Refresh your learning:
- Osteitis Pubis (OP) is caused by bad movement habits over time that put strain on your system, particularly the adductors and pubic area.
- OP describes a pattern of tissue damage, chronic dysfunction of the adductors (groin muscles), pubic bone and pubic symphysis caused by repetitive trauma or excessive stress across the pubic joint.
- OP can be described in three stages ranging from mild recurring discomfort when you train to severe and constant pain in the pubic area.
Diagnosing whether you have OP and what stage you are in
Obviously the very first step in treating Osteitis Pubis is making sure you have it. To date the medical community has no effective diagnostic protocol for Osteitis Pubis. They rely on X-Rays, MRI and CT scans. Scans can show physical changes and degeneration at the pubic symphysis and pubic bone but they have trouble detecting early stage OP. Nor do scans offer useful information on how to proceed. Scan results do not inform treatment or rehabilitation planning won’t help you fix your OP.
The OP clinic has developed a simple, effective diagnostic guide for OP. This guide will indicate whether you have OP (even in its early stages) and the stage (Stages of OP explained), to help us to work with you to develop a successful rehabilitation and recovery plan.
Diagnosing your Stage of OP: why it’s important
Knowing how aggravated and reactive your OP is vital information.
‘OP mechanics’ is the term we use for the biomechanical conditions, the very movement patterns that cause Osteitis Pubis. Fixing OP is about changing and correcting the dysfunctional ‘OP mechanics’ (the movement patterns that cause Osteitis Pubis) that caused you to develop OP in the first place. We need to determine how much movement, load and strain your body and adductors can manage right now.
A scan might say your pubic bone is perfect, but then a 2 kg weight leaves you sore for a week. You might have significant degeneration to your pubic bone, but little or no discomfort. Perhaps you are wasting time with a 2kg weight when you could be safely progressing through your rehabilitation faster.
Diagnosing the stage of your OP allows us to determine the:
- Amount of treatment required
- Timing/progression of exercises (when you can engage in certain functional challenges)
- Rest required between workouts
- Expected recovery time.
With this information we can create a rehabilitation plan with the highest likelihood of success.
Osteitis Pubis Self Diagnosis: a simple guide
The two main tools for OP self-diagnosis:
- Symptoms/case presentation (type and level of pain you feel, during which movements etc)
- Orthopaedic tests (a set of movements which test the integrity of the adductors, hip and pelvis).
OP is an unique musculoskeletal condition. As you well know, it doesn’t feel like any muscle tear or soft tissue injury you’ve had before. Case presentation and symptom history provides us with the most useful information.
We are interested in what your body does in the ‘real world’. How it functions and feels when your running and jumping. How it responds the day after training. It is these factors that make OP unique, because OP affects your body in a way that’s different to any other injury.
The type, level and number of symptoms provides us with significant and important diagnostic information which we can use to categorise the stage of OP you are in.
In early stage OP (stage 1) the condition has not progressed. The symptoms are fewer and more difficult to differentiate from normal musculoskeletal sensations (eg normal tightness and soreness associated with training). In these circumstances symptoms/case presentation alone may not be enough to determine whether you have OP. We then engage in orthopaedic tests.
Orthopaedic tests amplify, challenge and stress the adductors and pubic area. To put it bluntly; it involves putting pressure/stress on these areas by pushing, pulling and squeezing to see if it creates OP symptoms. We’re essentially exposing your adductors to the worst situations.
When the symptoms of OP are extremely mild this exposure shouldn’t cause significant lasting pain. If you have OP it will invoke your symptoms; confirming the diagnosis.
In stage 2 or 3 orthopaedic tests are unnecessary and dangerous. Stages 2, 3 and most cases of Stage 1 can be diagnosed without exposing you to Orthopaedic tests. We only engage orthopaedic tests if the symptom/case presentation is unclear.
Below is a checklist where we separate the symptoms of OP into moderate and severe symptoms. Every OP case is different, but as a general guide we can gain a lot of information from the amount and type of symptoms you are experiencing. Read through the checklist and simply record how many moderate and severe symptoms you experience.
