How To Treat Osteitis Pubis

[Music] good evening everybody so tonight's live stream is about osteitis pubis which is a painful condition that runners and footballers anybody who does impact sports like those can get what I'm going to talk about tonight is I'm going to discuss the symptoms how do you know you've got it the diagnosis how do they establish what it is exactly what causes osteitis pubis to develop in the first place recovery times what you can expect then we're going to look at treatment and specifically at the end of it I'm also going to go into the exercise that works for curing this disease so I'm going to try or go into a bit of detail as far as I can now if you new to these live streams first of all let me tell you who I am my name is Marika I'm a sports physiotherapist and I'm the physiotherapist from sports injury physio calm where you can get online physio fairy therapy treatment for your injuries if you're new to the livestreams you can ask questions as I go along I'll keep an eye on the comments sometimes I forget to look at the comments but I always come back and answer them if you're watching this on replay then please feel free to ask questions as they come up and if you tagged me then I'll definitely get them so yeah let's get going so let's look at the first thing so symptoms of osteo of osteitis pubis it's basically there are quite a few different aches and pains you can get with it sometimes the pain can come on gradually over time that you start noticing it other times it's as a sharp pain that you first feel it and then it just continues no the pain can be actually I want to stand up and just show you it can be so this is where your pubic symphysis is where the main injury will be your pain can be there but it can also be into the groin up into the abdomen it can really transfer into that it can transfer down into the adductors and into that and sometimes come right round into that bit as well so it's not that it has to be just over the front of the pubis it can be all around there and it can really refer right in deep into the buttock as well for men it can also refer into the scrotum so yes I think create quite a different variety of aches and pains now the intensity of the pain can vary as well if it's really acutely flared up and you've really annoyed it and not calmed it down when you felt it the first time it can keep you awake at night it can be painful at rest sitting can be painful even for other people when it's just starting to flare up it may only be painful after exercise and then calm down after a few days you can exercise again but then it flares up again or it can be that it slowly slowly builds and you have to stop your training session because it just becomes too intense so there's a wide variety depending on how far the injury has progressed and it's useful to discuss the diagnosis and causes in combination with that because then you understand why that is now I also have to say sorry for my husky voice tonight but I've had laryngitis so if I start coughing in a minute I've got my water just here and say if we look at the diagnosis what and what is osteitis pubis huh that's the wrong one let's start with us so if you look at the pelvis that's x-ray regular x-ray of your pelvis and it's of a normal pelvis so you'll see where the yellow arrow is pointing that is your pubic symphysis so that's where your pubic bones come together and there's a cartilage discs in between them that sits in there because remember especially females we've got to give birth so that has to be able to separate during the birthing process and then come back together and you can see the things I want to you know to note there is yes there's a space and that's because the disc is there that space is narrow here it can be a little bit wider on other people but that's how it looks and then look at the very nice regular line there there are quite sharp lines you can see exactly where the spaces end and then the other thing too note is the bone is kind of there's a bit of white in the bone but it's also a bit of dark there's nothing standing out specifically there now if we look at two x-rays of people with asti I dispute Asst if you look at the top one first can you see how irregular it looks as if something stood on the bone there also it's got quite a large space at the bottom there so you can see how the bone has worn away in that bit and also for the bottom one you can see how I rank irregular that joint line now is taking you back to this one if you look at that one it's beautiful and straight lines where's that one looks as if as a moths eating it and there's also a bit more white in that area showing inflammation now one way to diagnose osteoid is pubis is by doing x-rays like these because they can show you the bone changes but it's also useful to do a MRI scan because this condition is not just about the bone yes the pubic symphysis gets worn out because of all the impact and things you've done but you also end up often there's a combination of tendinopathy in the adductor tendon so where they attach right there in - let me just show you on myself again oops which way do I go so pubic symphysis is just there okay and into the groin you've got your adductor tendons attaching there they can have a tendon appa the-- and often your stomach muscles come and attaches to the top bone there and that can actually also create a tendinopathy because all of that area usually strains with this condition so an MRI scan once you see this on x-ray it's useful to have an MRI scan as well to see the extent of what's