My experience with osteitis pubis

by Jackson Clark

Osteitis pubis is one of the most frustrating injuries a young footballer can get. Commonly known as OP, the condition is inflammation of the pubic symphysis that leads to lower abdominal and pelvic pain. It severely drains a footballer’s power and kicking ability and creates a dull aching pain, which can sometimes develop into a sharp stabbing pain.

I first felt soreness in the pelvic area in August 2010, two days after a game of football and during a period where I was training for football five times a week. I typed my symptoms into Google and the results agreed with my suspicion that I may have the dreaded OP. I spoke to the physiotherapist at my club who gave me strengthening exercises and dropped off my training to try and reduce the inflammation. I did no running or kicking for six weeks and attempted to keep fit with some light bike riding and swimming. I returned to training in the middle of September hoping that the injury was a thing of the past, but unfortunately this was not to be the case and the familiar pain quickly returned.

On the first day I felt the soreness I met a guy named Jason who was working as a tutor in my maths class at school. He would be the person that would ultimately cure me of this frustrating injury. I often wonder whether I would still be suffering from osteitis pubis or how long it would have taken to fix it had I not met him. He told me that he used to be a physiotherapist and that he did a four-year study in biomechanics as well. He also said that he previously owned a clinic in Melbourne and that he worked with Collingwood in the 1999 season. When I told people about Jason, the majority doubted his qualifications with some even claiming that he was probably just some nut-job. But from my angle, the advice I had been given from other practicing physiotherapists had been unsuccessful and I was getting worried and impatient so I was willing to try anything. Jason told me that he believes the cause of osteitis pubis is excessive tibial torsion, which causes the pelvis to become unstable, especially after a high workload. Apparently the ideal tibial torsion reading for someone of my age was between 13-18 degrees. Anything less than that and the person is described as “pigeon-toed” while anything more than that and they are “duck-footed”. My readings were 27 degrees on my right leg and 37 degrees on my left so there was little wonder why I got OP.

Jason asked me what I knew about the injury and my response was that I believed it to be an “overuse injury”. However he hated this term and used marathon runners as an example of how someone can train hard every day yet still manage to escape the injury. I constantly researched osteitis pubis and tried to draw inspiration from AFL players that previously suffered from it yet managed to get back to full fitness. I was surprised at how common the injury actually is, as a lot of players have been affected by it at some stage of their career. There are so many different opinions on what supposedly fixes OP and it really opened my eyes just how uncertain the medical world is in regards to best way of treating the injury. The fact that there was no black-and-white, definitive answer on what the best method of treatment is did not fill me with much confidence. Many sources said complete rest is the only cure while others said that resting it will not help and may even make it worse. I was left confused and frustrated, doubting whether or not I would ever be able to run injury-free and at full fitness again. Through some light stalking, I contacted four AFL players on Facebook – Andrew Strijk, Rhys Palmer, Chris Schmidt and Sam Sheldon – and asked them about their experience with osteitis pubis and what they did to fix it. All of them took the time to reply and surprisingly they all had different ways of overcoming the injury from complete rest, strengthening the core, dry needling, acupuncture and Pilates or a mixture of these things.

Anyway, Jason was a confident man and he assured me that if I followed his instructions, he could fix my osteitis pubis for good. He sent away to get a special type of orthotics made up for me which would correct my tibial torsion readings by turning my feet, knees and hips inward. This was all made easier due to the fact that I was still under the age of 18 and my growth plates were still open. I was told I had to wear the orthotics six hours a day but I would wear them for much longer as I wanted to give myself the best chance of recovering. Eventually the time came when Jason said he believed I could slowly get back into playing footy. I had already missed half of the season but I was still excited to get back into it. I started slowly with a few light runs and kicks of the footy and while there was no significant pain, I was not convinced that I was completely cured. I felt tightness and a bit of soreness when I would change direction suddenly but Jason assured me that this was normal so I stuck with it. I always stretched the muscles around the groin (particularly the psoas) but made sure that I specifically did not stretch the groin itself. In the coming weeks the pain eventually subsided completely and was fortunate enough to play in an U18s premiership. Even though I was playing free of soreness I was still apprehensive about increasing my training workload, but that confidence would come in a couple of months.

