Pubalgia results from excessive and repetitive use of the pubic symphysis and may involve a prolonged interruption in physical activity. This entity is also known as pubic osteitis, since there is pain and inflammation of the structures around and on the pubic symphysis. The pubic bone is a place where several muscles are inserted, whose tendons become inflamed due to repetitive stress in the region of the pubic symphysis.

Many athletes, sportsmen, soccer players, long distance running, among others, feel an uncomfortable pain in the region close to the pubic symphysis, caused by overload, overuse, direct trauma or some blow that produces inflammation and pain.

Risk factors for pubalgia

Athletes are frequently subjected to a large number of games and training, and there is often no time needed for rest or an adequate stretching program, which predisposes the appearance of this entity.

The lack or inadequate execution of stretching the adductor musculature of the thigh, added to the excess of abdominal exercises that the athletes perform, can cause muscle imbalance in the pubic symphysis and, consequently, pubalgia.

Pregnancy is also a risk factor for pubalgia.

On the other hand, there are risk factors that are intrinsic to each person, such as, for example, congenital or acquired anomalies of the abdominal wall, especially in its lower locations, such as anomalies of the inguinal canal or inequalities in the length of the lower limbs that are very frequent, although inapparent, and that generate pelvic instability.

The quality of the soil and the shoes used (hard floors and the use of shoes with little shock absorption) can also contribute to the development of pubalgia.

Symptoms of pubalgia

The pain only increases in intensity when the disease gets worse. The onset of pubalgia is insidious, increasing progressively until movement is limited. Over time, the pains that previously were concentrated only on the hip, migrate to other parts, such as the lower abdomen and groins.

This disease can be easily confused with other problems, such as inguinal hernias, ruptures, urinary tract infection and tendonitis in the adductor muscles.

The symptoms are identical to those of a muscular stretch, with pain occurring during the run, abdominal exercises and squats.

Pain may also occur in the lower abdominal region, radiating to the inner thigh. Pain can also be felt at the insertion of the rectus abdominis.

Lateral movements, head movements, hip and trunk flexions can be painful.

This pain worsens with exercise, exertion or with certain postures, and can still be felt when climbing stairs or in the forward hip movement.

The pain can also radiate to the perineum and testicles and can cause low back pain when associated with an injury to the sacroiliac.

Diagnosis of pubalgia

The diagnosis of pubalgia can be delayed, given the large number of disorders that affect this region of the hip, which can mask the symptoms of pubalgia and delay an accurate diagnosis.

In general, the diagnosis is clinical, being confirmed by radiography of the pelvic area, to observe the presence of pubic symphysis instability in more than 2mm. Radiography also reveals the presence of signs of bone thickening, a sign that reflects the presence of inflammation.

Nuclear magnetic resonance allows to study the soft parts.

Treatment of pubalgia

Treatment involves rest, ice and oral anti-inflammatories.

After the acute phase, hot water compresses can be used over the region, which promote vasodilation, which is beneficial for reducing pain and relaxing the adjacent muscle.

As soon as the pain subsides, stretching exercises for the inner thigh muscles, abdominal and lower back strengthening exercises, strengthening exercises for adductors, abductors, hip flexors and extensors and stabilization exercises can be started. trunk and spine.

The return to sports activity can occur in the mildest cases after 3 to 5 days.

In the most severe cases, rest and treatment should last from 3 weeks to 3 months, and may take up to 6 months. If, after 3 months, conservative treatment is not effective, surgical treatment should be considered.

Prevention of pubalgia

Prevention goes through programmed and progressive training and prevention and treatment of all predisposing factors.

The abdominal muscles must be well worked out and the muscle stretches must be done in all workouts, in order to achieve a correct dynamic balance of the pelvis.

Alexandre Ichim