Remedies for Pubalgia

Pubalgia is a generic term, used to indicate the pain syndrome that affects the groin, the pubis and the inner thigh (only one or the combination of the three sites).

Most pubalgia cases are caused by repeated trauma.

A minority is caused by a single very intense event.

In general, acute tendon and muscle impairments do not require the in-depth examination of any predisposing causes, as is the case with pubalgia proper. On the other hand, if not treated with care, even these cases can become chronic and become pubalgia.

The structures affected by the groin can be very different depending on the case, as well as the triggering cause / circumstance.

In total, the possible etiological reasons for pubalgia are so numerous that they cannot be summarized in a single paragraph.

It is possible to group them in a logical and understandable way by dividing the events into three distinct branches:

Tendinopathies (affecting tendons).
Joint disorders (involving the pubic symphysis joint).
Neuralgia (affecting the specific nerve plexus).

Pubalgia affects mainly athletes but it is not a disorder exclusively related to motor activity.

What to do

Pubalgia is not the only disease affecting the pubic area; therefore, feeling one or more of these symptoms, it is advisable to go to the doctor:

Pain in pubic area irradiated in front, side and sometimes behind.
Initially the pain is limited to the moment of morning awakening and in the first stages of training. With the aggravation of the pathology it becomes constant.
The muscles of the adductors are tense, contracted and sore on palpation.
Sometimes, feeling of incomplete emptying of the bladder.

A first visit to the primary care physician is necessary to rule out other diseases. Certain disorders that are very often confused with pubalgia are:

Ernie (inguinal, crural).
Contractures and muscle tears.
Pathologies of the testicles or surrounding structures.

After a possible positive medical diagnosis, the groin should be treated as follows:

Acute phase:

Total rest.
Medical therapy.
Physiotherapy.

Chronic phase:

Elongation of the adductory musculature in the thigh.
Stretching of the posterior thigh muscle chain.
Mono- and bi-podalic proprioceptive exercises.
Strengthening of the retroversional muscles of the pelvis, especially of the abdominal girdle.
Strength development.
Stimulation of intermuscular coordination and reprogramming of the motor scheme with complex exercises.

Possible use of analgesic anti-inflammatory drugs.

During or at the end of the treatment it is important to carry out additional investigations to identify any primary causes of groin. Keep in mind that the onset of these diseases is mainly due to:

Tendon micro-traumas of the adductor and / or abdominal muscles at the level of insertion in the pubic symphysis.
Microtraumas at the pubic symphysis caused by the decompensated action of the adductors (more frequent in the age of development).
Impairment of the pubic symphysis joint due to hormonal causes and in the absence of anatomical or functional discomfort.
Stretching and compression of the perforating nerve of the abdominal rectum. It occurs mainly during the "calcium" gesture, in which the abdominal muscles contract abruptly creating a crack in the superficial fascia.

These pathological mechanisms can manifest themselves for biomechanical, para-physiological or pathological reasons. Some of these are transient and it is sufficient to wait for them to finish, others can be healed / compensated thanks to some precautions; some rare cases are not treatable. In summary:

Limb asymmetry: especially in subjects who run for sports or spend a lot of time standing, unilateral overloading can cause groin. In these cases, often the only prevention of pubalgia corresponds to the interruption of the activity.
Plantar defect and / or incorrect or worn footwear: both pathological structural defects of the feet and incorrect choice of footwear in relation to the tendency to support (pronation, supination, neutral) can cause incorrect movements and incorrect transmission of impacts. Sometimes, the consultation of a podiatrist and the prescription of orthotics and / or suitable footwear are decisive.
Joint or muscle pain: can alter posture and movement, overloading other joints or the contralateral leg. It is necessary to completely heal and avoid recurrences of primary diseases.
Incorrect occlusion of the teeth: it significantly affects the spine, hence the posture. The application of orthodontic tools has proved useful in the prevention of certain forms of pubalgia.
Pregnancy: this special physiological condition creates a laxity of the pubic symphysis due to the more significant release of relaxin. It is necessary for the pregnant woman to prevent acute cases by remaining at rest.

