Treatment, Healing, and Recovery in Osteitis Pubis Symphysis
Domlur, Bengaluru Feb 9, 2017
Osteitis pubis symphysis is an injury to the pubis symphysis, the midline cartilage uniting the pubic bones. It is an injury incurred due to overuse of the cartilage causing inflammation and tissue damage. It is characterized by groin pain.
Osteitis pubis is an injury due to overuse characterized by inflammation and tissue damage to the pelvis at the location where the 2 pubic bones unite (pubic symphysis), consequential in groin pain.
This disorder is characteristic to athletes but was first discovered in people who had undergone suprapubic surgery, an invasive procedure of the urethra.
Why do Some Suffer from Osteitis Pubis Symphysis?
Osteitis Pubis is caused due to the repeated muscle contraction of the area around the pubic bone and the cartilage attaching the bone.
There are many reasons and causes that result in the excessive contraction of the muscle near the pubic symphysis. The causes can be broadly be classified into two categories – Over Training and Biomechanical Inefficiencies.
Osteitis Pubis as mentioned earlier is caused by over contraction of muscles. It is most common in sportspersons. It generally occurs to those who play sports that require heavy lifting or constant speed.
Osteitis Pubis as mentioned earlier is caused by over contraction of muscles. It is most common in sportspersons. It generally occurs to those who play sports that require heavy lifting or constant speed. Below are the most frequent causes of this ailment:
• Using rough and uneven ground to workout
• Working out on concrete like surface
• Not giving body time to warm-up
• Rapidly increasing the intensity and length of workout period
• Not using proper shoes
Problems caused due to improper machines, or faulty body mechanisms are called biomechanical inefficiencies. Some of the common biomechanical inefficiencies are:
• Faulty foot such as being flat footed
• Abnormality in walking
• Improper movement mechanics
• Difference in length of leg
• Imbalanced muscles
• Tight or stiff muscles
Osteitis pubis has many symptoms many of which are often ignored. The first symptom is often just a slight pain in the abdomen and groin.
Some of the common complaints are:
• Pain in the groin area with concentrated hurting over the symphysis and reducing as it moves outwards
• Localized pain around the pubic area with adductor pain or lower abdominal pain
• Increasing pain while performing intensive activities such as running, kicking, or even by lying on the side
• Pain caused while walking, climbing stairs, sneezing or coughing
• Clicking or popping sensation while getting up from a seated position, changing sides and turning over in bed, or walking on uneven surfaces
• Weakness and difficulty ambulating
• Fever, chills, or rigors along with pubic pain
Finding osteitis pubis through physical examination for can vary from person to person. Such findings may include the following:
• Tenderness or palpation around the area of the superior pubic ramus
• When sacroiliac joint disorder is a cause, pain over the sacroiliac joints, often in addition to muscle spasm around the buttocks and resultant sciatic-type pain
• Difference of leg length causing hip pain on the side of the longer limb
For diagnosis, specific tests are used. The most accurate test for osteitis pubis is a direct-pressure spring test. The procedure for the direct spring test is as follows:
• The athlete’s pubic bone, Palpate straight over the cartilage; sensitivity to touch is often present
• Move the fingertips a few centimetres laterally to each side, and apply direct pressure on the pubic rami; in those suffering from osteitis pubis will experience a sharp pain
• Ipsilateral pressure is applied to check if one side hurts more than the other
Athletes with osteitis pubis typically experience pain over the front of the pelvis with pain into the groin. They are acutely tender on touching or palpating the pubic symphysis and also the bones either side.
Resisted muscular stretching and contraction of the hip flexors and groin muscles can cause ache Sneezing, coughing, and activity such as a sit-up will typically reproduce pain.
Further investigations like an X-ray, bone scan, magnetic resonance imaging or CT scan might be needed to help with identification and assess the severity of the condition.
How do you Treat Osteitis Pubis Symphysis?
