What Is Osteitis Pubis?

An Injury Common Among Contact Sports Athletes

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Osteitis pubis is inflammation of the pubic symphysis, the joint of the two major bones at the front of the pelvis. Osteitis pubis is a common cause of pain in the groin and pelvis in certain sports athletes.

The pubic symphysis is a joint situated in front of and below the bladder. It holds the two sides of the pelvis together in the front. Under normal circumstances, the pubis symphysis has very little motion. But when abnormal, ongoing stress is placed on the joint, osteitis pubis can occur.

woman with pelvic pain laying down
 BSIP / Getty Images

This article describes the symptoms and causes of osteitis pubis. It also explains how this overuse injury is commonly diagnosed and treated.

Osteitis Pubis Symptoms

The most common symptom of osteitis pubis is pain over the front of the pelvis. While the pain is most often felt in the center of the pelvis, one side may be more painful than the other. The central pain typically radiates outward.

Other signs and symptoms of osteitis include:

  • Limping
  • Hip or leg weakness
  • Trouble climbing stairs
  • Pain when walking, running, or shifting directions
  • Clicking or popping sounds when shifting directions
  • Lower abdominal pain in the center of the pelvis
  • Pain when lying down on your side
  • Pain when sneezing or coughing

Osteitis pubis is often confused with a groin strain (a "groin pull") or other causes of groin pain. It also shares similar symptoms to osteomyelitis, a bone infection often caused by a bacteria called Staphylococcus aureus.

Causes

Osteitis pubis typically occurs when the pubic symphysis joint is exposed to excessive, ongoing, directional stress.

Causes of osteitis pubis include:

  • Sports activities, particularly contact sports
  • Pregnancy and childbirth
  • Pelvic injury

Osteitis pubis is most often a sports injury caused by the overuse of the hip and leg muscles. It is common in athletes who play sports that involve kicking, pivoting, or changing directions. Hockey, soccer, and football athletes are most commonly affected.

Less commonly, pregnancy and childbirth can place stress on the pubic symphysis, leading to osteitis pubis. Certain injuries, such as a severe fall, can also cause the disorder.

Diagnosis

Osteitis pubis is diagnosed based on a physical examination and imaging tests. Other tests may be performed to rule out other possible causes.

The physical exam will involve the manipulations of the hip to place tension on the rectus abdominis muscle of the trunk and abductor muscle groups of the thigh. Pain during the manipulation is a common sign of osteitis pubis.

You may also be asked to walk to check for irregularities in your gait or to see if pain occurs with certain movements.

X-rays will typically reveal joint irregularities as well as sclerosis (thickening) of the pubic symphysis. Magnetic resonance imaging (MRI)—a type of imaging test that is better at imaging soft tissues—may reveal inflammation of the joint and surrounding bone. Some cases will show no signs of injury on an X-ray or MRI.

Lab Tests for Osteitis Pubis

There are no laboratory tests that can diagnose osteitis pubis. However, lab tests may be ordered to differentiate it from conditions like osteomyelitis.

Treatment

Treatment of osteitis pubis can take several months or longer to be fully effective. Because inflammation is the underlying cause of your symptoms (rather than a break or tear), the treatment will often involve:

  • Rest: Rest allows the acute inflammation to subside. During recovery, sleeping flat on your back may reduce pain.
  • Ice and heat application: Ice packs can help reduce inflammation. Heat can help ease pain after the initial swelling has gone down.
  • Anti-inflammatory medication: Over-the-counter nonsteroidal anti-inflammatory medications (NSAIDs) like Advil (ibuprofen) and Aleve (naproxen) can reduce both pain and inflammation.
  • Assistive walking devices: If the symptoms are severe, crutches or a cane may be recommended to reduce stress on the pelvis.

Can Cortisone Help?

There have been attempts to treat osteitis pubis with cortisone injections, but the evidence supporting its use is weak. Surgery is also not a standard treatment, even for people who are taking a long time to recover.


By contrast, physical therapy can be extremely helpful in treating osteitis pubis. While rest is needed for the inflammation to subside, physical therapy can help regain strength and flexibility.

Prognosis

Once diagnosed, the prognosis for full recovery from osteitis pubis is very good. Even so, it can take a considerable amount of time. It may take some athletes six months or more to return to the pre-injury level, but more commonly, most return by around three months.

If conservative treatment fails to provide relief after six months, surgery may be explored.

Summary

Osteitis pubis is the inflammation of the joint that connects the pelvic bones, called the pelvic symphysis. Symptoms include pain in the center of the pelvis. There may also be limping or popping or clicking sounds with movement. The pelvic pain can occur while walking, running, climbing stairs, laying on your side, shifting directions, or coughing or sneezing.

Osteitis pubis is mainly seen in athletes who participate in sports that require kicking, pivoting, or shifting directions. Hockey, football, and soccer players are commonly affected. Osteitis pubic may also occur as the result of an injury, pregnancy, or childbirth.

Osteitis pubis is diagnosed with a physical exam and imaging tests. Treatment typically involves rest, heat or ice applications, and over-the-counter pain killers. Physical therapy and assistive walking devices can also help.

Once diagnosed, the prognosis for osteitis pubis is good, although the recovery can be lengthy.

A Word From Verywell

Patience is required if you have been diagnosed with osteitis pubis. As much as you may want to return to activity now, doing so prematurely may only lead to the worsening of your condition and a longer recovery time.

By taking time off to rest, you'll be able to start physical therapy sooner. This, in turn, can ensure that you return to your pre-injury levels of activity faster.

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4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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