Osteitis Pubis in Football Players

Introduction

Football is an intense sport that places significant demands on the body, particularly in the groin region. One common groin condition that has a high prevalence, especially in late adolescent football players, is osteitis pubis.

In this blog, we will discuss what osteitis pubis is, as well as reviewing the available treatment options, rehabilitation techniques, and provide a conclusion to help football players understand and effectively manage this condition.

What is Osteitis Pubis?

Osteitis pubis is an overuse injury caused by biomechanical overloading of the pubic symphysis, the joint connecting the two pubic bones at the front of the pelvis. It is commonly seen in football players repetitive due to high volumes of twisting, turning, and kicking movements, placing a high amount of stress onto the pubic symphysis and surrounding muscle attachments onto the pubic bone.

The condition may progress from initial inflammation to the development of pubic bone oedema, which refers to swelling and accumulation of fluid within the pubic bone. This can further exacerbate pain and discomfort, leading to functional limitations for football players. The excessive stress placed on the pubic bone and surrounding structures, has lead to this condition also being referred to as pubic overload.

Symptoms of Osteitis Pubis in Football Players

The symptoms of osteitis pubis can vary, but here are some common signs to watch out for:

Groin pain: Footballers with osteitis pubis typically experience pain in the groin region, specifically around the pubic bone. The pain may be sharp, stabbing, or aching in nature. It can be aggravated by physical activity, particularly movements that involve kicking, twisting, or running.
Pelvic pain: The pain associated with osteitis pubis can radiate to the pelvic area, including the lower abdomen and hips. Footballers may feel discomfort during activities that require hip movement, such as changing direction or lifting the leg.
Pain during exercise: Footballers with osteitis pubis often experience pain during or after exercise. The pain may gradually worsen over time and may persist even with rest. It can limit their ability to participate fully in training sessions and matches.
Difficulty with specific movements: Certain movements, such as kicking, sprinting, or jumping, may exacerbate the pain and cause discomfort. Footballers may find it challenging to perform these actions with their usual speed and power.
Tenderness and swelling: In some cases, there may be tenderness and swelling over the pubic bone region. This can be felt upon palpation or visible as localised swelling in the area.
Decreased performance: Osteitis pubis can significantly impact a footballer’s performance. The pain and discomfort associated with the condition may lead to reduced speed, agility, and overall athletic performance.

If a footballer experiences persistent groin or pelvic pain, it is important to seek medical evaluation. A healthcare professional specialising in sports medicine can conduct a thorough examination, which may include imaging tests like MRI scans or dynamic ultrasound assessments, to diagnose osteitis pubis.

Causes of Osteitis Pubis in Football Players

The exact cause of osteitis pubis is not fully understood, but it is believed to be a multifactorial condition involving a combination of factors, including:

Repetitive stress: The repetitive and forceful movements performed during football, such as sudden changes in direction, kicking, and sprinting, can lead to microtrauma and inflammation of the pubic symphysis.
Training load: Sudden increases in training volume or intensity can lead to more stress being placed on the pubic area.
Muscle imbalances: Imbalances between the muscles of the pelvic region, including the hip adductors, abdominals, and gluteal muscles, can contribute to increased stress on the pubic bone.
Biomechanics: A players unique running or kicking technique as well as their movement patterns during sport specific movements can place excessive strain on the pubic symphysis and could predispose certain individuals to developing osteitis pubis.

Assessment of Osteitis Pubis in Football Players

Medical history: Understanding the player’s symptoms, previous injuries, and functional limitations.
Physical examination: Palpation, range of motion tests, strength assessment, and specific tests to assess the adductor muscles and pubic region.
Combined injuries: The groin is a notoriously problematic and complex area for football players, it is important to realise that with chronic groin issues there is often the possibility of having other co-existing injuries.
Imaging studies: Imaging modalities such as X-ray or magnetic resonance imaging (MRI), may be utilised to assess the pubic symphysis, identify any structural abnormalities, and evaluate the extent of pubic bone oedema. It is also advised a dynamic ultrasound assessment is included along with MRI as a standard protocol for assessing chronic groin injuries in football players.

