What is osteitis pubis? Causes, symptoms, treatments
Learn what causes osteitis pubis and how rest, physical therapy, and targeted exercises can help relieve pelvic and groin pain.
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Whether you are walking, running, rolling in bed, or simply getting through your daily routine, pain at the front of the pelvis can make movement feel harder than it should. For some people, it may even come with clicking, popping, or a sense of instability around the center of the pelvis.
If that sounds familiar, you may be dealing with osteitis pubis — inflammation of the pubic symphysis, the joint at the front of your pelvis. It often shows up after periods of repeated loading — especially with activities like running, kicking, or rapid changes in direction — when that area is doing more than it’s currently ready for.
But you don’t have to just live with this discomfort. Osteitis pubis usually improves with time, activity modification, and targeted exercises that strengthen and support the muscles around your pelvis and hips.
Here’s what to know about osteitis pubis symptoms, causes, treatments, and exercises recommended by Hinge Health physical therapists.
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What is osteitis pubis?
Osteitis pubis is inflammation of the pubic symphysis — the joint that connects the left and right pubic bones at the front of the pelvis. Because several muscles from the hips, inner thighs, abdomen, and pelvic floor attach in this area, tightness, weakness, or increased stress through these tissues can contribute to irritation of the joint and surrounding tissues.
“Osteitis pubis is often related to repetitive stress and muscle imbalance around the pelvis,” says Karla Arevalo-Alas, PT, DPT, a physical therapist with Hinge Health. “When the muscles around the hips and pelvis aren’t working together efficiently, extra strain can land on the pubic symphysis.”
The condition is most common in athletes who participate in sports involving running, kicking, cutting, or sudden directional changes — such as soccer, hockey, football, basketball, and long-distance running. But it can also affect anyone, especially those who are pregnant or are recovering from pelvic surgery.
Symptoms of osteitis pubis
The most common symptom of osteitis pubis is pelvic pain at the front and center of the pelvis. The discomfort may start gradually and worsen with activity. “Many people describe it as a deep ache or pulling sensation in the groin area,” says Dr. Arevalo-Alas. “It can become especially noticeable during single-leg activities like running or climbing stairs.” Symptoms may include:
Pain, soreness, or tenderness at the center of the pelvis
Pain that spreads into the groin, lower abdomen, hips, or inner thighs
Pain that worsens with running, kicking, pivoting, climbing stairs, or changing direction
Difficulty walking or a noticeable limp
Pain with coughing or sneezing
Discomfort when lying on your side
Clicking, popping, or grinding sensations at the front of the pelvis
Causes of osteitis pubis
Osteitis pubis usually develops from repeated stress on the pubic symphysis joint and surrounding muscles. Common causes include:
Repetitive stress and overuse. Activities involving repetitive running, kicking, twisting, or quick directional changes can strain the muscles and tissues attached to the pubic symphysis. Over time, this repeated stress may irritate the joint and lead to inflammation. “Muscle imbalances around the hips, pelvis, and core can also change how force moves through the pelvis,” explains Dr. Arevalo-Alas. “That can increase stress on the pubic symphysis over time.”
Pregnancy. During pregnancy, the body produces higher levels of relaxin, a hormone that loosens ligaments and joints around the pelvis to prepare for childbirth. Combined with the added weight and shifting posture of pregnancy, this can place extra stress on the pubic symphysis and contribute to pelvic pain.
Pelvic surgery or trauma. Less commonly, osteitis pubis can develop after pelvic or urological surgery, childbirth trauma, or direct injury to the pelvis.
How movement can help osteitis pubis
When pelvic pain flares up, it’s natural to want to avoid movement altogether. But gentle, targeted movement is actually an important part of recovery.
“Movement helps improve strength, flexibility, and coordination in the muscles that support the pelvis,” says Dr. Arevalo-Alas. “That can reduce stress on the pubic symphysis joint itself.”
Targeted exercises can also help address muscle imbalances around the hips, core, and thighs that may contribute to symptoms. Improving hip and core strength helps the pelvis absorb and distribute forces more efficiently during walking, running, and other activities.
The key is finding the right balance between activity and recovery. Rest from aggravating activities is important initially, but too much inactivity can sometimes increase stiffness and weakness. “Your body still benefits from movement while healing,” says Dr. Arevalo-Alas. “It just needs the right kind of movement.”
Exercises for osteitis pubis
Want expert care? Check if you're covered for our free program →- Side-lying hip adduction
- Kneeling hip adductor stretch
- Side-lying leg raise
- Bridge
- Straight leg raise
Together, these exercises help improve strength, flexibility, and coordination in the hips, thighs, and core to better support the pelvis and reduce stress on the pubic symphysis joint. Strengthening both the inner and outer hip muscles can also help address muscle imbalances that contribute to osteitis pubis pain.
The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.
Pelvic floor physical therapy is more than just kegel exercises. Various exercises tailored to your symptoms and needs are key to getting relief. Pelvic floor PT can relieve many different pelvic issues, such as pelvic pain, painful sex, and urinary incontinence.
Members of the Hinge Health pelvic health program experience an average 67% reduction in pelvic pain and 54% reduction in urinary incontinence within the first 12 weeks. Learn more*.
