Treatment For Osteitis Pubis

Diagnosing Osteitis Pubis

Treatment for osteitis pubis ideally starts with obtaining an early accurate diagnosis. Early detection can help prevent the condition progressing beyond the initial stage of localised bone stress. However, frequently landing on the diagnosis of osteitis pubis is often only made in the more advanced stages of the condition. When signs of erosion of the pubic bones at the pubic symphysis present on imaging. Clinical suspicion around a diagnosis of osteitis pubis is often the result of subjective history. A typical history of the complaint, as well as some assessment signs are highlighted below:

• A history of being involved heavily in running, jumping, kicking activities, where pain onset is related to overloading.
• Pain with osteitis pubis is typically experienced over the pubic symphysis. With accompanying referred pain into the groin region.
• The pubic symphysis, and pubic ramus being tender on palpation.
• Resisted muscle testing of the hip flexors and adductors frequently elicit pain. As does stretching the same muscle groups, through the appropriate hip movements.
• Coughing/sneezing and performing a sit up, also frequently reproduces relevant discomfort.

There are many potential causes of groin region pain. Other conditions that can have a similar presentation include; pain coming from a tendon strain, hernia, or the hip joint… Accurate diagnosis as in all circumstances allows for appropriate treatment planning, and a quicker return to play.

Investigations Used In Diagnosing Groin Pain

Investigations often used that can assist in diagnosis and help appropriately plan treatment for osteitis pubis include:

• The use of X-rays. X-rays can appear normal, especially early on in the presentation of the condition. In advanced cases, X-rays can highlight erosion of the pubic symphysis.
• An MRI can pick up signs of bone stress and swelling in the area.
• A bone scan if positive for osteitis pubis will highlight advanced uptake at the pubis symphysis. A bone scan is a very sensitive diagnostic tool for picking up change in bone. However doesn’t have the specificity of an MRI.

For this reason, it is not uncommon that with a diagnosis of oseitis pubis, individuals may have undergone several investigations before actually centering on the diagnosis.

In Treatment For Osteitis Pubis, Rest Is Vital

Frustratingly, a keys feature in the treatment for osteitis pubis is rest. The condition is typically a result of overloading. Through “too much” running, jumping, kicking… So, it makes sense that refraining from these, and other aggravating activities is vital to allow things to settle.

Additional Treatment Approaches

Beyond rest, treatment focuses on symptomatic relief. The use of therapeutic aids including; ice and nonsteroidal anti-inflammatory medications (NSAIDs) are commonly used. Physiotherapy, incorporating exercise prescription targeted at bringing stability to the pelvis is important. Individuals looking to return to their aggravating activities, and avoid relapses in symptoms frequently require biomechanical changes to unload the painful area. This may come from improved postural control, trunk stability, tissue loading tolerance, activity modification… But, can also come in the form of off loading supports.

• The prescription of a sacral belt may also be offered. Some individuals find these supports useful, as sacral belts work to increase stability around the joints of the pelvis assisting weaker muscles. Helping provide the necessary stability to reduce pain, and allow increased activity.

Even with early diagnosis and appropriate treatment, it is not uncommon for the rehabilitation process with osteitis pubis to take a few months. Pain can settle quickly but to successfully return to sport it can take considerable time. Making it a highly frustrating injury for athletes to suffer.

Disclaimer: Sydney Physio Clinic does not endorse any treatments, procedures, products mentioned. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific advice or assistance regarding Treatment For Osteitis Pubis should consult his or her general practitioner, sports medicine specialist, or physiotherapist.