DOI: https://doi.org/10.36719/3104-4700/6/4-11

Management of Osteitis Pubis in Athletes: Rehabilitation, Adjunctive Treatments, and Return-to-Sport Outcomes

Natig Suleymanov

Abstract. Background: Osteitis pubis (OP) and related pubic bone stress presentations can cause persistent groin pain and time loss in athletes. Treatment approaches include activity modification, exercise-based rehabilitation, physical modalities, injections, and surgery, but published evidence is limited and diagnostic terminology varies. Objective: To summarise clinical evidence on rehabilitation, physical modalities, injection-based interventions, surgery, and return-to-sport outcomes in athletes with aseptic OP or clearly described pubic bone stress. Methods: Targeted searches of PubMed-indexed records, publisher/open-access pages, and review references were conducted on 13 February 2026. This was a focused, non-exhaustive search, not a systematic multi-database search. No complete record export, deduplication, independent screening, full-text exclusion log, or formal risk-of-bias assessment was performed; therefore, PRISMA flow counts and pooled estimates are not reported. Results: A 2011 systematic review included 25 articles and found no randomised controlled trials under its search strategy; most evidence consisted of case reports and case series. A review of nonoperative rehabilitation identified four studies, all level IV. In a randomised study of 44 amateur football players with aseptic OP/pubic overload, shock-wave therapy added to intensive rehabilitation was associated with earlier pain relief and return to football. A 2024 randomised trial in 50 adolescent football players found greater improvements in several strength and function outcomes with a modified active physiotherapy programme, while the traditional physiotherapy group showed greater pain reduction. A review of surgical treatment identified 51 cases across eight studies and no comparative surgical studies. Conclusion: Progressive, individualised rehabilitation and appropriate load management are the most defensible initial approach. Shock-wave therapy may be a useful adjunct in selected athletes, but evidence remains limited. Active physiotherapy has promising findings in adolescent players, although the mixed outcome pattern and short follow-up require caution. Injection and surgery should be considered selectively. A completed systematic review requires reproducible database searches and transparent study selection and appraisal.

Keywords: osteitis pubis, athletes, athletic groin pain, rehabilitation, exercise therapy, shock-wave therapy, return to sport