Osteitis Pubis Exercises: Relieve Pubic Bone Pain

Osteitis pubis causes pain at the pubic symphysis—the joint connecting the left and right pubic bones at the front of the pelvis. Common in athletes and postpartum women, this condition involves inflammation and stress at this normally stable joint. These exercises help restore stability and reduce pain.

Understanding Osteitis Pubis

What's happening:

• Inflammation at pubic symphysis joint
• Stress or degeneration of the joint
• May involve bone marrow edema
• Related to mechanical overload

The pubic symphysis:

• Fibrocartilaginous joint at front of pelvis
• Normally very stable (1-2mm movement)
• Connects left and right pubic bones
• Attachment point for abdominal and adductor muscles

Common causes:

• Athletic overuse (running, kicking, cutting)
• Sudden increase in training
• Muscle imbalances (adductors vs. abdominals)
• Pregnancy and childbirth
• Pelvic surgery
• Trauma

Who gets it:

• Soccer, hockey, and rugby players
• Distance runners
• Postpartum women (especially after difficult delivery)
• People after pelvic surgery

Symptoms of Osteitis Pubis

Classic presentation:

• Pain at pubic bone/groin
• Worse with activity (running, kicking)
• May radiate to inner thigh
• Pain with sit-ups or crunches
• Discomfort with prolonged standing
• Pain getting out of car or bed

Pain behavior:

• Gradual onset in athletes
• Worse with single-leg activities
• Improved with rest
• May have clicking or catching

Differentiate from:

• Athletic pubalgia (sports hernia) - more lateral
• Adductor strain - more muscular
• Hip pathology - different location

Phase 1: Rest and Pain Management

Activity Modification

Reduce or avoid:

• Running (especially sprinting)
• Kicking
• Cutting and pivoting
• Single-leg stance activities
• Sit-ups and crunches
• Heavy lifting

Allowed:

• Swimming (except breaststroke)
• Upper body exercise
• Light cycling (if tolerated)
• Walking on flat ground

Ice

• Apply to pubic area 15-20 minutes
• Use thin cloth barrier
• 3-4 times daily
• Especially after activity

Positioning for Relief

Sleeping:

• Pillow between knees if side-lying
• Avoid sleeping with legs apart

Sitting:

• Keep knees together
• Avoid crossing legs
• Support low back

Phase 2: Gentle Mobility

Pelvic Clock

Gentle pelvic mobility without stress.

Setup:

• Lie on back, knees bent, feet flat

Movement:

1. Imagine pelvis as clock face
2. Gently tilt pelvis toward 12 o'clock (flatten back)
3. Then toward 6 o'clock (slight arch)
4. Move through 3 o'clock and 9 o'clock (side tilts)
5. Small, controlled movements
6. 10 rotations each direction

Hip Rotation in Hook-Lying

Setup:

• Lie on back, knees bent, feet flat, knees together

Movement:

1. Let both knees fall to one side
2. Keep feet on floor
3. Small range only
4. Return to center
5. Fall to other side
6. 10 times each side

Gentle Hip Flexor Stretch

Setup:

• Lie on back at edge of bed
• Affected leg off edge

Movement:

1. Let leg hang down
2. Pull opposite knee to chest
3. Feel gentle stretch in front of hanging hip
4. Hold 30 seconds
5. Repeat 3 times each side

Key: Avoid aggressive stretching that stresses pubic area.

Phase 3: Isometric Stabilization

Adductor Squeeze (Ball Between Knees)

Activates adductors isometrically.

Setup:

• Lie on back or sit
• Place ball or pillow between knees

Movement:

1. Gently squeeze knees together
2. Start at 25% effort
3. Hold 5-10 seconds
4. Relax fully
5. 10-15 repetitions
6. Progress to stronger squeezes as tolerated

Key: Should be pain-free. Start very gentle.

Abdominal Bracing

Activates core without stressing pubic symphysis.

Setup:

• Lie on back, knees bent

Movement:

1. Draw belly button toward spine
2. Brace as if expecting a punch
3. Maintain normal breathing
4. Hold 10 seconds
5. 10 repetitions

Bilateral Bridge

Hip extension with stable pelvis.

Setup:

• Lie on back, knees bent, feet flat together

Movement:

1. Squeeze adductors (knees together)
2. Engage core
3. Lift hips toward ceiling
4. Keep pelvis level
5. Hold 5 seconds
6. Lower with control
7. 15-20 repetitions

Supine March (Slow)

Controlled hip flexion with pelvic stability.

Setup:

• Lie on back, knees bent, feet flat
• Core engaged, spine neutral

Movement:

1. Slowly lift one foot 2-3 inches
2. Keep pelvis completely stable
3. Lower with control
4. Switch sides
5. 10-15 each side

Key: Pelvis should not move at all.

