Groin and pubic bone pain

What it is

The pubic symphysis is where the two halves of the pelvis meet at the front. The adductors attach just below it pulling downward, and the abdominal wall attaches just above pulling upward. When those forces are unbalanced, the joint and the surrounding bone take a shearing stress.

Osteitis pubis is the resulting bone stress reaction. It is common in footballers and other kicking and cutting athletes, it is notoriously slow, and the useful framing is that it is a balance problem between two muscle groups rather than an injury to one.

What it feels like

• Deep pain in the middle of the groin at the pubic bone
• Worse kicking, sprinting, changing direction and sitting up
• Sometimes radiating into the lower abdomen, the inner thigh or the perineum
• Tender to press directly on the pubic bone
• Building over weeks rather than starting with a single event

What causes it

Most people have more than one of these at once, and they feed each other. Read the list looking for the two or three that sound like your week rather than for the one true answer — the ones that describe you are the ones worth acting on.

Imbalanced load across the pubic symphysis

The adductors pull down and the abdominals pull up on either side of the joint. When the adductors dominate or the abdominal wall is weak, the joint is sheared repeatedly and the bone reacts.

Adductor strength relative to abdominal strength

This ratio is the central modifiable factor. Strengthening the abdominal wall as well as the adductors is what restores the balance across the joint.

Kicking and cutting sports

Football, Australian rules, hockey and rugby all involve repeated one-sided kicking and rapid direction changes, both of which load the joint asymmetrically.

Training volume increases

Preseason and periods of intensified training are when it typically develops. Bone stress reactions follow load exceeding adaptation, as everywhere else.

Reduced hip range

Restricted hip rotation means more of the rotational demand is taken at the pelvis. Hip stiffness is a consistent finding in athletes with this problem.

Weak trunk and pelvic control

Poor control of the pelvis during single-leg loading increases the shear at the joint on every stride and every kick.

Previous groin injury

An adductor injury alters the balance across the joint and raises the risk substantially. The two conditions frequently coexist and can be difficult to separate.

Playing on hard surfaces

Associated with a higher incidence, probably through higher forces and more abrupt direction changes.

Continuing to play through it

The main reason this becomes a season-ending problem. Early relative rest with rehabilitation produces far better results than playing on.

Being confused with other groin problems

Adductor tendinopathy, hernia, hip joint problems and nerve entrapment all present as groin pain. Multiple problems commonly coexist, which is why a proper assessment matters more here than usual.

Who tends to get it

• Footballers, Australian rules and hockey players
• Anyone with a previous adductor or groin injury
• Athletes in preseason or intensified training
• Those with restricted hip rotation
• Anyone with weak abdominal and pelvic control relative to their adductors

What makes it worse, and what settles it

The qFIT routine for this

Ready-made routineMuscle Strain Recovery (Hamstring, Calf, Groin & Quad)

qFIT already has this one built. It runs massage first, then stretching, then strength — the order that works on a body that is already sore — and every activity in it carries the reason it is there.

The button below opens your Checklist with this routine already selected, so instead of your whole list you land on just its Categories, Targets and Exercises, each with its checkbox, ready to tick as you work through them.

Have more than one problem? Tick yours under My Problems on My Profile and your Checklist's Routine list gains Recommended for my problems — every routine for the problems you picked, merged into one. Your picks stay private; that filter is the only thing they feed.

Get it checked if…

Groin pain with fever, or in a postpartum woman with severe pain on walking, needs assessment

And whatever the body part: chest pain or unusual breathlessness on exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or one calf that is swollen, warm and painful. Any of those, stop and get assessed.

How it usually goes

This is slow: three to six months is a realistic timeframe and some cases take longer. Early recognition and a proper period of relative rest with rehabilitation produces much better outcomes than playing through it, which is what usually happens. The muscle balance work needs to continue after return to play, since the imbalance that produced it does not resolve on its own. Persistent groin pain in an athlete deserves a thorough assessment, since several causes commonly coexist.

Prevalence basis: Sports medicine and obstetric series

Others the same routine covers

These share the Muscle Strain Recovery (Hamstring, Calf, Groin & Quad) routine, so the work is the same. If one of them also sounds like you, that is a reason to expect more from it, not less.

This is general information, not a diagnosis, and it cannot examine you. If it matches you, use it to ask better questions of a clinician rather than to replace one.