The most important and best possible way to treat osteitis pubis is to take loads of rest and give the body time to heal. Since the disorder is commonly caused due to overstress and training errors, resting the pelvis will help in the healing process. This ailment is easily treatable if a proper regime is followed.
Osteitis pubis is a long standing illness and requires constant care and direction. It is very essential to follow instructions given by the physician to the T.
The process of treatment can be divided into two phases the short term treatment and the long-term treatment.
Short Term Treatment
One of the most common causes of this ailment is over exercising. Hence when the injury occurs, it is important to know the immediate course of action required. Since osteitis pubis is a soft tissue injury the standard five stages of treatment needs to be followed – i) immobilization, ii) ice, iii) compression, iv) elevation and v) medical assistance.
Immobilization: The first step after realizing that a person is suffering from osteitis pubis is to lay the person down and ensure they are completely immobile.
Rest is the first and foremost in the treatment of this disease. Since the most likely cause for the injury was stress to the pubis cartilage, any further movement will aggravate the situation further.
Ice: The next step, also one of the most important and crucial stages of treatment and relief is the application of ice to the injury.
Use the ice pack to gently apply it on the area that hurts. The key point to note is not to apply the ice directly. Applying ice directly often causes ice burns. In case ice is unavailable, cold water can be used as a replacement.
This step must preferably be carried out within 72 hours of the injury as it helps reduce swelling. The reduction in the swelling will also help with pain relief.
The first 72 hours are very crucial in the process of recovery. The injured area must not be exposed to any heat. The application of ice must be continued at regular intervals for best effect.
Compression: The injured area should be bandaged to prevent bleeding and reduce swelling
Elevation: Using a pillow the injured area must be elevated slightly above heart level to reduce the swelling.
Medical Assistance: Once the patient feels better and experiences temporary relief it is imperative to seek medical help and start the long-term treatment.
Long Term Treatment
Once the initial treatment has helped to reduce most of the inflammation and pain, it is time to move onto the next stage of treatment. It involves applying heat; this will help in increasing the blood supply and therefore increasing the amount of oxygen and nutrients to the injured area.
Thereafter, very light stretching exercises can be used to improve and lengthen the muscles around the area of the symphysis that is the hips and groin. This will help to relieve some of the pressure on the pubic symphysis from tight muscles.
Surgery is generally not required or advised for osteitis pubis and should be avoided and not be considered during the acute phase. Surgical intervention is generally reserved for those in whom conservative management fails.
However in case surgery is performed, various approaches are available such as:
• Curettage: removing tissue by scooping
• Arthrodesis: Fusing of the pubis bones
• Wedge resection: Removing tissue by slicing
• Wide resection: Removing affected tissue and part of normal tissue
Osteitis pubis can frequently be a tricky injury to regenerate. However, with proper management of activity levels and physiotherapy, the majority patients can return to normal function in a number of weeks. In more severe cases rehabilitation may take significantly longer, often lasting 6 months or more before a successful return to sport can occur. Early physiotherapy treatment is, therefore, vital to hasten recovery in all patients with this condition.
The pain from osteitis pubis takes months to completely go away. Everyone recovers from this injury at a different rate. Returning to one’s daily activities depends on how the recovery progresses.
It is not determined by how many days or weeks it has been since your injury has occurred to resume a normal life. In general, the earlier the treatment started after the symptoms were first presented the faster and better will be the recovery. The goal of rehabilitation is to return the patient to normal activities as soon as is safely possible.
Over coaching ought to be avoided, significantly by those that participate in long or repetitive kicking sports. Core Strength and Core Stability exercises will improve muscle perform across the trunk and pelvis.
Core strength exercises on a mat utilizing a Swiss Ball and Resistance Bands are ideal, since the improved muscular strength and stability will facilitate to counteract the massive forces that are applied to the lower abdomen and pelvis. This may cut back the danger of developing osteitis pubis.