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Pain of
the Public Symphysis
Ross Hauser, M.D.
Pain of
the public symphysis area is often overlooked and blamed on
abdominal muscles
and adductor muscles which attach in this area with the diagnosis of abdominal
muscle pull or adductor tendonitis.
Because muscles have an excellent blood supply, they heal extremely quickly and
rarely cause pain that lasts more than a few days. A patient who continues to
complain of
groin
pain
area requires examination of the other structures. Many athletic trainers and
orthopedists do not even consider this structure as a source of pain.
If the area is examined, the diagnosis of osteitis pubis is commonly made, which
means that the pubis is inflamed. Once this diagnosis is made, the
RICE treatment,
ice,
anti-inflammatories,
and anything else to decrease the
inflammation
is usually given. Because the body is trying to heal the
pubic symphysis
area by
inflammation this is exactly the opposite of what is needed.
Osteitis pubis is felt to be an overuse injury associated with excessive
kicking, running, gymnastics, or abdominal muscle contractions, for example,
when an athlete does too many sit-ups. This is an erroneous notion. Inflammation
of the pubis is a sign that the pubic symphysis area is trying to heal
something. On bone scan there is evidence of increased circulation to the area
and on x-ray there is often
sclerosis
or an overgrowth of bone. On "flamingo" views, the x-ray shows some instability
in the area, and this is the explanation for the problem. Generally,
inflammation in a joint is a sign that the joint is becoming unstable. The
ligaments or capsule are no
longer able to stabilize the joint so the area becomes inflamed to overgrow bone
to stabilize it. The treatment is not to stop the inflammation, but to promote
it. A better diagnosis in this case is not osteitis pubis, but pubic symphysis
diathesis. This diagnosis indicates that the pubic symphysis area is loose.
Unfortunately, milder degrees of this condition are not picked up even in
"flamingo" x-ray views. One side of the pubic symphysis is generally higher than
the other side on physical examination of people with this condition. The person
also experiences exquisite tenderness in the pubic symphysis area.
The pubic symphysis joint may be stressed whenever the leg is pulled out from
underneath a person, as can occur during a hit or a tackle. Falling, tripping,
or slipping can also cause this. Swimmers who do the breast stroke often suffer
chronic groin pain
from a pubic symphysis injury. Prolotherapy for pubic symphysis
diathesis entails injections into the fibro-osseous junction of the superior
pubic symphysis ligament and
injections into the pubic symphysis itself.
Prolotherapy can be extremely effective in strengthening the pubic symphysis and
relieving chronic groin pain in this area.
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Ross
Hauser, M.D.
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POWER
OVER PAIN