Osteitis pubis

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Osteitis pubis is a medical condition which is prevalent among footballers, runners and other athletes, particularly players of Australian rules football.

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 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.

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

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:

• The increasing physical demands of Australian rules football. As the game has become more professionalised, with players becoming full-time athletes, such factors as running speed, kicking length, jumping and tackling have all increased, placing increasing stress on the pubic region.
• The increasing hardness of the surfaces of football grounds. Grounds are better drained than in the past, and the game is increasingly played in roofed stadiums in which the grounds receive no rain. Australian football evolved as a winter game played on soft, muddy grounds, and modern surfaces have made muscle and bone injuries more common.
• The increasing demand for size and strength among footballers. This has led young players to concentrate on building muscle mass before their bodies are fully mature. The additional strain that highly developed abdominal muscles place on the pubic bone explains the higher prevalence of osteitis pubis on young players. Some develop the condition while still playing school-level football.

There is no specific treatment for osteitis pubis, and it frequently causes long-term problems, in some cases ending a player's career. Management strategies involve modification of activity, physiotherapy, anti-inflammatory medication, and stretching and strengthening of the stabilising muscles. 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.