1. Symptoms

What are the symptoms of Osteitis Pubis? What does OP feel like? We will cover a list of symptoms, methods of diagnosis, self-treatment and rehabilitation in the rest of the site. For now let’s describe a common story we hear from OP patients.

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Stage 1: Early onset Osteitis Pubis

OP usually starts as just some stiffness and tightness in the adductors (groin) during exercise. You might feel some dull pain and stiffness the next day but with some heat, rest and gentle stretching you’re fine for your next training session. Except 20 minutes into training it starts again. You go through the same process of rest and stretching, except it keeps coming back. The pain will probably get a little worse, the stiffness might take longer to stretch out; but you just keep on training just the same. None of it strikes you as a ‘serious’ problem. The pain isn’t agonising and as long as you warm up properly before exercise, you can get through it. You probably assume it will ‘sort itself out’ at some point.

We refer to this is early stage OP. The pain and stiffness is present, but it’s minimal and doesn’t change your exercising/training habits substantially.

Stage 2: Fully developed Osteitis Pubis

You keep training but now the pain is worse. You wake up in the morning with stiff, heavy adductors. Stretching doesn’t help anymore, it might even make the pain worse. Pain often starts immediately upon exercise. It’s becoming harder to train, and if you do train, it takes twice as long to recover. At this stage you might see a physio or get a massage. They tell you to rest, stretch and might give you some exercises to strengthen your hips (pilates clams, theraband exercises etc.). You’ll see some improvement, but the minute you return to a full training load the pain is back, often worse than before.

No matter what you do, you can seem to get rid of that stiffness in your groin.

At this point you have full developed Osteitis Pubis. Rest helps but it also lets your adductors become weak, so that when you return they are susceptible to re-injury. Clams and theraband exercises might deal with a few biomechanical issues, but as you will learn if you keep reading they are a band aid for the bullet wound that is OP.

Stage 3: Final stage Osteitis Pubis

The final stage of OP I call late stage OP; and its not pretty. This is when you start feeling pain on the pubic bone and pubic symphysis when you exercise. The stiffness is ever present in your life. It might even migrate to your hip flexors, glutes and lower back. It feels as if your entire pelvis is breaking down on you. Coughing might even bring on pain.

At this stage you might be sent off for scans. These show scelorsis, widening of the pubic symphysis or other serious issues in your pelvis. Now you’re being told to completely rest. And to consider different surgical options, one of which includes burning off the ends of your pain receptors in your groin!

And all the while no one is talking about or explaining how you developed Osteitis Pubis to begin with. If no one can actually provide you with an answer to why you develop OP to begin with, how can they provide you with an effective solution? How can they ensure that your OP wont come back at another stage?

Symptoms of Osteitis Pubis

Stage 1 symptoms
Stage 2 symptoms
Tightness/sore in adductors: Your adductors feel rigid and tight most of the time. Numbness: in the adductors, hip or pubic area
Dull pain on exercise Weakness during exercise: a noticeable loss of strength
Feeling of heaviness: your groins feel even when not training. Pain in pubic bone during movement
Rest improves pain: but the minute you train it returns and you need to rest again to recover Migration: Symptoms begin migrating to the hip flexors, lower back.
Loss of flexibility/mobility: you’ve notice a distinct lack of mobility in the groins. More rest required: Long periods of rest between exercise needed for groin to recover
Slow onset: You don’t feel groin at the beginning of a workout. The pain comes on slowly. Pain immediately upon movement
Pain if you touch pubic bone