Treatment of Pubalgia

The best form of treatment is preventative maintenance. Preventative maintenance exercise concentrating on developing core stability with special focus to the pelvis and trunk area is the best way to ensure that one does not experience Pubalgia. Athletic trainers are beginning to understand the inherent value of developing core strength and stability. Training regiments are being developed that concentrate specifically on eccentric exercises designed to improve the stability of the anterior pelvis and surrounding core muscles.

 It is important to maintain an exercise regiment that incorporates training the abdominal and adductor muscles as well as thigh adductors. Strengthening the abdominal  oblique's may be the most important factor in prevention. This has shown to help reduce the occurrence of injuries to the region. It is very important that when training for athletic activities that one does not forget to include reciprocal training using both the agonist and antagonist muscles.

 It is important not to increase strength of certain muscles groups without improving others

which link to it in the kinetic chain. Balance and moderation is the key. If muscle strength is not balanced and stable, excessive external loads, shifting the axis of balance resulting in more stress  placed on certain soft tissues  resulting in micro tears of the said tissues. This evens out the strain on the body (remember- Our human anatomy is just one large tensegrity structure… Harmony and balance of each opposing anatomical piece is key to the integrity of the body as a whole.)

 Conservative treatments have statistically shown to be wholly ineffective at relieving the condition of Pubalgia. However, upon experiencing groin pain for which the cause is not readily known, it is recommended to rest, use ice and anti-inflammatory medications, and to avoid the application of heat, which may make inflammation worse. The healing power of ice is far more substantial for conditions in which inflammation is present than the application of heat.
When the physician diagnosis a minor cause of the condition such as muscle strain, or sprain, usually over-the-counter medication is recommended to help achieve relief from the symptoms. Aspirin, Acetaminophen or ibuprofen can be used to help quell the pain as needed, but should be taken in accordance to the instructions given by the physician. However, should these conservative treatments of Pubalgia pain prove ineffective, surgery is highly recommended. An athlete will experience pain that progressively gets worse if treatment is not sought.

Conservative treatments usually involve strengthening of the pelvic muscles, and should mainly be used for preventative measures as opposed to actual treatment of the condition once it

becomes chronic. It is recommended that an individual experiencing prolonged pain to seek the diagnosis of a physician or specialist who is experienced in sports injury management and treatment. Conservative therapies frequently include injections of steroids into the pubic symphysis or the adductor tendon origins. These injections may have provided temporary relief from symptoms, however patients often experienced a resurgence of the condition upon resumption of athletic activity. Therefore steroid injections are not considered to be an effective treatment of the underlying injury in the long term. Usually when athletes have not responded to conservative rehabilitation surgery is advised.

 The basis for the current techniques for surgical reconstruction are quite similar to those performed for inguinal hernias are often effective for use in sports hernias as well. Most procedures involve minor variations of the standard hernia repair. Once Pubalgia has been identified, the condition can be corrected surgically by reinforcing the muscles that were torn from the bone. The most effective technique being used today is laparoscopic surgery which involves a small number of 1/4-inch incisions into which instruments are inserted to visualize the muscle damage as well as perform repair.

Synthetic mesh material is usually used to reinforce the connection and ensure proper repair. Since this technique involves less extreme incisions, recovery time is significantly shorter. Less medication is needed because there is less pain present as a result of the surgery, and scarring is usually minimal. Usually patients are able to walk the first day of the surgery; though no exercise is permitted save for walking for at least two weeks after the operation procedure. Laparoscopic surgery is highly recommended as the recovery time is about 2-4 weeks as opposed to open-surgery which is more traumatic for the body and takes anywhere from 10 weeks to 6 months for full recovery to be possible. After two weeks has passed, patients are able to resume aerobic activities such as biking, jogging, and swimming, however no heavy lifting or sprinting is recommended until four weeks have past; at which time the patient can return to playing their sports as normal.

Pelvic floor repair is a common technique in which the Inferolateral margin of the rectus Abdominis is reattached to the fascia overlying the anterior pubis and the anterior pubic ligament. This technique does not affect the internal ring of the pelvic floor and is performed in conjunction with an adductor tendon release or "Tenotomy" where several longitudinal incisions are made in the anterior Epimysial fibers of adductor Longus at its pubic attachment. This treatment shows to have a 95% success rate when used, usually with the athletes reporting resolution of the injury or at very least a substantial improvement in symptoms allowing athletes to return to pre-injury levels of athletic activity.

Approximation surgery of the torn edges of the external oblique aponeurosis using nylon mesh usually leads to a full recovery in between 5 and 6 weeks following the operation. Pelvic floor surgery as a treatment for athletic Pubalgia has show to be effective in 96 % of the applications of its use. Newer techniques such as high-powered laser therapy and Myopulse have shown a 90% rate of injury resolution. Between 65 and 90% of athletes are able to return to sports activity after surgery for Pubalgia, rehabilitation has been shown to take anywhere from 6-8 weeks. Overall, 89% of procedures were considered successful. Laparoscopic repair seems to be the best bet, with a trans-abdominal preperitoneal technique used for hernias; patients were able to return to sporting activities 2-3 weeks after surgery. The fact that laparoscopic encourages a shorter recovery time suggests that this treatment is highly recommended for athletes seeking to get back into their activity of choice with less downtime.

Rehabilitation after surgery can take anywhere from 4 weeks to nearly 1 year depending on the treatment approach. The goals of rehabilitative treatments are to reduce the amount of pain and inflammation the individual is experiencing while improving flexibility and muscle conditioning in the associated areas (concentrating on core strength), thereby strengthening muscles which were once weakened. No sudden twisting or turning movements should be performed in effort to keep from aggravating the injury. Gradually fitness routines will become more intense until the individual is able to return to the prior level of fitness. Pain associated with the adductor inflammation may dissipate during exercise once the body is properly warmed up, however if it remains untreated it is likely to become worse.

 

 

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