Osteitis Pubis

Osteitis pubis is the inflammation of the pubic symphysis that connects the right and left portions of your pelvic bones. One of the three bones that make up the pelvic girdle is the pubis or pubic bone. The pubic symphysis, which is formed of cartilage, is the junction where the pubic bones are attached together with the help of ligaments. A group of bones called the pelvis joins the legs to your upper body. In addition, it supports your internal sex organs, the bladder, and your intestines. So, this joint and other joints such as sacroiliac joint has the main supportive and protective role for your internal organs.

Multiple groups of muscles are attached to the pubic symphysis. This includes the muscles of your abdominal wall, your pelvis, and the thigh. This provides strength to your joint. Also, it puts other muscles at a stake as the inflammation of this joint also causes inflammation of the muscles attached to it. Osteitis pubis is the result of inflammation of the joint along with the surrounding muscles due to the stress on the joint.

In youngsters, this disc is quite small and the hyaline cartilage is very wide, but these characteristics change over time. In men, the disc is taller, more concave, and narrower. The symphysis pubic gap is typically 4-5 mm broad in women and expands by 2-3 mm during the third trimester of pregnancy. This is essential to make the delivery of the baby easier.

Although osteitis pubis is rare, it affects between 0.5 and 6.2 percent of the overall athlete population. The prevalence of the condition is more in Soccer, football, ice hockey, and rugby players than any other sports player. 

In this article, you will get complete information about osteitis pubis and what you need to do if you are suffering from this condition.

Causes of osteitis pubis

Osteitis pubis is usually caused by one of the following conditions:

• Surgery. Osteitis pubis is a common complication that occurs after gynecological surgery(1). If you have undergone a surgery previously, especially a gynecological one, it is highly likely that your pelvic pain or lower abdomen pain is due to the osteitis pubis. In such surgery, your doctor gives an incision to your rectus abdominis to open up your abdominal wall up to the pubic symphysis to deliver the baby. If the hygienic conditions are not good or the surgical instruments damage your pubic bone, chances are great that you are going to suffer from osteitis pubis afterward.
• Sports injury. Sporting activities is a common cause of osteitis pubis in soccer players. Overuse of the muscles attached to the pubic bone develops micro-tears in the bone and this produces inflammation later on. Lesions in the inguinal region is also a common cause of osteitis pubis in sportsmen. Also, there are many sports injuries such as over-extension which directly damage your pubic bone or the muscles attached to it. Imbalance of the hip flexors (hamstrings) or abductors may also cause dysfunction of your symphysis pubis.
• Pregnancy & childbirth. Pregnancy is also another potent factor of inflammation and pain of the symphysis pubis in females. As you know that this joint supports all the internal body organs, so it has to support the weight of the developing fetus as well. Due to this continuous strain in pregnancy, the pubic symphysis often becomes inflamed and painful. 
  Injury during childbirth may also lead to osteitis pubis later on. This is due to the wide opening of the birth canal to deliver the baby which puts strain on the pubic symphysis. If you are a multigravida female, you need to consider this cause as this may be a potent one in your case.
• Trauma or accident. Trauma, direct blow, or injury to the pelvic region still remain a major cause of such painful conditions. If you have any previous history of injury to the pelvic region, then it may develop inflammation of the joints in the long run.
• Rheumatological disorders. Such disorders are the rare causes of osteitis pubis. In these disorders, your body develops immunity against your own self and starts damaging your organs(2). This causes widespread inflammation in your body. And the inflammation of bone and joints is a part of such widespread disease.

What osteitis pubis feels like

Pain is one of the main symptoms of osteitis pubis. A continuous, dull discomfort while seated still may be brought on by the inflammation in the joint and surrounding muscles. You could discover that movement aggravates the pain. A sharp rise in discomfort will result from applying pressure to the location. However, the site and the character of the pain are important. Here is what you need to know about this.

