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Groin injury you cannot "run through".

Last year I found a good chiropractor who recommended groin exercises known as the Active Release Technique, and it has helped in the healing of scar tissue in that area. However, in the last month, pain in the middle groin area became so severe that I could not perform any physical activity. After several examinations including a CT scan, prostate exam, x-rays, and blood tests--an unusual injury was detected. It has been diagnosed as osteitis pubis, but in my case, there is a widening gap of the pubic symphysis, toward the bottom. [The pubic symphysis is the slightly moveable joint at the front of the pelvis.] Cartilage loss and bone damage are present, causing pain in that area.

My surgeon has never seen this condition before, since there was never any trauma to that area. It is most likely the result of being a runner for 25 years. The recommendation is rest and non-impact activities. My surgeon is actually doing research on the subject, to determine the actual cause a prescribe the right rehab program. 1 am scheduled to be re-evaluated in two weeks.

Is the degree of this injury common among distance runners? How long will it take to heal, and when can I return to running regularly? My own limited research on the subject has introduced me to cortisone and prolotherapy injections, various drugs and surgeries, and an extended period of rest as all possible remedies.

Terry Mott

Granada Hills, CA

Osteitis pubis is inflammation of the joint between the two halves of the pelvis that join in the front (pubic symphysis). It's common in women immediately after pregnancy. It is very easily diagnosed by pointed tenderness in the exact middle of the pubic bone. If there is tenderness more than I cm on either side of the midline, it is something other than osteitis pubis. One may or may not see widening on x-ray. A bone scan is conclusive.

Treatment involves avoiding any activity that irritates it, plus simple o.t.c. anti-inflammatory medication. It usually responds within six or eight weeks of limited activity. This is one injury that you cannot "run through."Bicycling is usually acceptable. Cross-country ski machines or rowing machines are also usually relatively comfortable. It rarely becomes a chronic problem.

G. Maud Miller, MD

Rochester, MN

The pain in this condition manifests in the pubic region and lower abdomen, as well as along the inner thigh region, usually on both sides. It may occur for no identifiable reason, but is often due to overuse. Specifically, the repetitive back and forth or up and down shearing movements between the two halves of the pelvis.

Because they are joined infront by the pubic symphysis, it can become swollen and painful. Running sports that involve abrupt cutting and pivoting are often associated with the development of this condition. Unfortunately, it can sometimes become chronic.

Tight hip adductor (inner thigh) muscles especially, but also hamstrings and weak lower abdominal muscles have been implicated as being responsible for osteitis pubis. I have not heard that it occurs in distance runners any more often than in other running athletes. For most musculoskeletal conditions, the longer the symptoms have been present, the longer it takes for them to improve. Since you have had groin pain symptoms for more than a year, improvement in your pain is most likely going to be gradual, it may require months, rather than weeks, before you can cautiously try to resume short-distance, slow running without aggravating your symptoms.

If you haven't already doen so, a course of physical therapy is appropriate. This would involve your therapist finding and correcting any imbalances in muscle strength or flexibility that the initial evaluation may have revealed.

Brian Bowyer, MD

Cincinnati, OH

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Title Annotation:THE CLINIC:
Publication:Running & FitNews
Article Type:Column
Geographic Code:1USA
Date:Jul 1, 2014
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