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Pain: Will usually be present in the groin and lower abdominal region.
Agg: Aggravating activities will likely include running, stepping, jumping and kicking.
- AROM: generally reduced hip range of motion, particularly abduction and rotations
- RIMT: adduction and lower abdominal activation will reproduce pain
- Palp: there will be tenderness around the groin and lower abdominal musculature with marked tenderness on palpation of the pubic symphysis.
- NB: A cornerstone of successful conservative osteitis pubis treatment will be addressing biomechanical and functional deviations at both the hip and lumbosacral complex, therefore these regions should be appropriately assessed and treated (Wollin and Lovell, 2006). This is further discussed below.
- DDx: Some important and common competing hypotheses are listed below (Choi et al, 2011):
Stress #
Hip Pathology (FAI)
LBP Referral
reactive sclerosis
rarefaction
superficial bone destruction with occasional heterotopic ossification
greater than 10-mm separation of the symphysis
symphyseal instability as demonstrated by movement of the symphysis of more than 2 mm on step films (Lentz, 1995)
Core Control Exercises (TrA and Pelvic Floor Training)
Adductor Strengthening (Progression of gentle isometric through to loaded isotonic strengthening)
Gluteal Strengthening
PNF patterns
Stationary Bike
Return to running program
Graduated and progressive return to play
Whilst this is by no means a recipe for your patients, it should serve as an indicator of the components of a successful rehabilitation program. In this small case series (n=4) all players returned to play at a mean time of 13 weeks.
SURGICAL MANAGEMENT
Arthrodesis of the Pubic Symphysis: 87% RTP at an average of 6.6 months, with a 25% complication rate.
TAKE HOME MESSAGES
Conservative management should always be the first line of treatment for osteitis pubis.
Optimal management is individualised and always looks “beyond the groin”!
Prolotherapy could be used if physiotherapy fails (but it hurts!).
Surgery is a last resort only!
- Batt ME, McShane JM, Dillingham MF. Osteitis pubis in collegiate football players. Med Sci Sports Exerc 1995;27:629–33.
- Choi H, McCartney M, Best TM. Treatment of osteitis pubis and osteomyelitis of the pubic symphysis in athletes: a systematic review. Br J Sports Med 2011 45: 57-64
- Ekstrand J, Ringborg S. Surgery versus conservative treatment in soccer players with chronic groin pain: a prospective randomised study in soccer players. Eur J Sports Traumatol 2001;23:141–5.
- LeBlanc KE, LeBlanc KA. Groin pain in athletes. Hernia 2003;7:68–7
- Lentz, Samuel S. Osteitis Pubis: A Review. Obstetrical & Gynecological Survey 1995;50(4):310-315
- Topol GA, Reeves KD, Hassanein KM. Efficacy of dextrose prolotherapy in elite male kicking-sport athletes with chronic groin pain. Arch Phys Med Rehabil 2005;86:697–702.
- Wollin M, Lovell G. Osteitis pubis in four young football players: a case series demonstrating successful rehabilitation. Phys Ther Sport 2006;7:153–60
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