Commentary VII Osteitis pubis represents a chronic inflammatory and overuse condition of the pubic symphysis and adjacent ischial rami. Most commonly associated with urologic procedures, prostatectomy, and childbirth, osteitis pubis can also occur in athletes and appears to be related to repetitive shear forces transmitted to the pubc symphysis during running and repetitive adductor contractions during kicking sports. The athlete typically complains of the gradual onset of discomfort in the lower abdomen or groin area that is worsened by sport activity and relieved by rest. Physical examination reveals point tenderness at the pubic tubercles, rectus abdominis insertion, adductor origin, and inferior pubic rami. Pain is intensified with sit-ups and resisted hip adduction.
Range of motion is maintained.
Radiographic studies may reveal a fraying or roughening of the periosteum of the pubic symphysis. However, x-ray signs may be delayed for as long as 4 weeks after the onset of symptoms, therefore a bone scan or MRI may assist diagnosis in early stages. Eccentric overload, such as that experienced during quick changes in direction from a stretched out lunge position, is thought to be especially contributive. Ballistic stretching often leads to groin strain. The functional biomechanical deficits include tightness of the ipsilateral adductors and contralateral tensor fascia lata.