Initially, we treat the inflammation to reduce pain in the pubic bone. These simple treatments include rest from aggravating sport, anti-inflammatory tablets such as ibuprofen, compression shorts, and soft tissue massage.
Next, we suggest you see an experienced therapist to guide your rehab. Overall, the focus of recovery should be on improving the mobility and flexibility of your hips and strengthening the muscles surrounding the pelvis. The rehab exercises are staged in this order:
- isometric adductor exercise (especially if the person has high pain levels)
- standing single leg crab walks and adductor machine exercises
- Copenhagen adductor strengthening exercise – using short and long levers
Generally, we recommend three sessions per week to strengthen pubic bone pain. You should also work the other muscles in the pelvis, including the hip flexor and glutes. Overall, you can work through low-level pain, also known as stable pain. Also, therapists often check progress by using the isometric squeeze test to see if you are coping with rehab – any reduction in strength of a squeeze test is an early warning sign that you’re progressing exercises too quickly and your pubic bone pain worsens.
Finally, as your pubic bone pain settles, your therapist will guide the progression of your activity from straight-line running to changing direction running to the sport.
For complex cases, we use injections to help with exercise. Generally, we only recommend injections if you continue to struggle with pain despite 3-6 months of rehab.
In almost all cases, surgery is not recommended as surgery results are unpredictable.
More about osteitis pubis steroid injection
Overall, there are several options for an osteitis pubis steroid injection.
Firstly, for cases that involve the pubic symphysis primarily, we suggest an osteitis pubis steroid injection. This injection is usually done with a longer needle just above the joint.
Secondly, we may consider a nerve block for people with pain in the adductor, perineal or pelvic area (near the lower abdomen). Generally, we use a numbing solution with a small dose of cortisone. Injecting around a nerve can reduce pain coming from the area supplied by the nerve – this is usually immediate and has a longer-lasting effect of up to 1 month.
Overall, it is essential to understand that these injections do not cure the problem but help the rehab.
Final word from Sportdoctorlondon about osteitis pubis steroid injection
Osteitis pubis, also known as pubic overload or pain in the pubic bone, is common in runners and change of direction sports—generally, the earlier the diagnosis, the faster the return to sport. Rehab is the main form of treatment, but injections can be used carefully in complex cases. Overall, we need to remember that there are no quick fixes for this condition and that an osteitis pubis injection or surgery can delay progress or be harmful.