Osteitis pubis is inflammation of the symphysis pubis, which is the joint between the right and left pubic bones. It is a common cause of groin pain in athletes who perform repetitive motion of their lower extremities across their bodies. Soccer players are good examples of these athletes, as they often kick across their bodies.

Signs and symptoms of osteitis pubis

Athletes with this condition usually do not remember a specific event that initiated the symptoms. They complain of a vague pain in the hip, groin, or lower abdomen. Usually the pain is only present during sports activities that involve changing directions or moving the leg across the body. It is usually a dull soreness, but it can significantly limit the athlete’s ability to play.

Tests for osteitis pubis

Evaluation by a sports medicine physician is helpful, but the diagnosis can be difficult to make. The pain is usually localized to the groin, and the athlete can actually have pain on both sides. The physician usually can demonstrate tenderness at the symphysis pubis. I have found that it is often difficult by physical exam alone to differentiate groin pain in these athletes, as athletic pubalgia, adductor strains, and osteitis pubis can present in very similar fashions.
X-rays are often negative, but they can show reactive changes at the symphysis pubis. Occasionally a bone scan or MRI is performed to help confirm the diagnosis.

Treatment for osteitis pubis

The treatment for osteitis pubis is almost always nonsurgical. Initially rest from the aggravating sport can help alleviate the symptoms. Anti-inflammatory medications can be helpful. Physical therapy for hip, pelvic, and abdominal strengthening and stretching exercises is also very helpful. Return to sports depends on how quickly the athlete’s symptoms resolve. In my experience, return can be fairly quick, but occasionally it can take weeks or even months.

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