Osteitis pubis

Osteitis pubis is a condition that affects the pubic symphysis, where your hip bones meet at the front. It often occurs in sports that involve sprinting, kicking and sudden changes of direction, such as running, football and tennis.

Symptoms

The most common symptom is pain or tenderness around your pelvis and upper thigh when walking or exercising. You may feel pain when twisting, turning and kicking. Some people feel pain when walking up stairs, coughing, sneezing and lying on their side. You may also hear clicking or popping when turning over in bed, walking on uneven ground or rising from sitting. Men may feel pain in their scrotum after ejaculation.

Causes

The exact cause of osteitis pubis is unknown. It's thought that it may be caused stress across the pubic symphysis during physical activity.

Treatment

You should seek treatment from a sports medicine professional, such as a sports medicine doctor or a physiotherapist.

You can buy painkillers such as paracetamol or ibuprofen to treat mild and moderate pain. Your GP or sports medicine doctor may prescribe stronger painkillers if your pain is severe. As well as easing your pain, painkillers may help to any reduce inflammation and swelling. Always read the patient information that comes with your medicine, and if you have questions, ask your pharmacist or doctor for advice.

Try not to do any activity that causes pain. Rest can help to reduce the severity of your symptoms but the pain usually returns when you resume normal sporting activities.

Physiotherapy can be helpful. Your physiotherapist will give you rehabilitation exercises to strengthen and stretch the muscles around your pelvis to reduce the stress across the pubic symphysis. He or she will use various techniques such as stretching and massage therapy to reduce muscle tightness.

If your symptoms don't improve or your symptoms are severe, a steroid injection can be helpful. Rarely, you may need surgery.

Osteitis pubis usually improves within one year of treatment, but is difficult to rectify. The condition returns in one in four athletes.

Do

• Strengthen your core muscles to support your pelvis.
• Vary training methods so you don't repeatedly stress your pubic symphysis. If you are a runner, try doing some cycling or swimming to keep up your cardiovascular fitness.
• Stretch your adductor muscles regularly.

Don't

• Train on hard surfaces on a regular basis.

Peer reviewed by David Toy, MCSP, Bupa Sports Medicine physiotherapist

Publication date: June 2009