From the Guidelines
Osteitis pubis is a painful inflammatory condition affecting the pubic symphysis, characterized by symptoms such as bone pain, reduced functional capacity, and inflammation, which should be managed with treatment goals of relieving symptoms, maintaining functional capacity, reducing inflammation, and preventing structural damage, as recommended by recent expert consensus guidelines 1. The condition typically causes pain in the groin, lower abdomen, and inner thigh areas that worsens with physical activity.
- Key symptoms include:
- Bone pain likely caused by osteitis
- Reduced functional capacity, as evaluated by range of motion, fatigue, patient-reported functional capacity, and quality of life
- Focal inflammatory signs on physical examination, inflammation markers, and radiological signs of inflammation
- Treatment goals should be discussed and agreed upon with patients before the start of treatment, taking into account individual variations and disease stages, as emphasized in the expert consensus recommendations 1.
- Management strategies may involve a combination of rest, anti-inflammatory medications, physical therapy, and other interventions aimed at reducing pain and inflammation, improving functional capacity, and preventing long-term damage.
- The expert consensus guidelines published in 2025 in the Annals of the Rheumatic Diseases 1 provide a comprehensive framework for the diagnosis and treatment of chronic non-bacterial osteitis, including osteitis pubis, highlighting the importance of personalized treatment approaches and regular monitoring of treatment outcomes.
From the Research
Definition and Causes of Osteitis Pubis
- Osteitis pubis is a common source of groin pain in athletes, particularly those participating in sports that involve kicking, twisting, and pivoting movements 2.
- The condition is usually caused by abnormal muscle forces acting on the symphysis pubis 3 and may be related to muscular imbalance and pelvic instability 4.
Symptoms of Osteitis Pubis
- Athletes with osteitis pubis typically present with progressive pain or discomfort in the pubic area or groin 2.
- There is usually point tenderness over the pubic symphysis and pain localizing to the adductor or rectus abdominis tendons 2.
- The symptoms of osteitis pubis can mimic other injuries that affect the athlete's groin, making diagnosis challenging 3.
Diagnosis and Treatment of Osteitis Pubis
- Diagnosis is based on a detailed history, clinical evaluation, and imaging studies such as radiographs, bone scans, and magnetic resonance imaging 4, 3.
- Conservative management is often the first-line approach and may include activity modification, oral medications, progressive rehabilitation, therapeutic ultrasound, steroid injections, and prolotherapy 2, 4.
- Corticosteroid injections have been used to treat osteitis pubis, with some studies showing rapid return to athletic activity 5.
- Surgical options are also available, but are typically reserved for recalcitrant cases 4.