If you have osteitis pubis, the first and the foremost sign of it is the abdominal pain and pain inthe groin region(3). This pain is somewhat different from the pain of the intestines and feels like a dull pain that becomes sharp from time to time. If you have taken multiple medications for the pain and still not getting relief, chances are that you are suffering from osteitis pubis and you need to seek your doctor for the management of your condition. 

A sudden increase in pain occurs when you start to exercise if you are suffering from osteitis pubis. This is because the joint supports the attachments of all the muscles necessary for the movement of your body. And when you engage these muscles in activity, it pulls on your joint and you feel a severe and sudden onset of pain.

If you feel like a change in your gait, it is likely that your doctor will make a differential diagnosis of osteitis pubis. Pain during walking and running alters your gait and this is a potent sign of the inflammation of the joint involved in motion. Osteitis pubis patients may notice that their stride alters as a result of how painful walking can be. As you attempt to lessen the discomfort of moving, your walk could start to resemble a waddle.

Care & treatment of osteitis pubis

Short-term treatment

Osteitis pubis requires the same first care as any other soft tissue injury. This involves using R.I.C.E.R—Rest, Ice, Compression, Elevation—as well as getting an (R) recommendation for the proper medical care. The next two points are the most crucial.

1. Rest and Immobility: You need to take complete rest right away after being diagnosed with osteitis pubis. Any additional stress or movement will make the problem worse and delay the recovery process. Additionally, it’s crucial to keep your pelvis still to avoid any further damage.
2. Ice: By far the most crucial component to prevent pain. The most effective way to lessen pain and swelling is to apply ice at the site where you feel pain the most. As soon as you identify the site of damage, apply ice for at least 48 to 72 hours.

Conservative treatment

It’s time for you to go on to the next stage of conservative treatment once you are done with the initial treatment. This involves physical therapy, medications and injections. It may also involve curettage if you have such gynaecological anomaly. In addition, your doctor may also carry out a physical examination before the long-term treatment.

If you do physical activity daily, you must stop your activity for the time being until your inflammation is recovered. This is especially true if you are a sportsman or a professional gym worker. Avoiding physical activity is part and parcel of your treatment as this removes strain on your damaged area. Once you remove strain from your damaged area, only then the process of recovery can begin.

Taking anti-inflammatory medications and steroids as corticosteroid injections are equally important in the conservative management your condition(4). But be cautious about the dose you take and the contraindications of the drug you are taking. This is necessary to avoid any side effects of the medicine. However, if the medication doesn’t improve your condition in the long run, you may undergo surgical treatment.

Healing process

It may take two to three months to recover naturally but it may take even more depending on the severity of your injury.

You might be able to discover hobbies that won’t place too much stress on your pubic symphysis while you’re recovering. You can choose swimming rather than running as this would be better and safe for your injury. Your doctor may advise physical therapy(5), during which you’ll learn a number of stretches and muscle-building exercises.

In order to avoid further injury, it is important to take time off between workouts and relax after intense exercise when you resume physical activity. Additionally, try to avoid working out on rough or uneven surfaces.

Even though osteoid pubis can be uncomfortable, with rest and painkilling medications, it shouldn’t keep you out of the action for too long. You need to undergo radiographic methods like MRI (magnetic resonance imaging) or X-ray of your lower back to diagnose your condition. Follow your doctor’s and physical therapist’s recommendations after getting a correct diagnosis.

Exercises you need

Appropriate exercise of the muscles attached to the pubic region is necessary to prevent the inflammation of the symphysis pubis. Even you can reduce the incidence of nerve or muscle impingement with proper exercise. However, avoid the exercise if you feel pain doing it. Following are the effective exercises that you can add to your daily routine to see the difference.

Transversus abdominis retraining

Your midsection is surrounded by deep core muscles called transverse abdominals. They are crucial in keeping the pelvis stable. The following transverse abdominal workout can be performed while lying down, or you can practice a standing or seated variation of it.

