Running Doc: Why cortisone not the answer for osteitis pubis

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Dear Running Doc:


Like a lot of runners, I’ve been building my mileage through the fall to get ready for late-season races. Lately, though, I’ve had a nagging groin pain that never seems to go away. I’ve stretched it like I did my last groin pull, but that doesn’t seem to help. It’s been nearly a month now with no improvement. What do you think’s going on?


Andy M. Deal, NJ.


It’s tempting, Andy, to assume every pain in the pubic area is just another run-of-the-mill groin pull like you had last time, and that stretching the area before every work-out will take care of it. Fortunately or unfortunately, the hip area is a little more complicated than that. And one of the common but frequently undiagnosed ways it can object to hard training is a condition called osteitis pubis, an irritation of the pubic bone that can imitate a number of other things like a hernia.


It’s an inflammation of the bones where the two halves of the pelvis meet in the front. By moving up and down and rotating a little, that pelvis joint does its job mechanically by helping you to be more flexible. But nature supplied the pubic symphysis, as the joint is called, with a stingy blood supply and consequently a great ability to become inflamed rather than healed after irritation. So while it’s absorbing the shocks it was meant to take from the rest of the body, it’s not really able to deal with them after it gets them.


The classic osteitis pubis victim I see is a runner, male or female, who’s been pounding out the miles on a hard surface in worn shoes that no longer cushion, or possibly had too little cushioning to begin with. Men who’ve had prostate surgery are more vulnerable. In its early stages, a mild stretching program to loosen all the muscles that attach to and therefore pull on the groin area might have been enough, plus some rest or at least an exercise switch to water running, swimming, or even cycling on smooth roads. But by the time I see most athletes, their futile “groin pull” therapy piled on top of a full training schedule has produced severe pain, with particular tenderness right on the pubic bone. Now it hurts even worse when they stretch, and the softening of the pubic bone from all the irritation is obvious enough to be seen on a common X-ray.


By the time the inflammation has gone this far, it’s going to take some medication to reverse. Cortisone is not the answer because it will further soften the bone. PRP works perfectly to decrease the inflammation and strengthen the bone again. Ignoring it will not make it go away.


If it’s untreated long enough it becomes chronic, and the only choice left is surgery to actually fuse the pubic bone so it no longer moves.


Please let us know how you are doing, Andy, and I hope this information helps you.


Enjoy the ride.


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Lewis G. Maharam, MD, FACSM is one of the world’s most extensively credentialed and well-known sports health experts. Better known as Running Doc™, Maharam is author of Running Doc’s Guide to Healthy Running and past medical director of the NYC Marathon and Rock ‘n’ Roll Marathon series. He is Medical Director of the Leukemia & Lymphoma Society’s Team in Training program. He is also past president of the New York Chapter of the American College of Sports Medicine. Learn more at runningdoc.com.


Want your question answered in this column? Write to running doc at runningdoc@nydailynews.com.


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