There are many causes of groin pain in athletes. One of the more common causes of groin pain is osteitis pubis, also known as pubic symphysitis. This condition occurs when there is significant inflammation and overload of the pubic symphysis. So, what is osteitis pubis, and can an osteitis pubis steroid injection help?
What is the pubic symphysis?
The pubic symphysis is a thin joint containing cartilage in the middle. The joint joins the two parts of the pelvic bones together. It sits in front of the bladder; attached from above is the rectus abdominis and below the adductor longus.
Causes
Inflammation of the pubic symphysis occurs due to various causes:
- sport is the most common cause.
- trauma or fall can cause an inflamed joint
- pregnancy can overload the pubis symphysis causing pain
Some people are prone to this condition ranging from extreme sport to reduced movement of the hips to muscular imbalances between the abdominal and adductor muscles.
Osteitis pubis Diagnosis
Generally, osteitis pubis symptoms develop gradually over time. Pain is usually in the center, although it can move from one side to another. Typically, symptoms are worse after running and change of direction activity. There is associated limping and weakness of the muscles in the pelvis.
Overall, it is essential to make sure other causes of groin pain are ruled out.
Osteitis pubis radiology
Sometimes, imaging is needed, mainly if the pain has not settled with simple treatments.
Generally, in osteitis, an MRI scan of the pelvis shows swelling of the pubic bone on either side of the joint or thickening of the adductor tendon. However, we must carefully interpret these imaging changes, as many occur in active sportspeople without pain.
A recent study found that these MRI findings were more common in athletes with groin pain:
- Swelling in the pubic bone close to the joint (subchondral bone marrow oedema)
- Rupture of the capsule of the pubic symphysis, also called ‘cleft’ sign
Overall, we order MRI in. groin pain to exclude other causes, including severe pathology.
Osteitis pubis recovery
Overall, we know that pubic overload takes many months to get better. Indeed, taking shortcuts such as a cortisone injection or surgery will not get you back to sport faster. Also, the sooner you start treatment, the quicker the improvement and return to sport.
Your therapist should test your strength in your hip abductor and adductors to see if you have strength weakness that needs correcting.
Osteitis pubis rehabilitation: an example of a structured rehab program
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 cortisone injection.
Firstly, for cases primarily involving the pubic symphysis, we suggest an osteitis pubis cortisone 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 one 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 cortisone injection or surgery can delay progress or be harmful.
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