Osteitis Pubis

Since 1924, osteitis pubis has been known as a noninfectious inflammation of the pubis symphysis (also known as the pubic symphysis, symphysis pubis, or symphysis pubica), causing varying degrees of lower abdominal and pelvic pain. Osteitis pubis was first described in patients who had undergone suprapubic surgery, and it remains a well-known complication of invasive procedures about the pelvis. It may also occur as an inflammatory process in athletes. The incidence and etiology of osteitis pubis as an inflammatory process versus an infectious process continues to fuel debate among physicians when confronted by a patient who presents complaining of abdominal pain or pelvic pain and overlapping symptoms. (See image below and Image 1.)

Causes

• Pregnancy/childbirth
• Gynecologic surgery
• Urologic surgery
• Athletic activities (e.g. running, football, soccer, ice hockey, tennis)
• Major trauma
• Repeated minor trauma
• Rheumatological disorders
• Unknown etiologies

In the pre-antibiotic era, osteitis pubis was an occasional complication of pelvic surgery, and in particular, of retropubic prostatectomy.

Overload or training errors:

• 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
• Exercising in worn out or ill-fitting shoes

Biomechanical inefficiencies:

• Faulty foot and body mechanics and gait disturbances
• Poor running or walking mechanics
• Tight, stiff muscles in the hips, groin, and buttocks
• Muscular imbalances
• Leg length differences