Treatments for osteitis pubis
The most common treatment for osteitis pubis is rest, followed by a gradual return to your usual activities. Your healthcare provider may also recommend pelvic floor physical therapy and targeted exercises, ice and heat therapy, pain medication, and in rare cases, surgery. Here’s a closer look at treatments for osteitis pubis:
Rest and activity modification. If repetitive activity triggers your symptoms, taking a temporary break from aggravating movements gives the joint time to calm down and heal. “Very active people sometimes struggle with rest,” says Dr. Arevalo-Alas. “But recovery time is part of training. Your body needs time to rebuild and recover.” Once symptoms improve, activity should be resumed gradually.
Try physical therapy and targeted exercises. Targeted exercises, such as the ones above, can help improve the strength and flexibility of the muscles in and around your pelvis so they can better support your pubic bones. You can do exercise therapy at home or work with a physical therapist who can guide you through movements tailored to your needs. You can see a physical therapist in person or use a program like Hinge Health, where you may access a PT via telehealth/video visit.
Consider lifestyle modifications. Factors like sleep, stress, nutrition, and certain activities can all play a role in how you feel. In fact, many people are surprised to learn that pain isn’t just about what’s happening physically — your daily habits and overall well-being can have a real impact, too. Staying curious about how your routines affect your muscles and joints can help you identify where small changes might help reduce pain. For example, you might notice your pain is less noticeable on low-stress days.
Apply ice or heat. Ice can help reduce inflammation and pain during flare-ups, especially after activity. Heat may help relax tight hip and thigh muscles once acute inflammation settles down. Consider trying both or sticking to the one that provides the most relief for your symptoms. If you’re pregnant, check with your doctor first.
Take over-the-counter (OTC) medication as needed. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can help ease pain so you can do your targeted exercises and stay active when you have pelvic and groin pain. Other options are topical NSAIDs or pain relief creams. If you have a medical condition or take other medications, check in with your provider to make sure these OTC options are safe to take.
Ask about TENS therapy. TENS, or transcutaneous electrical nerve stimulation, uses gentle pulses to quiet your pain response and help reduce pain associated with conditions like osteitis pubis. One option is the wearable device Enso, available through Hinge Health. It’s small, wireless, and portable. While applying Enso directly over the pubic symphysis area is not recommended, it can be used to target surrounding muscle groups (such as the lower back or hips). Enso is not recommended for use during pregnancy.
Surgery. Though uncommon, surgery to the pubic symphysis joint may be recommended if you still have symptoms after several months of simple, at-home treatments.
Physical therapy for osteitis pubis
Physical therapy focuses on improving the strength, flexibility, and coordination of the muscles surrounding the pelvis. “Many people with osteitis pubis have weakness or tightness in different muscle groups around the hips and pelvis,” says Dr. Arevalo-Alas. “PT helps restore balance and reduce excess strain on the joint.” Your treatment plan may include:
Hip and core strengthening
Adductor (inner thigh) stretches
Glute strengthening
Movement retraining
Gait and running analysis
Gradual return-to-sport programming
Your PT may also help modify daily movements or workouts to reduce irritation while the joint heals. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.
Will osteitis pubis ever go away?
Yes. Most people improve with time and simple treatments such as the ones above. Recovery timelines vary, but symptoms often improve within several weeks to a few months, depending on the severity of irritation and how quickly aggravating activities are modified.
PT tip: Cross-training is key to prevention
“Your body benefits from variety,” says Dr. Arevalo-Alas. Repeating the same movements over and over — especially high-impact activities like running — can overload the same muscles and joints. Cross-training with activities like swimming, cycling, strength training, or walking can help build strength throughout the body while giving overworked tissues a chance to recover. “Strengthening the muscles around the pelvis from multiple angles can help improve stability and reduce strain on the pubic symphysis,” explains Dr. Arevalo-Alas.
How Hinge Health can help you
If you have pelvic pain, bladder, bowel, or other pelvic symptoms that are affecting your quality of life, you can get the relief you've been looking for with Hinge Health’s online exercise therapy program.
The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.
See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.
This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.
References
1. Amer, M. L., Omar, K., Malde, S., Nair, R., Thurairaja, R., & Khan, M. S. (2022). The challenges in diagnosis and management of osteitis pubis: An algorithm based on current evidence. BJUI Compass, 3(4), 267–276. doi:10.1002/bco2.127
2. Athanasiou, V., Ampariotou, A., Lianou, I., Sinos, G., Kouzelis, A., & Gliatis, J. (2022). Osteitis Pubis in Athletes: A Literature Review of Current Surgical Treatment. Cureus. doi:10.7759/cureus.22976
3. Dirkx, M., & Vitale, C. (2020). Osteitis Pubis. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK556168/
4. Gomella, P., & Mufarrij, P. (2017). Osteitis pubis: A rare cause of suprapubic pain. Reviews in Urology, 19(3), 156–163. doi:10.3909/riu0767
5. Sports Medicine: Osteitis Pubis. (2022). Nationwidechildrens.org. https://www.nationwidechildrens.org/conditions/sports-medicine-osteitis-pubis