Inflammation of the pubic bone – common ailment in athletes

Inflammation Of The Pubic Bone – Common Ailment In Athletes

Pubic arthritis ( osteitis pubis) is a nonbacterial inflammation of the pubic bone commonly occurring in athletes. The cause of an inflammation of the pubic bone is usually excessive strain during training. Inflammation of the pubic bone can usually be treated well with anti-inflammatory drugs and physical therapy exercises. Although treatment can take a few months, surgery is rarely necessary. We will tell you what signs you can use to recognize pubic osteitis and what you need to know about diagnosis and treatment.

Pubic pain as a symptom

Inflammation of the pubic bone usually develops insidiously as part of long-term, intensively exercised sports. The most important sign is pubic pain, radiating to the groin, hips or lower abdomen. Initially, the symptoms usually only become noticeable during sports or physical exertion, such as climbing stairs or sneezing. 

If no break is taken in training, the symptoms often appear after a while due to the ongoing irritation when walking or resting. Pain when pressure is applied to the pubic bone or the tendon attachments and when the inner thigh muscles are tense are typical of pubic inflammation.


Cause: Micro-injuries caused by overload

The pubic bone is part of the anterior pelvic ring, where numerous tendons of the abdominal and leg muscles attach. Because these two muscle groups pull in opposite directions, the pubic bone is subjected to high stress levels during sports involving rapid direction changes and sprinting, such as soccer, basketball, hockey, or running.

Suppose the training needs to be revised or corrected. Repeated micro-injuries can lead to inflammation of the pubic bone, the tendon attachments and the cartilage-joint connection in the middle of the pubic bone (symphysis). 

Factors that favour pubic inflammation

In addition, the following factors can promote pubic inflammation:

  • Current or previous pregnancy 
  • births in the past 
  • Operations on the lower abdomen
  • gynecological or urological operations
  • Fracture of the pubic bone or other injuries in the area of ​​the pubic bone
  • Rheumatological diseases
  • overweight


Which doctor for pubic pain?

Deciding which doctor to contact for pubic pain is not that easy. Apart from an inflammation of the pubic bone, other causes can also lead to pain in the pubic bone. In principle, the family doctor is always an excellent first point of contact: through targeted questioning and a physical examination, he can often already tell which colleague he should best refer you to. 

In most cases, an orthopedist or sports medicine specialist is the specialist of choice for pubic bone inflammation – depending on the patient’s history and clinical picture, a referral to a gynaecologist for women or a urologist for men may also make sense. 

Pubic osteitis: Diagnosis by MRI

To get to the bottom of the cause of pubic pain, the doctor will usually first take an X-ray of the pelvis after taking the medical history (anamnesis) and a thorough physical examination. The X-ray image helps to rule out a stress fracture and possibly find indications of pubic inflammation. An ultrasound can also be done to rule out other causes. 

As a rule, the diagnosis of pubic inflammation can be confirmed by an MRI. In unclear cases, further imaging tests such as skeletal scintigraphy can be carried out – this is useful, for example, in the case of fever, to rule out bone marrow inflammation (osteomyelitis) of the pubic bone. In addition, the inflammation levels in the blood are usually determined for this purpose.

Physiotherapy is an integral part of treatment.

Inflammation of the pubic bone can usually be treated conservatively, i.e. without surgery. Taking a break from sports first is essential so the inflammation can subside. Anti-inflammatory painkillers with active ingredients such as ibuprofen or diclofenac can relieve pain and support healing. 

Another essential part of the treatment is physiotherapy, where the muscles are strengthened and stretched through specific exercises. Physical therapies such as ultrasound treatment, cold or electrotherapy, osteopathy or chemotherapy can support pubic bone inflammation. 


What helps? Cortisone against inflammation

Suppose the pain in the pubic bone does not improve after a few weeks despite a break from sports and physical therapy exercises. In that case, it may be helpful to temporarily take cortisone-containing tablets for pubic inflammation since cortisone has a strong anti-inflammatory effect. 

Under certain circumstances, an orthopedist can inject cortisone and a local anaesthetic into the symphysis. The advantage of this is that the active ingredients act directly at the site of the inflammation, which can reduce side effects. 

Pubic inflammation: surgery as a last option

The therapy of pubic osteitis can take several months and often requires a lot of patience. As a rule, an operation should only be considered for pubic osteitis when all conservative treatment methods have been exhausted. 

In such cases, the inflamed tissue can be scraped out in an operation using a so-called curettage. As a final measure, a stiffening of the symphysis (arthrodesis) or a partial removal of the pubic bone can be carried out. 

Good chance of healing

 Even if the treatment can be very lengthy, the chances of healing in the case of pubic osteitis are excellent. In around 90 per cent of cases, the pain is entirely resolved without surgery.


Prevent pubic inflammation by stretching.

There are a few things you can do yourself to prevent pubic arthritis or prevent it from recurring: 

  • Warm up sufficiently before training by running and stretching your muscles. 
  • Let a trainer or physical therapist show you how to stretch and strengthen your abdominal and thigh muscles. Regular stretching can prevent muscular tension and imbalances. 
  • Wear appropriate, well-cushioned shoes to reduce stress on bones and joints when jogging.
  • Avoid sports with sudden movements on hard surfaces.
  • Please do not overdo it with training, and give your body regular training breaks.


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