Osteitis pubis is a medical condition which is prevalent among footballers, runners and other athletes, particularly players of Australian rules football. In Australia the condition is increasingly being referred to as simply “OP”, especially in media covering the Australian Football League.
Osteitis pubis, first described in 1924, is characterised by inflammation of the pubic symphysis, which is the joint at the front of the pelvis between the two ends of the pubic bone. This inflammation leads to sclerosis and bony changes of the pubis symphysis, causing both acute and chronic groin pain. The condition can render sufferers incapable of sustained physical activity. There is no specific treatment for the condition and it can seriously affect the careers of footballers affected by it.
The cause of osteitis pubis is excessive physical strain on the pubic bone, usually caused by the increasing rigorous demands of competitive sport, particularly soccer and football. In such sports, actions such as running, jumping, kicking and rapid changes of direction cause the abdominal and groin muscles to exercise a pulling or traction force on the pubic bone, which in some cases can result in excessive stress and inflammation. In Australian football this risk is increased by repeated jarring of the pelvis caused when players come down from the high leaps required by the game, and also by tackling from other players. This also forces the pain to arise when performing kicking motions.
In the pre-antibiotic era it was an occasional complication of pelvic surgery and in particular of retropubic prostatectomy.
Apart from an incident occurring during rigorous competitive sport or resulting from pregnancy, osteitis pubis can be categorized into two main groups:
Overload (or training errors).
The symptoms of osteitis pubis can include loss of flexibility in the groin region, a dull aching pain in the groin, or in more severe cases a sharp stabbing pain when running, kicking, changing directions, or even during routine activities such as standing up or getting out of a car.
The incidence of osteitis pubis among Australian footballers has increased sharply over the past decade. There are believed to be three reasons for this:
Until recently there was no specific treatment for osteitis pubis. As it frequently causes long-term problems, medication, stretching and strengthening of the stabilising muscles are usually used. Topol, in Argentina, used glucose and lignocaine injections (prolotherapy or regenerative injection therapy) to restart the healing process and generate new connective tissue in 72 elite athletes with chronic groin/abdominal pain who had failed a conservative treatment trial. The treatment consisted of monthly injections to ligament attachments on the pubis. Their pain had lasted an average of 11 months, ranging from 3–60 months. The average number of treatments received was 3, ranging from 1–6. Their pain improved by 82%. Six athletes did not improve, and the remaining 66 returned to unrestricted sport in an average of 3 months. Surgical intervention, such as wedge resection of the pubis symphysis, is sometimes attempted in severe cases, but its success rate is not high, and surgery may lead to later pelvic problems.
The Australian Football League has taken some steps to reduce the incidence of osteitis pubis, in particular recommending that clubs restrict the amount of body building which young players are required to carry out, and in general reducing the physical demands on players before their bodies mature.
Ostietis Pubis if not treated early and correctly can more often than not end a sporting individuals career or give them an uncertain playing future.
Damage can occur to the ligaments surrounding and bridging the pubic joint (symphysis) as a result of the hormone Relaxin which is secreted around the time of birth, to soften the pelvic ligaments for labor. At this time repetitive stress or falling, tripping, slipping can injure ligaments more easily. Usually after childbirth the hormone disappears and the ligaments become strong again. In some women the weakness persists and activities such as carrying a baby or stepping up even a small step can cause a slight but continual separation or shearing in the ligaments of the symphysis, where they attach to the joint surfaces, even causing lesions in the fibrocartilage and pubic bones. Symptoms include one or more of the following; pain in the pubic area, hips, lower back and thighs. This can take months or years to settle. X-rays taken during the early stages of osteitis pubis can be misleading, you may feel the pain but the damage doesn’t appear on the films, unless stork views are obtained (ie standing on one leg). As the process continues, later pictures will show evidence of bony erosion in the pubic bones. Osteitis pubis can also be associated with pelvic girdle pain.
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