going on there now diagnosis is not made purely on x-rays and scans you also your physiotherapist or doctor that you see will listen to your history it's often when we think of runners it's runners that does a lot of long-distance and impact running so your ultra distance are lise or people who you may only be running regular marathons but maybe you've just piled on the mileage too quickly or you've done too many of them in a row and you maybe haven't built up to that over years because it's overuse injury it's basically about repetitive impact without giving it enough time to recover then also your footballers can get it quite often because there's a lot of twisting a lot of high impact in there another part of the diagnosis about the symptoms listening to where the symptoms have come on how it's come on gradual versus sharp if it came on with a sudden kick of a ball then likely you want to exclude tears and things first before you think about this also you get a condition with very similar symptoms that's actually in from infection of the pubic bone which if you've if you've got a fever or something like that that may indicate that you've actually got an infection rather than pure osteo osteitis pubis like I've said x-ray and MRI scan can be useful for the diagnosis here and you want to be looking at the pubic symphysis that's the main one that tells you is this condition but then you can have a tendon opera in your attacked attendance as well as your rectus abdominus those three things often go hand-in-hand and that's why the pain can spread why it can be on the inside of the groin it can be high up into the stomach you could feel it in quite a few different places so let me just see where we're moving on to next okay so the causes the first and main cause for this injury is overuse and it's about a very high training volume a lot of high impact without enough recovery time and it's often not just a short period of time that you've done it it may be a whole year's worth of training that you slowly slowly built up that he just did not give enough recovery that he did too many ultra races in that year or things like that combine that with poor nutrition and things then you even get a more impressive impact on that muscle imbalances if you've got weaknesses in your certain stability muscles around that area absolutely if calls are over strain of that but so if you think of your gluteal muscles that's meant to support your pelvis as well as your hip joint if that's not strong enough on outside it can cause things to strain on the inside movement patterns if your leg collapses excessively or your pelvis drops excessively when you runs that can potentially cause over strain with that there's some research that shows flexibility or lack of flexibility can contribute to this I have to say at this point that the true and only cause of osteitis pubis has not been determined through the research there's a lot of research to show that this or that or that can help but then there's a few studies that'll show yeah actually these cases that wasn't the case so there's no clear reason and I think the reason for that is because this area is where a lot of your force or most of your force when you're on put one leg down as you run crosses through the pelvis in that area so I think it's more a combination of things that often brings it on rather than one clear cause as is with most injuries to be honest so that's why there's not a clear clear cause so for some people flexibility may be issue but other people may be hyper mobile so there's less stability so it doesn't mean that if you've got this condition you always have to stretch or you always have to strengthen it can be that you actually just need to look at your training loads that you did and then there are reasons unrelated to sports so I already mentioned high permeability that's when your ligaments are really lacks so you need really strong muscles to help stabilize your joints and it also means that your joints can take more strain than other people's joints can often ask the childbirth women can have trouble with this because let's face it especially if it's a difficult delivery things will strain for babies to move through that area so yes there are loads of other reasons that can cause this as well then if we move on to recovery time now it is overuse injury and it is an injury where there's a lot of changes that takes a long time to turn around and you're lucky if this condition settles within six months it's more likely that it takes up to a year or longer to fully get you back to your full training again now that doesn't mean that if you just sit on the couch for two years you're gonna be fixed no you've got to try and find the right level of exercise to strengthen yourself up during that time and finding the right level of exercise can also significantly actually decrease your recovery time that you can take quicker to get back to what you want to be doing and you'll see in the green they're the quicker you seek help the faster your recovery and that has actually been shown in the research that the people who had a longer period of symptoms before they looked for help they are the guys who have really struggled to get back to the normal running who has to have the injections and even go on to surgery often so if you getting any type of groin prep groin pain my advice to you would be go and seek medical advice as quickly as possible and don't go and see your GP because gp's aren't really geared up for this type of injury I would really go and see a physiotherapist especially