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 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 provoke 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 is 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 hip and groin physiotherapist for specific advice, a thorough assessment and the quickest relief from your groin pain.

Acute Injury Signs

Acute Injury Management.

Here are some warning signs that you have an injury. While some injuries are immediately evident, others can creep up slowly and progressively get worse. If you don't pay attention to both types of injuries, chronic problems can develop.

For detailed information on specific injuries, check out the injury by body part section.

Don't Ignore these Injury Warning Signs

Joint Pain

Joint pain, particularly in the knee, ankle, elbow, and wrist joints, should never be ignored. Because these joints are not covered by muscle, pain here is rarely of muscular origin. Joint pain that lasts more than 48 hours requires a professional diagnosis.


If you can elicit pain at a specific point in a bone, muscle, or joint, you may have a significant injury by pressing your finger into it. If the same spot on the other side of the body does not produce the same pain, you should probably see your health professional.  


Nearly all sports or musculoskeletal injuries cause swelling. Swelling is usually quite obvious and can be seen, but occasionally you may feel as though something is swollen or "full" even though it looks normal. Swelling usually goes along with pain, redness and heat.

Reduced Range of Motion

If the swelling isn't obvious, you can usually find it by checking for a reduced range of motion in a joint. If there is significant swelling within a joint, you will lose range of motion. Compare one side of the body with the other to identify major differences. If there are any, you probably have an injury that needs attention.


Compare sides for weakness by performing the same task. One way to tell is to lift the same weight with the right and left sides and look at the result. Or try to place body weight on one leg and then the other. A difference in your ability to support your weight is another suggestion of an injury that requires attention.

Immediate Injury Treatment: Step-by-Step Guidelines

  • Stop the activity immediately.
  • Wrap the injured part in a compression bandage.
  • Apply ice to the injured part (use a bag of crushed ice or a bag of frozen vegetables).
  • Elevate the injured part to reduce swelling.
  • Consult your health practitioner for a proper diagnosis of any serious injury.
  • Rehabilitate your injury under professional guidance.
  • Seek a second opinion if you are not improving.