Osteitis Pubis: How muscle imbalance can make your pelvis ache!

We recently encountered a young athletic male patient who came with pelvic pain mostly on his pubic bone without hearing any abnormal pop that started when he was training for an intense sport. After a thorough workup, we came to a diagnosis of Osteitis Pubis. In this article, we will discuss the definition, cause, symptoms, diagnosis, and treatment options for Osteitis Pubis.

What is Osteitis Pubis and what causes it?

Osteitis pubis is defined as an inflammatory disease of the pubic symphysis and surrounding structures in your pelvis. Osteitis pubis most commonly occurs among athletes with a prevalence ranging from 0.5 to 6%. It can also occur among non-athletes as a result of any pelvic stress such as trauma, pelvic surgery, and pregnancy. The pubic symphysis unites the superior rami of both left and right pubic bone to provide pelvic stability while moving (as seen pointed by the yellow arrow in the picture).

Repetitive trauma to the pubic rami in conjunction with opposing shearing forces across the pubic symphysis is likely the main contributing factor in athletes. Overuse of the adductor muscles and imbalances between the abdominal muscles and hip adductors also contribute to the disease. Good examples of this imbalance are kicking and rapid acceleration/deceleration running in the field.

What are the symptoms and long term consequences?

Clinical presentation with osteitis pubis can vary but generally includes the gradual onset of pelvic pain in the absence of systemic symptoms such as a fever. The pain can be localized in the hips, lower abdomen, thigh, testicle, or perineum. The pain may be exacerbated by a certain position or playing a particular sport, and may be accompanied by a wide-based gait as a way to compensate for the pain. If left untreated, long term consequences of osteitis pubis can lead to chronic pain and disability.

How is it diagnosed?

Diagnosis can be done by history and physical examination alone, but can be assisted with imaging like an X-ray or MRI. Pain along the pubic symphysis with resistance strength testing of the adductor and lower abdominal muscle groups is characteristic of osteitis pubis. Bloodwork can be obtain to rule out any inflammatory or infectious etiologies.

What are my treatment options?

As with most sports-related injuries, active management of osteitis pubis is key to reaching full recovery and returning to activities including sports. Conservative measures such as relative rest, ice, pain medication, and physical rehabilitation are the initial approach before following with glucocorticoid or Platelet Rich Plasma injection therapies and surgery as a last resort. The goal of relative resting is to refrain from activities that induce any type of discomfort. Complete resolution of osteitis pubis can take as long as 2 to 3 months. Surgery is reserved for patients with osteitis pubis that do not respond to medical treatment.


Albert Hsia, MS-IV

Dr. David Carfagno, DO, CAQSM


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