somebody who focuses on sports injuries could be useful except if you got this condition from childbirth then seeing somebody who specializes in antenatal and things like that could be more useful or see a sports physician sports physicians are excellent at diagnosing conditions and getting the diagnosis right and once you've got that diagnosis then they often also know knows the best person to refer you to for your rehabilitation and for getting you better but do not postpone it definitely go and seek help quickly okay so then we get to treatments there is no one-size-fits-all for this condition but Arado I will say is the one thing that everybody needs is load management now what do I mean with load management it means that you immediately have to decrease the loads through that area to get it to recover so remember this is a overuse injury so you have basically used that tissue to the point we haven't given it enough recovery time so it's go gone down into a little bit of a breakdown phase so now you have to unload it for a period of time to help build it back up but when I say unload it doesn't mean use crutches and don't walk at all it means that you decrease the load to the point where it doesn't aggravate aggravate your symptoms and you can get around without it increasing your pain as it comes down you can do more and more and more because the tissue will cope with it and it will get stronger so load management means bring down that low dramatically to the point where doesn't hurt and then slowly start building it up at the rate that your body allows you to and this is probably one of the reasons why it's useful to work with somebody who's who specializes in sports injuries and stuff because what they can do is they can look at your program and they can really listen to the symptoms and things and help you put things in perspective and gauge things accurately to decide what things are not useful to do at this point and what things you can carry on with what I will say is if you've got this injury it's really devastating because it does take a long time but you will do yourself a favor if you have any races and things booked for the rest of the year just cancel them because otherwise what's going to happen is you're gonna try and get force your rehab to get you better within that certain time frame and especially with this injury if you have to pull back and take it slower for a couple of months you have to take it slower if you're gonna try and push to get fit enough to do your race or something you're gonna over strain it again and you're gonna really prolong your recovery period so it's a very difficult decision to make but just decide that you're going to focus a hundred percent on rehab and go and cancel everything else that in of impacting activity even if it's a fun holiday that you've got planned like climbing a mountain or going for a long hike just cancel all of that for now and stick to exercise that is that doesn't put weight through that area so we're thinking cycling we're thinking spinning you can get really good workouts through spinning swimming rowing anything like that could work that doesn't cause big in force in force what on earth does that even mean some big large forces through the pelvis in that area now the second thing is compression shorts seams the research seems to back that up you'll see if you go on the internet and Google compression shorts for osteitis pubis you get loads of different types they definitely help for pain management they do not really increase your level of function so what that means is when you wear them you can do things without pain but it doesn't mean that you can run more than which you could run without them if that makes any sense sorry voice just needs some water so yes especially if your condition is quite painful and you're getting pain day-to-day it may be worth getting some of those compression shorts and just wearing them under your clothing physiotherapy exercises or strength training it's probably the except for load management that and load management are the two main main important things you have to get right because what we need to do now is once you have an injury the capacity of that tissue to deal with forces when you're running or when you're playing football or when you're walking dramatically Falls so where it could cope with a 5k or 20k run it can now just cope with walking through the shops if that makes sense so now as the tissue gets better and your injury recovers we've got to slowly strengthen and back up to get the capacity of the tissue up so that it can cope with the loads you want to put through it if you just rest it you just unload it you won't change anything because think about it the only way I can build muscle is going to the gym and doing some weights I'm not gonna get a beachbody by lying on the couch I have to slowly build it back up it's important to get the exercise but right because if you jump in with exercises that strains that part too much and it's not strong enough at the moment for that then you will make the injury worse and you will make your pain worse so that's why I'm gonna talk about that in a lot of detail in a minute okay so hang on for that the fourth point there is hands on treatment and what I mean with that is things like massage dry needling acupuncture laser therapy ultrasound all of those things they are really useful to help relieve feelings of tightness and pain and make you more comfortable they are not going to fix your injury you've got to understand that for that you need load management and you