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Pubic symphysis in Male Athletes | Caring Medical Sports



Ross.Hauser.MDRoss Hauser MD

This article will deal with the treatment of injury to the pubic symphysis in male athletes, for treatment in women please see our companion article: Symphysis Pubis Dysfunction Treatment in Women.

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.The pubic symphysis widens slightly whenever the legs are stretched far apart, and therefore activities requiring this type of movement have a higher risk of causing injury to the pubic symphysis. This widening leads to misalignment and instability of the symphysis pubis joint.

pubic symphysis injuryPubic symphysis injuries are a relatively frequent event in sports. Swimmers who do the breast stroke often suffer groin pain from a pubic symphysis injury. Sports accidents caused by falling with the legs in hyper abduction are also causes of pubic symphysis pain and injury.

 

Chronic pain that does not respond to exercise, massage, or manipulation is most likely a ligament problem. In the case of pain in the pubic symphysis, the cause is pubic symphysis diathesis or laxity. This means a loose pubic symphysis area. Unfortunately, mild laxity in the joints can only be diagnosed by palpation. There is no X-ray study that can be done to confirm it. This is also why many physicians do not diagnose it. The diagnosis of ligament laxity can generally only be made by a listening ear and a strong thumb for palpating for tenderness.

public symphysisThe pubic symphysis is actually a disc. It is a fibrocartilaginous disc that, like any other discs in the body, can be disrupted. It is supported on top by the superior pubic ligaments. In the male, the disc is higher, smaller and narrower and is located above the penis. The suspensory ligament of the penis attaches to the pubic symphysis. In cooperation with the sacroiliac joints the symphysis pubis forms a stable pelvic girdle.

Pain of the pubic symphysis area is often overlooked and blamed on the more “glamorous,” abdominal muscles and adductor muscles which attach in this area. When there is pain attributable to this area, the diagnosis is called “abdominal muscle pull” or “adductor tendonitis.”

Symptoms of pubic symphysis pain in men

Pain and tenderness is localized over the pubic symphysis and radiates outward to the upper thighs and perineum. Pubic symphysis pain may be mild or severe, and can develop into a chronic condition. It can be a burning, shooting, grinding or stabbing pain. Pain is experienced while performing such activities as running, doing sit-ups and squatting. In more severe cases, the pain affects activities of daily living and causes the sufferer to walk with a waddling gait, as pain is experienced while walking, climbing stairs, coughing, and sneezing. The person also experiences exquisite tenderness to touch in the pubic symphysis area.


Pubic Symphysis Pain Treatment with Prolotherapy


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 is extremely effective in strengthening the pubic symphysis and relieving chronic groin pain in this area. Prolotherapy solutions injected into the affected ligaments, tendons, and/or joints causes a local inflammation in the injected area. The mild, localized inflammation boosts blood supply and regenerative cells to the weakened area. This results in the deposition of new collagen, the material that the symphysis pubis is made of. The new collagen tightens the weakened, unstable joint and makes it stronger.

Only once has a patient said that a physician had examined the pubic symphysis. The pubic symphysis is the front joint of the pelvic bone. The back joint of the pelvic bone is the sacroiliac joint. If the sacroiliac joint is lax, there is a good chance that the pubic symphysis will also be lax. Regarding the treatment of chronic pain with Prolotherapy, it is advisable to treat both sides of a joint to ensure its strength. Someone suffering from low back pain should not only have the sacroiliac joints examined, but the pubic symphysis as well. Likewise, patients with pubic symphysis pain should have the sacroiliac joints palpated. Sacroiliac ligament laxity can also refer pain to the pubic symphysis.

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. In this instance, Prolotherapy 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 man’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.

Prolotherapy is extremely effective in strengthening the pubic symphysis joint and relieving chronic pubic symphysis pain.

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.

Muscles have a massive blood supply and heal extremely quickly. Rarely are they the cause of pain that lasts more than a few days. A man who continues to complain of pain in the groin area requires examination of other structures and other diagnoses should be considered.

It is rare that a man with this complaint reports that the pubic symphysis has been previously examined. Most athletic trainers and orthopedists do not ever consider the pubic symphysis structure as a source of pain.


Osteitis pubis


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.

In documented published research, Prolotherapy showed marked improvement in rugby and soccer players. (1)

1. Topol GA, Reeves KD, Hassanein KM. Efficacy of dextrose prolotherapy in elite male kicking-sport athletes with chronic groin pain. Arch Phys Med Rehabil. 2005 Apr;86(4):697-702.

 

 

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