Osteitis Pubis: A Closer Look At Pelvic Pain In Active Individuals
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Pelvic pain can disrupt even the most active lifestyles, making simple movements challenging and turning once-enjoyable activities into sources of discomfort. This type of pain often emerges subtly, interfering with daily routines, mobility, and overall quality of life in ways that are difficult to ignore.
Among the many potential causes of persistent pelvic pain in physically active individuals is osteitis pubis, a condition that can significantly affect athletic performance and everyday function. Understanding the causes, symptoms, and management options for osteitis pubis is essential for finding relief and regaining mobility.
Defining The Anatomical Structure Of The Pelvic Ring
To better understand osteitis pubis, it’s essential first to explore the anatomy of the pelvic ring and the symphysis pubis. The pelvis is a ring-shaped bony structure that forms the foundation for movement and stability in the lower body.
At its rear, it connects through two sacroiliac (SI) joints, while at its front, it joins at the symphysis pubis. This intricate arrangement of bones, joints, and soft tissues supports body weight, facilitates movement, and protects internal organs.
A closer look at the pelvic ring and the symphysis pubis helps provide context for understanding osteitis pubis. The pelvic ring comprises two sacroiliac joints at the back and the symphysis pubis at the front, forming a closed structure integral to lower body function.
The pelvic ring functions as a single, interconnected structure, meaning that any impact or issue affecting one part—such as an SI joint at the back—can also influence the symphysis pubis joint at the front.
This dynamic relationship underscores the importance of understanding how stress and movement are distributed throughout the pelvis. While these challenges are most often observed in athletes, they can also arise, albeit less commonly, following bladder or pelvic surgeries.
The symphysis pubis, a joint located at the front of the pelvis, has a unique design optimized for stability rather than mobility. Unlike highly mobile joints such as the knee or shoulder, the symphysis pubis incorporates a fibrocartilaginous disc between the left and right pubic bones. This structure enables the joint to absorb stress and adapt to physical demands without compromising the pelvis’s overall stability.
Defining Osteitis Pubis
Osteitis pubis is a condition that arises when the symphysis pubis joint is subjected to excessive stress or instability, either directly or as a consequence of dysfunction in the SI joints. This stress prompts the body to initiate a compensatory process to stabilize the joint by developing new bone at the affected site. However, this response often leads to pain, inflammation, and reduced mobility.
Due to its frequent occurrence in athletes and physically active individuals, this condition is sometimes referred to by alternative terms such as athletic pubalgia or sports osteitis pubis. These terms emphasize the connection between repetitive physical activities—particularly running, jumping, or sudden changes in direction—and the development of osteitis pubis.
Key Causes Of Osteitis Pubis
Osteitis pubis can result from various factors that place excessive stress on the pelvic ring, particularly the symphysis pubis joint. While the condition is most commonly associated with athletes, other circumstances can also contribute to its development. Understanding these causes provides insight into the mechanisms that underlie this painful condition.
- Athletic Strain: High-impact activities such as soccer, running, or other sports involving repetitive motions place significant stress on the symphysis pubis.
- Pelvic Instability: Muscle imbalances or core weakness can lead to pelvic ring instability, increasing joint strain.
- Post-surgical Complications: Abdominal or pelvic surgeries may destabilize the pelvic ring or irritate the symphysis pubis joint.
- Childbirth: The pelvic ring stretches significantly during delivery, potentially causing damage to the symphysis pubis and SI joints.
Risk Factors
Certain factors increase the likelihood of developing osteitis pubis by placing additional strain on the pelvic ring and the symphysis pubis joint. These include:
- Physical activity: High-impact sports or activities such as running, soccer, or hockey involve repetitive movements that place significant stress on the pelvis.
- Biomechanical issues: Poor posture, muscle imbalances, or improper movement patterns can create additional strain on the pelvic region.
- Medical conditions: Pre-existing conditions such as arthritis, pelvic instability, or a history of pelvic surgeries may compromise joint stability and increase the risk of osteitis pubis.
Early Warning Signs And Symptoms
The primary symptom of osteitis pubis is pain in the symphysis pubis at the pelvis’s front. This pain may radiate to the groin, lower abdomen, or inner thighs due to the involvement of nearby muscle attachments, including the adductors and rectus abdominis.
The discomfort can be localized to one side or felt in the center of the pelvis and often intensifies during physical activities. Movements that commonly aggravate the pain include kicking, pivoting on one leg, running, climbing stairs, hiking, lying on one side, or coughing.
