Osteitis pubis

What is osteitis pubis?

Osteitis pubis is a self-limiting injury that is characterised by pelvic pain in the pubis symphysis. It mainly presents in athletes aged 20 to 30 and is more common in females than in males. It is generally more common in kicking sports.

It can also affect pregnant women. During pregnancy hormones are released which relax ligaments. This laxity can result in pubic symphysis pain.

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Causes and symptoms

Causes of osteitis pubis

Repeated actions putting stress on the pubic synthesis (e.g. from kicking a ball, jumping, sit ups, etc)
Pregnancy and childbirth
Surgical procedures (gynaecological or abdominal, hernia repairs)
Trauma/injury
Leg length difference

Symptoms of osteitis pubis

Pain on activity, climbing stairs, running, kicking, and changing direction
Pain with cough or sneeze
Pain can radiate from the lower abdomen, down the groin, scrotum or perineum

Diagnosis of osteitis pubis

Osteitis pubis is generally diagnosed through thorough a physical examination. When there is diagnostic uncertainty further imaging, such as an MRI scan maybe needed.

Self management of osteitis pubis

Relative rest

Reduce your levels of activity to a point where you do not feel pain. Try and keep mobile as this will preserve strength in your knee.

Ice

Wrap ice (or a bag of frozen peas) in a tea towel and place this over your pubic synthesis. This will help reduce swelling. This can be done for 20 minutes every 2 hours.

Painkillers

Various over the counter pain killers are available for the management of pain. Use pain killers to reduce the pain to a tolerable level.

Exercises for osteitis pubis

Exercise 1: quadriceps stretch, side lying

Lying on side, bottom knee bent up level with hips
Tighten abdominals and flatten back
Hold top ankle so that heel is touching buttock
Pull top leg back behind you until good stretch is felt in front of thigh
Keep knee lower than hip and back flat
Hold 30 seconds x 3

Exercise 2: hamstring stretch

Sitting on chair
Perfect posture with good lumbar arch (lordosis)
Slowly straighten one leg, maintaining perfect posture
Full stretch is the point just before the back starts to lose its lordosis
Hold 30 seconds x 5

Exercise 3: single leg heel raise

Put your hand on a wall or other stable surface for balance
While standing on one leg, raise up on your toes as you lift your heel off the ground
Keep your knee straight

Exercise 4: bridge

Lie face up on the floor, with your knees bent and feet flat on the ground
Keep your arms at your side with your palms down
Lift your hips off the ground until your knees, hips and shoulders form a straight line
Squeeze your buttocks
Hold your bridged position for a couple of seconds before easing back down

Exercise 5: dead ant

Lying supine
Brace your core muscles
Lift your right leg to a table top position (right hip 90 right knee 90)
Keeping your abdominals braced
Lift your left leg to table top (left hip 90, left knee 90)
Now move your arm up right , then your left arm
Alternate movements of your arms and legs keeping abdominal control

What next?

If you are still experiencing symptoms despite following the above advice, it is important you seek advice from your GP. Your GP may decide to refer you to the musculoskeletal clinic or to a physiotherapist.

Page updated 01/12/2020. Review date 01/01/2024

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