I have a dual problem, a diagnosed stress fracture in my pubic bone (left
ischium), as well as something called "osteitis pubis". I went to four
doctors before I was given the proper diagnosis, and am wondering if you
can give me some insight into this painful condition. I would like to be
treated as the serious athlete I consider myself to be, and want to get
back on the road as soon as possible. Doctors often seem to underestimate
our need to run, and really don't understand that for many of us, it is a
huge part of our lives! The mental part of this rest period seems to be as
difficult as the physical!!! Is there anything else I can do in addition
to resting in order to help speed my recovery?
Julie, this is a tough place for a serious runner to be. Both the stress fracture and the osteitis pubis requires that you rest. On the other hand, you need to maintain your activity level for other reasons. My advice is that you take up swimming, and swim with a float between your knees to keep your legs quiet. Also, use weight machines and free weights in the gym to keep your legs and upper body strong.
In runners, osteitis pubis usually comes on after sudden increases in mileage, or starting of sprint work. It is more common in soccer players. The problem developes because the internal aspect of the pubic symphysis is only covered with periosteum and the parietal fascia. It also has a poor blood supply. The result is that as you develop sheer forces - when the stance leg hits the ground- tension from the rectus on one hand, or the adductors on the other, may produce excessive sheer forces, leading to subperiosteal damage and an acute periostitis. The onset is usually gradual, with local pain and tenderness at the pubic symphysis. Sudden tension is often intensly painful, and stretching of the adductors only aggrivates the problem.
One concern is that this proble is common in people who also have ankylosing spondylitis - a progressive bone fusion disease. You should have an HLA-B27 antigen study before you conclude that this is a traumatic osteitis pubis, (especially if you have plantar fasciitis, and S.I. joint pain).
Other issues...changes on x-ray lag about one month behind the onset of pain, so a bone scan is more helpful in the diagnosis.
Rehab should include, after a rest period, adductor stretching, functional progression LE challenges (balance, balance and reach, lunge, step up-stepdown, jumping, and hopping in all three planes) before running begins.
Good luck with this Julie.