treatment, healing, and recovery in osteitis pubis symphysis

what is osteitis pubis symphysis?

Osteitis pubis symphysis, often referred to simply as osteitis pubis, is a medical condition characterized by inflammation of the pubic symphysis, which is the joint located at the front of the pelvis where the two pubic bones meet. This joint is a cartilaginous joint, and it plays a crucial role in maintaining the stability of the pelvis, especially during activities that involve movement of the lower limbs.

 why do some suffer from osteitis pubis symphysis?

Osteitis pubis occurs due to the  repeated muscle contraction around the pubic bone and the cartilage connecting the bones. Several factors contribute to the excessive contraction of the muscles near the pubic symphysis, which can be broadly categorized into two main causes: overtraining and biomechanical inefficiencies.

Over training

Osteitis Pubis as mentioned earlier is caused by over contraction of muscles. It is most common in sportspersons. It generally occurs to those who play sports that require heavy lifting or constant speed. Below are the most frequent causes of this ailment:

• Using rough and uneven ground to workout

• Working out on concrete like surface

• Not giving body time to warm-up

• Rapidly increasing the intensity and length of workout period

• Not using proper shoes

Biomechanical inefficiencies

Problems caused due to improper machines, or faulty body mechanisms are called biomechanical inefficiencies. Some of the common biomechanical inefficiencies are:

• Faulty foot such as being flat footed

• Abnormality in walking

• Improper movement mechanics

• Difference in length of leg

• Imbalanced muscles

• Tight or stiff muscles

symptoms

Osteitis pubis presents with several symptoms, many of which are often overlooked. The initial sign is typically a mild pain in the abdomen and groin.

Common complaints include:

• Groin Pain: Pain concentrated over the pubic symphysis, which lessens as it radiates outward.
• Localized Discomfort: Pain around the pubic area, often accompanied by discomfort in the adductors or lower abdomen.
• Worsening Pain During Activity: Increased pain during strenuous activities such as running, kicking, or even lying on the side.
• Pain During Daily Movements: Discomfort when walking, climbing stairs, sneezing, or coughing.
• Clicking or Popping Sensation: A noticeable clicking or popping when getting up from a seated position, changing sides in bed, or walking on uneven ground.
• Weakness and Mobility Issues: Difficulty in walking and a general sense of weakness.
• Fever and Chills: Fever, chills, or rigors may accompany the pubic pain in some cases.

diagnosis

Finding osteitis pubis through physical examination for can vary from person to person. Such findings may include the following:

• Tenderness or palpation around the area of the superior pubic ramus

• When sacroiliac joint disorder is a cause, pain over the sacroiliac joints, often in addition to muscle spasm around the buttocks and resultant sciatic-type pain

• Difference of leg length causing hip pain on the side of the longer limb

For diagnosing osteitis pubis, specific tests are employed, with the direct-pressure spring test being the most accurate. The procedure for this test involves the following steps:

• Palpation of the Pubic Bone: Begin by palpating directly over the pubic symphysis; tenderness to touch is often present.
• Lateral Pressure: Move your fingertips a few centimeters laterally on each side and apply direct pressure on the pubic rami. Individuals with osteitis pubis will typically experience sharp pain.
• Ipsilateral Pressure: Apply pressure on one side at a time to determine if one side is more painful than the other.

Athletes suffering from osteitis pubis usually report pain at the front of the pelvis, which may extend into the groin. They exhibit acute tenderness when the pubic symphysis and surrounding bones are touched or palpated.

Pain can also be triggered by resisted stretching and contraction of the hip flexors and groin muscles. Activities like sneezing, coughing, or performing a sit-up often reproduce the pain.

Further investigations, such as X-rays, bone scans, MRI, or CT scans, may be necessary to confirm the diagnosis and assess the severity of the condition.

how do you treat osteitis pubis symphysis?

The most effective way to treat osteitis pubis is by ensuring ample rest, allowing the body the time it needs to heal. Since this condition often results from overexertion and training errors, resting the pelvis is crucial for recovery. When a proper regimen is followed, osteitis pubis is manageable and treatable.

Given that osteitis pubis is a chronic condition, it requires ongoing care and attention. It’s essential to follow the physician’s instructions precisely.

Treatment is typically divided into two phases: short-term treatment and long-term treatment.

short term treatment

One of the most common causes of osteitis pubis is over-exercising. Therefore, when the injury occurs, it’s important to know the immediate steps to take. As osteitis pubis involves  soft tissue injury, the standard five stages of treatment should be followed: i) immobilization, ii) ice, iii) compression, iv) elevation, and v) seeking medical assistance.

1. Immobilization: The first step after identifying osteitis pubis is to lay the person down and ensure complete immobility. Rest is paramount in treating this condition. Since the injury is likely due to stress on the pubic cartilage, any further movement could worsen the situation.

2.Ice The next crucial step is applying ice to the injured area. Gently apply an ice pack to the painful area, taking care not to place the ice directly on the skin to avoid ice burns. If ice is unavailable, cold water can be used as an alternative. This step should ideally be done within 72 hours of the injury to reduce swelling and help with pain relief. The first 72 hours are critical for recovery, and the injured area should not be exposed to heat. Continue applying ice at regular intervals for the best results.

