Osteitis Pubis

Osteitis pubis is a painful condition that affects the front of the pelvis.

It develops where the left and right pubic bones meet at the pubic symphysis joint.

Osteitis pubis is a common cause of groin pain in athletes and active individuals, especially those involved in kicking sports or activities with lots of twisting and turning. It is also common during and after pregnancy.

With the right treatment, most cases will settle down within a few weeks or months.

In this article, we’ll look at what osteitis pubis is, what causes it, the key symptoms to look out for, how it is treated, and how long it usually takes to recover.

What Is Osteitis Pubis?

Osteitis pubis can range from a mild irritation to a chronic inflammatory problem that limits both athletic performance and daily movement. In advanced cases, it may even cause degeneration of the joint or result in bony changes visible on imaging.

Osteitis pubis is most common in:

• Athletes: especially footballers, runners, hockey and basketball players
• Pregnant Women: or those who have recently given birth
• Post-operative Patients: particularly after pelvic or urological surgery

Osteitis pubis is a fairly rare condition and accounts for less than 15% of case or groin or inner thigh pain. But if left untreated, it can become a chronic and frustrating issue.

Osteitis Pubis Causes

There are several reasons why someone might develop osteitis pubis and common causes include:

• Repetitive stress from activities involving lots of running, kicking, pivoting or twisting motions
• Muscle imbalances around the pelvis, especially weak or tight abdominal and groin muscles
• Pelvic instability or excessive motion at the pubic symphysis
• Post-surgical changes, particularly after procedures like prostate surgery or bladder operations
• Pregnancy and childbirth, which can place strain on the pelvic girdle due to hormonal laxity and weight changes
• Sudden increases in training intensity or volume, especially in sports involving kicking or cutting motions
• Poor biomechanics, such as excessive pelvic tilt, leg length discrepancies, or altered gait patterns

In athletes, osteitis pubis often develops gradually due to repeated micro trauma rather than a single injury. Improper warm-up, inadequate recovery, and muscle imbalances can all increase the risk.

Osteitis Pubis Symptoms

Symptoms of osteitis pubis usually develop slowly over time and may fluctuate in intensity. Common signs and symptoms include:

• Pain at the front of the pelvis that may radiate to the groin, inner thigh or lower abdomen. People usually describe it as a dull, aching pain
• Tenderness and swelling over the pubic bone, particularly at the pubic symphysis
• Increased pain with movement, especially walking, running, kicking, turning, or pushing off
• Morning stiffness or aching after periods of inactivity
• Increased pain with activities that stress the pelvis, such as getting out of bed, sit-ups, coughing, sneezing, climbing stairs or standing on one leg
• Weakness in the hip or groin muscles, especially during resisted movement
• Clicking or popping sensations may occur with movement

Osteitis Pubis Diagnosis

Diagnosing osteitis pubis requires a detailed assessment from a healthcare provider, typically a physical therapist, sports medicine doctor, or orthopaedic specialist. The diagnosis is based on a combination of physical examination, medical history, and imaging studies.

At the clinical examination, your clinician will:

• Take A Thorough History: including asking about your activity levels, recent injuries, training habits, and any surgeries or pregnancies
• Palpate The Area: pressing over the pubic symphysis usually reproduces the pain. There may be localised tenderness and swelling
• Test Hip Strength And Flexibility: particularly the adductors, hip flexors, glutes and abdominals
• Perform Functional Tests: such as resisted leg raises, single-leg stance, sit-up tasks or hop tests to see if they reproduce symptoms which would indicate osteitis pubis
• Assess Gait And Posture: to identify movement abnormalities or asymmetries

Imaging studies may be used to confirm the diagnosis or rule out other possible conditions:

Differential Diagnosis

Several conditions can mimic osteitis pubis causing inner thigh pain such as:

• Groin strain or adductor tendinopathy
• Inguinal or femoral hernia
• Hip labral tear
• Femoroacetabular Impingement (FAI)
• Urinary or gynaecological issues
• Osteomyelitis (infection of the pubic bone)

A thorough clinical exam and the right imaging studies help distinguish between these conditions and ensure appropriate treatment.

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Osteitis Pubis Treatment

Most cases of osteitis pubis respond well to non-surgical treatment. The goals of treatment are to reduce inflammation, relieve pain, restore muscle balance, and gradually return to activity. Osteitis pubis treatment usually involves a combination of:

1. Rest and Activity Modification

The best place to start with osteitis pubis treatment is to avoid aggravating activities such as sprinting, kicking, or heavy lifting. This helps reduce irritation and gives the tissues time to heal.

