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For more ideas on how to cope with osteitis pubis go to
coping skills ,
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| Anatomy back |
| The symphysis pubis is a fibrocartilaginous
joint between the pubic rami. In addition, the abdominal muscles
(rectus abdominis and external and internal oblique muscles) attach
distally to the inguinal ligament, conjoined tendon, and pubic
symphysis, whereas the adductor muscles (pectineus, adductor longus,
adductor brevis, adductor magnus, gracilis) arise from the superior
and inferior rami of the pubis.
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| Osteitis Pubis
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| Osteitis pubis is a painful non-infectious
inflammatory condition that involves the pubic bone, symphysis,
surrounding muscle insertions and structures. Small avulsion
fractures can also occur at the attachment of the adductor tendons
to the pubic bone as well as repetitive microtrauma or shearing
forces to the pubic symphysis. This microtrauma exceeds the dynamic
capacity of tissue for hypertrophic remodelling, resulting in tissue
degeneration.
Osteitis pubis is considered to be the most common inflammatory
disease of the pubic symphysis. It is an overuse injury, that is, it
is caused by repeated trauma rather than a specific incident. Shear
stress at the symphysis pubis can also cause sacroiliac dysfunction.
Osteitis pubis could also affect hip internal rotation, causing
limitations in either flexion or extension.
Osteitis Pubis is predominantly caused by repetitive contraction
of the muscles that attach to the pubic bone and the pubic
symphysis. In sports, actions such as running, jumping, kicking and
rapid changes of direction cause the abdominal and groin muscles to
exercise a pulling or traction force on the pubic bone, which in
some cases can result in excessive stresses.
In Australian football this risk is increased by repeated
jarring of the pelvis caused when players come down from the high
leaps required by the game, by tackling from other players and the
crossed over kinetics of long distanced kicking, (crossed over
kinetics occurs when the energy released by the momentum of a
movement has not expelled the forces generated but collides with the
energy of another movement and due to the pelvis being the centre of
balance, it to absorb this kinetic energy manifesting itself to
release anomalous forces.)
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Incidence in Australian Football
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The incidence of osteitis pubis among Australian footballers has
increased sharply over the past decade. There are believed to be three
reasons for this:
The increasing physical demands of Australian rules football. As
the game has become more professionalised, with players becoming
full-time athletes, such factors as running speed, kicking length,
jumping and tackling have all increased, placing increasing stress
on the pubic region.
The increasing hardness of the surfaces of football grounds. Grounds
are better drained than in the past, and the game is increasingly played
in roofed stadiums in which the grounds receive no rain. Australian
football evolved as a winter game played on soft, muddy grounds, and
modern surfaces have made muscle and bone injuries more common.
The increasing demand for size and strength among footballers. This
has led young players to concentrate on building muscle mass before
their bodies are fully mature. The additional strain that highly
developed abdominal muscles place on the pubic bone explains the higher
prevalence of osteitis pubis on young players. Some develop the
condition while still playing school-level football.
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| Osteitis Pubis and Overload Injury or training errors)
(15)
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| Osteitis Pubis can be categorized into two main
groups: Overload & biomechanical inefficiencies.
Exercising on hard surfaces, like concrete.
Exercising on uneven ground.
Beginning an exercise program after a long lay-off period.
Increasing exercise intensity or duration too quickly.
Exercising in worn out or ill fitting shoes. Go to
girdles-and-footwear to read more.
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| Osteitis Pubis and Biomechanical Inefficiencies(15)
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| Osteitis Pubis can be categorized into two main
groups: Overload & biomechanical inefficiencies.
Faulty foot and body mechanics and gait disturbances.
Poor running or walking mechanics;
Tight, stiff muscles in the hips, groin and buttocks;
Muscular imbalances and
Leg length differences. |
| Traumatic Osteitis Pubis
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| Osteitis Pubis is also associated with
urologic procedures and as a complication of various obstetrical and
gynaecological procedures including vaginal deliveries. Increased
ligamentous laxity or muscle imbalance can act as a mechanism for
the development of osteitis pubis in athletes, this acquired laxity
maybe a result of adductor and/or gracilis dysfunction and act as a
potential mechanism for abnormal symphyseal motion and, hence, for
the development of traumatic osteitis pubis. The incidence of
osteitis pubis appears to be up to 5 times more prevalent in males
than in females.