Recognizing the following pain patterns can help identify osteitis pubis early, enabling timely intervention:
- Pain In The Symphysis Pubis: Localized discomfort at the front of the pelvis.
- Radiating Pain: Pain extending to the groin, lower abdomen, or inner thighs.
- Localized Pain: Discomfort may be one-sided or centered in the pelvis.
When To Seek Medical Attention
While some cases of pelvic pain may improve with rest and self-care, certain symptoms warrant professional evaluation. Seek medical attention if you experience any of the following:
- Severe Or Persistent Pain: Intense discomfort in the pelvis or surrounding areas that does not improve with rest or over-the-counter pain relief.
- Pain That Worsens With Activity: Symptoms that consistently intensify during physical movements, such as running, climbing stairs, or coughing.
- Difficulty Walking Or Standing: Pain or instability that disrupts basic mobility or balance.
- Swelling Or Tenderness: Visible swelling, warmth, or tenderness in the symphysis pubis or nearby regions.
- Radiating Pain: Pain extending to the groin, lower abdomen, or inner thighs that persists despite self-care measures.
- Post-surgical Pain: New or worsening pain following pelvic or abdominal surgery that limits daily activities.
- Postpartum Discomfort: Pain or instability in the pelvis after childbirth that interferes with recovery or caregiving.
If these symptoms occur, consulting a physician promptly can facilitate an accurate diagnosis and initiate appropriate treatment to prevent further complications.
How Is Osteitis Pubis Diagnosed?
Diagnosing osteitis pubis involves a combination of clinical evaluation and imaging studies to confirm the condition and exclude other potential causes of pelvic pain.
- Clinical Evaluation: A physician begins by reviewing the patient’s medical history and symptoms. During the physical examination, specific tests may be conducted to assess pain and identify pelvic instability. Key clinical signs of osteitis pubis include:
- Tenderness Over The Pubic Symphysis: Pain upon pressing the area at the front of the pelvis.
- Pain With Specific Movements: Discomfort exacerbated by activities such as running, pivoting, or climbing stairs.
- Radiating Pain: Pain extending to the groin, lower abdomen, or inner thighs.
- Reduced Range Of Motion: Difficulty moving the hips or pelvis due to pain or stiffness.
- Tenderness Over The Pubic Symphysis: Pain upon pressing the area at the front of the pelvis.
- Imaging Techniques: When osteitis pubis is suspected, imaging studies are typically used to confirm the diagnosis and evaluate the severity of inflammation or damage:
- X-rays: These are useful for detecting changes in bone structure, such as new bone formation or irregularities in the pubic symphysis.
- MRI (Magnetic Resonance Imaging): The most sensitive imaging tool for diagnosing osteitis pubis. MRI can identify soft tissue inflammation, fluid accumulation, and subtle bone changes not visible on X-rays.
- Ultrasound: Sometimes used to assess soft tissue structures around the pelvis.
- X-rays: These are useful for detecting changes in bone structure, such as new bone formation or irregularities in the pubic symphysis.
An accurate diagnosis is crucial for creating the most suitable treatment plan and avoiding unnecessary interventions. Physicians can confirm osteitis pubis by combining clinical evaluation with imaging studies and customize treatment to the patient’s needs.
Early detection and management can significantly enhance outcomes and reduce the risk of long-term complications.
Conventional Treatment Options
Managing osteitis pubis begins with conservative, non-surgical approaches designed to help manage inflammation, alleviate pain, and support stability in the pelvic region. These approaches aim to minimize stress on the symphysis pubis joint while promoting healing.
- Rest and Activity Modification: Treatment typically starts with rest and adjustments to physical activities to decrease strain on the pelvis. Athletes may need to avoid high-impact sports or movements that exacerbate symptoms temporarily.
- Heat Therapy: Heat therapy can provide targeted relief as it helps relax tight muscles and improve blood flow to the affected area.
- Physical Therapy: Physical therapy exercises to stabilize the pelvis or manipulation of the SI joints by a chiropractor or physical therapist may help.
- Surgical intervention: Surgery may be recommended if nothing else helps. This involves debriding the area (cutting out parts of the joint), resecting a bigger portion of the joint (wedge resection), resecting the whole joint (wide resection), or fusion (placing a screw or plate across the joint). Regrettably, all surgical options will damage the joint in one way or the other.