need strength training but they can make you a lot more comfortable so if you've got a physiotherapist or somebody you go to it is useful for them to do deep tissue massage your stuff for you because it will help with your pain but it's you have to do the exercise as well that's the thing that's gonna fix you the massage and things is kind of like the cherry on top and to be honest you don't have to have it you can do it yourself you can do some rolling and things like that and it's not gonna speed up your recovery either it's just gonna make you feel more comfortable then steroid injections they can be useful for some people but it's important not to have them too quickly and the reason for that is that corticosteroids actually decreases the healing response now remember this condition is already a condition where healing hasn't taken place it's an overuse injury so we're trying to get that stuff to heal and it doesn't want to heal and what the research shows is that you're better off if you're conservative management of exercise and load management just does not get you anywhere then after six months or so of that you can consider corticosteroid injection but people do better if they've had the condition for a very long time and then do an injection the ones that gets the injection early on don't actually recover that well so do not go for the injection and think if I kill the pain I can get on with things it has a long-term effect that you don't want unless you make in progress then the injections can be really useful okay the second type of injection that the research has shown can be useful is a Prolotherapy injection that is actually where they inject a high sugar based I think it's sucrose that they inject sugar based injection and the sugar irritates the joint and it makes it fuse so for some people that's really useful they also do it for sacroiliac joints sometimes and what that does is it just creates more stability in that pubic symphysis but again it's not a first-line treatment it's something if the other things does not work that is worth trying okay and lastly their surgery so if you look at the research for the steroid injections roughly 50% of people who's had prolonged osteitis pubis and not responded to other therapy responds to steroid injections 50% doesn't or don't respond to it and for them surgery may be an option and again surgery can be that they go in and clean things out clean some of the tendons that may be irritated off but that may not work for everybody I that so sometimes they go and they fuse the pubic bones together and that can work for some people none of this has a hundred percent success rate but if you sir if you look for treatment and advice and the right advice early on your chances of recovering through load management and just exercise is much higher than having to go through everything else okay good so remember let me know if you've got in questions even if you're watching this on replay so then if we move on to exercise now when we talk about exercise there's strength training and there's flexibility stuff and I better talk about the flexibility stuff I've put it at the bottom there but I'm gonna mention it first because otherwise I may forget not everybody gets this condition because they're overly tight so it's worth tasting and it's really easy I do it with all my online patients just checking how flexible the hips and things are and how flexible your quads are so when we look at flexibility we want to look at internal rotation external rotation of the hip so how far can it move in how far can we move out is one side equal to the other now there's a large variation between what people should be able to do but yes it's just about not being overly tight in those movements then also a very important one is how tight of your hip flexors are you're able to get your full extension of your hip about 10 degrees or so plus easily bend your leg back so let me show you what I mean with that so if I could make this lower a little bit with hurt so are you able to grab hold of your your foot without having to do that or this being stuck there if your leg is stuck there it means your hip flexors are really tight you've got to be able to bring it back without your pelvis coming forwards because that is now me just allowing my pelvis to come forward so my back is gonna be straight so there are very easy ways of testing these things so yes if you find your hip flexors and things are overly tight then flexibility exercises may be a useful thing to throw in here what I will say is if you have a lot of pain in your groin especially in your adducts attendants be really careful not to stretch them at the beginning because stretching tendons that's inflamed or painful or has attained an operative in them can often make the pain worse so stretching the hip flexors and the glutes and stuff may be a safer option to start for with rather than going in and stretching those adductor severely okay now strength training we're looking for strength around your core as well as your your hip stability as well as basically all muscles around the top of the thigh so not just the adductors we're looking for strength in the quads we're looking for strength in the glutes especially the glute medius the adductors as well as your core muscles because all of that works as a unit to stabilize the pelvis and the hips you have to do strength training at least three times a week with us not more than that because remember again you need recovery time so you can't do strength training for that area two days and rogues