Posted: July 4, 2006

Health and Fitness: Osteitis Pubis

Inflammation of the cartilage disc in the pubic bone

Osteitis Pubis is the inflammation of the pubic symphysis; the point where the left and right pubic bones meet at the front of the pelvic girdle. Individuals who are most at risk of Osteitis Pubis are those who participate in running events, especially distance runners. Weight lifters, ice skaters and dancers are also vulnerable to Osteitis Pubis, and people who have recently had prostate or bladder surgery.

Anatomy of the Pelvic Girdle
Osteitis Pubis results in pain in the front of the pelvic girdle due to inflammation of the pubic symphysis.

The pubic symphysis is a disc of cartilage located between the left and right pubic bones and can be seen at the bottom of the picture to the right.

The pubic symphysis is the point where several muscles from the abdomen and groin attach and contract quite vigorously during exercise. These excessive forces pull on the pubic symphysis and cause an inflammatory response.

Symptoms
The most common symptoms of Osteitis Pubis are pain and tenderness; this pain can be sharp or dull. The onset of pain is usually gradual, and is most commonly located in the front and center of the pubic bone. However, the pain may radiate into the lower abdomen and also down into the groin and thigh.

Causes
Osteitis Pubis is predominantly caused by repetitive contraction of the muscles that attach to the pubic bone and the pubic symphysis, and while many things can be attributed to this, they can all be categorized into two main groups: Overload (or training errors); and Biomechanical Inefficiencies.

Overload (or training errors): Osteitis Pubis is commonly associated with sports that require a lot of running, change of direction or weight bearing activity. Other overload causes include:

• Exercising on hard surfaces, like concrete;
• Exercising on uneven ground;
• Beginning an exercise program after a long lay-off period;
• Increasing exercise intensity or duration too quickly; and
• Exercising in worn out or ill fitting shoes.

Biomechanical Inefficiencies: The major biomechanical inefficiencies contributing to Osteitis Pubis are faulty foot and body mechanics and gait disturbances. Other biomechanical causes include:

• Poor running or walking mechanics;
• Tight, stiff muscles in the hips, groin and buttocks;
• Muscular imbalances; and
• Leg length differences.

Short Term Treatment... (First 48 to 72 hours)
The initial treatment for Osteitis Pubis is the same as any other soft tissue injury. This involves the application of R.I.C.E.R. (R) rest, (I) ice, (C) compression, (E) elevation and obtaining a (R) referral for appropriate medical treatment. The following two points are of most importance.

1. Rest & Immobilization
   Once Osteitis Pubis is diagnosed it is important that the affected area be rested immediately. Any further movement or stress will only aggravate the condition and prolong recovery. It is also important to keep the injured area as still as possible.
2. Ice
   By far the most important part. The application of ice will have the greatest effect on reducing swelling and pain. Apply ice as soon as possible after the injury has occurred or been diagnosed for at least 48 to 72 hours.

How do you apply ice? Crushed ice in a plastic bag is usually best. However, blocks of ice, commercial cold packs and bags of frozen peas will all do fine. Even cold water from a tap is better than nothing at all.

When using ice, be careful not to apply it directly to the skin. This can cause "ice burns" and further skin damage. Wrapping the ice in a damp towel generally provides the best protection for the skin.

How long, how often? This is the point where few people agree. Let me give you some figures to use, as a rough guide, and then I will give you some advice from personal experience. The most common recommendation is to apply ice for 20 minutes every 2 hours for the first 48 to 72 hours.

These figures are a good starting point, but remember they are only a guide. You must take into account that some people are more sensitive to cold than others are. Also, be aware that children and elderly people have a lower tolerance to ice and cold. Finally, people with circulatory problems are also more sensitive to ice. Remember to keep these things in mind when treating yourself or someone else with ice.

Personally, I recommend that people use their own judgment when applying ice to themselves. For some people, 20 minutes is too much. For others, especially well conditioned athletes, they can leave ice on for up to an hour at a time. The individual should make the decision as to how long the ice should stay on.

My personal recommendation is that people should apply ice for as long as it is comfortable. Obviously, there will be a slight discomfort from the cold, but as soon as pain or excessive discomfort is experienced, it is time to remove the ice. It is much better to apply ice for 3 to 5 minutes a couple of time an hour, than not at all.

During the first 72 hours after an injury, be sure to avoid any form of heat at the injury site. This includes heat lamps, heat creams, spas, Jacuzzi's and saunas. Avoid all movement and massage of the injured area. Also, avoid excessive alcohol. All these things will increase the bleeding, swelling and pain of your injury. Avoid them at all costs.

Long Term Treatment... (After the first 72 hours)
Once the initial treatment has helped to reduce most of the inflammation and pain, it is time to move onto the next phase of treatment. This involves applying heat, which will increase the blood supply, and thus increasing the amount of oxygen and nutrients to the injured area.

Next, very gentle stretching exercises can be used to lengthen the muscles around the hips and groin. This will help to relieve some of the pressure on the pubic symphysis from tight muscles. If you're interested in stretches for the hips and groin, The Stretching Handbook has detailed photographs and descriptions of more than 19 different stretching exercises you can do. Learn more about The Stretching Handbook here.

Prevention
Although it is important to be able to treat Osteitis Pubis, prevention should be your first priority. So what are some of the things you can do to help prevent Osteitis Pubis?

1. Warm Up properly
   A good warm up is essential for getting the body ready for any activity. A well-structured warm up will prepare your heart, lungs, muscles, joints and your mind for strenuous activity. Click on the following link if you would like to know the 4 essential steps to an effective warm up.
2. Avoid activities that cause pain
   This is self-explanatory, but try to be aware of activities that cause pain or discomfort, and either avoid them or modify them.
3. Rest and Recovery
   Rest is very important in helping the soft tissues of the body recover from strenuous activity. Be sure to allow adequate recovery time between workouts or training sessions.
4. Stretch and Strengthen
   To prevent Osteitis Pubis, it is important that the muscles around the hips and groin be in top condition. Be sure to work on the strength and flexibility of all the muscle groups in this area.
   • Stretching: For an easy-to-use, quick reference guide of more than 100 clear photographs of every possible sports related stretch, for every major muscle group in your body, get a copy of The Stretching Handbook. If you're interested in stretches for the hips and groin, The Stretching Handbook has detailed photographs and descriptions of more than 19 different stretching exercises you can do. Learn more about The Stretching Handbook here.
   • Strengthening: Strengthening the muscles around the mid section will help to prevent Osteitis Pubis. Core strength exercises like abdominal exercises and strengthening exercises using exercise balls (or Swiss balls) will help the most.
5. Footwear
   Be aware of the importance of good footwear. A good pair of shoes will help to keep your knees and hips stable, provide adequate cushioning, and support your lower legs, knees and hips during the running or walking motion.

Brad Walker is a leading stretching and sports injury consultant with over 15 years experience in the health and fitness industry. For more articles on stretching, flexibility and sports injury, subscribe to The Stretching & Sports Injury Newsletter by visiting http://www.thestretchinghandbook.com/newsletter.htm.

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