THE CLINIC: The Road Back from Severe Pelvic Inflammation

Wed, 12 June 2013 - 1:33 a.m. MT
Credit: ARA Staff - American Running Association

QUESTION:

I’m an internal medicine physician and triathlete. I’ve been running for about 30 years at 9- to 10-minute mile pace. I had my VO2 max done after a marathon and it was 53. I was told that was very good for a 50-year-old woman, and that I could get a lot faster with speedwork. I did, and could run 7-minute miles comfortably for a 15K. 

 

I next hired a coach at my husband’s prodding in order to get even faster. After working out with him for five months I could hardly walk. I can't even describe the pain. My adductors were weak and would spasm. I could not lift my legs to get dressed. I thought I had a stress fracture in my groin. I had an MRI of my hips and pelvis, which read as normal. Throughout all this I could still swim and ride my bike. I finally sought out an orthopedic surgeon specializing in sports medicine who after examining me and looking at my MRI told me I had osteitis pubis. I was sent to PT for core strengthening. Will I ever get better? I’m unsure that I will really run again. Can I be fast again, or is this going to be a chronic injury?

 

 

Barbara Brenner

Rockford, IL

 

ANSWER:

In runners a proposed pathological mechanism is cumulative trauma stress to the symphysis incurred during the up-and-down motion and/or the side-to-side pelvic motion that occurs with running. It may occur simultaneously and with adductor strains. Some study authors suggest that excessive arm swinging in running may contribute to excessive pelvic sway. A therapist or physician who is knowledgeable in gait analysis may offer some assistance here. 

 

The standard treatment, as in most overuse injuries, involves rest from aggravating activities followed by a graded return to sport. The problem with osteitis pubis is that this rehab program may require up to a year of time. I am not clear as to when you actually stopped running, but keep this time frame in mind.  

 

The literature suggests that in compliant patients with chronic osteitis pubis, prognosis is good, but a considerable degree of patience is required. I see a few patients a year with chronic osteitis pubis, and unfortunately most are lost to follow up. I have had very good success treating the

subacute cases with relative rest, NSAIDs, and a series of cortisone injections. The injections have been very helpful for diagnosis and treatment. They are relatively easy to perform in the office. I often take a film with a bead over the symphysis and mark it prior to injecting. This

is followed by a period of physical therapy to assist with pelvic stability. I know of no cases that have gone to any surgery.

 

Robert Scott MD

San Diego, CA

 

 

ANSWER:

To answer the easy part of your question first: you already have a chronic problem, although I am not so sure from the details of your email that it is musculoskeletal in origin. As you know, You can have a false negative MRI. You may consider having another. Also, you may want to consider a bone scan. Do you have any gynecological issues? Have you been examined and discussed your problem with your OB/GYN?

 

I have seen patients with malalignment problems of their symphysis pubis get good relief with muscle-energy techniques to their adductors. A good, manually trained local PT should be well equipped to evaluate and treat this. As a resource, go to www.apta.org, click on “find a PT,” and search for a specialist in ortho and/or women's health. Unless it hurts when you train, you should continue to exercise.

Stephen Rapposelli, PT, OCS

Hockessin, DE

 

 

DISCLAIMER: The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be patient education, does not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment. Please consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition. Clinic pieces are edited and details are changed. In some cases pieces represent composites from several queries to, and answers from, the Clinic Advisory Board.

 

The American Running Association (ARA) and its Clinic Advisory Board disclaims responsibility and shall have no liability for any consequences suffered as a result of your reliance on the information contained in this site. ARA does not endorse specifically any test, treatment, or procedure mentioned on this site.

 

 

(RUNNING & FITNEWS® January / February 2012 • Volume 30, Number 1)

 



Latest News
Luxury Cruise Fitness: It Can Be Done
Luxury Cruise Fitness: It Can Be Done

Aug 02 1:02 p.m.

Article by: Jeff Venables

Comrades Ultra - Loose and Fun = Success
Comrades Ultra - Loose and Fun = Success

Jun 04 12:26 p.m.

Article by: Rick Ganzi, M.D.

Young Milers in Anaheim CA love running
Young Milers in Anaheim CA love running

May 15 3:03 p.m.

Article by: Jeff Venables

Catch Them If You Can
Catch Them If You Can

Apr 08 7:22 p.m.

Article by: Jeff Venables

New Roles of Sports Chiropractic
New Roles of Sports Chiropractic

Feb 21 11:15 a.m.

Article by: Jeff Venables