The Effectiveness of Nonoperative Rehabilitation Programs for Athletes Diagnosed With Osteitis Pubis

Abstract

Clinical Scenario: The differential diagnosis of groin pain can be very challenging due to the many causative pathologies. Osteitis pubis is a pathology that is becoming more recognized in athletes who participate in sports such as soccer, ice hockey, rugby, and football. Conservative nonoperative treatment is often prescribed first before surgical intervention. Of particular interest are the outcomes of nonoperative rehabilitation programs and their effectiveness to return athletes to preinjury levels of participation. The most recent systematic review in 2011 examined the spectrum of treatments for osteitis pubis and found only level 4 (case report or case series) evidence with varying approaches to treatment. Due to the amount of time since the last published review, there is a need to critically appraise the recent literature to see if more high-quality research has been published that measured nonoperative interventions for athletes with osteitis pubis. Focused Clinical Question: Is there evidence to suggest that nonoperative rehabilitation programs for osteitis pubis are effective at returning athletes to their preinjury levels of participation? Summary of Key Findings: Four studies met the inclusion criteria. Only level 4 evidence was found. All studies reported using a structured nonoperative rehabilitation program with a successful return to preinjury participation between 4 and 14 wk, except for 1 study reporting a successful return at 30 wk. Successful long-term follow-up was reported at 6-48 mo for all patients. Clinical Bottom Line: There is weak evidence to support the efficacy of nonoperative rehabilitation programs at returning athletes to their preinjury levels of participation. Strength of Recommendation: There is grade D evidence that a nonoperative program for osteitis pubis is effective at helping athletes return to their preinjury level of participation. The Centre of Evidence Based Medicine recommends a grade D for level 4 evidence with consistent findings.

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

“…Most of the athletes return to pre-injury levels within 3 months (from 4 to 14 weeks). Moreover, a successful long-term follow-up was reported between 6 and 48 months for all patients 30…”

“…Some of these articles report resolution of pain at short-term follow-up with corticosteroids injections but a high rate of non-responders 33. Moreover, despite successful return to sport participation, a large percentage of these patients continued to report pain and/or required multiple injections 30. There is not enough evidence regarding the short- and long-term efficacy of corticosteroid injections 33–35…”

Dolor inguinal en el fútbol. Factores de riesgo y estrategias metodológicas de intervención: prevención, rehabilitación y readaptación físico-deportiva. Revisión bibliográfica

“…Aunque existen contradicciones con otros estudios que no determinan la rotación interna, abducción y extensión de cadera (Tak et al, 2017;Kloskowska et al, 2016), la fuerza de extensión de la rodilla (Kloskowska et al, 2016), ni la fuerza en la musculatura abductora, la función del tronco (Mosler et al, 2015) o el desequilibrio muscular (McCall et al, 2015) como factores de riesgo principales. También existe cierta discrepancia en cuanto a la limitación de valores de rotación externa con estudios que sí observan diferencia significativas entre sujetos lesionados y sanos (Nevin & De- (Cheatham, Kolber, & Shimamura, 2016) Revisión sistemática 4 estudios de series de casos Programa de ejercicio más terapia manual Encontraron que la combinación de programa de ejercicio terapéutico basado en la mejora de la fuerza más terapia manual (3-14 semanas) eran efectivos para la vuelta a la práctica deportiva de los jugadores (Charlton et al, 2017) Revisión sistemática 14 estudios incluidos Fuerte evidencia (estudios nivel 4) que el ejercicio terapéutico como un tratamiento para las lesiones inguinales en atletas en términos de remisión de síntoma, vuelta a la práctica deportiva y recurrencias. (Mosler et al, 2015).…”

A statistical study on the recovery of pubalgic syndrome in football players

“…Ceatham S.W. contradicted Vijayakumar P. in 2016, writing that there is little evidence of the effectiveness of recovery and reintegration programs in competitive activity (16).…”

“…Dr. Foot Analysis 4.0 -plantar surface, plantar footprint, pressure points together with the position of the center of gravity(16) …”