PUBIC BONE PAIN

THE PELVIS

Pubic bone pain involves the pelvis, a ring of three bones: An ilium (A) on each side, with the sacrum (B) wedged between them. Between the three bones are three joints:

Two sacro-iliac joints, and
one pubic symphysis (E).

A. Ilium (pl. two ilia, adjective iliac, as in sacro-iliac joint)

B. Sacrum

C. Acetabulum where the ball of the thigh bone (femur) fits into the ilium.

D. Superior pubic ramus

F. Inferior pubic ramus

E. Pubic symphysis.

The pubic ramus bones as you can see are part of the ilium, and thus make up a portion of the pelvis. There are two pubic bones, one superior and one inferior. They are very important for the attachment of some of the great muscles of the thigh.

The pubic bones on the left articulate with those on the right via the pubic symphysis joint (E). Where is this joint?

The pelvis is a unique ring of bones in the body. It gives attachment for the legs to the body, forms the foundation of the spine and gives protection to many organs such as the bladder, colon, rectum, prostate and many others. For more information on the bones of the pelvis, and the sacroiliac joints, click here.

The pubic bones can become extremely painful in differing syndromes, many associated with pregnancy. What is sometimes very distressing is that opening the legs during sex may be very painful and, untreated, it may last for for months and months after the birth.

Note the close approximation of the bladder and uterus to the pubic bone shown here (in white) in the front. When your baby starts dancing on your bladder it can cause very awkward and embarassing pubic bone pain.

In this picture you can see the two rami (one ramus, plural rami), one above, the other below. They are called the superior and inferior pubic rami.

As an aside: Osteoporosis, or brittle bone disease, is a condition that affects mainly women. This is an X-ray of an elderly woman who took a tumble, and fractured both rami. You can be sure she has extreme pubic bone pain, for some of the same reasons that we are considering - there are many large powerful muscles that attach to the inferior pubic ramus so, in her case, walking is also extremely painful. She's probably on crutches.

For more about the causes of osteoporosis, click here.

Note here the three very large muscles of the inner thigh that attach to the inferior pubic ramus. It is these muscles, together with the psoas muscle that usually cause the great pain of this syndrome. Opening the thighs stretches these muscles and, if their insertion into the pubic ramus is irritated, then sex will be very painful. Not vaginal pain, but thigh muscle and pubic bone pain.

Two other condition in and around the pelvis that can cause groin and pubic pain with soft end feel in the hip are the Piriformis Syndrome and the Ilio tibial band syndrome.

Treatment

Because these pubic pain syndromes are joint-muscle-nerve conditions, they responds very well to chiropractic management. The treatment is based on the findings during the examination, but the hallmarks are usually:

Sacro-iliac joint fixation.
Restricted hip range of motion, with soft 'end-feel'.
On palpation, marked pubic bone pain.
Extreme tenderness with active trigger points of the inner thigh. (and/or other muscles such as the piriformis or Ilio-Tibial Band.)
Occasionally neurological signs in the thigh, like numbness and even motor weakness. Usually in this case, a high lumbar subluxation will also be present.

The treatment of the spine and sacro-iliac joints is not usually particularly painful, but the treatment of the muscles of the thigh and groin will be extremely painful. In my experience, one light stroke along the muscle (painful), one deep stroke (very painful), and one or two stretches (not particularly painful) are about all that most people can tolerate. Follow up with ice at home. Some bruising may occur.

As you can see from the picture above, the stripping of the muscles will be very close to sensitive areas. Take your husband along for the first few visits, just to put everybody at ease. Your chiropractor may be even more anxious than you are, whilst working in this area.

A regular walk will help. Take granny along for company, good for you both. If you want to know just how fit granny is, click here for a simple three minute fitness test

FROM THE COAL FACE.

Mrs S. is a young woman in her late twenties who consulted me for severe headaches, which responded well to the usual chiropractic care. She also had had some mild sacro-iliac pain since the birth of her second child, some fifteen months earlier. At what I thought was going to be our last visit before she went onto her two monthly maintenance care, she posed the following question, her confidence in me having been established.

'Doctor, do you think you can do something for the pain here in my groins. It is so painful ... when I open my legs ... stumbling on awkwardly ... you know,' she finished lamely.

Because this condition involves examination of the more private areas close to the vagina, it is more than likely your chiropractor will omit it, unless you draw his attention to the fact that you have pain in the thighs and groin.

This is particularly true should you be pregnant. Leg pain is very common and readily treated by Chiropractic during pregnancy.

PERTHE'S DISEASE

Another condition with a soft end-feel is Perthe's Disease, a condition of the hip and groin in the growing child. Please, if your child is limping, and complaining of pain in the groin or hip, take him or her to your chiropractor. Perthes is such a serious condition that it must be caught early. Don't let anyone kid you with talk about growing pains. It doesn't exist. For more information about Perthes Disease, click here.

HIP OSTEOARTHRITIS

The hip, where the ball of the femur fits into its socket in the ilium is a weight bearing joint and is particularly prone to wear and tear arthritis.

This may occur after conditions such as Perthe's Disease (Tip: Never ignore pubic bone pain or pain in the groin in your growing child. Never!), sports trauma as in a Slipped Femoral Capitus Epiphysis, obesity, and abnormalities in the hip joint such as Femero Acetabular Impingement Syndrome

Both arthritis in the hip (generally in the older person) and the impingement syndrome (younger people, who of course become older, so in all age groups) are characterised by a hard end feel when ranges of motion of the hip are tested.

For more information about hip arthritis which is often characterised by groin and pubic bone pain, click here.

Love to read? Chiropractor Bernard Preston will keep you alternately laughing and crying as you enjoy these short stories from his clinic. Great bedside reading.

COCCYX

Last, but definitely not least, we will briefly consider the coccyx. Direct trauma to the coccyx can subluxate the coccyx and sprain the ligaments, causing months of pain, mostly when sitting. This is a very treatable syndrome that chiropractic excels in. A coccyx pillow has much virtue and the coccyx can usually be adjusted externally.

As a fall on the buttocks, injuring the coccyx often shakes the whole pelvis up, sacro-iliac and pubic bone pain may accompany this condition.

For more information about the bruised coccyx and coccyx pain relief, click here.

Click here to go from PUBIC BONE PAIN to SACRO-ILIAC JOINT TREATMENT.

footer for PUBIC BONE PAIN page