Pubalgia is a generic term used to indicate the painful syndrome affecting the groin, pubis and inner thigh (one or a combination of the three sites).
Most cases of groin pain are caused by repeated trauma.
A minority is caused by a single, very intense event.
In general, acute tendon and muscle compromises do not require the diagnostic investigation of any predisposing causes, as is the case for actual groin pain. On the other hand, if not treated with care, these cases too can become chronic becoming groin pain.
The structures affected by groin pain can be very different depending on the case, as well as the underlying cause / circumstance.
In total, the possible etiological reasons for groin pain 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 the tendons).
- Joint pathologies (affecting the pubic symphysis joint).
- Neuralgia (affecting the specific nerve plexus).
Groin pain mainly affects sportsmen but it is not a disorder exclusively related to motor activity.
The published material is intended to allow quick access to general advice, suggestions and remedies that doctors and textbooks usually dispense for the treatment of Pubalgia; such indications must in no way substitute the opinion of the attending physician or other health specialists in the sector who are treating the patient. , it is advisable to go to the doctor:
- Pain in the pubic area radiating to the front, to the side and sometimes to the rear.
- Initially the pain is limited to the moment of waking up in the morning and in the early stages of training. With the worsening of the pathology it becomes constant.
- The adductor muscles are tense, contracted and painful on palpation.
- Sometimes a feeling of incomplete emptying of the bladder.
- Ernie (inguinal, crural).
- Contractures and muscle tears.
- Diseases of the testicles or surrounding structures.
- Acute phase:
- Total rest.
- Medical therapy.
- Physiotherapy.
- Chronic phase:
- Stretching of the adductor muscles in the thigh.
- Stretching of the posterior thigh muscle chain.
- One-and two-breech proprioceptive exercises.
- Strengthening of the retroversion 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.
- Tendon microtrauma of the adductor and / or abdominal muscles at the level of the insertion into the pubic symphysis.
- Microtrauma to 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 rectus abdominis. It occurs mainly during the "kick" gesture, in which the abdominal muscles contract sharply, creating a crack in the superficial fascia.
- Limb asymmetry: especially in people who run for sports or who spend a lot of time standing, unilateral overload can cause groin pain. In these cases, often the only prevention of groin pain corresponds to the interruption of the activity.
- Plantar defect and / or incorrect or worn footwear: both the pathological structural defects of the feet and an incorrect choice of footwear in relation to the support tendency (pronation, supination, neutral) can cause incorrect movements and incorrect transmission of impacts. Sometimes, a consultation with a podiatrist and the prescription of suitable insoles and / or footwear are decisive.
- Joint or muscle pains: they can alter posture and movements, overloading other joints or the contralateral leg. It is necessary to recover completely and avoid relapses of primary diseases.
- Incorrect occlusion of the teeth: it significantly affects the spine, therefore the posture. The application of orthodontic instruments has been shown to be useful in the prevention of certain forms of groin pain.
- 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 situations by remaining at rest.
- Progressively start the activity.
- 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 involve bouncing, jumping and running it may be sufficient for it to drop below 30.0.
- Omega 3: they are the eicosapentaenoic acid (EPA), docosahexaenoic (DHA) and alpha linolenic (ALA). They have an anti-inflammatory role. The first two are biologically very active and are mainly contained in: sardines, mackerel, bonito, sardinella, herring , alletterato, belly of tuna, garfish, seaweed, krill etc. The third, on the other hand, is less active but constitutes 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:
- Vitamins: 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 crustaceans and milk.
Vitamin C is typical of sour fruit and some vegetables (lemons, oranges, mandarins, grapefruits, kiwis, peppers, parsley, chicory, lettuce, tomatoes, cabbage, etc.).
Vitamin E can be found in the lipid portion of many seeds and related oils (wheat germ, corn 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 mainly contained in: meat, fish products, egg yolk, milk and derivatives, enriched foods (potatoes, etc.).
- Polyphenols: simple phenols, flavonoids, tannins. They are very rich: vegetables (onion, garlic, citrus fruits, cherries, etc.), fruit and relative seeds (pomegranate, grapes, berries, etc.), wine, oil seeds, coffee, tea, cocoa, legumes and whole grains, etc.
If not compensated by a diet rich in omega-3, it would therefore be a good idea to avoid exceeding with the introduction of foods rich in linoleic, gamma-linolenic, diomo-gamma-linolenic and arachidonic acids such as: seed oil (especially peanuts) , most nuts, certain legumes, etc.
- Swings and impulses of the lower limbs.
- Different types of travel: straight, curved, in acceleration and deceleration, with changes of direction, with various types of stops, etc.
- Gaits: Skip, Back Kick Run, Side Step, High Knees etc. If necessary, also enter specific gestures.
- 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, than ointments and gels. They may require the use of a gastroprotector. People with liver or kidney disorders are not always able to take them.
- For topical use: they are mainly ointments or gels containing 10% Ibuprofen lysine salt or 2.5% Ketoprofen (for example Dolorfast®, Lasonil®, Fastum gel® etc.). They have the advantage of acting locally without straining the stomach and liver.
- Injectable: it is used only in the event that oral NSAIDs are not tolerated (allergy, gastric ulcer, etc.) or when their use is not 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.
- Aimed at cleaning the affected tendon. Today it is performed with small cuts and the application of radiofrequencies. It is useful when calcifications are present. Manual removal is still required for adhesions, fibrous clusters, cysts, etc.
- Aimed at treating the femoral sheath syndrome, caused by the stretching of the perforating nerve due to a superficial abdominal fissure. It is more common in football players and in those who practice combat sports with their legs.
