Ross Hauser, MD
Injuries to the hips and core muscles are frequent in athletes. Getting an accurate diagnosis and proper treatment of groin pain can be challenging for trainers and physicians. Clinical presentations of the various hip problems overlap with respect to history and physical examination.
A distraught parent brought his son, highly touted baseball prospect, into our office. His baseball career was abruptly halted when chronic groin pain occurred. He was told it was a hernia, so he followed the doctor’s advice and had surgery for it. That didn’t help. They next told him it was caused by an iliopsoas muscle strain. So he worked with various therapies to relieve the muscle strain. Those did not help either. His back was finally x-rayed, where they found some degenerative disc changes. At this time, the team doctor began talking surgery.
This case brings up a good point for any athlete whose diagnosis continues to change. Nobody knows what is wrong with you! Go to a Prolotherapy doctor or Orthopedic Medicine specialist.
Orthopedic Medicine is a discipline in which the physicians are specialists in all of the non-surgical techniques for treating chronic pain. This includes, but is not limited to, manipulation, massage, and physiotherapy techniques, as well as the various injection techniques for pain, including Prolotherapy.
The athlete had significant tenderness over the pubic symphysis, which was expected. His iliopsoas muscle was also very tender and he had some degenerative changes in the lower lumbar spine on MRI. The joints beneath the iliopsoas muscle are the hip joint and the lumbosacral junction where the degeneration was located. Palpation of the hip joint did not produce pain, but a positive jump sign was elicited at the iliolumbar ligaments, lumbosacral ligaments, and sacroiliac ligaments.
Many athletes are subjected to hernia surgeries for groin pain, which has nothing to do with a hernia. We have bailed out many a surgeon who referred patients to us (or the patients came on their own) after the hernia surgery failed to “cure” them of their groin pain.
Groin pain coming from an iliolumbar ligaments injury or dysfunctions at the thoracolumbar junction, may at times be mistaken for hernia injury. Athletes are again cautioned to rule out all of the possible causes of groin pain, and consult a doctor who performs Prolotherapy when such symptoms are present.
Athletic osteitis pubis is a painful and chronic condition affecting the pubic symphysis and/or parasymphyseal bone that develops after athletic activity.
Athletes with osteitis pubis commonly present with anterior and medial groin pain and, in some cases, may have pain centered directly over the pubic symphysis. Pain may also be felt in the adductor region, lower abdominal muscles, perineal region, inguinal region or scrotum. The pain is usually aggravated by running, cutting, hip adduction and flexion against resistance, and loading of the rectus abdominis. The pain can progress such that athletes are unable to sustain athletic activity at high levels. It is postulated that osteitis pubis is an overuse injury caused by biomechanical overloading of the pubic symphysis and adjacent parasymphyseal bone with subsequent bony stress reaction. The differential diagnosis for osteitis pubis is extensive and includes many other syndromes resulting in groin pain. Imaging, particularly in the form of MRI, may be helpful in making the diagnosis. Treatment is variable, but typically begins with conservative measures and may include injections and/or surgical procedures. Prolotherapy injections of dextrose, anti-inflammatory corticosteroids and a variety of surgical procedures have been reported in the literature with varying effectiveness. 1
1. Hiti CJ, Stevens KJ, Jamati MK, Garza D, Matheson GO. Athletic osteitis pubis. Sports Med. 2011 May 1;41(5):361-76. doi: 10.2165/11586820-000000000-00000.