Osteitis Pubis (Pubic Symphysis)
Osteitis pubis is also referred to as pubic symphysis, symphysis pubis, and non infectious inflammation of the pubis. ‘Symphysis’ means growing together. The pubic symphysis is a non synovial, cartilaginous joint located at the front of the pelvis. It connects the superior rami of the left and right pubic bones and is found in front of the bladder and above the male and females genitals. It is kept together tightly by strong ligaments (the superior and inferior). Both this ligaments give stability and allow for minimal movement. They are supported by two weaker ligaments the posterior and anterior. In most adults the pubic symphysis has approximately 1 degree and 2 mm of movement. Both ends of ends of the pubis are covered in a thin layer of hyaline cartilage.
Osteitis pubis is caused by swelling of the symphysis pubis and can be hard to heal.
Recently it has also been referred to as Pubic Bone Stress Injury, suggesting that no inflammation is present.
Pubic symphysis is an over use injury, and is usually not caused by a trauma.
Pregnancy: During pregnancy the hormone relaxin causes the ligaments to relax. This allows the pelvic bones to be flexible for birth, and can cause the pubis symphysis to widen up to 9mm, instead of the usual 4-5mm gap (when not pregnant). However, sometimes diastatis of the symphysis pubis occurs during delivery due to a rapid birth.
Training on uneven or hard ground.
Muscle imbalance and tightness in the hips, groin and buttocks.
Ice skating and dancing, where high kicks occur.
Commencing training after insufficient training and warm-up.
Wearing ill-fitting shoes
Poor gait, which can appear like a waddling action.
A discrepancy in leg length
Pain is felt throughout and after exercise, but can be severe the morning after an event.
Pain is felt around the groin area, especially in the front, and particularly when touching the pubic symphysis.
Pain can radiate to the abdomen and to the thigh.
The patient experiences difficulty walking.
There can be weakness and instability in the pelvis.
Pain tends to be gradual and can be mistaken for a muscle strain.
It is important to seek treatment early to avoid making the condition more chronic.
A doctor or physiotherapist might recommend an MRI scan to assess whether there is any inflammation of the pubic symphysis, erosion of the pubic bone or any sign of infection (which can have similar symptoms).
Unfortunately osteitis pubis can be unresponsive to treatment, and can take from 6 months to 2 years to heal. It can be a frustrating condition as it can be difficult to treat. Bed rest might be necessary to alleviate this pressure on the pubic bone.
Rest: is essential to prevent further damage and to assist recovery. The amount of rest is dependent on the severity of the injury. It is important to avoid any exercises that put a strain on the pubic symphysis and exercise should be avoided until the muscles have completely recovered.
In the sub acute (3 days to 3 weeks) and the chronic stage (3 weeks to 2 years) it is important that training should be adapted to avoid kicking or any exercises that put excessive strain on the pubic symphysis, such as lifting heavy weights. A physiotherapist can advise when exercise should be resumed and what exercise would be appropriate. It is important to always warm up and cool down properly when exercising.
Ice treatment: Ice, can be applied for 10-15 minutes, every 2-3 hours in the acute and sub- acute stage (frequency can be reduced according to recovery, and can be continued for as long as deemed necessary). In the sub-acute stage (3days – 3 weeks) heat therapy can be applied, usually in the form of a hot bath.
NSAIDS (anti-inflammatories) and paracetamol can be taken to aid pain relief. Medical advice should be sought, in case of possible side effects.
Steroid injections (under medical guidance) can alleviate pain and can be an effective form of treatment, but it is recommended exercise should be avoided for 1-2 weeks after an injection.
Orthotics can improve gait and avoid pressure forming on the pubic symphysis. It is therefore, worth consulting a podiatrist, who can perform gait analysis and advise on appropriate foot wear.
A physiotherapist might prescribe ultrasound treatment, sound waves; which speeds up the repair process, by breaking down tissues and stretching them. It can also help alleviate pain.
Massage can help aid recovery, and improve joint mobility and range of movement. It should not be administered during the acute stage. If there is any underlying medical condition, such as a heart condition, it is important to seek medical advice before receiving massage.
A physiotherapist can recommend strengthening, flexibility and proprioceptive exercises in the sub-acute and the chronic stage of recovery. Initially exercises should focus on improving flexibility of the adductor muscles. Once symptoms have improved, then attention can focus on strengthening the pubic symphysis, with exercises, such as stomach crunches, the Bridge, and adductor exercises. The intensity of the exercises should be increased gradually and in a controlled way. Cycling or swimming (with a pull buoy) is a good way of maintaining fitness while the adductor muscles recover. (Breast stroke leg kick is inadvisable.)
Published: March 2, 2012Author: Sophia Cross, BA (Hons) MA
Osteitis Pubis Treatments