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Demystifying ‘Osteitis Pubis’

In days gone by, any presence of groin pain was automatically classified as ‘osteitis pubis’. Used liberally, this term inherited a stigma that was associated with long-term injury and poor prognostic outcomes. Breaking the term down, 'pubis' refers to the pubic region or pubic symphysis; ‘osteo’ means bone and ‘itis’ refers to inflammation. Together its definition equates to inflammation of the pubic bone. Whilst this may be a simple explanation for symptomology, there are a vast array of other possible causes of groin pain that are related to the adductor region.

The understanding that groin pain can be caused by muscles, tendons, bone, the pubic symphysis, the sacroiliac joint, the lumbar spine or a combination of these is crucial in achieving a correct diagnosis. This leads to clear prognosis (timeframe of injury) and a rehabilitation program specific to the patient.

Regardless of specific diagnosis, management of this sort of injury often involves a variety of factors, but the three most common areas that will require improvement are strength, appropriate load management and addressing biomechanical flaws. Research has indicated that the strength ratio between opposite muscles - especially the adductors (groin muscles) and abductors (muscles that lift leg out sideways) - should be relatively equal. That said, what is often found is that the abductors are stronger than the adductors which causes muscle imbalance.

Recent research supports the belief that gradual progression of load is imperative, and utilising an acute (one week) versus chronic (approximately four weeks) workload can guide rehabilitation for an appropriate return to sport or previous levels of activity. Once loads peak or increase too rapidly, the individual is placed at a higher risk of injury or re-injury.

Unlike the other elastic/energy storage tendons of the lower limb region, such as the achilles and patellar tendons, the adductor tendon is a load transmitting tendon. This allows for the transfer of energy or force that the kinetic chain (whole body) produces to flow between the lower body to upper body via the pelvis. This is why the way one moves becomes important to ensure an area does not become overloaded or underloaded. Studies utilising 3D biomechanical measures have shown those with a history of groin pain and those that suffer with chronic groin pain move differently in comparison to normal healthy individuals. The tasks performed in these studies are the same that are utilised in the 3D Biomotion Lab at RSM, allowing us to identify areas of weakness in the way an individual moves and provide specific rehabilitation to address these directly and efficiently. 

If you would like to make an appointment with any of our Physiotherapist, or to enquire about the 3D Biomotion Lab, please call us on 1300 858 774 or email contact@recoversportsmed.com.au 

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