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Pubic Symphysis

Pain of the public symphysis area is often overlooked and blamed on abdominal muscles and adductor muscles which attach in this area with the diagnosis of abdominal muscle pull or adductor tendonitis.

Because muscles have an excellent blood supply, they heal extremely quickly and rarely cause pain that lasts more than a few days. A patient who continues to complain of groin pain area requires examination of the other structures. Many athletic trainers and orthopedists do not even consider this structure as a source of pain.

Osteitis pubis

If the area is examined, the diagnosis of osteitis pubis is commonly made, which means that the pubis is inflamed. Once this diagnosis is made, the RICE treatment, ice, anti-inflammatories, and anything else to decrease the inflammation is usually given. Because the body is trying to heal the pubic symphysis area by inflammation this is exactly the opposite of what is needed.

Osteitis pubis is felt to be an overuse injury associated with excessive kicking, running, gymnastics, or abdominal muscle contractions, for example, when an athlete does too many sit-ups. This is an erroneous notion. Inflammation of the pubis is a sign that the pubic symphysis area is trying to heal something. On bone scan there is evidence of increased circulation to the area and on x-ray there is often sclerosis or an overgrowth of bone. On “flamingo” views, the x-ray shows some instability in the area, and this is the explanation for the problem. Generally, inflammation in a joint is a sign that the joint is becoming unstable. The ligaments or capsule are no longer able to stabilize the joint so the area becomes inflamed to overgrow bone to stabilize it. The treatment is not to stop the inflammation, but to promote it. A better diagnosis in this case is not osteitis pubis, but pubic symphysis diathesis. This diagnosis indicates that the pubic symphysis area is loose. Unfortunately, milder degrees of this condition are not picked up even in “flamingo” x-ray views. One side of the pubic symphysis is generally higher than the other side on physical examination of people with this condition. The person also experiences exquisite tenderness in the pubic symphysis area.

The pubic symphysis joint may be stressed whenever the leg is pulled out from underneath a person, as can occur during a hit or a tackle. Falling, tripping, or slipping can also cause this. Swimmers who do the breast stroke often suffer chronic groin pain from a pubic symphysis injury. Prolotherapy for pubic symphysis diathesis entails injections into the fibro-osseous junction of the superior pubic symphysis ligament and injections into the pubic symphysis itself. Prolotherapy can be extremely effective in strengthening the pubic symphysis and relieving chronic groin pain in this area.

In documented published research, Prolotherapy showed marked improvement in rugby and soccer players. (1)

1. Topol GA, Reeves KD, Hassanein KM. Efficacy of dextrose prolotherapy in elite male kicking-sport athletes with chronic groin pain. Arch Phys Med Rehabil. 2005 Apr;86(4):697-702.