Athletes often require a temporary break (up to 6 months) from sport to allow the inflammation to settle. Cross-training with low-impact activities like swimming or cycling may be allowed.

2. Ice and Pain Relief

Applying ice packs to the front of the pelvis for 15–20 minutes a few times a day can help reduce pain and inflammation at the symphysis pubis.

Over-the-counter anti-inflammatories like ibuprofen may also be helpful in the early stages.

3. Physical Therapy

Physical therapy is a really important part of osteitis pubis treatment and may involve a combination of:

• Core strengthening to support the pelvis and reduce strain on the pubic symphysis. Pilates can be really helpful for this
• Hip and groin strengthening, focusing on the adductors, glutes, and abdominals
• Stretching exercises for tight muscle groups e.g. hip flexors, hamstrings
• Pelvic stability training to improve control and reduce strain on the pubic symphysis
• Manual therapy to address any joint or soft tissue restrictions and improve pelvic alignment

4. Taping or Support Belts

5. Injections

If symptoms are severe or persistent, corticosteroid injections may be considered to help reduce inflammation. These should be used alongside, not instead of, physiotherapy.

6. Surgery

Surgical intervention for osteitis pubis is rare (5-10% of cases) and typically reserved for cases that fail to respond to at least 6–12 months of conservative treatment. Surgical options may include:

• Pubic Symphysis Curettage: where inflamed tissue is removed from the joint
• Symphysiodesis: a fusion of the pubic symphysis to stabilise the joint
• Wedge Resection: where part of the symphysis pubis bone is removed

Osteitis pubis surgery is generally considered a last resort due to the long recovery time and potential risks, but it can provide relief for chronic, debilitating cases.

Osteitis Pubis Recovery Time

Recovery time from osteitis pubis varies depending on the severity and duration of symptoms, how early treatment begins, and individual factors like fitness level and rehab compliance.

Typical recovery times for osteitis pubis are:

• Mild Cases: 4–6 weeks with early intervention
• Moderate Cases: 2–4 months
• Severe or Chronic Cases: 6–12 months

It is really important to follow a gradual return-to-play plan and not rush back into full activity too soon, as this can lead to recurrence of the condition. With the right treatment and rehab plan, most people fully recover and return to their previous level of function.

Osteitis Pubis Prevention

While not all cases can be avoided, there are several steps you can take to reduce your risk of developing osteitis pubis:

• Warm up properly before exercise, especially before high-intensity or change-of-direction sports
• Gradually increase training loads to avoid sudden spikes in activity
• Incorporate regular strength training, particularly for the core, glutes, and groin muscles
• Address muscle imbalances with targeted stretching and strengthening exercises
• Avoid overtraining and schedule adequate rest and recovery days
• Improve movement mechanics with the help of a physical therapist or coach, especially if you have a history of pelvic or groin issues
• Wear appropriate footwear and consider orthotics if you have foot or gait abnormalities
• Address any underlying biomechanical issues, such as leg length discrepancies or pelvic tilt

Oseitis Pubis Summary

Osteitis pubis is a painful inflammatory condition of the pubic symphysis at the front of the pelvis, often triggered by repetitive stress or biomechanical overload. It commonly affects athletes and pregnant or postpartum women, and it can significantly impact movement and performance.

Osteitis pubis typically presents as groin and inner thigh pain, tenderness, and stiffness around the front of the pelvis.

Early diagnosis, rest, targeted physical therapy, appropriate activity modification and gradual return to activity are key to recovery. While it can be a slow-healing condition, most people make a full recovery from osteitis pubis with time and proper care.

If you're struggling with persistent groin or pelvic pain, don't ignore it — early intervention can make all the difference in getting you back to doing what you love.

You may also be interested in the following articles:

• Front Hip Pain
• Outer Hip Pain
• Upper Thigh Pain
• Snapping Hip Syndrome
• Knee Pain Diagnosis Chart
• Glute Strengthening Exercises

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Medical & Scientific References

1. Osteitis Pubis. National Library Of Medicine
2. Management Of Osteitis Pubis In Athletes: Rehabilitation And Return To Training – A Review Of The Most Recent Literature. Open Access Journal Of Sports Medicine
3. Osteitis Pubis. Radiopaedia

Last Updated: June 18th, 2025
Next Review Due: June 18th, 2027