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Osteitis Pubis, or instability of the Pubis Symphysis, is an injury affecting the pelvis. Resulting from overuse, it is a common side effect of activities such as dancing and ice skating and those that involve a kicking action. Over time, repeated movements can cause micro trauma to the Pubic Symphysis bone. Eventually, there may be an inflammatory response, erosion of the joint and slow healing. Those most at risk of developing Osteitis Pubis are pregnant women and those with rheumatological issues.
Those with Osteitis Pubis often feel pain during and following activity. The tenderness felt around the Pubic Symphysis typically radiates into the groin or up into the abdomen. The pain can be difficult to localise, as it moves around the pelvic area and may include hip pain.
Persistent groin or hip pain should be fully investigated by a GP to eliminate the chance of other more serious conditions. Once this has happened, Osteitis Pubis can be diagnosed with investigations such as x-rays and MRI scans. Occasionally, an MRI might reveal the presence of asymptomatic Osteitis Pubis, especially among athletes.
Unfortunately, Osteitis Pubis can be problematic for between six months and two years. Treatment is not always effective. Therefore focus tends to be on preventative measures, such as avoiding overtraining or activities that involve repetitive kicking movements.
When symptoms are very acute, treatment can be limited. Rest is recommended in the first instance to allow the inflammation in the tissues to heal.
Non-Steroidal Anti Inflammatory Drugs (NSAIDs) may be effective for those with a degree of affected tissue, although these will have no effect on bone damage. A pneumatology consultant may prescribe biphosphates if the patient is suspected of having brittle bones (osteoporosis). These work by binding to the surface of the bone, slowing down bone erosion and allowing for more effective bone development.
Corticosteroids are sometimes considered if there is no resolution after a period of rest. After one of two injections, patients are often able to return to previous activities. A programme of exercises may be recommended to stretch the pelvic muscles, usually once any groin or hip pain has resolved.
A surgical approach is rarely advocated. However, in cases where the condition has not responded to less invasive treatment within a year, or if the Pubic Symphysis is found to have a mechanical instability, it may be an option. Joint stability is restored with a plate and screws. The patient will usually be required to use crutches for a few weeks following the surgery and will not be able to return to sporting activities for about three months.
Core strength and stability exercises are a good way to ensure good muscle function and improved stability across the pelvic area. This can help counteract the effect of any large forces applied and decrease the chances of Osteitis Pubis developing.
Overtraining is also best avoided, especially where activities involve repetitive kicking movements.
A proper warm-up and warm-down should be performed before and after sporting activity.
Care should be taken to investigate any onset of pelvic or hip pain to ensure early treatment and damage limitation where necessary.