What is Pubic Apophysitis?

A growth related pathology that can cause groin pain in persons aged 16-21 years old. This injury is a result of increased muscle tension to the area surrounding the growth plate, known as an apophysis. Symptoms can develop at the apophysis when it is irritated. Irritation is caused by increased load to the area while the apophysis is open. The apophysis is believed to stay open until the age of 21 but this can vary depending on age, gender, race etc.

Location of pubic apophysitis groin pain (Source: http://sportsmedicineimaging.com)

Signs and Symptoms

  • Pubic bone pain with or without lower abdominal and/ or upper abdominal discomfort
  • Gradual onset and worsens with progressive loading
  • Symptoms are better after warm up but deteriorate after rest and worsen towards the end of physical activity
  • Reduced acceleration, agility and kicking distance
  • Sore at night and stiff following morning

Risk Factors

  • Younger persons who are late maturers
  • Increased load:
    • Ball – change in size or weight
    • Surface – Wet and uneven surfaces
    • Frequency of training with lack of rest between sessions
    • Type of training e.g. running
  • Males aged 16-21 years are most at risk of developing this condition
  • Type of sport – sports requiring running and rapid change of direction, e.g. AFL, puts you at greater risk

Treatment and Prevention

It is important to see your physiotherapist to address this pathology early rather than later as this condition can become quite painful if it is ignored. Current strategies to address this issue include:

  • Load management strategies
  • Training modification e.g. avoid training in wet weather
  • Optimal recovery/ cross training
  • Developing correct running biomechanics
  • Address shock absorption capacity
  • Multi-intervention neuromuscular training
  • Optimise hip rotation
  • Monitor groin strength

Prognosis

This can vary from 6 weeks to 12 months and is dependent on a number of factors such as level and type of sport, previous history of groin pain, coexisting groin pathologies.