(Darcy Daniher)

I love my football and while it was killing me not being out on the field playing, I cannot even begin to imagine the frustration that AFL players must feel when suffering from the injury. These footballers would have worked so hard just to get an opportunity at AFL level only for OP to severely restrict their training workloads. They would feel uncertainty and helplessness while being forced to watch training and matches from the sidelines. Players often push through the pain due to the pressures of performing at top-level football, especially if they are not an established player or approaching the end of their contract. This ultimately hinders their recovery and can even worsen the condition. I still remember the change-room vision of Luke Ball trying to get up off the ground after a match with St Kilda during the early days of his captaincy. Ball suffered from OP for years, which affected his kicking penetration and speed etc. However to Ball’s credit, through sheer persistence and a change of scenery with the move to Collingwood, he has tinkered his playing style to remain a star of the game. Others are not as lucky, such as former Bomber Darcy Daniher, who had his career ended due to a bad case of OP. Daniher was a star junior and had a promising future ahead of him until chronic OP forced him to give up on his AFL dream at only 21 years of age.

Twitter @JClark182

About Jackson Clark

Born and bred in Darwin, Northern Territory, I am a young, aspiring football writer that lives and breathes the game of Australian Football. I'm also a keen player and coach.

Comments

  1. Jeff Dowsing says:

    Fascinating insight Jackson. Glad to hear you got back on the field and playing in that flag is something you’ll treasure perhaps more as you get older.

    Whilst my footy playing days are behind me I’ve always done a lot of running and continued playing other sport. I’ve never had OP but I’d also be classified as pigeon toed.

    Just wish I could shake my damn Achilles soreness!

  2. Well written piece, Jackson. Chronic injury must be a burden, especially when you are getting established. Do you wear orthotics when you play? I wear them all the time for the sort of plantar fascia problem that has burdened the Eagles Josh Kennedy recently. A few days without them and I am hobbling. Who did you play in the U18’s premiership for? Hope we hear more of your exploits.

  3. Jackson Clark says:

    Firstly guys, thanks for the comments. I’ve heard that achillies injuries (tendonitis) and plantar fasciitis are up there with the most frustrating injuries in football.

    I played in the U18 premiership for St Marys in the NTFL.

  4. Great stuff, Jason. We have the Perth Almanac dinner tomorrow night with Sean Gorman talking about his Indigenous Team of the Century book “Legends”. I came from SA, and the first Grand Final I saw was the improbable 1964 game when South Adelaide (who had recruited Neil ‘Knuckles’ Kerley from West Adelaide as captain coach) came from bottom to top in a season. They beat the all conquering Port Adelaide coached by Mark Williams (now at GWS) dad Fos Williams. I remember David Kantilla from your club of St Mary’s very clearly because he was so tall; so skinny; so black; and so skilful. In those days ruckmen got tapouts but did little else. They were gangly and unco; or massive and clumsy. Polly Farmer and Kantilla changed the mould. Kantilla was not an all round athlete like Polly, but he could mark and was a good kick on goal. He was a skilful palmer of the ball to his rovers, in an era when most thumped hitouts. Fellow Almanacker Michael Sexton has written a great book on the SANFL 1964 season. Kantilla and Michael Long are great contributors to our game from your club of St Mary’s.

  5. OP grounded Stuart Powell, brother of Steve Powell (Footscray, Melbourne, St Kilda), back before it is was known. We all found it so strange that Stu couldn’t run or kick as he churned out endless laps of the school pool. It was a shame, because he was such a good player.

    I remember “straining” a groin (or so I thought) in lanework one Tuesday training night. I had a week off and did the right things and then “straining” the other one the next Tuesday in lanework again. I couldn’t shake them for over two years and eventually hung up the boots at the age of 24ish.

    A move to the country and a change of scenery saw me join the local club where there was less training. It never came back as bad, but was still always there.

    Ten years (and three boot hangings) later, the dull ache is still with me. But, I guess it is now something that I am just used to.

    I hope you can shake it off Jackson and can get back to free running and kicking. Good luck!

  6. pamela sherpa says:

    Teenagers training 5 nights a week for football is too much. The experts may not like the use of the word ‘overuse’ but honestly, a bit of common sense would come in handy.

  7. Jackson Clark says:

    Great insight about some of the champion players that have come through St Marys, thanks for that Peter_B.

