Osteitis pubis is a painful overuse injury affecting the pelvis, commonly seen in footballers, runners, and athletes engaged in high-impact sports. This condition results from repetitive stress on the pubic symphysis—the joint connecting the two sides of the front pelvis—leading to inflammation, bone stress, and eventual degeneration if left untreated.
While symptoms often develop gradually, some athletes report a sudden increase in pain following a particular movement or impact. Early detection is key to preventing more severe complications, including erosion of the pubic bones.
What is Osteitis Pubis?
The root cause of osteitis pubis is instability in the pelvic region, particularly around the pubic symphysis. This instability leads to uneven force distribution across the pelvis, making the area vulnerable to injury. Poor core and pelvic stability amplify this effect, increasing the risk of developing osteitis pubis.
Athletes with a history of groin strains, lower back pain, or sports-related hernias may be more susceptible due to existing weaknesses in the surrounding muscles and ligaments. Without proper stabilisation, repetitive movements such as running, kicking, or rapid directional changes can trigger excessive strain on the pubic joint, leading to inflammation and pain.
The main causes for Osteitis Pubis are:
Repetitive Stress: Activities that involve repetitive turning, kicking, or twisting can lead to inflammation of the pubic symphysis.
Muscles Imbalances: When imbalances are present between the adductor muscles and the abdominal muscles, this can increase stress on the pubic symphysis.
Trauma: Direct trauma to the pelvis can also be a contributing factor to the development of this condition.
Post-Surgery: Osteitis Pubis can develop as a complication after an abdominal or pelvic surgery.
Why Does Osteitis Pubis Develop?
Pain from osteitis pubis typically presents in the lower groin and pubic region, often radiating into the inner thigh or lower abdomen. The discomfort may worsen with specific movements, such as:
Running, kicking, or changing direction quickly
Resisting hip adduction (bringing the legs together)
Stretching the hip into abduction (away from the midline) or extension (behind the body)
Core-engaging movements like sit-ups
Coughing or sneezing
In more severe cases, even lying flat on the back can be uncomfortable.
Recognising the Symptoms
A thorough assessment by a physiotherapist or sports physician is essential for diagnosing osteitis pubis. The diagnostic process typically involves:
Physical Examination: Identifying tenderness over the pubic symphysis and pain during resisted hip movements.
Imaging: MRI scans are the gold standard for detecting early bone stress and inflammation, while X-rays may reveal more advanced bone changes.
Functional Testing: Assessing pelvic stability, muscle strength, and movement patterns to determine underlying imbalances.
How is Osteitis Pubis Diagnosed?
Managing and Treating Osteitis Pubis
Effective rehabilitation requires a structured approach that addresses both the symptoms and the root cause of instability. Recovery can take several months, with treatment progressing through the following stages:
1. Rest and Initial Pain Management
Minimise activities that aggravate symptoms, such as running, heavy lifting, and kicking.
Apply ice to reduce inflammation in the early stages.
Anti-inflammatories can help reduce pain and inflammation and may be beneficial in some cases.
In severe cases, crutches may be necessary to offload the pubic symphysis and prevent further stress.
Manual therapy techniques such as gentle joint mobilisations and myofascial release can help improve mobility and reduce pain.
2. Restoring Pelvic Stability and Strength
A tailored physiotherapy program will focus on core strengthening and pelvic stability exercises.
Activation and control of deep stabilising muscles (such as the transverse abdominis and gluteal muscles) are essential.
Stretching and myofascial release techniques help restore balance in surrounding soft tissues.
3. Gradual Return to Activity
Once pain is under control, low-impact exercises such as cycling or swimming (using a pool buoy to avoid leg strain) can help maintain cardiovascular fitness.
As stability improves, straight-line running can be introduced before progressing to multidirectional movements.
Strength training for the lower limbs and core will further support injury prevention.
Preventing osteitis pubis requires ongoing attention to pelvic stability, core strength, and movement mechanics. Athletes should:
Engage in regular strength and stability exercises
Address muscle imbalances or tightness that could affect biomechanics
Progress training loads gradually to avoid overuse injuries
Seek physiotherapy guidance at the first sign of groin discomfort
Long-Term Prevention
Osteitis pubis can be complex and challenging to manage without expert intervention. If groin pain persists or affects your performance, consulting a physiotherapist or sports physician is crucial for a structured rehabilitation plan and a safe return to sport.
At Melbourne Physio Clinic, we specialise in treating hip and groin injuries with evidence-based techniques to ensure a smooth recovery. Contact us today to book an assessment and take the first step towards pain-free movement.