Pubalgia can occur in very heavy subjects who start practicing motor activity (for example to lose weight). Then:

Start the activity progressively.
Always warm up properly.
When overweight is significant (obesity), try to restore a normal or "acceptable" Body Mass Index (BMI). If the activity does NOT include rebounds, jumps and travel it may be sufficient that it falls below 30.0.

At a preventive level, stretch with very warm muscles: it is very useful to dedicate specific sessions away from intense training.

What NOT to do

Ignore the symptoms, even when mild and not very debilitating. We must not wait for the problem to become significant.
Take medications without consulting the meditative or go to massage centers of dubious professionalism.
In the case of a positive diagnosis, leave out rehabilitation. Relapses almost always require much more time for healing.
Do not go into the diagnosis with the search for triggers. Even if the pathology is satisfactorily treated, the potential for relapse increases drastically if the triggering agent remains.
In case of plantar defect and / or use of incorrect or worn footwear, do not purchase the specific material by continuing to use the old one.
In the case of other muscle joint inflammations that may have caused the pubalgia secondarily, neglect them letting them become chronic or create other imbalances.
Neglecting orthodontic problems.
In case of pregnancy, do not reduce the level of physical activity and overload the pubic symphysis.
Start a sports activity:

With intensity that is not adequate for the level of preparation.
With an excessive body weight (obesity).

Do not warm up before riding.
Stretching incorrectly, violently, cold or with contracted muscles.

What to eat

There is no diet designed to heal better or more quickly from groin. However, some precautions can be useful:

In the case of obesity, it is advisable to reduce the weight. This especially affects people who tend to have recurrences on the same joint. To lose weight it is sufficient to reduce the caloric intake by about 30%, leaving the (balanced) distribution unchanged.
Increase the intake of anti-inflammatory molecules:

Omega 3: are eicosapentaenoic acid (EPA), docosahexaenoic (DHA) and alpha linolenic acid (ALA). They play an anti-inflammatory role. The first two are biologically very active and are contained above all in: Sardinian, mackerel, bonito, alaccia, herring, alletterato, ventresca of tuna, needlefish, algae, krill etc. The third one is less active but is a precursor of EPA; it is mainly contained in the fat fraction of certain foods of vegetable origin or in the oils of: soy, linseed, kiwi seeds, grape seeds, etc.
Antioxidants:

Vitaminics: the antioxidant vitamins are carotenoids (provitamin A), vitamin C and vitamin E.
Carotenoids are contained in vegetables and red or orange fruits (apricots, peppers, melons, peaches, carrots, squash, tomatoes, etc.); they are also present in shellfish and milk.
Vitamin C is typical of acidulous fruit and some vegetables (lemons, oranges, tangerines, grapefruit, kiwi, peppers, parsley, chicory, lettuce, tomatoes, cabbage, etc.).
Vitamin E is available in the lipid portion of many seeds and related oils (wheat germ, maize germ, sesame, etc.).
Minerals: zinc and selenium. The first is mainly contained in: liver, meat, milk and derivatives, some bivalve molluscs (especially oysters). The second is contained above all in: meat, fishery products, egg yolk, milk and dairy products, fortified foods (potatoes, etc.).
Polyphenols: simple phenols, flavonoids, tannins. They are very rich: vegetables (onion, garlic, citrus fruits, cherries, etc.), fruit and related seeds (pomegranate, grapes, berries, etc.), wine, oilseeds, coffee, tea, cocoa, legumes and whole grains, etc.

What NOT to Eat

To prevent or cure obesity, it is advisable to eliminate all junk foods and beverages, in particular fast foods and sweet or savory snacks. It is also necessary to reduce the frequency of consumption and the portions of: pasta, bread, pizza, potatoes, derivatives, fatty cheeses, meat and fatty fish, preserved meats and fish, sweets, etc.
The only group of foods (or rather beverages) not recommended in the case of groin is alcohol. Ethyl alcohol has a diuretic action and interferes with the metabolism, reducing the effectiveness of the active ingredients.
Furthermore, we remind that an excess of omega 6 fatty acids "could" have an effect diametrically opposed to the intake of omega 3 (resulting pro-inflammatory).
If not compensated by a diet rich in omega-3, it would therefore be a good idea to avoid exceeding the introduction of foods rich in linoleic, gamma-linolenic, diomo-gamma-linolenic and arachidonic acid such as: seed oil (especially peanuts), most of the dried fruit, certain legumes, etc.

