Sport is a massive part of life in Melbourne. We watch, play, coach and support all different kinds of sports over the course of the year. However I am sure that there are times when we don’t really understand the types of injuries that our players suffer and just nod our heads and think muscle tear or broken bone. One common injury term flown about commonly is ‘OP’ or ‘Osteitis Pubis’, an injury seen more often in Aussie Rules, soccer or tennis. Osteitis pubis is inflammation of the pubic symphysis, which is the joint at the front of the pelvis. This inflammation leads to a hardening and bony changes of the pubic symphysis, causing both acute and chronic lower abdominal and groin pain. (2)
The cause of osteitis pubis is thought to be the excessive physical strain on the pubic bone, usually brought on by sports with a great degree of leg movement such as soccer and football. (3) 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 stress and inflammation.
There are certain factors that are thought to increase local bone stress, therefore leading to pubic bone over load: (2)
- -limited hip range of motion
The onset of groin pain in Osteitis pubis is usually subtle, and pain can be felt either in the inside of your thigh, the inguinal or lower abdomen regions. Pain is usually felt after intense use like after a training session or game day.
The main cause of this condition is the shearing stress which is placed upon the pubic symphysis during mid-stance. When this joint is still mobile, the repetitive stress causes inflammation and therefore tenderness and pain. (4) People most susceptible to this stress of the pubic symphysis are long distance runners, footballers, and women after pregnancy.
The symptoms of this type of condition don’t have a set pattern. They seem to have peaks and troughs, often related to how much and when the athlete/patient is active. Pain and discomfort can be eased with rest from aggravating activities, but symptoms will return with a return to sport.
As a practitioner the idea would be to focus on stretching and strengthening based exercises for muscles that were weak and tight after an initial assessment. Deep tissue work would be focused on the adductor, hip flexors, hip rotators, and core muscles. Mobilisation techniques would also be a positive treatment modality, working on any abnormalities in the hip and pelvic mobility, as well as poor or restricted movement in the lumbar spine, as pain may also be referring from here. Dry needling techniques may be used in muscles to increased range of motion, decrease trigger points and increase blood flow.
Heat and cold therapies are another technique that can be used in the management of pain and inflammation.
In recent studies a strong push for a consistent Pilates program has been linked to decreasing the likelihood of early signs of osteitis pubis based on its profound results in increasing core stability and strength. (1)
For the elite athlete, like runners and footballer whose career is the cause of their injury, this will be very frustrating to cope with, as it has a long recovery time. But with early detection and a suitable treatment/rest regime, the condition can be successfully treated. (5)
- -lumbar spine/Sacro iliac joint dysfunction
- -Shortening and tightening of rectus abdominus, iliopsoas and the adductors
- -decreased stability in the pelvis.
- 1.Brukner, P & Khan, K 2001, Clinical Sports Medicine, 2nd edn, McGraw-Hill Australia Pty Limited, Australia, pp 380-385
- 2.Brukner, P & Khan, K 2005, Clinical Sports Medicine, 3rd edn, McGraw-Hill Australia Pty Limited, Australia, pp 405-424
- 3.Millar, A 1987, Sports injuries and their management, Williams & Wilkins and Associates Pty Limited, Erskineville, NSA, pp 42-43
- 4.Norris, C 1993, Sports injuries – diagnosis and management for Physiotherapists, Butterworth-Heinemann Ltd, Oxford, p 163
- 5.Peterson, L & Renstrom, P 1986, Sports injuries – their prevention and treatment, Methuen Australia Pty Ltd, Australia, p 277