    Such a frustrating injury, Shaken. It is often misdiagnosed and a lot of medical professional don’t offer the best advice in regards to curing the injury. Playing a fair bit of footy at the moment and feeling great so hopefully it stays that way!

    Pamela, I agree that training five times a week might be a little too much for teenages. However when it comes down to making state sides and trying desperately to improve your footy, sometimes it is hard to stop yourself.

  8. Brendan nannery says:

    Hey Jackson.grwat insight into your experience with the dreaded o.p injury.iv recently been diagnosed with this aswell and was wondering about this Jason bloke.does he still work in this field or is there a way of contacting him.id do anything to get this right now.cheers mate

  9. Jackson Clark says:

    Hey Brendan, sorry to hear that you have OP. As I said, I met Jason when he was working as a tutor at my school. He has now left that job as well and is doing something else and I have no way to get into contact with him. I’m also pretty sure my type of treatment only works for people under the age of 18 so unsure whether or not you fall in that bracket.

    Good luck with treating the injury though. There are so many different methods to fix it but it is all about finding a physio/doctor that you are confident with. I know of many other people that have suffered with OP that are now running at 100% so although it is extremely frustrating at times it is by no means the end of the world. Let me know if there is anything else you would like to know or I could help you with.

  10. Great article about OP. I believe I have been suffering from footy-induced OP for about six months. Went to a couple Physios who were baffled by my lack of response to various treatments like laser, etc. Desperate, I went to a Chiropractor who really took the time to treat me properly. With his techniques, you can literally hear a pop as my pelvis adjusts. He also prescribed custom orthotics. What a huge difference. I am now back to training. When I run without orthotics, I likely get some mild discomfort in the OP region the following day.

  11. Thanks for sharing JC.
    I’ve been a cyclist for 18 years and recently took up running too. Really enjoying it apart from the groin pain you describe. Coughing and sneezing 1-48hrs after a run is very painful.
    The tightness warms up within 1km of a run but sets in straight away after. So I run every alternate day and ride in between.

    I live in Melbourne and was wondering who made your orthotics to correct your tibial torsion?
    I am duck footed & even have my cleats set up this way on the bike so I pedal toe out.

    Thanks
    DC

  12. Jackson Clark says:

    I am not entirely sure of who made the orthotics. But it came in a box with packaging saying “Banksia Sports Clinic” or something like that. Does that sound familiar? Hope all goes well.

  13. hi jackson,
    ive now got this dreaded op, but im a 50 yr old woman who does lots of gym and hiking. Its been 3 weeks now and I hate being so stuck and unable to do much. Still walking with 1 crutch but much better than 3 weeks ago when I couldnt even weightbear. Im going to try abit of exercise bike riding now to keep a bit fit. Others Ive read about seem to go ok with this. Mine came on without warning and I was in hospital for 6 days……maybe an old lady thing!!!! All the best to you and thanks for your insight.

  14. Ashley says:

    Thanks for the article. I have been living with this for about 15 months now. It was originally diagnosed as a hernia which I had repaired. When I had a relapse I knew it was OP, confirmed by a physio.

    The subsequent treatment of strengthening the core etc didn’t really give me too much relief and I am only now managing the soreness by training within my limits, occasionally pushing them and tonight I am trying a one hour run for the first time since I felt pain.

  15. Thanks Jackson,
    Apologies for the late response, I didn’t realise you replied to my post. Just happened to check this website again!

    Appreciate it, I’ll check Banksia Sports Clinic out.

    Since my post, I had an MRI and am on a course of corticosteroids as have OP and adductor tendinopathy.
    I haven’t run for 6 weeks and have just been cycling.

    I have also started some glute, pelvic work. My adductors are SUPER tight and tender still (esp in the morning) , after 6 weeks of massaging , anti inflamms, strengthening and rest.

    I am hoping to try and run mid June and complete my first marathon October.
    I will try orthotics and keep you all posted

    Thanks mate
    Dan

  16. Sam Wallace says:

    Hey man, Im a born and bred darwin boy aswell! Just got the unfortunate news about the old op aswell! Was wondering if maybe you could email me at dannydude123@hotmail.com and have a chat? Sam

  17. Andrew Gardiner says:

    Suffered with OP for around 8 years. Struggled to even get out of bed. Endless physio and scans achieved nothing with no improvement what so ever but brought immense frustration. Had to eventually give up all forms of sport and exercise bar swimming.

