The medical community has not yet developed an effective diagnostic protocol for Osteitis Pubis. Doctors and specialists rely heavily on inaccurate X-Rays or expensive MRI and CT scans. These scans investigate if there are any physical changes and degeneration at the pubic symphysis and pubic bone. They do not help to determine the progression/stage of OP or help to inform our treatment or rehabilitation decisions.
More information is always better, and when scans are free we support that. But MRI’s can be expensive, and we really need to question…. Exactly how useful is a scan when treating Osteitis Pubis?
3 main reasons scans aren’t particularly useful
It’s already obvious you have OP!
Radiological scans detect physiological changes in adductors, pubic bone, pubic symphysis and hip joints. They commonly find narrowing, widening, arthrosis, sclerosis, scleroderma and other ‘scary’ technical terms. All these terms essentially mean ‘wear and tear’, ‘degeneration’ or simply ‘damage’ to the area .
Unfortunately the detail/resolution of scans isn’t perfect. There needs to be appreciable physical damage/degeneration for the scan to pick it up. You are probably already in Stage 2 or 3.
The symptoms and case presentation of an OP is unique; it’s difficult to mistake OP for a muscle strain. If a patient is already in Stage 2 or 3 a practitioner/doctor should be able to recognize OP without a scan.
If your OP has progressed to the point of appearing in a scan, it should be pretty obvious that you have OP before the scan.
Scans are not detailed enough to pick up ‘early stage OP’.
Scans are poor at detecting ‘early stage OP’, which presents minor, subtle symptoms. You are unlikely to have enough (if any) physical ‘damage/degeneration’ to appear in a scan. In the early stage, scans can contribute to a misdiagnosis; the practitioner rules out OP because scans come back ‘clear’. You’re left simply waiting for your OP to get worse, to the point where it will show up in scans.
Specialized orthopaedic tests provide a more robust way to identify early stage OP. These tests mimic and challenge the functions/movements of the human body, exposing dysfunction.
Degenerative changes do not predict the seriousness of the OP case
Logically we assume that the greater the degeneration/damage to your pubic symphysis/adductors, the worse your OP must be. This is simply not true. Similar to disc pathology and lower back pain the level of damage/degeneration present in your adductors does not accurately reflect the level of pain you feel or the stage of OP.
This is because scans cannot uncover the ‘timeframe’ of the damage/degeneration, how long you have been developing OP. The following examples are two different interpretations of the same scan.
Example 1: Pregnant OP patient,one interpretation
A patient develops OP after giving birth. Three months post birth the pubic bone shows significant degeneration/damage in an MRI. If all of this damage has occurred post birth this is a serious case of OP; that is the patient’s OP mechanics (the cause of OP – link here) were bad enough to cause significant damage in short period of time.
She needs to stop all weight bearing activities, limit her walking and start with very low level core activation and pelvic stabilization to avoid continual aggravation to the groin.
Example 2: Same pregnant patient; different interpretation.
But what if our pregnant patient did not accrue her pubic bone damage post pregnancy? What if the damage/degeneration present was the result of a lifetime of overloading her pubic area, a gradual process she didn’t notice happening.
The birthing process aggravated and irritated the weakened pubic area and pushed it over the edge and into ‘OP’.
This is an extremely important and different interpretation. She is not actively damaging her pubic bone. We need to safely increase her weight bearing and rehabilitation activities, encouraging her body to strengthen and correct the weaknesses that are causing her OP. In this situation, reducing weight bearing/walking will further weaken her core and adductors, exacerbating the very causes of her OP.
There is no way to tell the timeframe of damage/OP from a radiological scan.
Scans provide static information
A radiological scan is a static snapshot of the bones and joints in your pubic area. It doesn’t tell us how your adductors or pubic area are functioning or how strong your core is or if your glutes are supporting pelvic stabilization. Scans cannot tell us how well your pelvic area is actually functioning.
If we can understand what your pelvis can and cannot do, we can develop rehab to strengthen your weaknesses and correct any imbalances. We can mould the ‘function of your pelvis’, from a pelvis which wears down/damages your pubic bone to one whose function is healthy.
Symptom profiling (see our checklist), biomechanical and orthopaedic testing provide us with the functional information we need to address the actual causes of your OP. Scans simply do not.
Should I get the scan anyway?
Certainly, if your doctor recommends it….. if it’s free, and it’s not a significant stress to do so. But if you’re having to spend considerable time or resources, perhaps you are not getting great value back from a scan. Perhaps ask the medical professional what they are looking for.
Occasionally complications or unique cases do benefit from a scan so this can be important. These situations are uncommon though. The reason for the scan in these cases would be more than to ‘diagnose OP’.
Conclusion on scans: no actionable intel!
- They cannot diagnose your OP, only confirm it when you already know you have it.
- They do not inform the timing, type or amount of your treatment or rehab you will require.
There are better tools than this to help us decide effective treatment.