Pubic Symphysis Disorder (Osteitis Pubis/Pubic Symphysis Sprain)

Pubic symphysis groin pain is often associated with a compressive or stretching trauma of the pubic symphysis, repetitive strain or in pregnancy.

Diagnosis
Pain is often aggravated by pressure over the pubic bone or by trying to hold the legs together against resistance. There is often a relatively increased range of movement in some areas and reduced movement in other areas. Sometimes bone scans are useful to assist diagnosis.

Chiropractors perform a thorough history of complaint and examination (orthopaedic, neurological and chiropractic testing).

Evidence based summary for manual therapy [53].

Other effective non-invasive physical treatments or patient education [53]

Back-in-Action Clinic Comment
Chiropractic treatment of pubic symphysis problems in the initial phase is based on improving the movement, position and stability of the pelvis and surrounding structures in order to reduce the risk of stress and further tissue damage.

Self help recommendations of using ice or heat is often given in the acute stage. Nutritional approaches can be beneficial to help support soft tissue healing. Chiropractic adjusting techniques (manipulation) and mobilisation may be applied to improve the function of the pubic joint itself and other functionally related joints in the lower back and leg. Various muscle release techniques may be applied. An emphasis is placed on self help exercise which might include self mobilisation, stretching, strengthening and balance training. Core stability exercise often is useful for improving the position of the low back, pelvis and hip. Areas of severe muscle spasm may also benefit from massage or acupuncture. Foot orthotics, sitting advice and other ways to improve postural problems affecting the pubic bone may be suggested. Use of supportive belts can sometimes assist stabilisation. Functional neurological treatment and exercises can be helpful.

In certain severe cases where the joint is grossly unstable surgical stabilisation may be required.

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