[Zirbelkiefer]

Unfortunately I was diagnosed with a Osteitis pubis. I do not really know what to do now. I was in the best shape of life … Should I stay away from all activities and completely rest? Do you have any experience how to best speed the healing procedure?

Thank you!

Topic

[Thomas Summer, MD]

Thomas Summer, MD on April 28, 2020 at 2:50 am #40969

Hi Zirbelkiefer,

give us some more infos, please.
What’s your main sport? What are your symptoms? Since when? How was the osteitis diagnosed? What can you do without pain? Core exercises? …

alles Gute!
Thomas

[Zirbelkiefer]

Zirbelkiefer on April 28, 2020 at 5:54 am #40976

I am a trailrunner/mountaineer with a little bit of climbing. I have been doing hill sprints 2x a week lately. During my last hill sprint session I felt some discomfort in my groin/right adductor region but it was not severe. On the next day I did a 2h run with quite some elevation. I did not have any pain during the run but when I walked the last 100m to my car I felt severe pain in my groin/adductor region.

My doc did some movement tests with the leg and asked where I had pain. I also have some pressure pain on pubis although not severe. He said he assumes osteitis pubis and that I have to take a break and suggested some physical therapy when the pain ceases. I am taking ibuprofen now. Pain is still there when I raise my leg or stand on one leg and lean forward … Not sure what to do now.

[Thomas Summer, MD]

Thomas Summer, MD on April 28, 2020 at 7:17 am #40977

That sounds not too bad. Good to react early.
Give the structures some rest, in this acute phase. Try to relieve the tension of your adductors, hip flexors, and abdominal muscles. Self-massage! But everything without pain. You can start with easy core work, but also without pain. Stop running for some days and then report back how you feel in daily life.
I would recommend taking the Ibuprofen only for some days. And then stop it, if you can tolerate the pain.
Also, look for the reasons why this problem could have started. Think about your training. 2x sprinting per week can be a lot!? Too much too soon? Core stability/training? running ground, shoes… other factors…?

[Zirbelkiefer]

Zirbelkiefer on April 28, 2020 at 8:52 am #40978

Thank you for your reply. I will emphasize rest and do some stretching. I will try a short run when the pain completely ceases and report back.

I think the reason for the injury is that I have not warmed up properly on this particular hill sprint … I know it is important to warm up properly and so some dynamic stretching before sprinting …

[Pete Dickinson MS,PT]

Pete Dickinson MS,PT on April 28, 2020 at 10:02 am #40981

The big picture on this is it’s an overreaching event. Take a look at the lead up to this injury, did you increase your volume or intensity at too quick a pace? You might like some kinesiotape support early on. I agree that complete rest is not advised, but listen to your pain levels as you return to activity. Water rehab, and bike might be avenues for activity early on.
Cheers,
Pete

[Zirbelkiefer]

Zirbelkiefer on June 2, 2020 at 2:00 am #42313

Hello,
I just wanted to give you an update of my course of injury. A couple of weeks ago I went to a different doctor who diagnosed a muscle bundle tear in the adductor region but sent me to MRI just to make sure. The MRI showed that I have a stress fracture of the pubis. The doctor advised me to stay away from running for 6 weeks in total and suggested to slowly take on training again after this periode.

These 6 weeks in total are over now. I did some core training, upper body strength and climbing in this time. No running. I can still feel the injury from time to time … not really sure how serious to take this through … I would gladly appreciate you experience with this kind of injury and how to resume training … thank you.

[Pete Dickinson MS,PT]

Pete Dickinson MS,PT on June 3, 2020 at 9:21 pm #42366

Running takes a lot of strength to attenuate the loads going into your pelvis. Your adductors are the second most powerful hip extensors, so hip hinge work will activate this region. Start off with two legged strength movements, then gradually progress to single leg work. Once you can do some single leg step up/downs with resistance, add more dynamic movements and consider a walk/jog program. Take it gradual and listen to your symptoms. It will take a while (months) to return back to higher level activity, but you’ll get there!!
Cheers,
Pete

[rich.b]

rich.b on June 11, 2020 at 6:31 am #42658

This relates back to Thomas Summer’s earlier question on the fundamental cause: a running aquaintance and I both experienced a similar problem to yours – but without getting to the point of the tear or stress fracture. In both of our cases, separate PTs identified inactivation of one of the gluteus muscles, which led eventually to overuse injury elsewhere (groin/pubis pain/inflammation). Was kind of hilarious when my PT demonstrated it. Retraining the neurological contact with specific movements was part of the rehab process.
Pete Dickinson – maybe you have encountered this in your practice?

[Pete Dickinson MS,PT]

Pete Dickinson MS,PT on June 11, 2020 at 8:57 pm #42712

rich.b,
In general, we teach movement, not specific muscle activation. Not to deny the benefit of specific activation of some muscles in certain situations. Science of human movement teaches us that movement is rarely separated out to specific deficits in a muscle activation. We went down that road with the VMO, and multifidus in the spine, only to find that trying to focus rehab activity to a single muscle was ‘missing the boat’. Now granted, there are many paths to health, and I of all people see this after 30 years ‘in the business’.
Respect,
Pete