Osteitis Pubis

with Rehab

ExitCare ImageOsteitis pubis is an overuse injury of the joint in the front of the pelvis (symphysis pubis), which connects the two pubic bones of the pelvis. The joint is lined with cartilage, surrounded by a joint covering (capsule), and filled with joint (synovial) fluid. Osteitis pubis involves bone loss (resorption) of the ends of the pubic bones, which causes pain. The cause of osteitis pubis is unknown, but it may be a reaction to repeated stress on the pubic bone.

SYMPTOMS

  • Pain, discomfort tenderness, and swelling at the front of the pelvis, over the pubic symphysis joint.

  • Pain that possibly extends to the groin, inner thigh, or lower belly.

  • Symptoms that slowly increase in frequency and eventually become constant.

  • Pain that gets worse when pivoting on one leg, kicking a ball, sprinting, jumping, climbing stairs, or suddenly changing direction while running. Pain that gets worse with stretching, particularly separating the legs and thighs, or with bringing the thighs and legs together against resistance.

  • Walking or running with a limp.

  • Weakness when bending the hip or kicking.

  • Sometimes, clicking in the front of the pelvis.

  • Possibly, no symptoms.

CAUSES

The cause of osteitis pubis is unknown. However, it is believed to be caused by repeated stress on the pubic bone, that occurs faster than the body can heal.

RISK INCREASES WITH:

  • Sports that require repetitive kicking (soccer or football kicking), sports that require repetitive jumping, as well as distance runners, fencers, ice hockey players, and weightlifters.

  • Poor strength and flexibility.

  • Previous osteitis pubis.

  • Previous sprain or injury to the pelvis.

  • Stiffness or loss of hip motion.

  • Previous hip injury.

  • Rheumatoid arthritis of the spine (ankylosing spondylitis).

  • Bladder or prostate surgery.

PREVENTION

  • Avoid trauma to the hip.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

  • Learn and use proper technique.

PROGNOSIS

If treated properly, osteitis pubis is usually curable within 3 to 8 months.

RELATED COMPLICATIONS

  • Recurring symptoms, especially if activity is resumed too soon.

  • Longer healing time, if usual activities are resumed too soon.

  • Chronic pain and inflammation of the joint in the front of the pelvis.

  • Unstable or arthritic joint, following continued injury or delayed treatment.

TREATMENT

Osteitis pubis should only be treated if symptoms are present. Treatment first involves use of ice and medicine to reduce pain and inflammation. It is important to modify activities that aggravate symptoms, so there is little to no pain during activity. If an activity cannot be performed without pain, it should be eliminated. The use of strengthening and stretching exercises may help reduce pain with activity. Exercises may be performed at home or with a therapist. Sometimes, corticosteroids may be given by injection or pills, to help reduce inflammation. It is necessary to return to sports gradually, after symptoms have gone away. If symptoms persist, despite non-surgical treatment, or you are unwilling or unable to give up certain activities, surgery may be needed. Surgery may involve removing motion from the joint (fusing) or cleaning the joint.

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often advised.

  • Do not take pain medicine for 7 days before surgery.

  • Prescription pain relievers may be given, if your caregiver thinks they are needed. Use only as directed and only as much as you need.

  • Corticosteroid injections may be given by your caregiver. These injections should be reserved for the most serious cases, because they may only be given a certain number of times.

HEAT AND COLD

  • Cold treatment (icing) should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

  • Heat treatment may be used before performing stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or a warm water soak.

SEEK MEDICAL CARE IF:

  • Pain, tenderness, or swelling gets worse or does not improve, despite 2 to 6 weeks of treatment.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Osteitis Pubis

These exercises may help you when beginning to rehabilitate your injury. Doing them too aggressively can make your condition worse. Complete them slowly and gently. Your symptoms may go away with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue. If these stretches make your symptoms worse, even when done gently, consult your physician, physical therapist or athletic trainer.

ExitCare Image STRETCH - Hamstrings/Adductors, V-Sit

  • Sit on the floor with your legs extended in a large "V," keeping your knees straight.

  • With your head and chest upright, bend at your waist, reaching for your left foot to stretch your right thigh muscles.

  • You should feel a stretch in your right inner thigh. Hold for __________ seconds.

  • Return to the upright position to relax your leg muscles.

  • Continuing to keep your chest upright, bend straight forward at your waist, to stretch your hamstrings.

  • You should feel a stretch behind both of your thighs and knees. Hold for __________ seconds.

  • Return to the upright position to relax your leg muscles.

  • With your head and chest upright, bend at your waist, reaching for your right foot to stretch your left thigh muscles.

  • You should feel a stretch in your left inner thigh. Hold for __________ seconds.

  • Return to the upright position to relax your leg muscles.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRETCHING - Hip Flexors, Lunge

  • Half kneel with your right / left knee on the floor and your opposite knee bent and directly over your ankle.

  • Keep good posture with your head over your shoulders. Tighten your buttocks to point your tailbone downward. This will prevent your back from arching too much.

  • You should feel a gentle stretch in the front of your thigh and hip. If you do not feel any resistance, slightly slide your opposite foot forward and then slowly lunge forward, so your knee once again lines up over your ankle. Be sure your tailbone remains pointed downward.

  • Hold this stretch for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

ExitCare Image STRETCH - Adductors, Lunge

  • While standing, spread your legs, with your right / left leg behind you.

  • Lean away from your right / left leg, by bending your opposite knee. You may rest your hands on your thigh for balance.

  • You should feel a stretch in your right / left inner thigh. Hold for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRETCH - Adductors, Standing

  • Place your right / left foot on a counter or stable table. Turn away from your leg, so both hips line up with your right / left leg.

  • Keeping your hips facing forward, slowly bend your opposite leg until you feel a gentle stretch on the inside of your right / left thigh.

  • Hold for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTHENING EXERCISES - Osteitis Pubis

These exercises may help you when beginning to rehabilitate your injury. They may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Progress the resistance and repetitions only as guided.

ExitCare Image STRENGTH - Hip Adductors, isometrics

  • Sit on a firm chair, so that your knees are at about the same height as your hips.

  • Place a large ball, firm pillow or rolled up bath towel between your thighs.

  • Squeeze your thighs together, gradually building tension. Hold for __________ seconds.

  • Release the tension gradually, and allow your inner thigh muscles to relax completely before repeating the exercise.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Hip Adduction

  • Lie on your side, with your right / left leg on the bottom.

  • Place the foot of your top leg flat on the floor for balance. It may be in front or behind the bottom leg.

  • Lift the bottom leg. Hold this position for __________ seconds.

  • Slowly lower your leg to the starting position.

  • Repeat exercise __________ times, __________ times per day.