Natural Cures and Remedies

Stretching: stretching can be static or dynamic. In pubalgia it has a preventive role, but also a therapeutic one in the chronic phase of treatment. Some types are:

Classic.
PNF Stretching: Proprioceptive Neuromuscolar Facilitation.
Mezieres method: it is complementary to osteopathy. It has a global rehabilitative vision and intervenes on the entire kinetic chain.
Souchard's Decompensated Global Stretching: represents an evolution of the previous system.

Proprioceptive rehabilitation: on various surfaces, in various decubitus areas, with open and closed eyes, climbing with a leap etc.
Concentric exercises for strength: use of elastic bands.
Isometric exercises for strength: use of elastics or isokinetic machines. The active phase can be performed by the therapist.
Exercises for the coordination and restoration of motor patterns:

Oscillations and impulses of the lower limbs.
Different types of runs: straight, curved, accelerating and decelerating, with changes of direction, with various types of stops etc.
Gaits: skip, back kick, side step, high knees, etc. If necessary, insert specific gestures as well.

Cryotherapy: cold therapy is useful in reducing pain and inflammation. It should be performed 2 or 3 times a day. Ice should not be applied directly; on the contrary, it must be placed in a bag containing water and applied by interposing a woolen cloth to protect the skin.

Pharmacological care

Non-steroidal anti-inflammatory drugs (NSAIDs):

For oral use: for example Ibuprofen (Brufen®, Moment®, Spidifen® etc.). They are used more than topical ones, as the structures affected by the inflammation are quite deep. They are more powerful, even if generic, compared to ointments and gels. They may require the use of a gastroprotector. Those who suffer from liver or kidney disorders are not always able to take them.
For topical use: they are mainly ointments or gels containing Ibuprofen lysine salt 10% or Ketoprofen 2.5% (for example Dolorfast®, Lasonil®, Fastum gel® etc.). They have the advantage of acting locally without tiring the stomach and liver.

Cortisone:

Injectable: it is used only in cases where oral NSAIDs are not tolerated (allergy, gastric ulcer, etc.) or when their use does not prove useful within 60 days. These are infiltrations to be used only in case of real need. They have a very strong anti-inflammatory action but in prolonged therapy they tend to compromise the affected tissues. They are not recommended in case of diabetes mellitus.

Prevention

Treating diseases or avoiding specific situations that can predispose pubalgia.
In case of overweight, lose weight.
Warm up thoroughly before intense sport.
Stretch at the end of each session, waiting for the muscles to relax, or engage in specific sessions.
Start new activities gradually.

Medical Treatments

Ciriax and myofascial manipulations: eliminate the fibrosis that can form during the healing process in the abdominal and inguinal muscle tissues. Obviously, they are recommended in cases of predominantly muscular pubalgia.
Osteopathic manipulations: this manual therapy can cure pubalgia by relaxing the muscles that block the pelvic and sacrum joints that can exert negative traction.
Shock waves: they can accelerate healing if the damage is to the soft tissues. They are based on the localized release of acoustic impulses. The effect is an increase in the metabolic activity of the target tissue and the breaking of any calcifications in the chronic forms.
Ultrasound: exploit high frequency acoustic waves. This treatment is very useful as an anti-inflammatory, stimulating edematous reabsorption and to dissolve the adhesions that are formed during healing. It produces heat and increases the permeability of cell membranes.
Laser therapy: it is a treatment that uses electromagnetic rays directly on the affected area. The laser electron beam acts on the cell membrane and mitochondria, increasing metabolic activity, reducing pain and inflammation, creating vasodilation and increasing lymphatic drainage.
Surgery: it is of two types:
1. Aimed at cleaning the affected tendon. Today it is performed with small cuts and the application of radio frequencies. It is useful when calcifications are present. Manual adhesion is still required for adhesions, fibrous clusters, cysts, etc.
2. Aimed at treating the femoral sheath syndrome, caused by stretching of the perforating nerve due to a superficial abdominal cracking. It is more common in soccer players and in those who practice combat sports with their legs.