Pubic Bone Pain

author : AMSSM

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Ache in pelvic area after difficult runs and rides

Question from jdotten: Pubic Bone Pain

After my long runs or after somewhat hilly runs I have pain in my pubic bone for several hours, on the right side. Is this a hip joint thing? Sometimes I notice it after a really hilly bike ride too. I'm fine while sitting or lying down, but as soon as I stand up and put weight on my legs, I have pain in the pubic area with every step. I googled it, and got a bunch of info regarding this pain during pregnancy. I'm not pregnant. I did do a marathon late March, and was having the pain on some of the longer runs prior to the event. While running the marathon I had some hip pain, but it was more of a piriformis type pain radiating down the butt/back of the leg. I've also had some sciatica all on the same side. Anyone have any ideas?

Answer by Jeremy Wells, MD
Members AMSSM

Pubic, groin, and anterior hip pain can be difficult to diagnosis. Further delineating your symptoms can help narrow down the cause. The pelvis is a large bone and does include the hip joint. The pubic symphysis is where the right and left pelvis joins together at the lower abdomen. The location of this pain is typically midline but can be offset slightly to the right or left. It is caused by increased motion at the joint due to injury, alignment issues, or joint laxity. This is a type of pain that is common during pregnancy but can be activity related. It will typically be painful with stressing activities and pressing on the area.

Another cause of pubic bone and anterior hip pain is a stress fracture. If present, this is commonly on one of the pubic rami, which would be just right or left of midline. This is an area that will be painful with activity and also tender to palpation. A fracture in this area may be due to direct trauma or injury, but can be related to overuse or over stressing of the bone.

Hip joint pain is often felt at the front of the hip and in the groin area. Hip joint pain may be related to osteoarthritis (degenerative changes of the hip joint) or hip impingement (femoroacetabular impingement).

Hip joint pain due to arthritis is typically painful with weight-bearing and worsens with increased activity levels. The intensity of this pain and the degree of joint limitation varies depending on the severity. It can be related to age, genetics, prior injury, and overuse.

Hip impingement pain is caused by hyper motion of the joint, causing injury to the surrounding tissue, or variation in bone shape leading to impact injury. It is typically worsened by full range of motion, especially hip flexion, and repetitive running or cycling type activities. It may also be painful with prolonged sitting, crossing the legs, or yoga poses. It is typically a sharp pain during activity but can linger for several hours.

There can also be an injury to the muscle attachments above the hip joint. These are areas that some of the thigh muscles attach. It is possible to have a fracture or muscle/tendon injury here. This pain will worsen with activity and typically be felt at the front of the hip but not midline. It can be tender to palpation and typically worsens with activity. There can be weakness.

There can also be nerve entrapment at multiple sites of the pelvis and hip. This can cause a sharp and burning type pain that is caused or worsened with activity.

Any of these problems may be the cause of your symptoms. With the limited information provided it is difficult to confirm but I suspect you may be having pubic symphysis pain or hip impingement. You should make note of what activities and range of motion make this worse. Also make note if any area is painful to touch. If it is only with activities, make note of when the pain develops and at what stage of activity.

For more diagnostic accuracy you may need to see a sports medicine specialist and ultimately have some type of imaging such as x-ray, ultrasound, or MRI.

Treatment for these types of symptoms generally starts with basic musculoskeletal injury treatment such as rest and ice. I would suggest taking a 2 week rest from offending activities and then, if pain-free, start a slow and gradual return to prior levels. Medication treatments typically involve mild analgesics such as acetaminophen and anti-inflammatory medications such as NSAIDs.

With multiple ailments of the right hip, I would suggest that you spend some time evaluating your running mechanics, surfaces, shoes, seat position, etc. Also pay attention to see if there any alignment issues with your pelvis or leg length discrepancies. You may need someone else to help you observe for gait or foot strike abnormalities. Evaluate your running shoes for uneven wear and make sure to vary your running surface and running directions.

Hope this helps you narrow down your problem and find a solution. Good luck with getting back to pain-free activities.

Jeremy Wells, MD
AMSSM Member
Hattiesburg Clinic Sports Medicine

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date: May 31, 2016