    Took a flight down to Melbourne to visit Miritis Massage 12 months ago who specialise in treating OP.

    Two treatment sessions over a weekend and then 2 weeks later I woke up and all the pain was gone. I’m now back playing competitive hockey with no issues strength or pain wise and I’m nearing 30. Wouldn’t waste my time doing anything else because it just doesn’t fix the issue itself. Miritis Massage didn’t just alleviate the pain, it cured me of something that according to some is not curable.

    Feel free to email me or post on here if you would like further information on my experiences with the treatment. I was compelled to post as OP is an utterly terrible, debilitating condition. Thankfully one that is now in my past.

  18. Jackson Clark says:

    Good to see all the replies though and it’ interesting to discover the different methods that are used in an attempt to treat OP. All I can say is that I am glad that I’m cured of it. I know of many people that have stopped playing footy or lost the passion because of OP.

  19. What are the symptoms for osteitis pubis? I’m 25 y/o living in rural Victoria and have missed the past month with a groin injury. I’m having on-going physio treatment however my injury is yet to be diagnosed properly.

    I have pain in my lower groin around the bone, up near the v on my waistline and lower abs. It’s sore when I first wake up and get out of bed and sneezing. I’ve started back running after a months rest, unable to run at full pace and kick the footy long distances without severe pain and pull-up very sore the following day.

    I’m frustrated and feel like my injury is not getting better.

    Is this symptoms of OB? What are the other symptoms you’ve experienced?

  20. Jackson Clark says:

    I’m not a doctor so obviously I can’t properly diagnose you but your symptoms sound similar to what I had. Unfortunately you may have OP mate. Go to a doctor so he can properly diagnose you so you can begin treatment on the injury. Keep your head up though, OP is frustrating but it’s quite curable and now I am feeling better than ever.

  21. Andrew Gardiner can you reach out to me? my gmail is JCase16. I tried to email you directly but nothing was listed to do so.

  22. Andrew Gardiner says:

    Jason – email sent

  23. Elaine Loperena says:

    Hello from California! I have had OP now for 12 years due to a surgery from a very rough surgeon. I feel for everybody that has this. Over the years and( am still going) I have been to numerous Chiropractors, PT’s, Doctors, an Acupuncturist even a couple of Massage Therapists. Really to no avail. I am still in pain 80 per cent of the time. I do the exercises , adjustments and they might work for a day or a few hours then the pain comes back. Andrew could you please email me? I would so appreciate it and tell me what Miritis did or how they did the therapy. Thank you so much. tealane56@aol.com

  24. Hello Andrew,

    Could you shoot me an e-mail as well regarding Miritis and what he did. I have OP and am considering retirement at age 23. I am american. My e-mail is josuefaga@yahoo.com…this would be so helpful. Thank you.

  25. Jackson, I read this with interest, and all of the other posts re athletes suffering OP like symptoms.
    I don’t want to advertise as I understand that’s not the point of your blog.
    Our compression range has been used by elite footballers in AFL and soccer with outstanding results re OP and groin, hamstring and glute related syndromes. We have a range of shorts and legging sold as Coretech for anyone who is interested.
    Cheers
    Jon

  26. Thank you for this discussion. Andrew Gardiner, your mention of Miritis in Melbourne has meant that our 16 year old lad has had the burden of the potential absence from his beloved world football removed after ONE visit to Miritis Clinic. Darren at the clinic resolved the OP/ groin strain which had affected him for around three months and had been diagnosed by a MRI scan. Physiotherapists proved disappointing with one keeping the diagnosis from us and the other fast tracking without our consent. We highly recommend Miritis Clinic. We also took our lad to another remedial massage therapist who specialises in postural integration and has worked with a number of elite sports people, for a second opinion and he was in agreement that the OP/ groin strain was resolved and then he worked on the cause of the groin issue.
    Regards,
    John

