Introduction

Osteitis pubis is an inflammatory condition affecting the pubic symphysis, the joint at the front of the pelvis where the left and right pubic bones converge. This joint, though only slightly movable, is essential for the stability and proper functioning of the pelvic girdle. Osteitis pubis primarily involves inflammation of this joint, leading to significant discomfort and impaired function.

The hallmark symptom of osteitis pubis is localized pain in the pubic region, which can radiate to the lower abdomen, groin, or inner thighs. This pain often worsens with activities that stress the pelvis, such as running, kicking, or even prolonged sitting. Alongside pain, individuals may experience tenderness in the pubic area and stiffness that can limit pelvic mobility and daily activities.

Several factors can contribute to the development of osteitis pubis. Overuse or repetitive stress from activities such as sports—particularly those involving sudden changes in direction or high-impact movements—can lead to the condition. Additionally, direct trauma or injury to the pubic area can trigger inflammation. In pregnant women, hormonal changes and increased stress on the pelvic region can also predispose them to osteitis pubis. Furthermore, it can be associated with other conditions like arthritis or infections, complicating its presentation.

Diagnosis is typically confirmed through a combination of patient history, physical examination, and imaging techniques such as X-rays or MRI. Treatment focuses on alleviating symptoms and reducing inflammation, often involving rest, activity modification, pain relief medications, physical therapy, and, in some cases, corticosteroid injections.

Osteitis pubis can significantly impact an individual’s quality of life by limiting mobility and causing discomfort. Understanding its causes, symptoms, and management strategies is crucial for effective treatment and recovery.

Pathophysiology of Osteitis Pubis

Osteitis pubis is an inflammation of the pubic bone, located at the front of the pelvis. It is often associated with athletic activities, especially those that involve repetitive movements or direct trauma to the pubic region. Here is a step-by-step explanation of the pathophysiology of osteitis pubis:

  1. Repetitive Stress or Trauma:
    • Stage 1: Exposure to Stress – Osteitis pubis can be triggered by sports activities or repetitive movements that put excessive stress on the pubic area. This can include sports such as football, hockey, rugby, or activities that require frequent changes of direction.
  2. Microtrauma and Inflammation:
    • Step 2: Microtrauma – Repetitive movements or direct trauma can cause microtrauma to the pubic area. These microtraumas can cause damage to the pubic bone.
  3. Inflammatory Response:
    • Stage 3: Inflammatory Response – Microtrauma triggers a local inflammatory response in the affected area of ​​the pubic bone. This inflammation is a natural reaction of the body to heal damaged tissue.
  4. Pain and Swelling:
    • Stage 4: Pain – Inflammation causes localized pain in the pubic area. Pain may be felt during physical activity, movement, or even at rest.
    • Stage 5: Swelling – In response to inflammation, there may be some degree of swelling in the affected area.
  5. Formation of Lesions and Calluses:
    • Step 6: Lesion Formation – Repetitive microtrauma can lead to lesion formation in the pubic bone. These lesions may involve cracks or areas of fragility.
    • Stage 7: Callus Formation – In response to injury, the body may form a bone callus in the affected area, in an attempt to strengthen the bone.
  6. Alteration of Bone Architecture:
    • Step 8: Bone Structure Alteration – Over time, repeated injury and callus formation can lead to alteration of the bony architecture of the pubis. This can affect the strength of the bone.
  7. Persistent Symptoms:
    • Stage 9: Persistence of Symptoms – Symptoms such as pain and swelling may persist, even after the activity that initially triggered the osteitis pubis has ceased.

Causes of Osteitis Pubis

The causes of osteitis pubis can be varied and include:

  1. Overuse: Excessive physical activity, especially in sports involving repetitive movements or frequent changes in direction, can overload the pubic joint.
  2. Repetitive Strain Injuries: Repetitive movements or repeated minor trauma, common in some sporting activities, can lead to inflammation.
  3. Muscle Imbalances: An imbalance in muscle strength around the pubic joint can create uneven tension, contributing to inflammation.
  4. Poor training technique: Incorrect training technique, including improper movements or sudden overload, can be a trigger.
  5. Anatomical factors: Some individuals may have anatomical variations that increase their susceptibility to osteitis pubis.
  6. Postural problems: Postural problems can lead to poor distribution of forces in the pelvic region.
  7. Direct trauma: Shock or direct trauma to the pubic region can cause inflammation of the pubic joint.
  8. Infections: Although less common, local infections can sometimes be associated with osteitis pubis.

It is important to note that these causes are not mutually exclusive, and multiple factors may contribute simultaneously to the development of osteitis pubis.