1. Contract your abdominal muscles while resting on your back and imagine dragging your belly button toward your spine.
2. Hold on to this position for a while. Avoid raising your ribcage.
3. While contracting your abdominal muscles, try to keep the rest of your body relaxed.
4. Repeat this exercise three to four times a day.

Adductor stretch

On the inside of your thigh are the adductor muscles which are attached to the pubic region. Regular exercise of these muscles keeps them flexible and strong and this lowers the strain on your pubic symphysis(6).

1. Bend towards your left side while keeping your right leg straight. 
2. Keep standing with your back straight and your legs wider than your shoulder width. You will feel your right leg stretched.
3. Hold yourself in this position for 10 to 15 seconds.
4. Return to your starting position gradually and repeat the procedure for your opposite side.

Osteitis pubis prevention

Osteitis pubis treatment is crucial, but prevention should come before treatment. Following are the actions that you can take to avoid Osteitis Pubis.

• Warm-up effectively: Prepare your body before any exercise, a thorough warm-up is necessary. Your muscles, joints and mind will all be ready for rigorous activity after a well-planned warm up.
• Rest and restoration: Rest is crucial for your body’s soft tissues to recover from demanding exercise. Make sure you give yourself enough time to recover between workouts or training sessions.
• Stretching exercise: Stretching and strengthening exercises are essential for preventing osteitis pubis(7), as it keeps your hip muscles strong. Make sure you concentrate on the flexibility and strength of all your muscle groups in this region. The best results come from core strengthening activities like crunches and strengthening drills utilizing exercise balls (or Swiss balls).
• Wear appropriate footwear: While running or walking, a decent pair of shoes will support your lower legs, and knees and keep your hips in a stable position. This will allow you to walk properly without putting strain on your pubic region. And by doing this, you will be able to prevent osteitis pubis in the long run.

Take away

Athletes often have chronic groin pain from sports hernias and osteitis pubis, which significantly reduces their ability to participate in sports. These ailments are due to the rigid lower extremity muscles that are abnormally developed relative to the abdominal musculature, which causes the anterior pelvic tilt. Osteitis pubis is a rare condition and you need to seek your doctor if you feel that you are suffering from this condition. You need to be very careful about your health and physical fitness and regularly consult your orthopedic doctor or journal of sports medicine(j sports med). You can carry out daily exercises to improve your illness. If you are prone to developing osteitis pubis, do take preventive measures and your future self will thank you for this.

References

1. Lentz, S. S. (1995). Osteitis Pubis: A Review. Obstetrical & Gynecological Survey, 50(4), 310–315.
2. Scott, D. L., Eastmond, C. J., & Wright, V. (1979). A comparative radiological study of the pubic symphysis in rheumatic disorders. Annals of the Rheumatic Diseases, 38(6), 529–534. https://doi.org/10.1136/ard.38.6.529
3. Gomella, P., & Mufarrij, P. (2017). Osteitis pubis: A rare cause of suprapubic pain. Reviews in Urology, 19(3), 156–163. https://doi.org/10.3909/riu0767
4. Choi, H., McCartney, M., & Best, T. M. (2008). Treatment of osteitis pubis and osteomyelitis of the pubic symphysis in athletes: a systematic review. British Journal of Sports Medicine, 45(1), 57–64. https://doi.org/10.1136/bjsm.2008.050989
5. Sudarshan, A. (2012). Physical therapy management of osteitis pubis in a 10-year-old cricket fast bowler. Physiotherapy Theory and Practice, 29(6), 476–486. https://doi.org/10.3109/09593985.2012.753650
6. Wollin, M., & Lovell, G. (2006). Osteitis pubis in four young football players: A case series demonstrating successful rehabilitation. Physical Therapy in Sport, 7(3), 153–160. https://doi.org/10.1016/j.ptsp.2006.03.005
7. Pizzari, T., Coburn, P. T., & Crow, J. F. (2008). Prevention and management of osteitis pubis in the Australian Football League: A qualitative analysis. Physical Therapy in Sport, 9(3), 117–125. https://doi.org/10.1016/j.ptsp.2008.06.002