For moderate symptoms you would expect to experience them at least 2 to 3 times a week or when exercising to record them as being present. Severe symptoms you only need to feel once or twice to record as being present.
|Moderate Symptoms||Severe Symptoms|
|Tightness/sore in adductors. Your adductors feel rigid and tight most of the time.||Numbness in the adductors, hip or pubic area|
|Dull pain on exercise||Weakness during exercise, a noticeable loss of strength|
|Feeling of heaviness: your groins feel heavy even when not training.||Pain in pubic bone during movement|
|Rest improves pain, but the minute you train it returns and you need to rest again to recover||Migration: Symptoms begin migrating to the hip flexors, lower back.|
|Loss of flexibility/mobility: you’ve notice a distinct lack of mobility in the groins.||More rest required. Long periods (3-4 days) of rest between exercise needed for groin to recover|
|Slow onset: You don’t feel groin at the beginning of a workout. The pain comes on slowly.||Pain immediately upon movement|
|Pain if you touch pubic bone|
How to interpret the symptoms of Osteitis Pubis (OP)
Simply tally up the moderate and severe symptoms you are experiencing and compare this to the table below.*
|Stage||Number and type of symptoms||Action|
|Possible stage 1||2 or less moderate symptoms||Perform palpation test. If positive (illicits pain) OP diagnosis confirmed. If not continue through orthopedic tests until positive result. If all tests come back negative then it’s unlikely you have OP.|
|Stage 1: Early onset||3 moderate symptoms||No Orthopedic tests required; early stage OP diagnosis confirmed|
|In between stage 1 and 2||4 moderate symptoms||No Orthopedic tests required; OP diagnosis confirmed|
|Stage 2: Fully developed OP||1 severe symptom and at least 2 moderate symptoms4 moderate symptoms experienced daily||No Orthopedic tests required; OP diagnosis confirmed|
|Stage 3: end stage OP||3 or more severe symptoms||No Orthopedic tests required; OP diagnosis confirmed|
* This stage diagnosis is a guide. Your practitioner will analyze and adjust his/her advice, treatment and planning based on other information you provide and your progress during the treatment/rehab process.
Orthopedic testing: confirming early stage Osteitis Pubis (OP)
If you have 2 or less Stage 1 symptoms there is a good chance that you have early onset OP. We can confirm a diagnosis of OP with some orthopedic testing. (Do not do orthopedic testing if you have more or severe symptoms).
The palpation, Squeeze and FABERS test will attempt to bring on/reproduce the symptoms of early onset OP by placing the adductors and pubic symphysis in a compromised mechanical position. In simple terms we put the adductors/pubic symphysis under mild pressure highlighting any pain or dysfunction present. Noticeable pain or reproduction of your symptoms would confirm OP.
Please follow the instructions above under interpreting symptoms. If you get a strong positive sign for any of the orthopedic tests do not continue on to the next test; you have OP.
Orthopedic tests for Osteitis Pubis; can they make things worse?
We only perform these tests when we are unsure of an OP diagnosis. Not to sound like a broken record, but orthopedic tests can aggravate the adductors. In stage 1 your OP has not progressed and brief testing will not cause significant issues. However in stage 2 and 3 the adductors may be extremely compromised; which is why the symptoms are severe (numbness, tingling, weakness etc.). If you have experienced any stage 2 symptoms you should avoid all orthopedic tests, as they constitute an unnecessary risk to your condition!
The adductors attach to the pubic bone. In OP the adductors are over contracted; placing excessive pressure at their attachment on the pubic bone and pubic symphysis. Over time this area of bone will become inflamed and painful; and this will present as pain when you touch the area.
The squeeze test measures the strength, function and integrity of the adductor muscles. If the squeeze test reproduces any of the moderate or severe symptoms you have OP. The severity of these symptoms will determine whether you are in stage 1 or 2 (refer to the ‘interpreting the symptoms’ section).
The FABERS test should only be performed if you are still unsure whether you have OP or not. The FABERS test puts the pubic symphysis and adductors in a very compromised position with the ball of the hip joint being leveraged out of the socket. The adductors have to work very hard to prevent this from happening. If you are performing this test you are testing for very early stage OP. Confirmation of OP will allow you to address the injury before it becomes serious.