Symptoms of Osteitis Pubis

Symptoms of osteitis pubis can vary in intensity from person to person, but are typically associated with pain and discomfort in the pubic area. Common symptoms include:

  1. Pain in the front of the pelvis: The pain is usually localized to the symphysis pubis, at the front of the pelvis, and may radiate to adjacent parts of the pelvic region.
  2. Pain with physical activity: Pain often worsens during or after activities that place stress on the pubic joint, such as walking, running, climbing stairs, or participating in sports.
  3. Stiffness or decreased mobility: Some individuals may experience stiffness or decreased mobility in the pubic joint.
  4. Pain on palpation: The pubic area may be tender to the touch, and direct palpation may trigger or worsen the pain.
  5. Discomfort during specific movements: Certain movements, such as pelvic swiveling, can be particularly uncomfortable.
  6. Pain during daily activities: Everyday activities, such as getting up from a chair or bending over, may become painful.
  7. Persistent pain: Pain may persist even at rest, although it may decrease during prolonged periods of rest.

The pubic symphysis is a fulcrum for muscles that insert into and originate from the anterior pelvis, such as the rectus abdominis and the adductor muscle complex, which are antagonists. Repetitive use causing microtrauma or damage to the anterior pelvic musculature results in a muscular imbalance between the two. This imbalance disrupts the distribution of forces across the pubic symphysis and alters the biomechanics of the joint. The altered biomechanics of the joint results in stress injuries to the pubic bone and eventual cartilage degeneration.

Incidence of Osteitis Pubis

It is a disease that occurs between the ages of 20 and 40, women are more frequently affected than men.

Risk factors for osteitis pubis

Certain risk factors can increase the likelihood of developing osteitis pubis. These factors are often related to specific physical activities, anatomical features, or other medical conditions. Here are some of the risk factors associated with osteitis pubis:

  1. Participation in specific sports: Athletes involved in sports requiring repetitive movements, frequent changes of direction, impacts or intense efforts, such as football, soccer, hockey, rugby, are at greater risk of osteitis pubis.
  2. Overuse: Intense physical activity or excessive training can increase the risk of overloading the pubic joint, leading to inflammation.
  3. Muscle Imbalances: Imbalances in the strength of the muscles surrounding the pubic joint can increase uneven pressure on this area, promoting the development of inflammation.
  4. Poor training technique: Incorrect training technique, including improper movements or sudden overload, can contribute to the risk of osteitis pubis.
  5. Anatomical conditions: Certain anatomical variations, such as abnormalities in the structure of the pelvis or lower limbs, may increase susceptibility to osteitis pubis.
  6. Postural problems: Postural problems or pelvic misalignments can increase pressure on the pubic symphysis.
  7. History of pelvic injuries: People with prior pelvic injuries or trauma may be more likely to develop osteitis pubis.
  8. Gender: Osteitis pubis is more common in men, especially male athletes.
  9. Age: Although it can affect individuals of any age, osteitis pubis is often seen in young adults and active athletes.

It is important to note that the presence of these risk factors does not guarantee the development of osteitis pubis, and some people can develop the condition without having these factors.

Approach for those suffering from Osteitis Pubis

Osteitis pubis presents with tenderness above the pubic symphysis, pain radiating to the inner thigh, and a waddling gait. This dysfunctional gait can lead to bursitis and tendonitis of the lower limbs, which can blur the clinical picture and increase pain.

Exercise

Transverse abdominis rehabilitation

While lying on your back, contract your abdominal muscles as if you were pulling your belly button toward your spine.
Hold this position for several seconds. Do not lift your rib cage.
Try to keep the rest of your body, other than your abdominal muscles, relaxed.
Repeat this exercise three or four times a day.

Osteitis Pubis X-ray

Radiographic signs of osteitis pubis can vary and can sometimes be subtle. It is important to note that in many cases, changes may not be evident on plain radiographs, and more advanced imaging techniques, such as MRI (magnetic resonance imaging) or CT scans, may be necessary for a more detailed evaluation. However, here are some possible radiographic signs that may be seen in advanced or chronic cases:

  1. Widening of the pubic symphysis: Osteitis pubis can sometimes cause widening of the pubic joint, which may be visible on x-rays.
  2. Erosion or degenerative changes: Signs of bone erosion or degenerative changes may be seen at the pubic symphysis.
  3. Bone sclerosis: Thickening or densification of the bone around the pubic symphysis may be a sign of a reaction to inflammation.
  4. Fracture line or cracks: In some cases, fracture lines or cracks may be visible, reflecting a response to excessive stress on the pubic joint.

It is important to note that radiographic changes may not be evident early in the condition. MRI is often more sensitive for detecting early signs of inflammation and soft tissue changes around the pubic joint.

X-rays show erosion, sclerosis and widening of the pubic symphysis.

Reference

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