Physical Therapy for Groin Pain following Pubic Ramus Fracture-A Case Report

Abstract

Background and Purpose: Non-displaced pubic fracture often spontaneously heals without treatment. Occasionally, inguinal or pubic pain may develop due to irritation of the abundant neurovascular structures in the pelvic area. Scarce literature described conservative management for this condition. Methods: A 58-yearold woman initially visited emergency room for groin pain owing to motor-vehicle accident. Plain radiograph revealed left superior and inferior pubic rami fracture. The orthopedic physician prescribed bedrest and analgesics. However, intractable inguinal pain persisted after two months of rest, resulting in impaired mobility and job performance. She was referred to the physiatrist, who ordered manual therapy, strengthening, and shortwave. Palpation disclosed multiple tender points around the groin and hip. The therapist then applied extra-vaginal soft tissue mobilization to the according areas. Manual techniques incorporated 60 seconds of sustained pressure on each trigger point, as well as myofascial release to lengthen the restricted tissues. Facilitating pelvic and hip stabilizers were also performed. Results: After nine sessions of physical therapy, the subjective pain decreased from 10 to 2 in the 10-point-pain-scale. Walking ability improved from relying on walker to ambulating without device. She could even perform single leg standing and take stairs without symptoms. She was able to return to work by the third months and then discontinued therapy. Conclusion: Manual therapy as an adjunct to other modalities in resolving abnormal tissue tension in the pubic area was promising. Even simple pubic fracture deserves early evaluation and intervention. Clinical Relevance: For cultural concern, careful extra-vaginal manual therapy may serve as an acceptable method to treat myofascial and neuropathic pain.