Osteitis Pubis (OP) – A Possible Cause of Groin Pain

Osteitis Pubis (OP) used to be an injury that I rarely saw in the clinic. However, it has been a more common sight the last few years. OP is more common in sports where kicking, twisting and explosive change of directions are required such as Australian Rules Football, football, rugby, Muay Thai and mixed martial arts (MMA).


It is hard to diagnose initially as Osteitis Pubis (OP) presents similarly to a groin strain which never goes away. With Osteitis Pubis, athletes typically complain of pain near or on the pubic bone at the base of the groin when walking, stretching, or strengthening the adductor muscles or abdominal muscles.

The narrow inferior pubic ramus and symphysis is the site of attachment for two adductor muscles (longus, and brevis) and the gracilis muscle (Figure 1). The repetitive pull of these muscles on this bit of bone inflicts micro-trauma to the area. Inflammation and irritation in the bone, and often in the muscle tendons themselves, results.

Adding to the problem, abdominal muscles also attach at the pubic bone. Therefore, both muscle groups may be pulling on the area at the same time and in opposite directions, especially when kicking.

Another contributing factor may be decreased hip internal rotation. Without adequate hip range of motion, turning and cutting manoeuvres generate a greater pull on the pelvis. The adductor longus and the gracilis muscles both arise from the pubic ramus (or tubercle). The pubic symphysis is the joint that connects the two bones of the pelvis anteriorly. Note that the pubic ramus is also the site of origin of the rectus abdominus.



Physiotherapy treatment aims to correct muscle and range of motion imbalances around the pelvis, manage symptoms through physical agents and modalities, and amend training errors through therapeutic exercise and guided return to sport. This is a very important process as improper management can set the athlete back even more. Furthermore, patience is extremely essential and the treatment protocol cannot be sped up.

Written by ALPHONSE TRANNE, Senior Physiotherapist, Prohealth In Touch Physiotherapy
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