Pubalgia: Cause of groin pain? (Treatment and remedy)

Article reviewed and approved by Dr. Ibtissama Boukas, physician specializing in family medicine

La pubalgia is pain in the pubis that constitutes a common injury among athletes, especially footballers. It affects different groin muscle areas. It is also commonly called groin pain. Let’s take stock of this pathology: causes, symptoms, diagnoses and treatments.

Definition and anatomy


The word pubalgia means pain (algia) in the pubic area (pub). It is located at the union of the hip bones (in front, between the thighs).


Pubalgia in men and women


The word pubalgia is regularly used to refer to pain in the abdominal region lower, in the groin and on the upper thigh (especially in the adductors, which are the muscles on the inside of the thigh).


This pain syndrome is usually associated with sports practice, whether recreational or competitive sports. Both men and women can suffer from it.


Some women may also experience groin pain during pregnancy, from the sixth month. This usually comes from the pressure generated by the baby in the pelvis.


Groin pain: link with the intestine and the adductors


If bowel and adductors are involved, the pubalgia results in a sharp and brutal pain starting from the pelvis. It results from a inflammation in the insertion area of abdominal muscles at the upper edge of the pubis and adductor muscles.


The insertions of the rectus abdominis and adductor longus muscle exert nearly opposite forces on the symphysis. The slightest alteration in the balance of this antagonism is one of the classic causes of pubalgia in the athlete.



Causes of pubalgia


Le pubalgia syndrome can have many causes.


The pregnancy


The culprit behind pubalgia during pregnancy is the relaxin. It's a hormone that makes the ligaments stretch so the baby can push through the pelvis.


Sometimes the relaxin does its job too well. She loosens the ligaments around the pelvic bones long before baby is ready to come out. This causes excessive (unfortunately painful) movement within thepelvic joint.


Usually the pain is concentrates on the pubic area, but in some women it radiates up the thighs and perineum.




Being extrinsic factors, causes of pubalgia in athletes are usually related to type of surface in practiced sport and shoes used by the athlete.


Many athletes show a pubalgia due to surface change. A change of terrain requires a rehabilitation of the musculature to achieve better stability of the whole body. However, this is difficult to achieve due to the intensity and frequency of the matches played. So themusculoskeletal system does not have enough time to adapt to the change of surface.


The sporting disciplines most likely to cause pubalgia are those that include acceleration, deceleration et sudden changes in direction. We can cite :


  • football ;
  • tennis ;
  • athletics (triple jump, obstacle courses);
  • ski.


The same is true for disciplines that require maintaining stability, such as gymnastics and ballet.


Anatomical factors


The anatomical factors can be atorigin of pubalgia group together:




Symptoms of pubalgia


The pubalgia symptoms may vary and tend to increase over time, until they radiate entirely over the entire surface of the thigh. The source of pain is located in the groin or lower abdomen. It usually appears after a workout or at the end of a strenuous physical activity. Afterwards, she begins to make herself felt during the activity physical.


She even ends up showing up for a few moments after the start of an activity and prevents its execution. There, the pain becomes persistent, until you are at rest, which prevents you from doing simple movements.


Moreover, if we refer to the duration of the symptoms, we can distinguish two types of pubalgia.


Acute pubalgia


It is characterized by a sudden pain that appears during the practice of a sport. Most often, it testifies to the existence of a muscle damage in the adductors or other muscles of this region. To be certain of the diagnosis, it is important to identify the nature and type of the lesion.


Chronic pubalgia


We are talking about chronic pubalgia when the pain lasts 3-6 months (or more). It is the most common ailment in sports.


During these chronic conditions, it is very important to rule out the existence of a hernia (inguinal or femoral) as well as pathology in the hip joint (such as hip osteoarthritis).



Diagnosis: How to detect pubalgia?


Le diagnosis of athlete's pubalgia syndrome is based on two principles:


  • know the structure causing the pain (tendon, muscle, bone, etc.);
  • identify the reason for this pain (inflammation, rupture, alteration of normal structure, etc.).


