That deep ache at the front of your pelvis or groin can be frustrating, especially when it warms up during training, then returns with a vengeance later that day or the next morning.
For some athletes and active people, this pattern can be linked to osteitis pubis, a load-related problem around the pubic symphysis, the joint at the front of the pelvis.
Osteitis pubis is an overuse injury that affects the pubic symphysis, the joint at the front of your pelvis where the two pelvic bones meet. This joint plays an important role in transferring load during walking, running, kicking and changing direction. Over time, repetitive stress through this area can irritate the joint and its surrounding tissues, leading to pain around the groin and pelvis. Unlike a muscle strain which often happens suddenly, osteitis pubis usually develops gradually over time, worsening with repetitive movements, an increase in load or increase in training volume. Many people notice it starts as a mild ache after exercise before becoming more persistent over time.
Pain from osteitis pubis is usually felt around the pubic symphysis, the joint at the front of the pelvis. It can feel like a deep ache in the groin and may spread into the inner thigh, lower abdomen or across the front of the pelvis.
Groin pain is common in running and kicking sports, and research suggests it can make up a significant proportion of sporting injuries depending on the sport, level of play and how injuries are recorded. Osteitis pubis is most commonly seen in sports that place repeated stress through the groin and pelvis. This includes:
Recent research has found that osteitis pubis accounts for approximately 0.5–8% of all sporting injuries, with higher rates found in athletes that participate in regular sprinting, kicking and change direction. Although men are at higher risk, females can also develop osteitis pubis. It can also develop in people who do not participate in sport, particularly following pregnancy or pelvic surgery.
Everyone experiences pain a little differently, but common symptoms can include:
Individuals with osteitis pubis often report that symptoms ease once the body has warmed up, only for the pain to return later that day or feel worse the following morning.
These symptoms can be frustrating, and they can overlap with other causes of groin pain. That’s why a proper assessment is important before assuming it’s osteitis pubis.
Osteitis pubis is diagnosed through a detailed history and physical assessment. Your physiotherapist will look at your pain pattern, training load, hip and groin strength, mobility, walking or running mechanics, and how your symptoms respond to specific tests.
Imaging, such as an MRI, may be used in some cases, especially when symptoms are severe, persistent or unclear. This can help rule out other causes of groin pain and guide the right treatment plan.
There usually isn’t one single cause. Instead, osteitis pubis tends to develop when several contributing factors combine over time. These often include:
Rather than thinking of it as something that has gone wrong, it’s more your body’s way of telling you that it has been asked to do more than it has been prepared for.
The encouraging news is that most people recover without surgery. Physiotherapy is considered the first line of treatment and focuses on reducing pain, whilst addressing the causes of the injury.
Physiotherapy treatment aims to:
Some people may also benefit from treatments such as shockwave therapy alongside a structured rehabilitation exercise program. While research is promising, shockwave should be viewed as an adjunct to rehabilitation rather than a replacement for strengthening and load management. Surgery is only considered when symptoms persist after months of conservative management strategies.
Recovering from osteitis pubis takes time, and trying to push through pain can often prolong the process and make your pain worse. There are simple and effective ways you can help support your recovery, including:
A structured rehabilitation program and appropriate guidance can allow most people with osteitis pubis to return to sport safely and confidently. Even at the highest levels of sport, persistent groin pain is taken seriously. The earlier it’s assessed, the easier it is to manage load, protect strength and plan a safe return to activity.
If groin pain is stopping you from running, kicking, training or moving comfortably, don’t wait for it to become a bigger problem. Book an appointment with one of our physiotherapists at The Healthy Body Company. We’ll assess what’s contributing to your pain, guide your recovery, and help you return to sport or daily activity with a clear plan.
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Athanasiou, V., Ampariotou, A., Gliatis, J., & Ditsios, K. (2022). Osteitis pubis in athletes: A literature review of current surgical treatment. Cureus, 14(3), e22976. https://doi.org/10.7759/cureus.22976
Delahunt, E., Thorborg, K., Khan, K. M., Robinson, P., Hölmich, P., Weir, A., Ardern, C., Serner, A., Mosler, A. B., Hainline, B. (2017). Groin pain in athletes: Clinical practice guidelines linked to the International Classification of Functioning, Disability and Health (ICF) from the Academy of Orthopaedic Physical Therapy of the American Physical Therapy Association. Journal of Orthopaedic & Sports Physical Therapy, 47(6), A1–A36. https://doi.org/10.2519/jospt.2017.7314
Gaudino, F., Spira, D., Bangert, Y., Ott, H., Beomonte Zobel, B., Kauczor, H.-U., & Weber, M.-A. (2017). Osteitis pubis in professional football players: MRI findings and correlation with clinical outcome. European Journal of Radiology, 94, 46–52. https://doi.org/10.1016/j.ejrad.2017.07.009
Schöberl, M., Prantl, L., Loose, O., Zellner, J., Angele, P., Zeman, F., Spreitzer, M., Nerlich, M., & Krutsch, W. (2017). Non-surgical treatment of pubic overload and groin pain in amateur football players: A prospective double-blinded randomised controlled study. Knee Surgery, Sports Traumatology, Arthroscopy, 25(6), 1958–1966. https://doi.org/10.1007/s00167-017-4423-z
This article was written by Callum, a Western Sydney University physiotherapy student who recently completed a five-week placement with our Penrith team.
During his time at The Healthy Body Company, Callum worked alongside our physiotherapists, developed his clinical reasoning skills, and contributed to patient education resources like this one. Supporting students and early-career physiotherapists is an important part of how we build strong, thoughtful clinicians for the future.