  27. Jackson,I am a 17 year old football (soccer) player who was diagnosed with OP as well. I have been resting for about 8 weeks now and have been suffering from this for about a year now and it does not seem to go away. I am very glad I stumbled upon this because I feel like you are the only person that truly understands what it feels like. I really do not know what do to anymore. Do you have any advice for me? Is there a way to overcome this by continuing to train? After an MRI my doctor didn’t really help me. He just told me to strengthen my core and try to start playing little by little and that if it continued to hurt I should stop because it can get worse. Have you learned anything new on how to overcome this injury? Could the orthotics thing that you did help me?
    Thank you very much, hope to hear from you,
    Nick

  28. Jackson Clark says:

    Hey mate,

    Yeah I feel your pain 100%, it is such a frustrating injury to have. Perhaps the worst part about the injury is that there is no “one size fits all” diagnosis and everyone’s case is different. This makes it so hard to effectively treat the injury. From my own personal view, I always make sure to stretch my hip flexors and psoas muscles to make them as loose as possible. This gives me more freedom and movement around the groin area and I find that it takes the pressure off a little bit. Stick with it all mate, there will be light at the end of what can sometimes seem like a dark tunnel.

  29. I appreciate your advise Jackson I’ll keep them in mind!

  30. optreated says:

    Well I was diagnosed with op. Had for about 10 weeks now and just got a cortisone injection in my pubis symphysis. Not sure if this forum is still going on. if it is let me know and I continue.

  31. I too suffer from OP I’m on my second dosage of prednisone since October 2014 it went away for a little while but now it is back and it sucks! The pain is terrible! If u could email me about miritis massage that would be great! I’m a miserable mess trying not to work out so it can heal AGAIN!

  32. Michelle Rogovich says:

    My son is a junior in high school and he is a wrestler. He was diagnosed with OP about two years ago. He had Physical therapy and does stretching but it seems to sporadically re-occur and not usually when he is wrestling, more if he tries to lift weights. He is completely frustrated. I would be interested to know more about the massage therapy.

  33. Hi Jackson,
    Great post!! I play football and have developed osteitis pubis (OP), I had to go see my physio for treatment but then I did my own research as well and came across Supacore compression. One of their products, the Coretech short, is made specifically for OP support and it definitely helped with the pain. It made playing so much easier, and even when I was training or off the field, I wasn’t in any pain. A lot of compression brands don’t work but this is incredible and you have to try it!!! I bought mine online at http://www.supacore.com and they have a heap of different styles, shirts, shorts.
    Hope this can help you and everyone else like it did for me.

  34. Andrew,
    Can you please email me with your experience at MIritis massage in Melbs.
    What practitioner did you see?
    I’ve been diagnosed with OP after the birth of my Son 8 months ago. Suffering with chronic pain day to day… 5 months of physio, 2 months osteo, seeing a naturopath…. XRAY, MRI… I’m still a long way off feeling normal.
    Hoping to hear from you.
    Kind regards

  35. Michael Makensie says:

    Hey guys

    Thought id share my recent experience with OP because this post really helped me out along the way. Between reading you guys here and the post on the ‘big footy’ site i ended up at some guys out in Port Melbourne called Step Up Physical Therapies.

    Anyway I’ve had OP from Basketball on and off for over a year now. Like everyone else, just when i thought it was getting good and i would ramp up the training it would pop up again and id be back at square one. It was really killing me, and it didn’t seem to matter which specialist i saw, it was always the same old story.

    Jason out in Port Melbourne was awesome though. He talked about the tibial rotation stuff that Jackson mentioned in his story. Except he was dead against orthotics. He had me do a bunch of coold, weird exercises which he said he borrowed from yoga, pilates and a few other things. Anyway they improved my tibial angle with just treatment and rehab.

    The clinic has cameras and a big screen setup in their gym and he recored and analysed all my movements. It started pretty simple then built up to really heavy deadlifts, squats and eventually plyometric stuff. He also used a bunch of differenc balance stuff (wobble discs etc.).

    Anyway its been 12 weeks and im back playing and training at 100%. I only get soreness the day after the game, but i have a exercise routine for when i get sore that goes for about 20 min and then im usually good.

    I think that Jason is awesome. Here’s his site: http://www.supt.com.au . If you check them out on google their got plenty of good reviews as well.