Phase 4: Progressive Strengthening

Clamshell

Hip external rotation strengthening.

Setup:

• Lie on side, hips and knees bent 45 degrees
• Keep feet together

Movement:

1. Lift top knee toward ceiling
2. Keep feet touching
3. Don't let pelvis roll back
4. Lower with control
5. 15-20 repetitions each side
6. Progress to resistance band

Side-Lying Hip Abduction

Setup:

• Lie on side, bottom knee bent
• Top leg straight, in line with body

Movement:

1. Lift top leg toward ceiling
2. Lead with heel
3. Don't rotate pelvis
4. Lower with control
5. 15-20 repetitions each side

Eccentric Adductor Slide

Progressive adductor loading.

Setup:

• Stand with one foot on slider or towel on smooth floor
• Hold support

Movement:

1. Slowly slide affected leg out to side
2. Control the movement (3-5 seconds)
3. Use arms to help return
4. 10-15 repetitions
5. Progress to more range as tolerated

Copenhagen Plank (Modified)

Adductor strengthening.

Setup:

• Lie on side, forearm under shoulder
• Top leg on bench or chair

Movement:

1. Lift bottom leg to meet top leg
2. Hold 5-10 seconds
3. Lower with control
4. 10 repetitions each side

Easier version: Bend knee on bench instead of straight leg.

Phase 5: Functional Progression

Single-Leg Balance

Movement:

1. Stand on one leg
2. Hold 30-60 seconds
3. Progress to eyes closed, unstable surface

Lateral Step-Down

Controlled single-leg work.

Setup:

• Stand on low step (4-6 inches)

Movement:

1. Step down sideways with one foot
2. Touch heel to floor
3. Return to start
4. 10-15 repetitions each side

Split Squat (Supported)

Setup:

• Feet in staggered stance
• Hold support

Movement:

1. Lower straight down
2. Keep torso upright
3. Front knee tracks over toes
4. Push through front heel to stand
5. 10-15 repetitions each side

Lateral Shuffle

Begin dynamic lateral movement.

Movement:

1. Take small shuffle steps sideways
2. Stay low with bent knees
3. 10 steps each direction
4. Progress speed as tolerated

Return to Sport Protocol

Prerequisites:

• Pain-free daily activities
• Full adductor and hip flexor strength
• Single-leg balance 60 seconds
• Pain-free jogging 20 minutes
• Copenhagen plank 30 seconds each side

Running progression:

Week 1: Walk 5 min, jog 1 min × 5 Week 2: Walk 3 min, jog 2 min × 5 Week 3: Walk 2 min, jog 3 min × 5 Week 4: Continuous jogging 15-20 min

Sport-specific progression:

• Straight-line running first
• Then curves and gentle turns
• Then cutting and pivoting (last)
• Kicking (soccer) returns last

Sample Weekly Program

Daily:

• Pelvic clock: 10 each direction
• Adductor squeeze: 3x10
• Abdominal bracing: 3x10
• Ice if needed

Monday/Thursday:

• All Phase 3 exercises
• Bridge: 3x15
• Clamshell: 3x15 each side
• Hip abduction: 3x15 each side

Tuesday/Friday:

• Mobility exercises
• Copenhagen plank (modified): 3x10 seconds each side
• Single-leg balance: 3x30-60 seconds
• Walking 20-30 minutes

Wednesday:

• Rest or pool exercises

Weekend:

• Progress to Phase 5 exercises when ready
• Begin lateral movements

Prevention Strategies

Training:

• Gradual progression of kicking/sprinting volume
• Adequate rest between high-intensity sessions
• Balanced adductor and abdominal strength
• Regular hip mobility work

Strength balance:

• Keep adductors and abdominals balanced
• Include hip rotation strengthening
• Core stability in all planes

Recovery:

• Address muscle imbalances early
• Don't play through groin pain
• Proper warm-up before sport

When to Seek Medical Care

See a specialist if:

• No improvement after 8-12 weeks
• Severe pain limiting daily activities
• Pain at rest or at night
• Associated hip clicking or catching
• Suspected stress fracture

Treatment options:

• Physical therapy
• Corticosteroid injection (limited use)
• PRP injection
• Prolotherapy
• Surgery (rare, for severe cases)

Key Takeaways

1. Rest is essential early: This is not a "push through" injury
2. Start with isometrics: Adductor squeeze and core bracing
3. Progress slowly: Weeks, not days
4. Balance adductors and abs: Key muscle groups around pubic symphysis
5. Control single-leg activities: Major challenge for this condition
6. Running returns before kicking: Kicking is highest stress
7. Be patient: Recovery typically 2-6 months

With careful progression and proper rehabilitation, most cases of osteitis pubis resolve completely. Rushing return to sport is the most common cause of setbacks.