you'll just over train it and then you'll end up with more pain you've got our love allow enough recovery if you're really weak you may only get away with twice a week so again it's useful to work with somebody who can just decide what is the best rhythm for you to do your strength training and things we're looking for like I said stability training so you'll look at movement patterns like with a squat does your knees move in line with the middle of your foot with the middle of your hip that they're not moving in or out and squashing the groin area there you're looking for pure strength and those muscles and things as well now don't confuse the fact that I'm saying strength training with thinking that you have to go in heavy because if you're going to go in with heavy every weights at the beginning you may actually make things worse for instance if you also have a tendon appa the-- in your rectus abdominis your stomach muscles if you're gonna go and do sit-ups often that makes it feel worse so the safest place to start is with isometric exercises which means you just hold the position so easy isometric exercise for the stomach muscles for instance would be a blank and you start with shorter holds that you don't hold it to the point where you aggravate your pain the plank is actually a nice one because it also gets the day flexes to an extent and the front of the front part of the adductor muscles an example of isometric exercise for the posterior part of the adductors and the hamstrings and stuff is isometric glute bridge and of course a side plank would really get the abductors so the side of the the hips but also do a side plank with your hips legs straight and feel how hard you add actors after work so that's a way to strengthen them as well at the beginning so I usually start my patients with isometric exercises they have to be done pain-free for this condition that's my own opinion you may have a different one but I do find that if you push into pain with this condition you end up just flaring it up then I take people through doing exercises where they do them on double legs so if we're thinking about squats and deadlifts and stuff like that before I move them on to single leg because single leg starts to put a rotation force through that pelvic area as well sorry I think we're at the end of what my voice wants to do tonight so yes I would usually work people with double leg squats and things first starting with a low load maybe bodyweight first and build that up and as soon as I find they can tolerate single leg work I'll start with that ball started with nice supported things and be careful of doing heavy lunges and stuff because of a lunge really puts a rotation through force through the pubic symphysis so if you're going to start with lunges start with static lunges and just kind of dip in dip up and always respect pain and just ease into it always keeping in the back of your mind that you're building the capacity of the tissue up you're building the strength of the tissue up it doesn't matter if today you can't go all the way down just do it to the point where you can do it and eventually your body will get used to it it will strengthen up for that range and you'll be able to do more okay then we start from stable exercise to more dynamic things what that means is you'll be doing your static squats your your static lunges then you'll go into dynamic lunges in directions and you'll also go into jumps and plyometric stuff if you're doing football if that's the sport you're getting back to you you're gonna have to add in twisting motions and things as well and kicking motions eventually but that all has to be taken for really easy levels to more heavier and faster levels eventually and from low impact to high impact now at the beginning you won't be running until you've got your base strength there if you can hop without pain usually I say okay fine and you don't have pain with your other daily activities then it's time to try a run walk but you have to kind of tick a few boxes of base strength and base exercises that you can do first before you can start running again remember what I said about if you've got any courses or any but I mean any competitions or anything booked for running or triathlon anything like that please cancel them because otherwise it's gonna make you run before you're ready for it because with the running even when we get you back to running it'll be little tasters to first see what the 24 hour responses of that because often it's only 24 hours later that you understand you feel oh no I've actually aggravated that pain again excellent so that is basically my preach for the evening let me know if you've got any questions remember if you need any help with any injuries you're welcome to consult me via video call I'll put a link to my website in the description of the video and yeah if you're watching this on replay please ask questions I'm always there and you can either message me on Facebook or you can email me through my website or you could just ask in the comments take care guys bye bye

Channel: Sports Injury Physio

Views: 57,853

Rating: 4.9262819 out of 5

Keywords: osteitis pubis, osteitis pubis treatment, osteitis pubis exercises, osteitis pubis symptoms, osteitis pubis rehab exercises, osteitis pubis self treatment, groin pain treatment, groin pain exercises, osteitis pubis running, osteitis pubis rehabilitation, osteitis pubis rehabilitation protocol, what causes osteitis pubis, treatment for osteitis pubis

Id: 2qfPvxho8tk

Length: 30min 45sec (1845 seconds)

Published: Tue Sep 17 2019