About Pubalgia...What is Pubalgia?
Pubalgia is a medical condition caused by repeat trauma and hyperextension of the abdomen causing severe musculotendinous or musculoskeletal injuries and characterized by a slow onset of chronic (ongoing) pain, or aching in the lower abdominal regions, specifically the pelvis, groin, hip, testicular region and the lower extremities. It is also characterized by dilation in the superficial ring of the inguinal canal (see What is the inguinal canal, below). Usually a tear in one of the lower abdominal muscles, inguinal canal or associated connective tissues is the source of the pain. Pubalgia is typically experienced by athletes after partaking in intense athletic activities which place a great deal of stress or shear forces on the groin, pelvic area and abdominal regions.
Symptoms are usually exacerbated by running, twisting and turning, rapid side-to-side ambulatory movements , and bending forward. Sports in which Pubalgia is found most frequently
Pubalgia has no obvious objective signs such as a bump or bulge, if this condition is observed it is most likely inguinal hernia and a physicians examination is highly recommended. London Surgeon Jerry Gilmore recognized the syndrome as a pathology in 1980 and devised a surgical repair technique for repairing the pathology. There are a number of combined factors which could lead to the experiencing of Pubalgia. Factors such as weak musculature, weakness in the abdominal or inguinal wall, unbalanced muscles, faulty training regiment (especially during warm-up), fatigue, flexibility constraints, poor body mechanics, previous injury and psychological state are all attributed to setting the stage for the possibility for Pubalgia to develop. However, more attention is given to neuromuscular factors such as poor neuromuscular control and lack of strength, which make a significant contribution to the possibility of injury in the pelvic/groin region. There are a wide variety of anatomical anomalies which may be observed upon surgical exploration that account for the pain observed by the patient.
What are the most frequent causes of groin pain?
○ Inflammation of the pubic bone, or a tear in tendons which connect to
it.
○ Torn external oblique aponeurosis
○ A tear in the Myofascia of the transversalis
○ Torn conjoined tendon usually in proximity to the Pubic Tubercle
○ The early stages of development of inguinal hernia.
○ An anomalous attachment or tear of the adductor muscles, most commonly
in proximity with the pubic bone.
○ An abnormal insertion of the Rectus Abdominis muscle (birth defect)
○ Changes within the lumbosacral section of the spine.
○ Changes in and around the interpubic joint area.
○ Neuralgia of the nervus ilioinguinalis
○ Entrapment of the ilioinguinal nerve or genitofemoral nerve.
○ Damage to the acetabelum (socket-joint) of the hip
○ Necrosis of the superior head of the hip bone.
○ Avulsion type injuries.
○ Detachment between the inguinal ligament and the torn conjoined tendon,
which usually is the chief cause of the symptoms associated with Pubalgia.
Early efforts to image the abdominal and pubic regions had variable results. This may have been due to an incomplete understanding of the biomechanics of the pubic symphysis and the surrounding anatomy. Imaging techniques were not tailored for the best possible observation of the abdominal and pubic and thus less information was obtained in the diagnostic process.
Now that the anatomy of the region is understood more in depth
techniques for diagnosis are becoming more adequate in detecting the
subtle anatomical changes which elicit such conditions. It is recommended
to get a full MRI scan of the pelvic region from multiple angles in order
to get the best diagnosis, since there are quite a few muscles, ligaments,
tendons, and nerve connections in the pelvic region. Better diagnosis
leads to better treatment of the given condition.