Athletic Osteitis Pubis

Abstract

Athletic osteitis pubis is a painful and chronic condition affecting the pubic symphysis and/or parasymphyseal bone that develops after athletic activity. Athletes with osteitis pubis commonly present with anterior and medial groin pain and, in some cases, may have pain centred directly over the pubic symphysis. Pain may also be felt in the adductor region, lower abdominal muscles, perineal region, inguinal region or scrotum. The pain is usually aggravated by running, cutting, hip adduction and flexion against resistance, and loading of the rectus abdominis. The pain can progress such that athletes are unable to sustain athletic activity at high levels. It is postulated that osteitis pubis is an overuse injury caused by biomechanical overloading of the pubic symphysis and adjacent parasymphyseal bone with subsequent bony stress reaction. The differential diagnosis for osteitis pubis is extensive and includes many other syndromes resulting in groin pain. Imaging, particularly in the form of MRI, may be helpful in making the diagnosis. Treatment is variable, but typically begins with conservative measures and may include injections and/or surgical procedures. Prolotherapy injections of dextrose, anti-inflammatory corticosteroids and a variety of surgical procedures have been reported in the literature with varying efficacies. Future studies of athletic osteitis pubis should attempt to define specific and reliable criteria to make the diagnosis of athletic osteitis pubis, empirically define standards of care and reduce the variability of proposed treatment regimens.

Presence of Inguinal Hernia in Soccer Players with Osteitis Pubis

“…İki patoloji birlikte iken sadece birine tanı konulması durumunda tedavinin başarı şansı azalacaktır. Çünkü osteitis pubis sıklıkla konservatif yöntemlerle tedavi edilirken (3,4), inguinal herni varlığında cerrahi girişim esastır (9,11). Futbolcularda herni onarımı uygulansa bile, abdominal/adduktor kas zayıflığı ve imbalansı giderilmeden spora dönülmesi de sonradan osteitis pubis gelişimine zemin hazırlayabilir.…”

“…Etyolojisinde kronik zorlayıcı mikro--travmalar, akut yüksek enerjili travmalar, abdominal ve adduktor kaslar arasındaki imbalans, simfizis pubisde anormal vertikal hareket, kalça ekleminin rotasyonel hareket açıklığında azalma ve sakroiliak disfonksiyon yer alır (3,4). Yüksek yoğunlukta egzersizler, ani hızlanma ve yavaşlama, şut çekme, keskin yön değiştirme ve pivot hareketleri pubik bölgede traksiyon ve makaslama kuvvetlerine yol açarak osteitis pubis gelişimini kolaylaştırırlar.…”

“…Yüksek yoğunlukta egzersizler, ani hızlanma ve yavaşlama, şut çekme, keskin yön değiştirme ve pivot hareketleri pubik bölgede traksiyon ve makaslama kuvvetlerine yol açarak osteitis pubis gelişimini kolaylaştırırlar. Simfizis pubis ve pubik kemiklerde ödem, enflamasyon ve zamanla gelişen dejeneratif değişiklikler patolojik bulgulardır (3,5).…”

Surgical treatment of chronic groin pain in athletes

“…With pain over the pubis, the positive lateral compression test helps distinguish osteitis pubis from other conditions, such as chronic adductor tendinosis. MRI of the pubic region is recommended to distinguish between these two conditions and should be obligatory when choosing between surgery or initial conservative treatment [19].…”

The Effectiveness of Nonoperative Rehabilitation Programs for Athletes Diagnosed With Osteitis Pubis

“…1 It is theorized that osteitis pubis is an overuse condition caused by a biomechanical overloading of the pubic symphysis and adjacent parasymphyseal bone and soft tissue. 2 Predisposing factors that may contribute to this condition include increased athletic participation, trauma, pregnancy, degenerative or rheumatologic pathology, and urological and gynecological procedures. 1,3 Osteitis pubis is often categorized based on the level of severity (Table 1).…”