Symptoms of OP: stage by stage description
Stage 1: Early Onset Osteitis Pubis
OP usually starts as just some stiffness and tightness in the adductors (groin) during exercise. You might feel some dull pain and stiffness the next day but with some heat, rest and gentle stretching you are fine for your next training session. Then, 20 minutes into training it starts again. You go through the same process of rest and stretching, but it keeps coming back. The pain will probably get a little worse, the stiffness might take longer to stretch out, but you just keep on training just the same.
None of it strikes you as a ‘serious’ problem. The pain isn’t agonizing and as long as you warm up properly before exercise, you can get through a session. You probably assume it will ‘sort itself out’ at some point.
We refer to this is Early Stage OP. The pain and stiffness is present, but it’s mild and doesn’t change your exercising or training habits very much.
Early stage OP can be corrected easily. Removing aggravating activities whilst engaging in rehabilitation and self treatment, you should be able to continue your personal training whilst recovering. Preventing OP from every truly developing, you should recover within 2 – 6 weeks.
Stage 2: Fully Developed Osteitis Pubis
You keep training but now the pain is worse.
You wake up in the morning with stiff heavy adductors. Stretching doesn’t help anymore; it might even make the pain worse. Pain often begins as soon as you start exercising. The pain migrates and may be felt in your hip flexors, lower back or lower abdomen. It’s becoming harder to train, and if you do train, it takes twice as long to recover. You might even start to get that dreaded pain on the pubic bone.
You see a physio or get a massage. They tell you to rest, stretch and give you some exercises to strengthen your hips (pilates clams, theraband exercises etc.) or core (planks, bird dog etc.). You see some improvement, but the minute you return to a full training load the pain is back and often worse.
No matter what you do, you cannot seem to get rid of that stiffness in your groin.
At this point you have fully developed Osteitis Pubis. Rest helps, but it also lets your adductors weaken, so they are vulnerable to re-injury. Clams and theraband exercises might deal with a few biomechanical issues, but it’s like plugging a hole in a dam wall with chewing gum! The fix just doesn’t last.
At stage 2 you need to move quickly. If you can engage effective rehabilitation and self treatment you can halt its progression to stage 3. You will need to rest from most running, cycling and change of direction activities, but your body should respond well to rehab, and you should be back on the track/field within 8 – 12 weeks.
Stage 3: Late stage Osteitis Pubis
In the final or Late Stage OP you start feeling regular pain on the pubic bone and pubic symphysis. The stiffness is ever present in your life. The pain has migrated to other areas. It feels as if your entire pelvis is breaking down on you. Coughing might even bring on pain.
At this stage you might be sent off for scans. These show scelorsis, widening of the pubic symphysis or other serious issues in your pelvis. Now you’re being told complete rest and being asked to consider surgical options. These can include burning of the ends of your pain receptors in your groin, shaving your hip socket or cutting your adductor tendon to release pressure.
And still no one has explained to you how or why you developed Osteitis Pubis in the first place. If they cannot tell you why you developed OP, how can they give you an effective solution? How can they ensure that your OP won’t come back?
At stage 3 your situation seems dire; will you ever recover? Will you ever be able to return to that activity/sport you love?
It will involve hard work, but the body is resilient. It’s built to heal itself and recover; it just needs the right treatment, the right rehabilitation and most importantly the right attitude. You will need to start from ground zero, building up your core strength and glute activation. Methodically you will need to rebuild your pelvic stability. It might seem impossible but it isn’t. You may have been injured for years, but with quality treatment and rehabilitation you can be back to running with 12 – 16 weeks!