Osteitis Pubis

Osteitis pubis is an inflammatory condition affecting the symphysis pubis, which is the cartilage-based joint connecting the left and right pubic bones. This condition is particularly common in sports that involve frequent kicking, jumping, and running.

If not properly managed, osteitis pubis can lead to complications such as sclerosis (joint roughening), displacement or separation of the pubic junction. This can be career-threatening for athletes.

Causes

Several factors contribute to the onset of osteitis pubis. Changes in training routines can play a role in injury risk. These include increased intensity, running on solid or uneven surfaces, or resuming activity after a long rest period.

Additionally, biomechanical issues may also be contributing factors. These involve worn-out or ill-fitting shoes and abnormalities in gait or lower limb mechanics. The leg length discrepancies are sometimes linked to this condition. However, they account for only a small percentage of cases. Therefore, investing in costly orthotics or specialised footwear may not always be the most effective solution.

Symptoms

The primary symptom of osteitis pubis is a gradually worsening pain in the groin. This discomfort is often described as a dull ache but can sometimes feel like a sharp, sudden “grabbing” sensation. The pain may be felt in the centre or on one side and is typically aggravated by running, kicking, or jumping. In more severe or advanced cases, even everyday movements—such as dressing, getting in and out of a car, or walking—can prompt discomfort.

Furthermore, osteitis pubis can develop after pregnancy, particularly vaginal childbirth. This form of the condition is often one of the most challenging to manage with conservative treatment.

Diagnosis

During diagnosis, a detailed symptom history will be taken. If the patient is a female, this will involve questions about potential gynaecological conditions that could contribute to groin pain, such as cystitis, urethritis, endometriosis, or pelvic inflammatory disorders.

A comprehensive physical examination will follow. This focuses on the lower back, sacroiliac joints, hips, and symphysis pubis. Several conditions can have symptoms similar to those of osteitis pubis. Hence, it is essential to rule out more serious underlying issues. Additionally, your doctor will assess for femoral, inguinal, and umbilical hernias. This is because they can also be potential reasons for discomfort.

Treatment for Osteitis Pubis

Physiotherapy is highly important in managing osteitis pubis. It primarily focuses on damage control and preventing further complications. Strengthening and stretching exercises targeting the pelvic muscles can improve muscle balance and stability. Nonetheless, they often require months of consistent effort before yielding noticeable results. Due to their repetitive and time-consuming nature, adherence to these exercises can be challenging for patients.

The three main objectives of physiotherapy in treating osteitis pubis are:

Accurate diagnosis – Ensuring a correct diagnosis while ruling out other conditions that may be more easily treated.
Patient education – Helping individuals understand how to prevent recurrence or worsening symptoms. This can be through prescribed exercises, sport-specific training, or biomechanical guidance.
Exploring treatment options – Providing information on both medical and surgical interventions if needed.

For conservative treatment to be effective, complete rest from high-impact activities is necessary for at least 4 to 6 weeks. However, low-impact exercises like swimming or cycling may still be allowed. Non-steroidal anti-inflammatory drugs can help manage acute pain, although they do not accelerate healing.

During this recovery phase, patients must follow a structured strengthening and stretching program tailored to their body type, flexibility, strength, and specific sport. This typically includes:

Stretching the groin muscles and hip flexors
Strengthening the gluteus medius and transverse abdominis muscles
In some cases, pelvic floor exercises support deep abdominal muscle engagement. However, evidence supporting their direct role in osteitis pubis treatment is limited.

Additional Support

In cases of significant pelvic instability, such as post-childbirth or pelvic trauma, a compressive brace may be recommended. This simple strap wraps around the lower waist to provide added support.

If the diagnosis remains uncertain, a bone scan may be necessary. This imaging test detects regions of high cellular activity, indicating inflammation or stress fractures. Standard X-rays may not always reveal early-stage changes. Single-leg standing X-rays (stork views) can sometimes highlight positional shifts between the pubic bones. Even so, they are not always reliable in guiding treatment decisions.

Medical Management of Osteitis Pubis

Acute treatment

In the early stages of osteitis pubis, a carefully administered corticosteroid injection can provide rapid and significant pain relief. This treatment offers a short-term solution—particularly for those with work or sports commitments. However, it does not address the condition’s underlying causes. It should be followed by a structured exercise program and a gradual return to physical activity for best results.

Long-term management

A more sustainable treatment option is prolotherapy. It involves injecting an irritant—typically a sugar component or the patient’s blood—into the ligaments surrounding the pubic symphysis. This stimulates tissue growth (a fibroblastic response) to strengthen and stabilise the area. Prolotherapy generally requires three to five injections, spaced one to two weeks apart. It should also be administered by an experienced and ideally empathetic physician.

Bottom Line

Osteitis pubis can be a frustrating and limiting condition. A combination of early diagnosis, rest, rehabilitation, and medical management can help reduce pain. This also helps restore mobility and prevent future issues. Whether you’re an athlete eager to return to your sport or struggling with daily discomfort, a tailored treatment plan is key to long-term relief.

Book an appointment today for a thorough assessment and expert guidance on your recovery journey.