Pubic symphysis injury in Male Athletes does this ever heal?

Ross Hauser, MD
Danielle R. Steilen-Matias, MMS, PA-C

Pubic symphysis injury in Male Athletes – Does this ever heal?

We see many male athletes who have confusing and frustrating groin pain. They will come into our clinics after bouncing from doctor to doctor to doctor looking for some answer that will let them get back to his game without pain. This is a problem that they have been dealing with for years.

If you are looking for answers for your groin pain, you may be on similar paths to others we have seen.

If you are reading this article it is very likely that you are very well educated about your problem because it has gone on for some time. You have also likely not had success with the standard of care treatments you have been prescribed.

So one day you had groin pain

Symptoms that we may suspect is causing pubic symphysis pain in male athletes

Pain and tenderness are localized over the pubic symphysis and radiates outward to the upper thighs and perineum (the area between the anus and the scrotum). It can be mild or severe and is chronic.

Why nothing is working for you

In this section we are going to talk about the standard of care options doctors typically offer. We will also talk about why these treatments work very well for some people and why they are not working for you.

Pelvic ring

Let’s introduce the idea that you have a ligament problem causing pelvic instability and stress on the pubic symphysis and this is why you have pain.

In sports injuries, the glamorous ligaments are those of the knee, the ACL, MCL, and sometimes PCL and the UCL of the elbow made so famous by the Tommy John procedure. Rarely however, do patients who have pubic symphysis dysfunction have a discussion with their health care provider about the problems of the ligaments of pelvic, hip, and low back region.

So what happened that caused your pain?

Where do ligaments fit in?

In the case of pain reproduced by palpating the pubic symphysis, the cause of the pain is pubic symphysis diathesis. 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 palpation.

“abdominal muscle pull” or “adductor injuries” or pubic symphysis degeneration and slippage

The pubic symphysis plays a role very similar to that of the sacroiliac joint by enhancing overall pelvic mobility. It also is the site of attachment of the powerful adductor muscles, which move the leg inward, and the abdominal muscles whose strength helps keep force off of the lower back and discs.

Pubic symphysis dysfunction or injury 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.”

 

public symphysis

Cortisone injections into the pubic symphysis

Doctors from Ohio State University writing in the British Journal of Sports Medicine (1) discussed the use of cortisone injections into athletes with public symphysis pain. Here are their findings:

The doctors examined three studies which documented corticosteroid injections into the pubic symphysis. They note that they could not come up with definitive conclusions on an ideal strategy for cortisone because each study did not use a consistent type, strength or quantity of medication for injection

In the studied research, an average 1.24 injections (range of 1–3 injections) was performed.

The same research team also examined a 2005 study using Prolotherapy (dextrose and lidocaine) to treat osteitis pubis.(2) They note that numerous injection sites were targeted across the pubic rami and into the pubis symphysis rather than one single injection into the pubic symphysis.

Pubic Symphysis Pain Treatment with Prolotherapy

Prolotherapy for pubic symphysis injury and instability are 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.

As mentioned above, the pubic symphysis is the front joint of the pelvic bone and the sacroiliac joint is in the back. The doctor should check for sacroiliac joint instability and treat it at the same time.

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.

Do you have a question about Pubic symphysis pain? Get help and information from Caring Medical staff

1 Choi H, McCartney M, Best TM. Treatment of osteitis pubis and osteomyelitis of the pubic symphysis in athletes: a systematic review. British journal of sports medicine. 2010 Nov 1:bjsports50989. [Google Scholar]

2 Topol GA, Reeves KD, Hassanein KM. Efficacy of dextrose prolotherapy in elite male kicking-sport athletes with chronic groin pain. Archives of physical medicine and rehabilitation. 2005 Apr 30;86(4):697-702.  [Google Scholar]

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