Osteitis pubis, althletic pubalgia, adductor tendonitisAdductor tendonitis, athletic pubalgia and osteitis pubis are some the most common causes of groin pain in athletes, although not the most common as was once thought. Their differential diagnosis is femoroacetabular impingement, acknowledged in the present day to be the main cause of hip and groin pain in athletes (Philippon et al. AJSM 2007). What is more, many cases of femoroacetabular impingement eventually lead to retraction-shortening of the adductor tendons. The adductor muscles and abdominal muscles act like windmill blades with their axis on the pubic symphysis. Any imbalance (muscular imbalance of the aforementioned muscles, repetitive use of wet/heavy footballs, sudden changes in training, incorrect training, ) leads to an alteration in the forces, a shear effect on the pubic symphysis and consequently, a localised pathology which causes pain and functional incapacity in the patient.  Adductor tendinitis consists of inflammation of these tendons which manifests itself during exercise and improves with rest. Meanwhile, in athletic pubalgia the pain is localised more in the inguinal ring due to the weakness of the abdominal wall and increases with movements which increase the pressure on the abdomen, such as coughing, sneezing, All of these conditions come together in osteitis pubis, with inflammatory-reparative alterations at the level of the pubic bone, both at the attachment of the adductor muscles and the abdominal muscles and is often associated with a weak abdominal wall-floor. Illustration of the forces which act on the pubic symphysis in the form of "windmill blades". The downward arrows represent the forces exerted by the adductors and the upward arrows represent the forces exerted by the muscles of the abdominal wall.
|
