Osteitis pubis in four young football players: a case series demonstrating successful rehabilitation

Abstract

Objectives Four young football players developed osteitis pubis acutely within six months of a rapid increase in training load after joining a junior elite programme. This case series study reports on successful rehabilitation outcomes and two new possible clinical indicators for return to football following osteitis pubis. Design Case series report. Participant Four elite youth football players with acute onset Osteitis pubis. Main outcome measures The clinical outcome measures included strong effort pain-free hip adduction, no tenderness over the pubic symphysis, bone or adductor complex. The functional outcome measure involved a pain free completion of a running programme based on average distances covered by players in a game. The performance markers used in this case study (20 m shuttle run, 20 m and 5 m sprint tests), are frequently employed in football to measure player performance. Results All players were commenced on a conservative rehabilitation program involving abdominal and pelvic strengthening exercises in a graduated format and successfully achieved this outcome between 10 and 16 weeks after diagnosis. During their rehabilitation a consistent pattern of clinical milestones emerged that coincided with the players’ readiness to return to football. The players were able to perform 5 min of skating on a 3 m slide board and three sets of twelve repetitions of adductor exercises against 6 kg of resistance. No recurrence of injury has been reported at 12 months follow-up and none of the players required injection or surgery. There has been no recurrence of injury and the players have been training and playing at the same high level for over 12 months since returning from OP. The data available from the 20 m shuttle and sprint testing post injury has indicated that the players had returned to a high level of fitness similar to pre-injury levels and within team averages. Conclusion This case report details a successful rehabilitation process using progressive modules of exercises and activity in four youth football players who had presented with OP. The results from this case series report indicate that a programme should be based around sport specific requirements and further, that two exercises (slide board skating and specific adduction loading) may provide useful additional tests for return to sport of injured football players. These ‘in-office tests’ may also be useful for practitioners in the screening and prevention of OP in football players.