what if it was pubalgia?

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Each week, Dr. Jean-Marc Sène, sports doctor, his sports column in Priorité Santé. This week he tells all about pubalgia, a diagnosis often mentioned when an athlete complains of pain in the pubic region.

What is pubalgia?

Pubalgia is a pain that starts gradually and whose seat is the lower abdomen, pubis or even the adductors. Indeed, in pubic bone disease (another name for pubalgia) there is inflammation of the pubic symphysis, a practically immobile joint for the pelvis next to the bladder. It is often found in football players.

Clinicians generally distinguish under the term pubalgia three clinical forms associated with anatomical lesions:

  • muscle damage of the abdominal and/or adductor muscles;
  • weakness of the abdominal wall with involvement of the inguinal canal;
  • pubic osteoarthropathy, corresponding to bone and joint damage to the pubic symphysis and its appendages

The pain associated with pubalgia is progressive. They start with occasional discomfort during exercise. They intensify and then become chronic. The pain becomes uni or bilateral and persistent, radiating to the lower abdomen and groin area (groin), even to the adductors.

How to explain this painful syndrome?

Pubalgia usually manifests itself in the context of intense sports activity, a source of repeated microtrauma at the abdomino-inguino-pubic junction. Its precise pathophysiology is not yet the subject of clear consensus, but most specialists believe that the presence of a muscular imbalance between the abdominal ligament and the adductors is the cause of the main occurrence of the pathology.

The main predisposing factor for pubalgia to develop is pelvic instability during exercise, particularly associated with poor muscle coordination. This is caused by the presence of anatomical and biomechanical imbalances mainly found in people who can present:

  • pelvic anteversion;
  • asymmetry in the size of the lower extremities;
  • lumbar lordosis;
  • a strong and shortened musculature of the adductor muscles, associated with less development of the abdominal muscles.

Pubalgia mainly affects male athletes (amateurs or professionals) who are exposed to intense physical activity, characterized by technical gestures and movements with strong asymmetrical limitations.

There are also a number of factors that favor the appearance of the pathology during sports practice, such as:

  • the use of unsuitable equipment or a sudden change of equipment (shoes, ground, etc.);
  • a state of overtraining: as soon as there is fatigue, there is a risk of injury to the athlete. Recovery is an integral part of training;
  • an inadequate lifestyle in the context of intensive and daily sports practice (insufficient sleep, nutrition, hydration);
  • the presence of an infectious focus such as dental abscesses can also contribute to a spinal imbalance.

How do you know if you have pubalgia?

Pubalgia presents a complex clinical picture with a symptomatology that varies according to the patient and the sports practices.

The pains are described unilaterally or bilaterally in the inguino-pubic region, but they can also radiate to the adductors, or even to the level of the abdominal wall and genitals.

During his examination, the practitioner takes into account the patient’s symptoms, will examine him carefully and study any predisposing factors: posture, muscle imbalance, lumbar lordosis, leg length asymmetry, pelvic tilt, etc.

Depending on the suspected clinical form, additional imaging tests may be needed in the diagnosis of pubalgia:

  • frontal X-ray of the pelvis;
  • MRI of the pelvis;
  • ultrasound.

How to cure pubalgia?

The treatment of pubalgia should combine a reduction in physical activity, even complete rest, and the implementation of a progressive rehabilitation program. The total duration varies from 2 to 6 months, depending on the clinical form and its severity.

Rehabilitation can include muscle strengthening, stretching, physical therapy, or even osteopathy. It should allow the patient to restore muscle balance in order to obtain optimal stabilization of the pelvis when practicing sports.

After completing this rehabilitation phase and provided that he no longer feels pain, the patient can gradually resume his sporting activity.

Depending on the patient’s clinical presentation, some doctors recommend medical treatment aimed at reducing pain through the use of anti-inflammatories, muscle relaxants, or even mesotherapy. Infiltrations of local anesthetics and corticosteroids are more marginal and are used in severe and persistent symptoms.

In case of failure of conservative treatment or in severe cases, surgery is sometimes considered, especially in the case of pathology in the abdominal wall. Different interventions can be proposed.