Interventional Orthobiologic Options
Physicians in the licensed Regenexx network offer interventional orthobiologic procedures that may help manage osteitis pubis without surgery. These procedures are designed to support the body’s natural healing processes and improve joint stability.
The Regenexx approach to osteitis pubis includes platelet-rich plasma (PRP) injectates and bone marrow concentrate (BMC) injectates.
- Platelet-Rich Plasma (PRP) Injectates: PRP involves drawing a small sample of the patient’s blood, concentrating the platelets, and injecting them into the affected area to support tissue healing.
- Bone Marrow Concentrate (BMC) Injectates – BMC, which contains reparative cells and growth factors, is derived from a patient’s own bone marrow and may help support joint function and stability.
Physicians in the licensed Regenexx network use advanced imaging techniques, such as fluoroscopy, to precisely target affected areas, supporting the potential benefits of these procedures.
Case Study On Non-Surgical Management Of Osteitis Pubis
Over the years, advancements in non-surgical approaches have provided new options for managing osteitis pubis. Image-guided interventional orthobiologic procedures allow physicians in the licensed Regenexx network to target affected tissues, helping to address joint instability and promote function.
Case study:
A 30-year-old dentist and avid endurance athlete presented with mild osteitis pubis. He regularly participated in ultramarathons exceeding 100 miles, competing three to six times annually. About a year prior, he received a non-image-guided steroid injection into his symphysis pubis to manage the condition. Initially, he experienced symptom relief and resumed his rigorous training schedule.
Unfortunately, he later developed a sacral stress fracture. Imaging confirmed the fracture, and further investigation suggested it could be linked to steroid injections. Steroids have been associated with depleting progenitor cells, crucial in maintaining bone health and strength.
Treatment approach:
At that point, his treatment options included the use of orthobiologics to support the healing of the sacral fracture. Additionally, loose ligaments at the SI joint were likely contributing to joint instability, potentially placing excessive force on the sacrum and contributing to the fracture.
Orthobiologic injections could have been considered to help support the lax SI joint ligaments and restore stability. However, under the care of an orthopedic surgeon, the patient opted for an SI joint fusion instead.
The two large screws visible on the left pass through the SI joint into the sacrum. While this fusion stabilizes the joint, it also eliminates its natural movement. The SI joint is designed to absorb and distribute energy, and this functionality is lost after fusion. As a result, the energy that would typically dissipate through the SI joint is redirected elsewhere in the pelvic region.
When the patient resumed running just two months after the fusion surgery, the stress that the SI joint would typically absorb was instead redirected to the symphysis pubis. This excessive strain led to the rapid onset of severe osteitis pubis. Imaging studies (X-ray and CT scan) revealed significant damage: the normal space within the symphysis pubis, which houses the fibrous disc, had disappeared entirely, and the surrounding bone exhibited marked erosion.
At this stage, the patient faced the prospect of another surgery—this time to address the osteitis pubis resulting from the initial procedure. Instead, he sought treatment from Dr. Markle at Regenexx HQ in Colorado, where orthobiologic procedures were utilized to address the worsening condition of his symphysis pubis joint.
Fluoroscopy-guided imaging demonstrated the precise delivery of the patient’s own bone marrow concentrate into the deteriorating bone surrounding the symphysis pubis and into the degenerated joint itself. This approach aimed to support healing, reduce inflammation, and promote stability in the affected area.
Outcome:
The images below, taken several months after the orthobiologic procedure, demonstrate significant improvement in the condition of the symphysis pubis joint.
The follow-up images indicate a restored joint space in the symphysis pubis, with improvements in the surrounding bone structure. The patient reported noticeable improvement, noting that 80–90% of his symptoms had diminished and that he experiences no daily pain (0/10). This outcome illustrates the potential role of orthobiologic procedures in supporting joint health and function.
Supporting Recovery Without Surgery After Osteitis Pubis
Osteitis pubis can disrupt daily activities and athletic performance, making proper management essential. While surgery may be considered in severe cases, many individuals explore non-surgical approaches to support joint function and symptom relief.
Interventional orthobiologic procedures, such as PRP and BMC injectates, may help reduce inflammation, promote tissue health, and enhance pelvic stability. Complementary strategies like physical therapy, targeted strengthening exercises, and posture adjustments can further support long-term pelvic and spinal health.
If you are experiencing persistent discomfort or mobility challenges, consult a physician in the licensed Regenexx network to explore treatment options customized to your needs.
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