Pelvis / Coccyx
Osteitis Pubis
치골염
Overuse inflammation of pubic symphysis and surrounding structures
- How common
- 2–7% of kicking-sport athletes
- Typical age
- Male athletes, ages 20–40
What is it?
Repetitive shear forces and adductor/rectus imbalance produce microtrauma at the symphysis, causing inflammation and bone remodeling.
Commonly affected: Pubic symphysis and adductor/rectus attachments
How it develops
- Repetitive ShearKicking/cutting loads the symphysis in torsion
- Muscle ImbalanceAdductor vs rectus abdominis pull mismatch
- Microtrauma/InflammationMicrodamage to cartilage and bone
- Bone RemodelingSclerosis, erosion, widening
Symptoms
- Central pubic painLocalized tenderness over symphysis
- Worse with kicking/sprintingAggravated by cutting, acceleration
- Groin painUni/bilateral groin radiation
- Adductor tightnessPain with resisted adduction
- Stair/rising painPain during load transfer
How it is examined
- Symphysis tendernessDirect tenderness over symphysis pubis
- Resisted adduction testSqueeze test reproduces pain
- Resisted sit-upRectus contraction provokes pubic pain
- Single-leg stanceSingle-leg stance reveals pain/instability
Imaging
AP pelvis X-ray is primary — shows widening, sclerosis, erosion.
- Pubic symphysis widening
- Subchondral sclerosis
- Erosion of articular surface
- Irregular margins
MRI is sensitive for early disease and surrounding edema.
- Pubic bone marrow edema (STIR)
- Symphyseal joint effusion
- Adductor/rectus enthesis edema
- Possible microfracture line
Non-surgical care
- Relative rest/activity modTemporary halt of kicking/cutting, graded return
- NSAIDs2–4 weeks anti-inflammatory
- Core/adductor rehabTransverse abdominis and adductor strengthening
- ESWT / injectionESWT or steroid injection for chronic cases
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Conservative failure >6 months, chronic instability
Procedures that may be discussed
- Symphyseal curettage
- Symphyseal arthrodesis
- Polypropylene mesh reinforcement
Outlook
Most improve in 3–6 months with conservative care; balanced strength prevents recurrence.