PUBIC SYMPHYSIS LAXITY
A COMMON SOURCE OF ABDOMINAL MUSCLE PAIN / SPORTS HERNIA
Ross Hauser, M.D.

Many people are subjected to hernia surgeries for chronic groin pain, which has nothing to do with a hernia! Patients come to us after a hernia surgery failed to "cure" them of their groin pain.

Most orthopedists do not routinely examine the pubic symphysis area because it means making the patients drop their drawers and palpating them in the groin area. The pubic symphysis is the front of the pelvis joint. It is connected together by a fibrocartilagenous disc, which is often injured. Injuries to this area are most often caused by slipping or falling, when the leg is suddenly pulled out from underneath. Swimmers who do the breast stroke are also vulnerable to injury in this area. Prolotherapy is extremely effective in strengthening the public symphysis and relieving chronic groin pain in this area. This is one of the most overlooked injuries and one of the most easily treated by Prolotherapy.

A patient had had every abdominal xray/scan/medication one could think of, but still had abdominal pain. They were not particularly tender in the abdomen but did had tenderness over the pubic symphysis.

Their abdominal pain did seem to occur when they were doing a lot of exercise, but no one really thought about the connection. Well, the real connection is the one between the rectus abdominis and the pubic bones. The abdominal muscles attach to the pubic bone and when the pubic bone connection (via the pubic symphysis) is not stable, it means the abdominal muscles are contracting against a non-stable base. The end result dull, non-descript abdominal pain.

Prolotherapy to the pubic symphysis caused the area to become stable. Then when the patient contracted their abdominal muscles, there would be no pain because muscle contraction would be normal. Do you or a friend have abdominal pain that is not resolving, consider an evaluation by a doctor familiar with Prolotherapy.

Pubalgia (Groin Pain)
Sometimes athletes come in with the diagnosis of pubalgia. The "algia" prefix just means "pain."

A diagnosis of pubalgia, therefore, just means groin pain. In our opinion, the most common cause of pubalgia, or groin pain, is pubic symphysis diathesis or injury to the pubic symphysis itself. Traditional orthopedics teaches that the most common cause of groin pain is a strain injury to the muscles of the groin region, including the adductor longus, rectus abdominus, iliopsoas, and rectur femoris muscles. (Renstrom, P. Groin injuries in athletes. British Journal of Sports Medicine. 1980; 14:30-36.)

Muscle strains, however, heal very quickly but, in rare cases, do not heal. They do cause some of the chronic groin pain problems in athletes, but not all.

One etiology that is often overlooked in the evaluation of groin pain is an incompetent abdominal wall in the groin. In cases of groin pain with no palpable hernia and no other etiology for the groin pain, the diagnosis is called pubalgia in the European literature. In such cases, what is sometimes found are microscopic tears of the internal oblique muscle in the area of the muscle that attaches to the superior pubic symphysis. (Taylor, D. Abdominal musculature abnormalities as a cause of groin pain in athletes. American Journal of Sports Medicine. 1991; 19:239-242.)

In patients with groin pain due to abdominal wall abnormalities, one finds a history of inguinal pain that worsens with strenuous activity, especially activity stressing the abdominal muscles, such as sit-ups. On physical examination there is tenderness of the pubic tubercle and a positive jump sign is elicited. Prolotherapy, in this instance, to the muscle attachments onto the pubic symphysis is often curative. All of the other muscle attachments to the groin area, including the rectus femoris, gracilis, rectus abdominis, and adductor group, can all be treated with Prolotherapy if there is tenderness and reproduction of the athlete's pain upon palpation of the area where the muscle attaches to the bone. If a positive jump sign is elicited, the diagnosis is made and Prolotherapy is given to the weakened fibro-osseous junction.

Read our Groin Pain Blog