Osteitis Pubis

Osteitis Pubis

Article by J.Miller, Z.Russell

Osteitis Pubis

What is Osteitis Pubis?

Osteitis Pubis is a common cause of chronic groin pain in the football codes. It is an overuse injury, e.g. repeated trauma rather than a specific incident. However, it is not uncommon for a particular event to trigger the symptoms.

Diagnosis is usually made in the advanced stages when the pubis bones have begun to erode at the pubic symphysis. Early diagnosis can prevent the condition from progressing beyond the stage of “bone stress”.

What Causes Osteitis Pubis?


The leading cause is the instability of the pelvic bones and in particular the pubic symphysis.

The instability aggravates your pubic symphysis with asymmetrical loads through your pelvis. Usually, forces accommodate adequately in the typical “stable” athlete, but with poor lumbopelvic control, the additional energy becomes uncontrollable and will cause injury.

Due to the instability in the region, it is not uncommon for the athlete to have experienced a previous history of groin strains, a “sportsman’s” hernia or low back pain.

How to Diagnose Osteitis Pubis

Pain is usually experienced over the pubic symphysis with referred pain into the inguinal region and the groin. Palpation of the pubic symphysis and the pubic ramus is acutely tender. Resisted muscle contraction of the hip adductors and flexors will elicit pain. Likewise stretching into abduction and extension can elicit pain in the acute stage. Coughing, sneezing and performing a sit-up will reproduce pain. This athlete is often unable to lie flat on their back or prone.

A bone scan will highlight advanced uptake at the pubis symphysis. X-rays will show cysts and erosion of the pubic symphysis in advanced cases. MRI will show the bone stress injury and swelling present.

Figure 1. Osteitis pubis. Plain X-ray findings in 2 separate cases:

  • A. Irregular resorption of the articular cortex and variable mild subcortical sclerosis seen along both sides of the symphysis. Also note subtle soft tissue calcification in the line of the right adductor longus (white arrowhead), indicative of simultaneous pathological change at two separate anatomical structures in this case.
  • B. Longstanding disease on the right side has produced prominent traction spurs at the pubic insertion of rectus abdominis (white arrow) and adductor origin (black arrow), a broad zone of bony enthesial sclerosis at the conjoint tendon insertion and adductor origin (*), and irregular resorption of articular cortex along the right side of the pubic symphysis.

(Courtesy of Atlas of Imaging in Sports Medicine, McGraw-Hill, Sydney 1998)

This condition is tricky to treat. Please consult your sports physician or physiotherapist for specific advice.

Treatment for Osteitis Pubis

We highly recommend thorough rehabilitation under the guidance of an experienced Sports Physiotherapist or Sports Physician for osteitis pubis sufferers. The return to sport should be guided by their experience to avoid future reaggravation.

Stages of Rehabilitation

  • Rest is essential to unload the injured region. Active rest will almost certainly entail a cessation of running and kicking. In the acute stage, it may even require the use of crutches if walking is painful.
  • Retrain stabilisation control of the pelvic girdle via particular exercises. You will need to consult your physiotherapist for these unique exercises, including core stabilisation exercises.
  • Normalise the adjacent soft tissue and muscle flexibility to avoid excessive forces placed through the region. Assess and improve lumbopelvic, hip and lower limb biomechanics. Your physio will know what to do.
  • Early return to sport is via less stressful activities such as cycling, swimming with a pool buoy. These activities should progress in consultation with your therapist. Use these activities to maintain your cardiovascular fitness.
  • Once pain permits, light straight-line running drills may commence.

It is not uncommon for this rehabilitation process to take over three months.

This condition is tricky to treat. Please consult your sports physician or physiotherapist for specific advice.

Common Causes of Hip & Groin Pain

General Information

Hip Joint Pain

Lateral Hip Pain

Adductor-related Groin Pain

Pubic-related Groin Pain

Inguinal-related Groin Pain

  • Inguinal hernia
  • Sportsman's hernia

Iliopsoas-related Groin Pain

  • Hip Flexor Strain

Other Muscle-related Pain

Systemic Diseases

Referred Sources

Hip Surgery

Experience the PhysioWorks Difference?

You'll be impressed with the experienced physiotherapists, massage therapists, allied health team and reception staff representing PhysioWorks.

If you've been searching for health practitioners with a serious interest in your rehabilitation or injury prevention program, our staff have either participated or are still participating in competitive sports at a representative level.

To ensure that we remain highly qualified, PhysioWorks is committed to continuing education to provide optimal care. We also currently offer physiotherapy and massage services for numerous sports clubs, state and national representative teams and athletes. Our experience helps us understand what you need to do to safely and quickly return to your sporting field, home duties, or employment.

How You'll Benefit from the PhysioWorks Difference?

At PhysioWorks physiotherapy and massage clinics, we strive to offer our clients quick, effective and long-lasting results by providing high-quality treatment. With many years of clinical experience, our friendly service and quality treatment is a benchmark not only in Brisbane but Australia-wide.

What are Some of the BIG Differences?

We aim to get you better quicker in a friendly and caring environment conducive to successful healing. Our therapists pride themselves on keeping up to date with the latest research and treatment skills to ensure that they provide you with the most advantageous treatment methods. They are continually updating their knowledge via seminars, conferences, workshops, scientific journals etc. Not only will you receive a detailed consultation, but we offer long-term solutions, not just quick fixes that, in reality, only last for a short time. We attempt to treat the cause, not just the symptoms.

PhysioWorks clinics are modern thinking. Not only in their appearance but in the equipment we use and in our therapists' knowledge. Our staff care about you!  We are always willing to go that 'extra mile' to guarantee that we cater to our client's unique needs. All in all, we feel that your chances of the correct diagnosis, the most effective treatment and the best outcomes are all the better at PhysioWorks.