Athletes and physically active individuals who participate in activities, exercises, and sports that involve kicking, pivoting, and/or shifting directions can develop pelvis overuse injury of the pubic symphysis/joint at the front of the pelvis known as osteitis pubis. Can recognizing the symptoms and causes help in treatment and prevention?
Table of Contents
Osteitis pubis is the inflammation of the joint that connects the pelvic bones, called the pelvic symphysis, and the structures around it. The pubic symphysis is a joint in front of and below the bladder. It holds the two sides of the pelvis together in the front. The pubis symphysis has very little motion, but when abnormal or continued stress is placed on the joint, groin and pelvic pain can present. An osteitis pubis injury is a common overuse injury in physically active individuals and athletes but can also occur as the result of physical trauma, pregnancy, and/or childbirth.
The most common symptom is pain over the front of the pelvis. The pain is most often felt in the center, but one side may be more painful than the other. The pain typically radiates/spreads outward. Other signs and symptoms include: (Patrick Gomella, Patrick Mufarrij. 2017)
Osteitis pubis can be confused with other injuries, including a groin strain/groin pull, a direct inguinal hernia, ilioinguinal neuralgia, or a pelvic stress fracture.
An osteitis pubis injury usually occurs when the symphysis joint is exposed to excessive, continued, directional stress and overuse of the hip and leg muscles. Causes include: (Patrick Gomella, Patrick Mufarrij. 2017)
The injury is diagnosed based on a physical examination and imaging tests. Other tests may be used to rule out other possible causes.
Effective treatment can take several months or longer. Because inflammation is the underlying cause of symptoms, the treatment will often involve: (Tricia Beatty. 2012)
Once diagnosed, the prognosis for full recovery is optimal but can take time. It can take some individuals six months or more to return to pre-injury level of function, but most return by around three months. If conservative treatment fails to provide relief after six months, surgery could be recommended. (Michael Dirkx, Christopher Vitale. 2023)
Gomella, P., & Mufarrij, P. (2017). Osteitis pubis: A rare cause of suprapubic pain. Reviews in urology, 19(3), 156–163. doi.org/10.3909/riu0767
Beatty T. (2012). Osteitis pubis in athletes. Current sports medicine reports, 11(2), 96–98. doi.org/10.1249/JSR.0b013e318249c32b
Via, A. G., Frizziero, A., Finotti, P., Oliva, F., Randelli, F., & Maffulli, N. (2018). Management of osteitis pubis in athletes: rehabilitation and return to training – a review of the most recent literature. Open access journal of sports medicine, 10, 1–10. doi.org/10.2147/OAJSM.S155077
Dirkx M, Vitale C. Osteitis Pubis. [Updated 2022 Dec 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK556168/
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