Pubic-Bone-Stress-Related Longstanding Groin Pain
It has been well accepted that athletic groin pain can arise from bony stress around the pubic symphysis, hence the term “osteitis pubis”. That ‘diagnosis’ is confirmed by typical radionuclide imaging appearances. The radiographic features are the typical ‘moth-eaten’ appearance along the margins of the pubic symphysis with asymmetrical bony erosions, osteophytes, sclerotic bony margins and subchondral bone cysts. The radionuclide bone scan shows increased uptake on the delayed static images over the pubic tubercle.
CT scanning is also a sensitive investigation for displaying abnormalities of the bony architecture, such as cystic changes and perisymphysis erosions. In more recent times, MRI has shown bone marrow edema in the body of the pubis.
The significance of the bone marrow edema in sportspeople (mainly men) with longstanding groin pain is presently a topic of great interest and vigorous debate. As we know, Verrall et al have that bone marrow edema is present in a large percentage (77%) of footballers presenting with longstanding groin pain that is associated with pubic symphysis tenderness and a positive squeeze test. They proposed that pubic bone stress was a possible cause of the symptoms and signs such as the squeeze test but their subsequent research showed only moderate levels of sensitivityof the squeeze test when correlated with clinical and MRI criteria.
Abnormalities in all imaging modalities are seen in athletes who have no history of groin pain; nevertheless, the presence of bone marrow edema elsewhere in the body is significant. For example, on MRI it is characteristic of the bone bruises associated with serious knee injuries.
The pubic bones are subjected to considerable forces by the various pelvic structures mentioned above. It may be that pubic bone abnormalities are the cause of pain in a small group of patients or they may simply be a sign of increased bone stress when the other clinical entities are affected.
Treatment of Groin Pain
A variety of treatments have focused on the symphysis pubis and bony abnormalities.
The use of corticosteroids both as a local injection into the symphysis pubis and in oral form (25-50 mg/day for 7 days) has been anecdotally helpful, but no controlled trial has been reported. We have found a short (5-7 days) course of oral prednisolone (50 mg/day)to be helpful in settling pain, thus enabling the patient to commence the rehabilitation program earlier.
Dextrose prolotherapy injections have been shown to be helpful in one study. Monthly injections of 12.5% dextrose and 0.5% lignocaine (lidocaine) into the adductor origins, suprapubic abdominal insertions and symphysis pubis were given until resolution of symptoms. An average of 2.8 treatments were required.
Three-to six-monthly courses of intravenous injections of the bisphosphonate pamidronate were found to be helpful in one report of three cases. Some physicians are advocating the use of extracorporeal shock wave therapy but there is no evidence to support this.
Surgery has been advocated by some clinicians. In the chronic stage of the condition, where imaging shows erosions and cystic changes in the pubic symphysis, surgical exploration and debridement of the symphysis may be indicated. Symphyseal wedge resection is out of favor as it can give rise to progressive sacroiliac arthrosis and ultimately posterior pelvic instability requiring major pelvic stabilization. Arthrodesis of the pubic symphysis by bone grafting and a compression plate has been used successfully in patients with proven pubic instability.
Physical therapy is the best way to get relief of groin pain .Physical Therapy are to promotes body strength, function and mobility and prevent future physical injury. Physical Therapists design individualized treatment plans to achieve the specific goals for each patient per your doctor’s expectation. Its a unique rehabilitation technique and art that utilizes a wide variety of procedures such as restoring original functionality and movement to the body, but not limited to eliminating various kinds of pain including lower back pain, neck pain (cervical) leg pain (sciatica), groin pain and post-operative procedures. Typically after being thoroughly evaluated by your physician they generate a specific diagnosis and prescribe physical therapy. But in case of certical and serious chronic Groin pain then Surgery is the best way.