Background
Osteitis pubis is an inflammation of the pubic symphysis and surrounding muscle insertions.[1, 2, 3, 4, 5] Although the exact etiology of osteitis pubis is unknown, it is most likely caused by repetitive microtrauma or shearing forces to the pubic symphysis.
In 1924, Beer described inflammation of the pubic symphysis as a result of urologic surgery. He called it an orthopedic disease sponsored by urologic surgery. In 1932, Spinelli wrote about osteitis pubis in athletes. Since that time, multiple sports-related occurrences of this condition have been reported. As shown by Alderink, sacroiliac (SI) joint motion has a very large impact on the motion about the pubic symphysis. Batt et al postulated that osteitis pubis is a result of muscle injury to the hip adductors or abdominal musculature, causing muscle spasm, which, in turn, produces increased shearing forces across the pubic symphysis.[2]
For excellent patient education resources, visit eMedicine's Bone, Joint, and Muscle Center, Men's Health Center, Women's Health Center, and Sports Injury Center. Also, see eMedicine's patient education article Sexually Transmitted Diseases.
Epidemiology
Frequency
United States
The exact frequency for osteitis pubis is difficult to estimate; however, in a study performed by Lloyd-Smith et al in Canada, this condition comprised 6.3% of the 222 overuse injuries that were studied.[6] In smaller studies, the incidence of osteitis pubis appears to be up to 5 times more prevalent in males than in females.
International
A study by Westlin reported that 80% of the athletes that presented to the Sports Medicine Clinic in Malmo, Sweden, had this condition.[7]
Functional Anatomy
The anatomy around the pelvic girdle is quite complex. The pelvis is a ring, and any change in anatomy or applied forces to one area will be compensated throughout the ring. This simple fact makes it easier to understand why a leg-length discrepancy or SI dysfunction can greatly change the shear forces across the pubic symphysis. In addition, understanding the functions of the muscles that attach to the pubic rami is important. The hip adductors (ie, gracilis, adductor longus, adductor brevis, and adductor magnus) originate at the inferior pubic ramus.[8] The pectineus and rectus abdominis muscles, along with the inguinal ligament, insert superiorly. The muscles of the peroneal floor insert posteriorly.
Sport-Specific Biomechanics
Osteitis pubis seems to be more prevalent in sports that involve running, kicking, or rapid lateral movements. Sports in which participants develop osteitis pubis more often include the following[1, 3, 4, 8, 9, 10] :
- Soccer[11, 12] : This sport involves a great deal of running and rapid change of direction. These movements can lead to strains of the adductor muscles, which change the forces directed on the pelvis during recovery. Kicking is another inciting motion in soccer. Many times the athlete is not well balanced when planting the foot to kick, placing a great deal of strain on the muscles stabilizing that is stabilizing him or her to perform the kick. This translates to abnormal forces across the pubic symphysis.
- Sprinting: This activity can lead not only to repetitive microtrauma to the pelvis, but also to muscle pulls, which are common occurrences due to the rapid acceleration in sprinting. This condition, coupled with multiple repetitions, can lead to cumulative stress on the pubic symphysis.
- Ice hockey: This sport has multiple risk factors, including the skating motion and the contact with other players and the dasher boards. Ice hockey players may sustain minor adductor strains, but the continued play and resultant changes in flexibility lead to abnormal forces across the pubic symphysis. This condition can often be aggravated by the rapid change in direction that is required in ice hockey.
- American football[2] : This sport also has multiple reasons for a high rate of injury. The first factor is the amount of sprinting that is performed. The second factor is the amount of violent collisions that often lead to minor injuries, which many athletes may play through. Certain positions (eg, defensive backfield) also demand a great deal of back pedaling, with a rapid abduction of one hip to turn and run with a receiver. This motion can lead to hamstring or adductor strains, which change the muscle balance and forces across the pubic symphysis.
Fricker PA. Osteitis pubis. Sports Med Arthrosc Rev. 1997;5:305-12.
Batt ME, McShane JM, Dillingham MF. Osteitis pubis in collegiate football players. Med Sci Sports Exerc. May 1995;27(5):629-33. [Medline].
Karpos PA, Spindler KP, Pierce MA, Shull HJ Jr. Osteomyelitis of the pubic symphysis in athletes: a case report and literature review. Med Sci Sports Exerc. Apr 1995;27(4):473-9. [Medline].
Sing R. Osteitis pubis in the active patient. Phys Sportsmed. 1995;23(12):67-73.
Reid DC. Sports Injury Assessment and Rehabilitation. New York, NY: Churchill-Livingstone; 1992:633-9.
Lloyd-Smith R, Clement DB, McKenzie DC, Taunton JE. A survey of overuse and traumatic hip and pelvic injuries in athletics. Phys Sportsmed. 1985;18(10):131-41.
Westlin N. Groin pain in athletes from southern Sweden. Sports Med Arthroscopy Rev. 1997;5:280-4.
Holmich P. Adductor-related groin pain in athletes. Sports Med Arthrosc Rev. 1997;5:285-91.
Lynch SA, Renström PA. Groin injuries in sport: treatment strategies. Sports Med. Aug 1999;28(2):137-44. [Medline].
Hiti CJ, Stevens KJ, Jamati MK, Garza D, Matheson GO. Athletic osteitis pubis. Sports Med. May 1 2011;41(5):361-76. [Medline].
Cunningham PM, Brennan D, O'Connell M, et al. Patterns of bone and soft-tissue injury at the symphysis pubis in soccer players: observations at MRI. AJR Am J Roentgenol. Mar 2007;188(3):W291-6. [Medline]. [Full Text].
Gilmore J. Groin pain in the soccer athlete: fact, fiction, and treatment. Clin Sports Med. Oct 1998;17(4):787-93, vii. [Medline].
Braun P, Jensen S. Hip pain - a focus on the sporting population. Aust Fam Physician. Jun 2007;36(6):406-8, 410-3. [Medline].
Ruane JJ, Rossi TA. When groin pain is more than "just a strain": navigating a broad differential. Phys Sportsmed. 1998;26(4):78-103. [Medline]. [Full Text].
Hureibi KA, McLatchie GR. Groin pain in athletes. Scott Med J. May 2010;55(2):8-11. [Medline].
Paajanen H, Hermunen H, Karonen J. Pubic magnetic resonance imaging findings in surgically and conservatively treated athletes with osteitis pubis compared to asymptomatic athletes during heavy training. Am J Sports Med. Jan 2008;36(1):117-21. [Medline].
Kunduracioglu B, Yilmaz C, Yorubulut M, Kudas S. Magnetic resonance findings of osteitis pubis. J Magn Reson Imaging. Mar 2007;25(3):535-9. [Medline].
Kneeland JB. MR imaging of sports injuries of the hip. Magn Reson Imaging Clin N Am. Feb 1999;7(1):105-15, viii. [Medline].
Holt MA, Keene JS, Graf BK, Helwig DC. Treatment of osteitis pubis in athletes. Results of corticosteroid injections. Am J Sports Med. Sep-Oct 1995;23(5):601-6. [Medline].
King JB. Treatment of osteitis pubis in athletes: results of corticosteroid injections. Am J Sports Med. Mar-Apr 1996;24(2):248. [Medline].
Topol GA, Reeves KD, Hassanein KM. Efficacy of dextrose prolotherapy in elite male kicking-sport athletes with chronic groin pain. Arch Phys Med Rehabil. Apr 2005;86(4):697-702. [Medline].
Radic R, Annear P. Use of pubic symphysis curettage for treatment-resistant osteitis pubis in athletes. Am J Sports Med. Jan 2008;36(1):122-8. [Medline].
Print
