Osteitis Pubis is the inflammation of the pubic symphysis; the point where the left and right pubic bones meet at the front of the pelvic girdle. Individuals who are most at risk of Osteitis Pubis are those who participate in running events, especially distance runners. Weight lifters, ice skaters and dancers are also vulnerable to Osteitis Pubis, and people who have recently had prostate or bladder surgery.
Osteitis Pubis is predominantly caused by repetitive contraction of the muscles that attach to the pubic bone and the pubic symphysis, and while many things can be attributed to this, they can all be categorized into two main groups: Overload (or training errors); and Biomechanical Inefficiencies.
Overload (or training errors): Osteitis Pubis is commonly associated with sports that require a lot of running, change of direction or weight bearing activity. Other overload causes include:
- Exercising on hard surfaces, like concrete;
- Exercising on uneven ground;
- Beginning an exercise program after a long lay-off period;
- Increasing exercise intensity or duration too quickly; and
- Exercising in worn out or ill-fitting shoes.
Biomechanical Inefficiencies: The major biomechanical inefficiencies contributing to Osteitis Pubis are faulty foot and body mechanics and gait disturbances. Other biomechanical causes include:
- Poor running or walking mechanics;
- Subluxation of the sacroiliac joints;
- Tight, stiff muscles in the hips, groin and buttocks;
- Muscular imbalances; and
- Leg length differences.
The following exercises are commonly prescribed to patients with osteitis pubis. You should discuss the suitability of these exercises with your osteopath prior to beginning them. Generally, they should be performed 3 times daily and only provided they do not cause or increase symptoms.
- Transversus Abdominus Retraining. Begin this exercise in lying or standing. Slowly pull your belly button in “away from your belt line” and breathe normally. Your rib cage should remain relaxed and should not elevate during this process. You should be able to feel the muscle contracting if you press deeply 2cm in from the bony process at the front of your pelvis. Practise holding this muscle at one third of a maximal contraction for as long as possible during everyday activity (e.g. when walking etc.) provided it does not increase your symptoms. Repeat 3 times daily
- Adductor Stretch. Begin this exercise by standing tall with your back straight and your feet approximately twice shoulder width apart. Gently lunge to one side, keeping the other knee straight, until you feel a stretch in the groin or as far as you can go without pain (figure 3). Ensure the stretch is pain-free. Hold for 15 seconds and repeat 4 times at a mild to moderate stretch provided there is no increase in symptoms.
- Bridging. Begin this exercise lying on your back in the position demonstrated (figure 4). Slowly lift your bottom pushing through your feet, until your knee, hip and shoulder are in a straight line. Tighten your bottom muscles (gluteals) as you do this. Hold for 2 seconds and repeat 10 times provided the exercise is pain free.