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Osteitis pubis is inflammation in the joint between your left and right pubic bones (pubic symphysis) resulting in groin and lower abdomen pain.
It is commonly believed to result from overuse stress injury of the pubic symphysis. Repetitive use causes microtrauma or injury of anterior pelvic musculature resulting in muscle imbalance between the two. This imbalance alters the joint’s biomechanics, resulting in injury to the pubic bone and surrounding structures (Dirkx et al, 2023).
Patients with osteitis pubis often present with pubic pain that radiates to the anterior and medial groin that is dull or throbbing in nature. Pain is worsened with physical activity including walking, turning, going up and down stairs, kicking or coughing.
Diagnosis is based on detailed history, physical examination, and imaging, which are crucial for a correct diagnosis and proper management. Clinical evaluation will assess the location and severity of pain while observing for tenderness directly over the pubic symphysis. The patient will be put through various repetitive movements testing the hip and core, looking for symptom exacerbation. Certain physical tests may be utilized to reproduce symptoms at time of exam.
Magnetic resonance imaging (MRI) can help assess for bony swelling (edema) and tissue damage. An MRI may be ordered to rule out similar pathology and confirm the presence and location of injury.
Initial treatment consists of rest, NSAIDs, and physical therapy. Nonsteroidal anti-inflammatory drugs (NSAIDs) are used for pain relief and physical therapy may be utilized to improve strength and flexibility of the hip flexors, hip rotators and adductors, avoiding kicking and running motions in early stages. Osteitis pubis tends to have a longer recovery period and may take up to 6 months to return to normal pre-injury function (Elattar et al, 2016).
Steroid injections into the joint between the left and right pubic bones (pubic symphysis) may be used as an adjunctive therapy, due to its immediate symptom relief (Erçalik et al, 2016). It is important to note however, that their use is still somewhat controversial.
OMM aims to treat the pelvic dysfunction and surrounding somatic dysfunctions with the hopes of improving overall biomechanics of the kinetic chain restoring function and decreasing pain.
More recently, PRP has been considered for treatment of osteitis pubis as a viable non-operative treatment before considering surgery (Park et al, 2022). The scientific literature regarding these regenerative injections is currently limited to case reports, thus further high quality studies are necessary.
In cases that do not respond to long term conservative treatment surgery may become indicated. There are a number of surgical approaches that may be used to address the symphysis directly or reinforce or repair abdominal or pelvic floor musculature (Dirkx et al, 2023).
Dirkx M, Vitale C. Osteitis Pubis. [Updated 2022 Dec 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556168/
Elattar O, Choi HR, Dills VD, Busconi B. Groin Injuries (Athletic Pubalgia) and Return to Play. Sports Health. 2016 Jul;8(4):313-23. doi: 10.1177/1941738116653711. Epub 2016 Jun 14. PMID: 27302153; PMCID: PMC4922526.
Erçalik T, Özsoy T, Gündüz OH. Clinical and Radiological Recovery of Osteitis Pubis: Spontaneous or Steroid-Induced? Arch Rheumatol. 2016 Apr 6;32(1):84-85. doi: 10.5606/ArchRheumatol.2017.5947. PMID: 30375540; PMCID: PMC6190936.
Park, David J. MD; Sussman, Walter I. DO. Osteitis Pubis Treated With Platelet-Rich Plasma: A Case Report. Clinical Journal of Sport Medicine 32(2):p e172-e174, March 2022. | DOI: 10.1097/JSM.0000000000000875.