There are many causes of groin pain in athletes, and one of the most common is osteitis pubis (pubic symphysitis) — inflammation and overload of the pubic symphysis. Rehabilitation is the mainstay of treatment, but can a steroid or cortisone injection for osteitis pubis help? This page focuses on the injection options; for the full rehab programme, see our osteitis pubis treatment page.
A quick recap: what is osteitis pubis?
The pubic symphysis is a small cartilage joint at the front of the pelvis, joining the two pubic bones. It sits in front of the bladder, with the rectus abdominis attaching above and the adductor longus below. Osteitis pubis is inflammation and overload of this joint, usually from sport (the commonest cause), and sometimes from trauma or pregnancy. Pain is typically central, worse after running and with changes in direction, and can shift from side to side.
Imaging (usually MRI) is used mainly when pain doesn’t settle — it shows bone-marrow oedema on either side of the joint or a “cleft” sign, though similar changes occur in pain-free athletes, so MRI is also used to exclude other causes of groin pain. For detailed diagnosis and rehab, see the osteitis pubis treatment page.
Where do injections fit in?
Rehab comes first. We know pubic overload takes many months to settle, and shortcuts such as a cortisone injection or surgery won’t get you back to sport faster. We generally only recommend an injection if pain persists despite 3–6 months of good rehabilitation — and even then, the injection isn’t a cure. It creates a less painful window for rehab. Surgery is rarely recommended, as the results are unpredictable.
Osteitis pubis steroid injection: the options
There are three main injection approaches, chosen based on where the pain originates.
1. Cortisone injection into the pubic symphysis
For pain coming mainly from the symphysis joint itself, a cortisone injection is placed just above the joint, usually with a longer needle. We perform it under ultrasound guidance for accuracy. It typically relieves pain for a few months, sometimes longer. Like any injection, it carries small risks, including infection (about 1 in 10,000) and the chance it doesn’t work.
2. Tendon injection (cortisone or PRP)
When the pain is predominantly from the adductor tendon — adductor tendonitis — we inject the tendon under ultrasound guidance with cortisone or PRP to settle tendon-related pubic overload pain.
3. Groin nerve blocks
For pain in the adductor, inguinal, lower-abdominal, perineal, or pelvic area, a groin nerve block can help. We use a numbing solution with a small dose of cortisone around the relevant nerve — the obturator nerve for adductor pain, the ilioinguinal nerve for inguinal pain, and the pudendal nerve for perineal pain. The effect is often immediate and lasts up to about a month. Nerve blocks are less invasive than joint injections.
For complex pubic overload, we often combine joint, tendon, and nerve injections, tailored to the presentation. In every case, the injection supports the rehab rather than replacing it.
Frequently asked questions about osteitis pubis injections
Does a cortisone injection cure osteitis pubis?
No. A cortisone injection reduces pain and inflammation for a period, but it doesn’t cure the underlying overload. Its value lies in creating a less painful window to progress rehab, which is what produces lasting recovery.
When should I consider an osteitis pubis steroid injection?
Generally, only after 3–6 months of good rehab that hasn’t settled the pain, or where severe pain is preventing meaningful rehab. An injection is an adjunct to rehab, not a first-line treatment or a shortcut back to sport.
Which injection is best for osteitis pubis?
It depends on where the pain comes from — the symphysis joint (cortisone into the joint), the adductor tendon (tendon cortisone or PRP), or a nerve (a targeted nerve block). An ultrasound assessment helps make a decision, and the approaches are often combined.
Is the injection done under ultrasound?
Yes. We use ultrasound guidance to place the injection precisely around the symphysis, tendon, or nerve — improving both accuracy and safety in this anatomically complex area.
How long does an osteitis pubis injection last?
A symphysis cortisone injection typically helps for a few months, sometimes longer; a nerve block tends to last up to about a month. The aim is to use that window to push the rehab forward.
Final word from Sport Doctor London about osteitis pubis steroid injection
Osteitis pubis is common in runners and change-of-direction sports, and the earlier the diagnosis, the faster the return to sport. Rehab is the main treatment, but a carefully chosen steroid injection for osteitis pubis — into the joint, tendon, or around a nerve — can help in stubborn cases. There are no quick fixes here: an injection or surgery used as a shortcut can delay progress or harm.
To discuss whether an injection suits your groin pain, Dr Masci can assess you in London under ultrasound. Contact the team here or call +44 (0) 203 488 0350.
Can radiation treatment from prostrate cancer cause osteitis pubis
As my father has been diagnosed with this and now cannot walk..
Hi Leigh, I’ve never seen this before but there’s no reason why it can’t happen. Injection therapy may help your dad.
LM