3. Compression: Bandage the injured area to prevent bleeding and minimize swelling.

4. Elevation: Elevate the injured area slightly above heart level using a pillow to further reduce swelling.

5. Medical Assistance: After the patient experiences temporary relief, it is essential to seek medical help and begin long-term treatment.

long term treatment

Once the initial treatment has helped to reduce most of the inflammation and pain, it is time to move onto the next stage of treatment. It involves applying heat; this will help in increasing the blood supply and therefore increasing the amount of oxygen and nutrients to the injured area.

Thereafter, very light stretching exercises can be used to improve and lengthen the muscles around the area of the symphysis that is the hips and groin. This will help to relieve some of the pressure on the pubic symphysis from tight muscles.

surgical intervention of osteitis pubis

Surgery is typically neither required nor recommended for osteitis pubis and should be avoided during the acute phase. Surgical intervention is generally considered only when conservative treatments have failed.

However, if surgery is necessary, several approaches can be taken, including:

• Curettage: Removing tissue by scraping or scooping.
• Arthrodesis: Fusing the pubic bones together.
• Wedge Resection: Removing tissue by making a precise cut.
• Wide Resection: Removing the affected tissue along with a portion of the surrounding normal tissue.

healing for osteitis pubis

Osteitis pubis can often be a challenging injury to recover from. However, with proper management of activity levels and appropriate physiotherapy, most patients can return to normal function within a few weeks. In more severe cases, rehabilitation may take significantly longer, sometimes lasting 6 months or more before a successful return to sports is possible. Early physiotherapy is crucial in accelerating recovery for all patients with this condition.

recovery of osteitis pubis

The pain from osteitis pubis can take months to fully subside, and recovery times vary from person to person. Returning to daily activities depends on the individual’s recovery progress rather than a specific number of days or weeks since the injury occurred.

In general, the sooner treatment begins after the symptoms first appear, the faster and more effective the recovery will be. The goal of rehabilitation is to safely return the patient to normal activities as quickly as possible.

prevention of osteitis pubis

Over-coaching should be avoided, especially for those involved in sports that require long or repetitive kicking. Core strength and stability exercises are crucial for enhancing muscle performance in the trunk and pelvis.

Using a Swiss Ball and Resistance Bands for core strength exercises on a mat is highly effective. Strengthening and stabilizing these muscles helps counteract the significant forces applied to the lower abdomen and pelvis, which can reduce the risk of developing osteitis pubis.

faq’s

How common is osteitis pubis, and who is most at risk of developing it?

Osteitis pubis is relatively common among athletes, particularly those involved in sports with repetitive kicking, running, or sudden changes in direction. It is frequently seen in soccer players, runners, and dancers. However, it can also affect individuals involved in other high-impact activities or those who experience repetitive stress on the pelvic region.

What are the primary management strategies for osteitis pubis?

The primary management strategies for osteitis pubis include:

• Rest: Reducing or avoiding activities that stress the pelvis.
• Ice Therapy: Applying ice to the affected area to reduce pain and swelling.
• Compression: Using bandages or supports to reduce swelling.
• Elevation: Keeping the injured area elevated to further minimize swelling.
• Pain Management: Using medications like NSAIDs to relieve pain and inflammation.
• Physiotherapy: Engaging in specific exercises to improve core strength and stability, which can aid in recovery and prevent recurrence.

What treatment options are available for osteitis pubis, and how effective are they?

Treatment options for osteitis pubis include:

• Conservative Management: Rest, ice, compression, and elevation, along with physiotherapy, are typically effective and can lead to significant improvement.
• Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) can help manage pain and inflammation.
• Physiotherapy: Focused exercises and stretches can enhance recovery and prevent future issues.
• Surgery: In rare cases where conservative treatments fail, surgical options like curettage, arthrodesis, wedge resection, or wide resection may be considered, though these are usually last resorts.

What steps can I take to manage osteitis pubis on a daily basis?

To manage osteitis pubis daily:

• Follow a Rest and Activity Plan: Avoid activities that exacerbate the condition and follow your physician’s advice on when to gradually resume normal activities.
• Apply Ice: Use ice packs to reduce pain and swelling as needed.
• Perform Physiotherapy Exercises: Engage in prescribed exercises to strengthen the core and improve pelvic stability.
• Use Supportive Gear: Wear supportive bands or braces if recommended.
• Monitor Symptoms: Keep track of any changes in symptoms and consult with your healthcare provider if there is any worsening or lack of improvement.

How can I prevent osteitis pubis from recurring or worsening?

To prevent recurrence or worsening of osteitis pubis:

• Avoid Overtraining: Gradually increase the intensity and duration of physical activities to avoid overstressing the pelvis.
• Strengthen Core Muscles: Engage in regular core strengthening and stability exercises.
• Use Proper Technique: Ensure correct techniques in sports and exercises to minimize stress on the pelvis.
• Wear Appropriate Footwear: Use supportive footwear that provides adequate shock absorption and stability.
• Listen to Your Body: Pay attention to warning signs and address any discomfort promptly to prevent exacerbation of the condition.

about author

Dr. Rajprabha Patra

Dr.Rajprabha Patra practiced as a Dental Surgeon for 5 years before making a switch into the business domain with an MBA from ISB. As the Product Manager for Counselling Services at Portea, she aims to make a difference in the way mental health is perceived in India.