The story of Osteitis Pubis…
Osteitis Pubis (OP) was a very fashionable diagnosis in Australia for a very long time. It seemed every footballer with chronic groin pain was diagnosed with OP. You may be reading this thinking “I had OP, it must exist!”. However in fact, the labelling of OP was far from correct. As many of you will know, the term “itis” refers to inflammation and therefore Osteitis Pubis is suggesting that this is an inflammatory condition of the pubic bone. However, studies involving biopsies of patients diagnosed with OP have in fact revealed no inflammatory markers present. In fact, what we now know is that rather than inflammation, there is a stress response occurring in the pubic bone, similar to that which one may get in a stress reaction or stress fracture.
A funny story came out of the AFL recently, where an Adelaide Crows Footballer was seen reporting to media that he had OP. Meanwhile, coaches were reporting to the media that this player had pubic related groin pain – both parties talking about exactly the same injury, however using different terminology. Quite hilariously, the media went into a frenzy spinning a story that there was conflict within the Adelaide Crows as players and coaches were not in agreement. Maybe the media reporting this story should read this blog hey!
So I’m sure you’re thinking…“I’ve got pain in my groin and if it’s not OP, what is it then?”
Well, turns out pubic joint pain is only one small piece in a large puzzle that can lead to groin pain.
In 2014, the medical experts came together in Doha and decided on universal terminology. They concluded that groin pain should be classified as one or a combination of the following:
- Adductor-related groin pain
- Pubic-related groin pain
- Iliopsoas-related groin pain
- Inguinal-related groin pain (which includes abdominal related groin pain)
- Hip-related groin pain
So, what does this all mean?
The groin is a very complex region of anatomy as shown in the image above. As a result, pain in the groin can be referred from multiple structures. Thanks to the Doha agreement outlined above, we have universal understanding that groin pain can be referred from a wide range of structures including muscles such as the adductors, hip flexors (Iliopsoas) or abdominals and from joints including the hip joint and pubic bone joint.
So what should you do?
If you are suffering from groin pain, it is integral to determine what structure is causing this pain as this will guide treatment. Our physiotherapists are trained in assessment of a wide range of musculoskeletal conditions including groin pain. During this consultation, our physiotherapists will assess:
- Tenderness via palpation
- Strength, endurance, power and flexibility – particularly of abdominals, adductors and Iliopsoas
- Joint integrity – particularly of the hip joint and pubic bone joint
Following this assessment, our physiotherapists will ascertain the cause of your groin pain and treat you accordingly.
What will treatment involve?
It is paramount that any muscle deficits in terms of strength, power, endurance and flexibility are addressed. Therefore, a graduated exercise based rehabilitation program must be at the core of intervention. In addition, treatment of groin pain may include, but is not limited to:
- Education regarding pain management and load management strategies
- Soft tissue mobilisation
- Dry needling
- Sport (or activity) specific training