It is also mandatory to screen for possible changes, imbalances and biomechanical asymmetries may be the cause ofonset of groin pain.


Once the medical history is obtained, further studies should be performed.


  • Ultrasound : an examination that will show the inflammatory process in the tendon area and its insertion.
  • X-rays : they allow the visualization of the bone, the inflammatory characteristics, the small bone excretions on the upper edges of the pubis, towards the abdominal muscles, and lower, towards the adductor muscles.
  • Magnetic Resonance Imaging (MRI): in case of doubt, she could demonstrate, in addition to all this inflammatory process previously described by ultrasound, the possible presence ofbone edema, giving edges of severity to the array.



Pubic Pain Treatments and Remedies


Natural and homeopathic treatments for groin pain


If pubalgia is intense, You can apply ice (cold) on the painful area. Ice is a common method for ease the pain and it can be very useful for coping with pubalgia. To do this, press ice regularly (for 15 minutes with breaks of at least 2 hours between each application) against the affected area to reduce swelling and associated pain.


A hot water bottle on the stomach or groin can also help and will bring the blood to the surface and activate blood circulation. This will stimulate the healing of muscle tissue and avoid spasms.


THEhomeopathy has also gained popularity due to its health benefits. When you are dealing with pubalgia, certain homeopathic medicines used in rheumatology such as Calcarea phosphorica can be used as background therapy. In the event of a pain crisis, the Ruta Graveolens can also help. Between drugs and surgery, homeopathic treatment can intervene to speed up the recovery process.


Physiotherapy to treat pubalgia


Within the framework of the pubalgia, le rehabilitation program ou physiotherapy treatment intended to :


  • reduce pain;
  • return joint function to normal;
  • recreate good flexibility and rebalance muscles;
  • regain adequate muscle strength.


In the functional rehabilitation program a pubalgic syndrome, the recovery exercises concern the musculotendinous structures directly affected: the long adductor, the rectus abdominis and the iliopsoas.


The number of sessions as well as the type of exercises vary depending on the cause of the pain (rupture, tendonitis, tendinosis, bursitis, etc.).


Apart from physical exercises, the physiotherapist also gives you indications on the good management of the loads.


Physio helps reduce inflammation and pain. It is based on isometric exercises of the adductors, rectus abdominis and accessory muscles. These exercises will then be progressed and adapted to your needs.





La surgery comes into play when there is no improvement in pain with a conservative treatment. The causes of pubalgia most often requiring surgery are :


  • the inguinal pathologies (inguinal canal or changes in other structures of the abdominal wall);
  • the hip pathologies (femoroacetabular impingement or labral changes).



How to sleep with pubalgia?

It is easy to conceive that if our adductor pain makes us suffer at night, our quality of sleep will inevitably be affected. That's why it's important to find a comfortable sleeping position that can optimize your sleep and reduce stress on the inguinal region.


In the presence of pubalgia, I often recommend that my clients adopt one of the following positions to see if there is a beneficial effect on the level of symptoms.


1. Lying on your back with a pillow under your knees


sleeping postures for back pain


This position reduces the anteversion of the pelvis (lumbar hyperlordosis), which reduces stress on the psoas muscle and hip flexors. For people who see their symptoms worsen when they arch their back, this position can be comfortable and thus improve the quality of sleep. 



2. Lying on your side with a pillow between your legs


sleeping posture for back pain


Keeping a pillow between the legs allows for a reduction in hip adduction movement. This is more comfortable for many people with pubalgia.


For added comfort, many of my patients opt for a knee pillow such as thereof, available on Amazon (affiliate link). 


3. Lying on your stomach


If you are used to sleeping on your stomach, placing a pillow can reduce the pressure on the inguinal region and thus reduce the symptoms. This position also avoids lumbar hyperlordosis and tensioning of the psoas muscle (and other hip flexors).


stomach sleep


Consult the products of Cervi-Care if you are looking for a orthopedic, ergonomic or shape memory pillow to reduce stress on the cervical region.




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