The symptoms of inflammation of the pubic bone (pubalgia) are caused by a disease that affects the tendons that attach to the pubic bone, i.e. the abdominal muscles and hip adductors.
It involves pain in the abdomen or groin area and can prevent people from playing sports or doing their daily work, eventually leading to a long break in sports activities.
Pubalgia primarily affects hockey, football, and soccer players, and almost exclusively men .
It is almost impossible to find people in the hospital who do not belong to one of these categories.
Children and adolescents under the age of 16 are rarely affected.
The muscles and tendons involved in pubalgia attach to the pubic bone:
- external oblique muscle of the abdomen;
- internal oblique muscle of the abdomen;
- Kammmuskel (Pectineus);
- short adductor (adductor brevis);
- langer Adduktor (Adductor longus);
- large adductor (adductor magnus);
- slender muscle (gracilis).
These muscles may suffer injury, while the tendons may have enthesitis with calcification , possibly associated with irritation of the groin nerve. The pain may radiate to the lower abdominal muscles: the perineum, testicles , adductors, hips, and thighs.
Symptoms usually appear on one side only, but they can be bilateral in nature. The occurrence is traumatic in nature or occurs insidiously, with slowly increasing symptoms. Acute pain becomes chronic if athletes do not take a break from sport. This illness can drag on for months or years and ultimately mean the end of a sporting career.
In fact, the main problem is that the pain persists despite immobilization. The following movements can trigger pubalgia: quick changes of direction, shooting, straddling, rotating movements and dribbling.
Coughand sneezing usually increase pain symptoms. It often takes months to diagnose pubalgia because there are no objective criteria for discrimination. Therefore, other diseases must be ruled out first.
Pubalgia is not an inguinal hernia , there is no tissue protrusion.
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What are the causes of pubalgia?
Pubalgia only affects competitive athletes who practice a sport that overuses the pubic bone.
The possible origin of the pain can be attributed to various circumstances:
- a violent or aggressive movement that causes injury to the adductors, obliques, or myofascial structure;
- inflammation of the tendons (enthesitis) of the above muscles;
- a degenerative arthropathy of the pubic symphysis;
- a tightness of the lumbar iliac muscle (iliopsoas);
- inflammation of the pubic area from trauma ;
- a tear of the adductor tendons;
- an abnormal attachment of the adductors or rectus abdominis;
The possible risk factors are:
- weakness of the abdominal or groin muscles;
- sports activities with a hollow back posture, which overstrains the abdominal muscles;
- Mismatch between (stronger) adductors and (weaker) abdominal muscles, causing abnormal distribution of pelvic forces;
- an excessively rigorous exercise program that can produce muscle injuries and tendonitis (enthesitis);
- Women don’t suffer from pubalgia as their muscles and tissues are more stretchy (like during pregnancy ) so it’s all a matter of elasticity.
What are the symptoms of pubalgia?
Athletes suffering from pubalgia complain of pain and stiffness in the groin area. Where exactly is the pain? The pain occurs at the level of the bone below the abdominal muscles and above the genitals, it can be slightly shifted to the right or left.
The pain increases with physical activity, but in the early stages of pubalgia, physical activity can continue.
Symptoms worsen with any movement that involves contraction of the abdominal muscles and adductors.
Whenever the abdominal pressure increases, the pressure on the pubic bone also increases, causing severe pain.
Some of the normal daily routines can be painful: coughing, bowel movements, and sexual intercourse.
At an advanced stage, simply getting out of the car and standing for a long time can cause pain; moreover, the pain can last throughout the day, making it difficult to carry out everyday activities.
The patient finds it difficult to localize the painful stitches because the pain is diffuse.
The intensity of the symptoms can change over time: they can subside a little during rest periods and get worse after a game.
Without treatment, this disease becomes chronic and can mean the end of a sporting career.
How is pubalgia diagnosed?
In this case, a naturopath or orthopedist is responsible. The doctor must examine the patient’s medical history to identify risk factors such as physical activity and activities that involve repetitive movements. It is important for the patient to inform the physician whether the symptoms result from direct trauma or whether they have an insidious onset. The doctor must know the patient’s symptoms and how long they have been present; it is also important to know what kind of pain it is.
Physical examination
First, the doctor examines the painful area and presses on the affected tendon in order to be able to precisely localize the symptoms and any swelling of the tendon. There is a test to assess pubalgia: the patient lies on his back with his knees bent and his back firmly pressed against the surface.
He then has to perform a hip closure movement by bringing his knees closer, against the doctor’s resistance. The test is positive if there is pain in the groin area. Then the doctor must assess whether there is a restriction of movement, because the symptoms could also be caused by joint problems.
Assess the myotendinous reflexes to rule out a pinched nerve. With pubalgia, it is particularly important to evaluate weakness in the abdominal muscles, particularly the rectus abdominis.
Normally there is a big difference between the muscle strength of the abdominal muscles and that of the adductors.
Differential diagnosis
The doctor must exclude the following diseases:
- inflammation of the pubic bone;
- adductor muscle strain or muscle tear ;
- pubic fracture ;
- Entrapment of the genitofemoral or ilioinguinal nerve;
- Hüftarthrose;
- neuropathy of the femoral nerve ;
- Referred pain from back ;
- gastrointestinal and urinary tract infections;
- Formation of varicose veins in the vein plexus of the spermatic cord (varicocele);
- inflammation of the prostate;
- Inflammation of the lymph nodes .
Diagnostic investigations
Imaging procedures are of great help in diagnosing pubalgia; the doctor may order an X-ray to rule out other conditions, such as arthritis and fractures, but tendons and muscles will not be shown there. A skeletal muscle sonography, on the other hand, is very helpful in detecting tendon damage because this diagnostic method provides images of the soft tissue. Magnetic resonance is the best form of examination because it shows tendon swelling, inflammation, lesions and other problems such as arthritis , calcifications , tumors, etc.
- Treatment of pubic inflammation
- Symptoms of appendicitis and surgical intervention
- Inflammation of the long biceps tendon of the shoulder
