal forces across the pubic symphysis. Notably, it may represent a bony stress response rather than classic inflammation.
Sports with high pelvic stress, such as:
- Soccer
- Sprinting
- Ice hockey
- American football
are associated with higher risk. Athletes with prior hip or groin injuries are particularly susceptible.
Causes of Osteitis Pubis
Osteitis pubis develops due to a combination of:
- Joint misalignment
- Muscle tightness or weakness
- Overactivity of pelvic muscles
- Repetitive microtrauma or shearing forces
Other contributing factors include:
- Pregnancy and childbirth
- Major trauma
- Pelvic or urologic surgeries
- Rheumatologic disorders
Symptoms and Signs
- Pelvic or perineal pain
- Discomfort during hip adduction
- Groin pain aggravated by activity
- Pain triggered by movements stressing the pubic symphysis
Early detection allows prompt treatment. Physical exams may reveal tenderness, stiffness, and positive pain provocation tests.
Diagnosis
Diagnosis combines imaging (X-ray, MRI) and physical tests. MRI may show bone resorption, osteophytes, subchondral cysts, and periosteal reaction. Physical tests include ‘pubic spring’, ‘lateral compression’, FABER, and adductor squeeze tests. Blood markers like ESR or CRP may be slightly elevated but are nonspecific.
Non-Surgical Management
Conservative management is first-line:
- Rest and activity modification
- Ice and NSAIDs for pain relief
- Comprehensive physical therapy focusing on adductor, abdominal, and pelvic stabilization exercises
Prolotherapy
Prolotherapy is a regenerative treatment that addresses the root cause of osteitis pubis. Tiny injections stimulate collagen production, repairing damaged tissues and providing long-term relief. Clinical evidence supports its pain-relieving, anti-inflammatory, and regenerative effects.
Physical Therapy Focus
Physical therapy is central to recovery. Early stages may use heat, ice, and manipulative therapy. Exercises strengthen the pelvis, hip flexors, adductors, glutes, and lumbar stabilizers. Rehabilitation progresses from gentle stretching and cardiovascular activity to sport-specific movements.
Medication
NSAIDs are commonly used for pain and inflammation, with caution for prolonged use. Corticosteroid injections may help, but risks exist, and their effectiveness is not fully established.
Surgical Options
About 5-10% of cases may require surgery if symptoms persist after six months of conservative therapy. Procedures include:
- Curettage of symphyseal fibrocartilage
- Repair of abdominal or pelvic floor muscles
- Symphyseal fusion
- Wedge resection with or without arthrodesis
Prevention
Preventing osteitis pubis involves:
- Proper training and gradual progression
- Avoiding activities causing pelvic torsion or excessive pressure
- Physical therapy for strength and flexibility
- Early intervention for groin pain
Rehabilitation and Recovery
Recovery typically takes 3-6 months. Key steps:
- Manage pain
- Build lumbo-pelvic stability
- Enhance muscle strength
- Progress to sport-specific activities
Rest
Avoid activities that stress the pubic symphysis, including running, jumping, twisting, pivoting, or high-impact exercises.
Gradual Return to Activity
Return to sport gradually, maintaining strength and correct biomechanics to prevent recurrence.
Complications and Challenges
Chronic inflammation, persistent pain, infections, or femoral artery involvement are potential complications. Misdiagnosis can lead to bone erosion, highlighting the importance of correct evaluation.
Prolotherapy for Osteitis Pubis
In recent years, Prolotherapy has built its reputation within the medical community for its clinically proven ability to treat Osteitis Pubis. Published research has demonstrated its pain-relieving, anti-inflammatory, and regenerative benefits.
Prolotherapy involves injecting a natural regenerative solution with tiny needles, which has been shown to stimulate the production of collagen cells, the small cells needed to help repair damage associated with Osteitis Pubis. By addressing the root cause of the condition, Prolotherapy provides a permanent fix, preventing symptoms from returning.
About the Author
Having performed over 10,000 procedures, Mr. Oliver Eaton is one of the UK’s leading practitioners in treating Osteitis Pubis, with patients travelling from across the UK, Europe, and the Middle East. With over 12 years of clinical experience, Oliver is dedicated to helping patients understand their symptoms and providing effective treatment options.
He qualified in Prolozone Therapy and Prolotherapy in America with the American Academy of Ozonotherapy, and continued his training at the Royal Society of Medicine, Charing Cross Hospital in London, Keele University’s Anatomy & Surgical Training Centre, and Heidelberg University’s medical department in Germany. Over the years, he has treated many elite-level athletes, including Olympic and Commonwealth medallists.
LinkedIn: https://www.linkedin.com/in/oliver-eaton-4338225b/
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Frequently Asked Questions
Where is the pelvic bone?
The pelvic bone is in the lower torso, between abdomen and legs, supporting organs and providing structural stability. Male and female pelvises differ structurally.
What is Osteitis Pubis?
A chronic condition affecting the pubic symphysis and surrounding muscles, often caused by overuse. Symptoms include groin and lower abdominal pain, affecting athletic performance and daily life. Treatment involves physical therapy, NSAIDs, corticosteroid injections, and in some cases, surgery. Symptoms may mimic Osgood Schlatter disease.
Symptoms of Osteitis Pubis
Pelvic pain, perineal discomfort, hip adduction pain, and activity-related groin pain.
Diagnosis
Combines imaging (X-ray, MRI) with physical tests such as ‘pubic spring’ and adductor squeeze tests.
Treatment
Conservative methods including rest, ice, NSAIDs, and rehabilitation. Surgery is considered if symptoms persist after six months.