It didn’t seem too long ago that professional and amateur sportspeople alike were spending lengthy periods on the sidelines with the dreaded diagnosis of osteitis pubis. Associated strongly with field sports that required fast paced agility running and kicking, osteitis pubis was a common diagnosis that often meant prolonged rehabilitation and time away from competition. What were the issues with calling groin pain “osteitis pubis”?
- Inconsistent imaging findings for a similar presentation of “osteitis pubis”
- The lack of inflammation associated with the pubic symphysis dysfunction (Holmich, 2007; Weir, 2014).
True osteitis pubis is a gynaecological condition commonly seen in the post-operative period. While irritation to the pubic symphysis can occur in athletes and be a source of pain, unlike in post-partum women it is less likely to be the primary source of a pain. Instead, pubic symphysis pain is often the result of muscle imbalances and altered biomechanics secondary to one of the other three groin pain entities described below, as well as hip, lumbar and SIJ dysfunction.
As you can see from the image above, the anatomy of the area is complex and very much inter-linked. It is common for patients to have a mixed presentation that has two or more of the groin pain entities described above. Weir et al (2015) highlighted the importance of specific palpation findings and muscle testing to assist the clinician in making an accurate diagnosis.
So what does this mean for patients?
- Getting to the source of the problem
While it seems like a simple terminology change, re-classifying groin pain can help patients to better understand the primary source of their pain and streamline their rehab program. This will avoid wasting time on exercises or treatments that are not getting to the source of the problem!
A thorough assessment by your physiotherapist will help to identify biomechanical factors that might be contributing to the development of pain, including movement changes, weakness and/or reduced flexibility. Failure to address these factors may increase the likelihood of maintenance of pain, or recurrence once normal activity is resumed.
- Don’t ignore the early warning signs
Remember, not all groin pain starts with an acutely painful event. Overuse groin pain may present with a tightness in the area of the adductors during or after exercise, reduced acceleration and agility, reduced running speed and reduced kicking distance. Patients will often report that their pain started after these initial warning signs!
If you are experiencing groin pain or any of the symptoms described above, then please consider discussing this with your physiotherapist at Complete Sports Care.
Hölmich P. Long-standing groin pain in sportspeople falls into three primary patterns, a “clinical entity” approach: a prospective study of 207 patients. Br J Sports Med. 2007;41(4):247-252; discussion 252.