Pubalgia (Groin Pain)

The pelvis consists of three paired bones: the ilium, ischium, and pubis that interconnect and form the innominate bones, meeting in the midline at the Pubic Symphysis anteriorly and the sacrum posteriorly. The midline joint anteriorly is called the pubic symphysis joint and posteriorly the sacroiliac joint. These are the two joints of the pelvis.

Sometimes athletes come in with the diagnosis of pubalgia or some other kind of -algia. What they do not know is that the -algia prefix just means "pain."

A diagnosis of pubalgia, therefore, just means groin pain. In other words, the doctor who gave them the diagnosis had no idea what the cause of the groin pain was except that they have pubalgia, or groin pain. In our opinion, the most common cause of pubalgia, or groin pain, is pubic symphysis diathesis or injury to the pubic symphysis itself. Traditional orthopedics teaches that the most common cause of groin pain is a strain injury to the muscles of the groin region, including the adductor longus, rectus abdominus, iliopsoas, and rectur femoris muscles. (Renstrom, P. Groin injuries in athletes. British Journal of Sports Medicine. 1980; 14:30-36.)

Muscle strains, however, heal very quickly but, in rare cases, do not heal. They do cause some of the chronic groin pain problems in athletes, but not all.

One etiology that is often overlooked in the evaluation of groin pain is an incompetent abdominal wall in the groin. In cases of groin pain with no palpable hernia and no other etiology for the groin pain, the diagnosis is called pubalgia in the European literature. In such cases, what is sometimes found are microscopic tears of the internal oblique muscle in the area of the muscle that attaches to the superior pubic symphysis. (Taylor, D. Abdominal musculature abnormalities as a cause of groin pain in athletes. American Journal of Sports Medicine. 1991; 19:239-242.)

In patients with groin pain due to abdominal wall abnormalities, one finds a history of inguinal pain that worsens with strenuous activity, especially activity stressing the abdominal muscles, such as sit-ups. On physical examination there is tenderness of the pubic tubercle and a positive jump sign is elicited. Prolotherapy, in this instance, to the muscle attachments onto the pubic symphysis is often curative. All of the other muscle attachments to the groin area, including the rectus femoris, gracilis, rectus abdominis, and adductor group, can all be treated with Prolotherapy if there is tenderness and reproduction of the athlete's pain upon palpation of the area where the muscle attaches to the bone. If a positive jump sign is elicited, the diagnosis is made and Prolotherapy is given to the weakened fibro-osseous junction.