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| Osteitis pubis and Pregnancy
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| Damage can occur to the ligaments surrounding
and bridging the pubic joint as a result of repetitive stress or by
falling, tripping, slipping and also from pelvic surgery and
pregnancy.
In childbirth it mainly appears post partum caused by a degree
of trauma during the birth. Particular movements or activities can
cause a slight but continual separation or shearing in the
symphysis, which can erode the joint surfaces, causing lesions and a
kind of roughening in the area jointing the fibrocartilage and pubic
bones that form the symphysis pubis. Symptoms include one or more of
the following; pain in the pubic area, hips, lower back and thighs.
X-rays taken during the early stages of osteitis pubis can be
misleading, you may feel the pain but the damage doesn't appear on
the films, it is only as the process continues that later pictures
will show evidence of bony erosion at the ends of the pubic bones.
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| Symptoms of Osteitis Pubis
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| The symptoms of osteitis pubis can include:
Pain while climbing stairs, running, kicking, changing
directions, or even during routine activities such as
standing.
Pain when coughing, or sneezing.
Loss of flexibility in the groin region.
A dull aching pain in the groin. In more severe cases a
sharp stabbing pain.
Difficulty in ambulation and the characteristic waddling
gait.
A low grade fever.
Pain over the pubic symphysis with referred pain into the
inguinal region and the groin.
An audible or palpable click over the symphysis might be
detected during daily activities.
Muscular imbalances: Tight inner thigh and hamstring
muscles and weak abdominal muscles can cause osteitis
pubis.
Leg Length Discrepancy: If one leg is longer than the other,
it could contribute to the problem.
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| Diagnosis back |
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Blood test.
Needle biopsy.
Pelvic X-rays can be normal early on, or there might be slight
separation of the pubic bones with patchy sclerosis and irregular
cortical margins. X-rays will shows cysts and erosion of the pubic
symphysis in advanced cases.
Bone scan will highlight advanced uptake at the pubis symphysis.
MRI will show the bone stress injury and swelling present.
The thoracolumbar junction, commonly refers pain to the groin.
Subtle lumbar spine instabilities can cause neural or joint
irritation commonly refer pain to this area.
Associated pathologies, especially adductor or other tendon
injuries from recurrent stretching and tearing of the stabilizing
anterior ligaments and adductor muscles.
The whole process usually occurs over a period of six to eight
weeks, but symptoms can last as long as six months or more. In
severe and long standing cases surgery could be considered.
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| Ways to Help
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Rest, it may even require the use of crutches if walking
is painful.
Initial therapy you should use ice to reduce inflammation. Your
Healthcare Professional might consider the use of anti-inflammatory
or injected corticosteroids.
Use moist heat: In chronic cases, heating the area before
exercising can be helpful.
Physical Therapy. The aim being to restore flexibility around
the pelvis and implement modalities to control pain and
inflammation.
Change shoes. Choose shoes with maximum shock absorption.
Get an orthotic device: You may need some type of lift in your
shoe if you have a leg length discrepancy.
Avoid uneven terrain while symptomatic.
Painful symptoms may be reduced using a TENS machine.
Assess and improve lumbo-pelvic, hip and lower limb
biomechanics.
Ultrasound and electrical stimulation are often very helpful.
Manipulation can be an option. If any SI dysfunction or pubic
shearing occurs, manipulative therapy can alleviate some pain and
decrease the shearing force that is created across the pubic
symphysis.
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| Doctor's Role
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| Healing is characterized by gradual
reossification with complete restoration occurring after many
months. Because of its chronic nature, osteitis pubis is extremely
frustrating for both patient and Doctor. Ideally the Doctor should
provide care, encouragement and support for patients with this
problem, as well as education regarding prevention. This will
encourage a greater understanding and awareness while improving
overall outcomes.
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