    Anyway hope this helps. And thanks everyone for their posts, they really helped me along the way as well

    Cheers

    Michael

  36. Hi there i’ve been having groin and lower abdomin pain on my right side and pubic region for 2 months now. It all started from playing football. I can’t exactly pin point the area but it gets aggravated when running, twisting and doing sit ups or working my abs. Also coughing and sneezing is painful. I went to see my doctor and he told me its not a hernia and that I should just rest and take anti inflammatory tablets. I’ve stop playing football for 6 weeks and its
    still not getting better. Two weeks ago i went to see a physiotherapist and she told me i have Athletic Pubalgia( sports hernia) she told me to do
    strengthening exercises but it still isn’t getting better. A friend of mine recommend me to see a osteopath. What do you think? Can you please help me

  37. Andrew Gardiner says:

    Talk to Darren at Miritis Massage for those asking. He manipulates your pubic syphesis to get it back in line so it can heal properly and OP not reocur. Very painful but it works. 3 years on I’m still fine. All the other treatments were a waste of time in my expeirence. This fixes it instead of just alleviating but give them a call, everyone’s situation is different. Best of luck

  38. Andrew Gardiner can you contact me? Shane.poll@hotmail.com

  39. Andrew Gardiner, I have been suffering from this injury for about one year. I have tried to find your contact however have not been successful, can you please e-mail me at 1992lucas@live.com ? Thank you very much.

  40. I had pregnancy related OP. After 7 months of being in constant pain and not being able to walk properly I took a flight down to Australia to see Garry Miritis and like Andrew Gardiner mentions here (thanks a lot Andrew), he puts the symphysis back in alignment so it can heal. This was two months ago and I’ve been feeling so much better, the typical symphysis pain is gone, I can walk, ride a bike and swim pain free now which is something I thought I would never be able to do again. I still don’t feel ready to play tennis, badminton or go skiing but the improvement is huge. If you have questions, you can contact me at hasil@centrum.cz

  41. I have had OP for around a year from doing martial arts and was diagnosed with OP by a sports doctor around 2 months ago. I was put on predisolone and told to do core exercises then slowly build up from there. After a couple of weeks of searching on the internet because the protocol i was given didnt seem to be working i found post about Miritis massage, It sounded too good to be true 1-2 massages and i could be completley cured? So i searched further and found Gary Miritis had retired but had trained a few other therapist. When i searched for Miritis massage on maps it instead came up with Waverly massage which is the pretty much the new Miritis massage. So i went there and had 3 massages from Adam (who was trained by Gary). I am now able to jog for an hour but changing directions and sprinting is out of the question. Hopefully the next massage will be the last one and then i will be fully cured but for now i am skeptical and feel like it would be too good to be true. I encourage anyone who is reading this to post what has been successful for them and what has not been so we can gather some more options for treatment.

  42. the pain is unbearabe and i have been suffering with op for a year and i cant fully partake in sports and have recently pulled out altogether.i found that running full speed with long strides was when the sharp shooting pain came in my lower abdomen on my right side. i would then pull out altogether.i find that an ice bath helps for short term relief. any other short term relief strategies ?

  43. Great post and comments! My case is a little bit weird because I’ve read all the comments and I see this injury is common in sports like football, soccer, hockey and running. I’ve done karate for about fifteen years now, however, my pain started during a social soccer game back in January this year. I saw a physio who was only giving me massage (very rough sessions which were causing me a lot of discomfort), but I stopped seeing him because I had a karate competition back in March and a few days earlier he gave me that massage and caused me a lot of pain that persisted over the two days of competition. Further, I think he had no idea what he was doing. I started seeing another physio last week and he diagnosed OP. However, I am still a bit skeptical about it because I’ve never had pain on the symphisis and although I’ve been sore all the time, the pain has improved and I’ve been able to continue my karate training. In fact, I didn’t feel sore during the last two classes I had before the end of school term. I’ve rested since for nearly two weeks and I’m planning to restart next week.

    In our training we do lots of kicking (not rough surfaces and obviously, not balls) and jumping; I do Shotokan karate, so my stances are very low. I really wonder what of those moves may worsen my injury. Does anyone have a suggestion?

  44. I had OP for over a year from training for a marathon incorrectly i.e. Going to fast and too long to quickly. In desperation I flew to Melbourne from Sydney to visit Waverley Massage (formerly Mirtis Massage). After three treatments I was cured and went on to run the Hawaiian Kona marathon the following year, I can not recommend them enough.

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