Groin pain in Runners
Alternative treatment for osteitis pubis
Runner finds help for groin pain after a 2 year search, plus 2 surgeries!
WB a 27 year old runner from Indiana came to see us with a diagnosis of osteitis pubis. Running especially aggravated the injury but most activities aggravate it. Patient reported that if he rested the injury for a few days, he would be pain free. But then after running a mile or so, then the pain became so bad that he had to stop all activity again after just two days of running. WB’s pain started in the bilateral groin area and got progressivly worse. He also reported that the pain radiated to the abdomen and inner thighs. He was checked by a sports medicine doctor for hernias back in 2008 and had two hernia repairs at that time. However, WB reported that he continued to have his same type of pain even after the hernia repair surgery. He then tried several cortisone injections into the pubic symphysis area which helped the pain for about 1-2 weeks, but then the pain would return. He felt that the pubic symphysis area was where the pain was originating from and that it radiated out from there. He had also tried taking oral anti-inflammatory medications for a short period of time, but those stopped working as well. WB reported that his pain was a 7/10 typically, worse when he tried to workout. WB had been suffering with this condition for two years before finding Caring Medical on the internet.
WB’s initial consultation & treatment:
Dr. Hauser examined WB and felt that he was correct. The underlying cause of his pain was due to ligament laxity in the pubic symphysis area. Because this problem was so longstanding and chronic, Dr. Hauser also recommended a strong solution, so sodium morrhuate was added to the regular dextrose Prolotherapy solution. The patient received 36 cc to the area and was told to avoid using anti-inflammatories, to use heat instead of ice, and to utilize natural healing supplements.
What about exercise?
Because this injury had been going on for so long and due to the history of running worsening the pain, Dr. Hauser advised WB to avoid running until his next appointment. Now you might think that WB was horrified at that recommendation, but Dr. Hauser showed him other less traumatic ways to continue his level of fitness including training on the ellipitical or recumbant bike, as well as swimming. WB had the right attitude – he looked at this as a good reason to start cross training. Who knows? He might end up doing a triathlon!?
WB reported that after his first visit he felt no pain with activity, but he did not run, as he was instructed to avoid doing. On WB’s second visit 3 weeks later, Dr. Hauser treated the same area and asked the patient to begin exercising on the elliptical. Patient was unable to swim as he didn’t have access to a pool. He was taking the supplements and thought that these helped his healing. WB’s third treatment produced even more pain relief and Dr. Hauser allowed WB to start running with planned walk breaks. On WB’s fourth visit, he reported that he started running and weight lifting. He was definitely feeling improvement in the level of pain and the frequency. On treatment number 5, WB reported that his pain was significantly improved. He had also greatly increased his exercise and physical activity so he did experience some pain because most likely he added too much back too soon. Dr. Hauser treated the area again with the strong solution. On the patient’s last treatment (7 total) Dr. Hauser used PRP (platelet rich plasma) to give him that final level of healing he was looking for. After this treatment, he reported that his condition had 100% resolved. He is back to running and weight lifting with out incident. Except for one minor problem – he injured his left shoulder from all the weight lifting! Guess what? Yup! He is now treating his shoulder with Prolotherapy! So far, he has had 3 treatments and is seeing great results. He reports it is much more stable and he no longer hears any cracking or pain with palpation or activity. WB is back to doing light weight-lifting, and is still able to run.
Pubic pain in athletes:
Pain of the pubic symphysis area is often overlooked and blamed on the more “glamorous” abdominal muscles and adductor muscles which attach in this area. When there is pain attributable to this area, the diagnosis is called “abdominal muscle pull” or “adductor tendonitis.” You can see how this affected WB – he ended up with two hernia surgeries, only to be left with the same pain he had prior to the surgeries!
Muscles have a massive blood supply and heal extremely quickly. Rarely are they the cause of pain that lasts more than a few days. An athlete who continues to complain of pain in the groin area requires examination of other structures and other diagnoses should be considered. It is rare that an athlete with this complaint reports that the pubic symphysis has been previously examined. Most athletic trainers and orthopedists do not ever consider this structure as a source of pain.
If the area is examined, the diagnosis of osteitis pubis is commonly made, which means that the pubis is inflamed. Once this diagnosis is made, ice, anti-inflammatories, and anything else that can be thrown to the athlete to decrease the inflammation is given. Because the body is trying to heal the pubic symphysis area by inflammation this is exactly the opposite of what is needed. As you can see, this is exactly what happened to WB. If he had not found Caring Medical on the internet, who knows what would have happened to WB. He might have ended up with chronic pain for the rest of this life and he certainly would not have been able to run again.
Ross A. Hauser, M.D
Dr. Hauser the Medical Director of the comprehensive Prolotherapy, PRP, and Bone Marrow Prolotherapy clinic, Caring Medical & Rehabilitation Services in Oak Park, Illinois treating groin pain and other running related injuries. Dr. Hauser is one of the leading experts in the treatment of chronic pain and sports injuries with Prolotherapy.