Osteitis Pubis Treatment Guidelines Handout

What is osteitis pubis?

Osteitis pubis is an inflammatory condition affecting the pubic symphysis (the joint connecting the left and right pubic bones) and its surrounding soft tissues.  Its symptoms include chronic groin pain and difficulty or pubic pain when moving the hip and leg muscles. Patients may present with medial groin pain, lower abdominal pain, pain localized to the adductor muscles, or hip pain. They may also have difficulty walking normally.

Osteitis pubis has multiple etiologies and is most commonly seen in athletes such as football players (Nickerson & Herickhoff, 2024). It also sometimes occurs as a complication of invasive surgery in the pelvis or in people who are pregnant or have recently given birth. Osteitis pubis in athletes is typically a dysfunction of the symphysis pubis due to overuse. Continual, high-impact use of the lower abdominal muscles and musculature of the thighs without adequate rest can result in a pubic bone stress injury.

The pubic symphysis serves as a fulcrum for the surrounding anterior pelvic muscles, stabilizing the pelvis. Repetitive overuse of this anterior pelvic musculature results in irritation or tendon, which may, over time, develop into unilateral chronic muscle imbalance across the pubic symphysis.

Osteitis pubis and other groin injuries may take months to heal fully, and it is crucial that the patient receives adequate rest and treatment. Typically, a patient with osteitis pubis will need to be referred to a physical therapist who can diagnose it, as it is commonly mistaken for a core muscle injury or a groin pull. Physical therapy management of osteitis pubis can help the patient regain strength and mobility and prevent re-injury.

Management and treatment of osteitis pubis

Appropriate management of osteitis pubis is crucial to avoid exacerbating the injury. While conservative management will be sufficient for most cases of osteitis pubis, some severe cases require invasive forms of rehabilitation medicine such as injections or surgery. Here are some of the keyways to manage osteitis pubis:

Initial steps

When a patient first presents with osteitis pubis symptoms such as groin pain, it is important to take some initial steps to reduce their pain and avoid making the injury worse. Groin pain in athletes should be taken especially seriously, as it may indicate the patient is at risk of developing osteitis pubis and needs to cease physical activity. People who are pregnant and report pelvic pain should also be tested for osteitis pubis.

A healthcare professional trained in sports medicine will need to perform a physical examination to detect osteitis pubis. This typically involves palpitating over the pubic symphysis to determine if the patient reports pain. Here are some key initial steps for managing a patient with suspected osteitis pubis:

• immediately following the injury, the patient should rest and minimize walking. Ice the injury for 15 minutes every few hours to reduce swelling
• cease physical activity as soon as groin pain is reported. It's crucial they do not try to 'play through the pain!'
• refer the patient to a physical therapist, who will perform a physical examination, differential diagnosis and begin to formulate a treatment plan
• prescribe anti-inflammatory medication, such as ibuprofen or naproxen
• if the patient is experiencing significant pain, they may require prescription strength pain relief medication

Physical therapy

Nonsurgical treatment, including rest and rehabilitation exercises, are highly effective in most cases of osteitis pubis. These methods are particularly crucial to recovery as they can help correct faulty movement patterns or muscle imbalances that may have originally contributed to or caused the injury. Note that there are currently no standardized guidelines for physical therapy of osteitis pubis patients, so rehabilitative programs differ significantly.

Graduated return to sports

It is especially crucial to develop a comprehensive rehabilitation program for elite athletes with osteitis pubis to gradually return to their sport. Premature return to physical activity can exacerbate athletic osteitis pubis and delay the patient's full recovery. Ongoing use of an injured pubic symphysis can lead to chronic osteitis pubis.

Surgical intervention

in some rare cases of chronic osteitis pubis, orthopedic surgery may be necessary. Endoscopic pubic symphysiotomy is a common surgical procedure used to treat severe osteitis pubis cases as it is minimally invasive.

Other therapies

In some cases, ultrasound-guided corticosteroid injections may be prescribed to help reduce pain and inflammation associated with osteitis pubis. These have long-acting anti-inflammatory properties and can be effective in pain relief.

Emerging evidence suggests shock wave therapy - a noninvasive treatment - can also expedite the healing process of osteitis pubis.

How to use our treatment guidelines handout template

Using our Osteitis Pubis Treatment guidelines helps physical therapists to take a diagnostic and therapeutic approach to the management of osteitis pubis. By providing a comprehensive summary of all the treatment options available for managing osteitis pubis, this resource directs healthcare professionals toward the best possible patient care.

Initial treatment

The Osteitis Pubis Treatment guidelines can be used by general practitioners, physical therapists or physiotherapists to guide treatment of osteitis pubis. Refer to the 'initial steps' section on the handout to make recommendations to the patient about how they should respond immediately following the injury.

Formulating treatment plans

These guidelines are a great starting-point for treating patients suffering from osteitis pubis. Providing straightforward and comprehensive treatment strategies in one place, this handout simplifies the process of formulating a treatment plan for osteitis pubis.

Patient consultation

The Osteitis Pubis Treatment guidelines can also be given by physicians to patients experiencing osteitis pubis to help them understand the treatment options available to them. This makes the guidelines an invaluable resource in patient-centered care, empowering patients to be active participants in their recovery.

Benefits of using this handout

Using our Osteitis Pubis Treatment guidelines handout helps healthcare providers to optimize their patient care and improve recovery planning. Here are some of the key advantages to using this handout:

Effective recovery

These guidelines direct healthcare providers towards evidence-based, effective treatments for osteitis pubis. This allows patients to receive optimal care for their injury and makes recovery as quick as possible.

Patient-centered care

Using this resource allows health practitioners to comprehensively compare and evaluate which treatment options are best for their patient. It also empowers patients to understand treatment options and be involved in essential decisions and planning around their recovery.

Efficient treatment planning

This handout is hugely beneficial in formulating treatment plans for osteitis pubis. By comprehensively summarizing all the treatment options, this resource quickly and easily directs healthcare professionals to effective care strategies.

Reference

Nickerson, M., & Herickhoff, P. (2024). Femoroacetabular impingement and groin injuries among soccer players. Sports Med Arthrosc., 32(3). https://doi.org/10.1097/JSA.0000000000000394