What is osteitis pubis?

Osteitis pubis is a term given to lower abdominal and / or pelvis pain that can occur in athletes. Typically in causes pain towards the middle of the pelvis, at the front.

In medicine a term ending in “itis” implies an inflammation, such as in appendicitis or tonsillitis. In these cases you can measure what are called “acute phase proteins” in the blood and these will be at higher levels then normal in the presence of inflammation. In osteitis pubis none of these inflammatory markers is raised; so it is not an inflammation at all. It is now more correctly known as “pubic bone stress injury”. The question then arises as to what is causing the “stress”.

Changes in the pubic symphysis can sometimes be seen on an ordinary x-ray, a CT scan or on an MRI scan. There can widening of the symphyseal space (as if the joint at the front of the pelvis is being pulled apart) or irregularity of the bony margins.

There are, undoubtedly, some cases of osteitis pubis that are “primary”. That is they are not caused by something else. These cases can be particularly difficult to treat. Pain killers can help, and often non steroidal anti-inflammatory painkillers are used (although, as we have seen it is not really an inflammation). Other drugs that are sometimes used include a class of drugs called “bisphosphonates”. These directly affect the bone and can sometimes help. Other people have tried injecting steroids or platelet rich plasma into the area where there is pain.

In many cases, in athletes and sportsmen and women, it seems that the “stress” is coming from the many muscles and tendons that insert into the pubic bone at the front (the pubic tubercle). It is often seen as part of the symptoms of a “groin disruption” (also known as sportsman groin or Gilmore’s Groin). In these cases it is the muscles pulling hard on the pubic tubercle at the front of the pelvis that causes the pubic symphysis to pull apart and become frayed. The muscles pull so hard that they tear off their normal attachments causing a groin disruption (sometimes referred to as being like a muscle dislocation)

In these cases treating the symptoms will not cure the problem; the groin disruption needs to be repaired. At operation the inguinal ligament, which attaches to the pubic tubercle, is found to be very tight. This tight ligament can be partially divided to relieve the tension (termed an “inguinal ligament tenolysis”) as part of the groin reconstruction. Repairing the muscles in an anatomical fashion restores the normal structure and function of the groin and can cure the symptoms.

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