Nonoperative Management, Rehabilitation, and Functional and Clinical Progression of Osteitis Pubis/Pubic Bone Stress in Professional Soccer Players: A Case Series

Abstract

Study Design Case series. Background Pubic bone stress (PBS) is a common acute or chronic response of the pelvis in sports where sprinting, kicking, twisting, and cutting are the dominant movements. There are few nonoperative rehabilitation strategies for the condition reported in the literature, and the outcome of conservative treatment has not been documented. Case Description Five professional and academy soccer players complaining of pubic symphysis pain, confirmed as PBS on magnetic resonance imaging and objective assessment, were treated with a nonoperative rehabilitation program that featured functional and clinical objective markers as progression criteria. Interventions in the acute phase included pharmacological and physical therapeutic modalities to reduce pain initially. Rehabilitation management focused on improving range of motion at the hips and thorax, adductor strengthening, trunk and lumbopelvic stability, gym-based strength training, and field-based rehabilitation and conditioning. Clinical follow-up was performed at least 8 months following return to play. Outcomes All players demonstrated reduced or resolved pain, increased adductor squeeze strength, and return to pain-free training and match play. Return-to-training time averaged 40.6 days (range, 30-60 days) and return to play averaged 49.4 days (range, 38-72 days) within the 5 players. At final follow-up (mean, 29.6 months; range, 16-33 months), there had been no recurrences. Discussion This report of 5 cases suggests that a nonoperative protocol, using clinical and functional progression criteria, may be successful in rehabilitating athletes with PBS for return to sport within 11 weeks. Level of Evidence Therapy, level 4. J Orthop Sports Phys Ther 2017;47(9):683-690. Epub 3 Aug 2017. doi:10.2519/jospt.2017.7314.

Management of osteitis pubis in athletes: rehabilitation and return to training – a review of the most recent literature

“…Physiotherapy seems to have been successful for treatment of osteitis pubis in the athletes, and local shock wave therapy significantly reduced pain, thus enabling return-to-play within 3 months of injury 31. McAleer et al32 described a non-operative rehabilitation program for professional and aspiring professional football players with osteitis pubis. Their rehabilitative protocol was based on a specific nine-point program that included pain control, tone reduction of over-active structures, improved range of motion at hips, pelvis and thorax, adductor strength, functional movement assessment, core stability, lumbo-pelvic control, gym-based strengthening and field-based conditioning/rehabilitation.…”

Long-standing pubic-related groin pain in professional academy soccer players: a prospective cohort study on possible risk factors, rehabilitation and return to play

“…Nevertheless, Schöberl et al showed the superiority of intensive conservative therapy over the absolute abstention from sports in their level 1 study [10]. Recent studies have emphasized the importance of an individualized, progressive, multimodal rehabilitation program [10,11,25,36]. In the program presented in this study, patients move through the levels after they are able to perform exercises without pain and achieve adequate levels of motion and core stability grading [11].…”

“…Youth players suffering from long-standing pubic-related groin pain typically present with nonacute, load-dependent pain over the os pubis or symphyseal gap. Pain can be unilateral or bilateral, and it is typically Eberbach et al BMC Musculoskeletal Disorders (2021) 22:958 exacerbated by running, kicking, hip adduction or flexion, and eccentric loads on the M. rectus abdominis and/ or the adductors [11,25].…”

“…1). It was developed according to the evidence available for adult players and adapted to the specific characteristics of youth players, resulting in a step-wise return-to-play process for each individual youth player [10,11,13,25,[33][34][35][36][37][38][39][40]. Except for the first phase, there was no time recommendation for completing the rehabilitation levels.…”

Does trunk and hip muscles strength predict performance during a core stability test?

“…31 In fact, a recent study demonstrated that a nonoperative rehabilitation program including core stability training reduced pain and allowed return to training in soccer players with pubic stress syndrome with no recurrence after two years. 32 Hip extensors strength predicted increased magnitude of pelvic posterior rotation during the bridge test. Gluteus maximus is a hip extensor that is recruited to maintain hip extension of the support limb during the bridge test.…”