Click the image below for further information on the assessment and rehabilitation of different groin injuries in football players.

Treatment Options for Osteitis Pubis

The management of osteitis pubis in football players typically involves a combination of conservative measures aimed at reducing pain, promoting healing, and restoring optimal function. The treatment options may include:

Rest and activity modification: Temporary modification or cessation of activities that exacerbate symptoms, allowing the affected tissues to heal.
Physical therapy: A structured rehabilitation program focusing on muscle strengthening, flexibility, and pelvic stability exercises can help address muscle imbalances, improve biomechanics, and reduce stress on the pubic symphysis.
Anti-inflammatory measures: Nonsteroidal anti-inflammatory drugs (NSAIDs) or other pain-relieving modalities may be prescribed to manage pain and reduce inflammation.
Shockwave therapy: Shockwave therapy has been shown to reduce pain, stimulate healing and enable a faster return to sport.
Injection therapy: In some cases, platelet-rich plasma (PRP) injections may be considered to promote healing.
Surgical intervention: Surgery is rarely required for osteitis pubis but may be considered in severe cases that do not respond to conservative measures. Surgical options may include decompression of the pubic symphysis or repair of any associated structural abnormalities.

The choice of treatment option should be individualised and made in consultation with a qualified healthcare professional, taking into consideration the severity of symptoms, duration of pain, and the player’s goals and expectations.

Rehabilitation Techniques for Osteitis Pubis

Rehabilitation plays a vital role in the management of osteitis pubis, helping football players recover, improve function, and prevent recurrent episodes. The rehabilitation program may include:

Flexibility and stretching: Regular stretching exercises targeting the hip adductors, hip flexors, and other relevant muscle groups can help alleviate muscle imbalances, improve range of motion, and reduce strain on the pubic symphysis.
Core and hip muscle strengthening: Strengthening the muscles around the pelvic region, including the core hip adductors, abdominals, and gluteal muscles, is essential for improving stability and reducing stress on the pubic symphysis. Exercises may include:
Testing & monitoring: It is advised to use adductor squeeze testing to analyse the players muscular strength and pain levels. Training load should be adjusted according to this and additional rest may be required.
Biomechanical correction: Addressing aggravating movement patterns, running or kicking technique, and optimising pelvic stability through specific exercises and functional movements.
Gradual return to sport: As symptoms improve and strength and flexibility are restored, a gradual return-to-sport program should be implemented under the guidance of a qualified sports physiotherapist. This includes progressive reintroduction of football-specific drills, movements, and eventually full training and match play.

Products that may help

Foam roller with mini bands – Available here

The foam roller can be used for self massage of the groin and other muscle groups. The mini bands are useful for strengthening or muscle activation work.

Vitamin D Supplementation – Available here

Vitamin D contributes to normal immune, muscle and bone function. Due to the pubic bone stress associated with osteitis pubis, it is often advised to consider vitamin D supplementation to optimise bone health.

Conclusion

Osteitis pubis can be a challenging condition for football players, causing significant pain and functional limitations. Understanding the condition, seeking early assessment, and following a comprehensive management plan are crucial for successful recovery.

Treatment options may include rest, physical therapy, anti-inflammatory measures, injection therapy, or surgery in severe cases. Rehabilitation techniques focusing on core and hip muscle strengthening, flexibility, biomechanical correction, and gradual return to sport play a vital role in the recovery process.

By adhering to a structured rehabilitation program and allowing sufficient time for healing, football players can enhance their chances of returning to the field stronger, more resilient, and ready to perform at their best.

Disclaimer

The information provided in this article is for educational purposes only and should not substitute professional medical advice. Always consult with a qualified healthcare professional for diagnosis, treatment, and personalised recommendations based on your specific condition. Some affiliate links may also be used in this article, these are from products we have specifically selected to display based on our own experience.

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