Inflammation of the pubic bone is also known as osteitis pubis or pubalgia. It is an overload reaction of the symphysis. To get a better idea, it is useful to first take a look at our anatomy.
The pubic bone is located in our pelvis. It is the front part, which consists of two bones that converge, the pubic branches.
Between them lies the pubic symphysis, which doctors call the symphysis. The symphysis is surrounded by firm connective tissue. Excessive strain causes very fine tears in this connective tissue and in the capsule/ligament apparatus. These ultimately cause inflammation of the pubic bone.
There is a left and a right pubic bone, the pubic symphysis connects the two@ Henrie /AdobeStock
Typical symptoms of pubalgia are pubic bone pain. It is often difficult for doctors to diagnose because the pain radiates. As a result, doctors are often unable to make a clear diagnosis.
In addition, the intensity of the pain gradually increases. What you currently only experience as unpleasant can become painful in a few weeks or months.
Initially, it often starts with an unpleasant pulling sensation in the thighs, similar to sore muscles. Treatment is rarely given at this stage, which is why the next stage is usually diffuse hip pain.
This can affect the groin or the adductors (parts of the hip muscles). It is also possible that the pain radiates to the lower back or abdomen.
It is also characteristic that certain movements intensify the pain. This includes one-sided strain on the hip, for example when you lift your knee while standing.
Climbing stairs, standing up after sitting for a long time or sit-ups also trigger stabbing pain in the lower abdomen in the case of pubitis.
In addition, the pubic bone and symphysis become increasingly sensitive to pressure. The reason for this is water retention(oedema), which accompanies the inflammation in the bone.
The cause of inflammation of the pubic bone is usually overuse @ georgpfluegl /AdobeStock
The most common cause of osteitis pubis is prolonged overuse. This leads to micro-tears in the tissue around the symphysis and ultimately to inflammation.
The strain comes primarily from muscular tensions that act on the pelvis. Both the abdominal and adductor muscles run along the symphysis pubis.
This is why sports physicians have long believed that pubalgia mainly affects athletes. The condition is particularly common in footballers, field hockey and rugby players, hurdlers and tennis players. This is because these sports involve jerkymovements in the hip area.
However, we now know thatsitting for long periods of time also leads to a one-sided pull on the abdominal muscles. This tension can also cause osteitis pubis.
Another, much rarer cause is a pubic bone fracture. This is caused by violent kicks or impacts. In this case, however, more serious symptoms such as nerve pain and restricted movement occur.
In women, the condition sometimes also occurs during pregnancy or after childbirth. The reason for this is the hormonal change, which leads to a loosening of the ligaments and a widening of the symphysis. The increasing weight of the embryo can ultimately lead to overloading of the pubic bone.
As the pain often radiates, it is sometimes difficult for sports physicians and orthopaedists to make the correct diagnosis. In any case, a detailed medical history, i.e. a discussion about the patient's life circumstances, is part of the examination. This enables the doctor to identify risk factors.
This discussion is supplemented by a physical examination. During this examination, the patient should perform certain movements. For example, standing on one leg.
At the same time, the patient should describe the intensity of the pain. The symphysis flap test is also a common examination method. In the symphysis flap test, the doctor applies pressure to the symphysis pubis and checks for pain.
To get a better picture of the structures in the pelvic area, the doctor often orders an X-ray or MRI. This allows him to recognize the condition of the symphysis, for example an enlargement of the bone, as well as possible water retention (bone marrow oedema).
The treatment of osteitis pubis is often lengthy. The disease rarely heals on its own. This is why orthopaedists generally take a conservative approach initially.
Physiotherapy and exercises at home are intended to counteract the inflammation. Painkillers and cortisone support the treatment. Taking a break from sport is most helpful.
If these measures are not sufficient, you can try injections with cortisone or a local anesthetic. Most patients feel a clear improvement afterwards. Shock wave therapy is also useful to improve the bone marrow edema and heal the tendon insertions.
As a last resort, surgery can be performed to treat osteitis pubis. Doctors either scrape out the tissue around the symphysis. In particularly stubborn cases, stabilization of the symphysis pubis together with groin stabilization is used.
Osteitis pubis rarely heals on its own and if it does, then in conjunction with rest. If left untreated, the pain can become chronic and increasingly impair the patient's quality of life . Everyday movements are then only possible to a limited extent.
The earlier the doctor diagnoses osteitis pubis, the faster it usually heals. Therefore, do not hesitate to consult a sports physician or orthopaedist if you experience pain!
If you suffer from osteitis pubis, conservative or minimally invasive surgical therapies will help you to be pain-free soon.