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381 Views 2 Replies Latest reply: Mar 27, 2013 4:45 PM by Damien Howell RSS
HappyCoop Rookie 1 posts since
May 26, 2010
Currently Being Moderated

Mar 26, 2013 6:08 AM

Severe pelvic/pubic pain need help!

Hoping that maybe someone here has heard of a similar situation and could offer some advice.

 

27 y.o. female runner, gets severe pain (rated a 10 out of 10) approximately 1.5 miles into her run. The pain is concentrated in the supra-pubic area (think front of pelvis), and is described as a stabbing pain. Pain is severe enough to bring her to her knees, but subsides with about 5-10 minutes of inactivity (squatting down with elbows between knees seems to help somewhat). Once the pain is gone, she can continue to run, with no further pain episodes for the duration of the run regardless of the distance.

 

Interesting points: the pain seems to be related to high impact aerobic activity; unable to replicate the pain with anaerobic start/stop activity (like ultimate frisbee, where she is sprinting back and forth on a field), or when running on a treadmill or using an eliptical. Essentially, it only happens when running on a hard surface (happened once when in a race on the beach, but that was hard packed sand). The pain does not always happen...some runs she has no pain whatsoever, but others it happens in the exact same scenario every time.

 

Visits to General Practice, GI, and OB/GYN have resulted in no leads. Lab tests and bloodwork all come back fine. The doctors are at a loss for what could be causing this.

 

Any ideas, suggestions??

 

Thank you!!

  • JamesJohnsonLMT Legend 1,127 posts since
    Aug 23, 2009
    Currently Being Moderated
    1. Mar 26, 2013 11:48 AM (in response to HappyCoop)
    Re: Severe pelvic/pubic pain need help!

    There are many explanations for groin pain, but most of them can be ruled out after a simple medical history. The purpose of the history is to produce a better picture of how things came to be, so we are not blindly reverse-engineering from symptoms. The penlight and magnifying glass approach has severe limitations in cases like this.

     

    You don't have to reveal (her) med history online, but at 27, active, a few possibilities come to mind. The most important point you have revealed so far is that pain begins shortly after running begins, and subsides after two things: (a) the warmup, and (b) some time for recovery. I spend a lot of time in this forum speaking up for muscular causes of pains that are frequently misdiagnosed as something else. This behaves a lot like a muscular problem, which can be as painful as you describe.

     

    Your time spent with doctors so far makes this a likely case of a classic adductor spasm. Why? because a look at other differential diagnoses reveals that pain under these same circumstances would be more likely to increase with activity, especially of the type represented by Ultimate, and anything ending in "itis" would most likely get worse as well. Ditto for nerve entrapment. Cold muscles, on the other hand, are famous for complaining early before exercise relaxes them.

     

    All well and good, but what if the incidence of pain becomes more frequent and more debilitating? Still consistent with spasm, which left untreated can worsen over time, even if the actual cause is considered benign. Are any of the medical professionals likely to be trained to treat an adductor muscle spasm directly? No, not likely. Two examples of indirect medical treatment include exercise and stretching. No kidding. We already know that can help some, but how do we deliver the knockout punch? An example of direct treatment that is considered illegal in most states when performed by a practitioner, but she can probably do herself, is trigger-point massage of the adductors near the pubic area (and perhaps the inta-pelvic muscles). Works very well, solves many a suspected OB/GYN issue, but is a bit too private to hand over to someone else. I did the honors once at a triathlon for a female athlete about her age at her request, but frankly, it does not look kosher. I think she can handle it if she tries. Please. We want to stay out of jail.

     

    No youtube videos of technique, I'm afraid, it's a minefield out there. However, an osteopath discusses this subject in light of myofascial pain treatment techniques in the following article:

     

    http://www.massagetoday.com/mpacms/mt/article.php?id=13515

     

    I didn't link it due to an error in the editor linking function, but you can cut and paste it into your browser if it does not work.

     

    Now for some possible explanations and consequences of non-treatment. A history of pregnancy is one possibility as a cause, because relaxation of the pelvic sutures during pregnancy forces several muscles to stabilize the pelvis to prevent areas such as the SI joints and pubic symphasis from excess movement and resulting tissue pathologies such as Osteitis Pubis. I bring this up not because I suspect OP in her case, but because it could result if there is excess movement due to muscle/ligament laxity (actually, excess muscle tone can exacerbate symptoms, much as tension in the earth's crust makes an earthquake more violent).

     

    While surgery to stabilize these joints is the extreme option, and strengthening of the musculature via physical therapy would be tried first, the result of either could be a worsening of spasms in the intrapelvic or adductor muscles as an adverse reaction. In other words, tackling the spasm directly gives her the opportunity to stop the myofascial pain in the early stages, allows her to continue to strengthen it painlessly, and avoids unfortunate outcomes like OP and/or invasive surgery, which carries its own risks and repercussions. In fairness, I should point out that an alternative to surgery for tightening the pubic symphasis is Prolotherapy, a chemically induced pro-inflammatory procedure that can thicken and toughen ligaments. Risks are lower, but needles, let alone scalpels, always carry risks to non-target tissue.

     

    Another potential cause of excess movement in the area that might lead to spasms, is the athletic life itself. I'm sure you considered this, but as my aforementioned client found, the athletic life can lead to chronic spasms in embarrassing places. While people often feel more confident when others are treating them, this is an example where self-treatment makes more sense, at least in the here and now. The above article details one example of this.

     

    Good luck, and kudos for following up on the symptoms with medical professionals. It makes troubleshooting much easier, and had to be done anyway.

  • Damien Howell Legend 306 posts since
    Feb 27, 2008
    Currently Being Moderated
    2. Mar 27, 2013 4:45 PM (in response to HappyCoop)
    Re: Severe pelvic/pubic pain need help!

    Do a browser search for Osteoitis Pubsis and Stress Fracture of pubic rami.

    Damien  Howell PT, DPT, OCS

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