Pubic Bone Pain

Keyword; pubic bone pain, causes of osteoporosis, sacroiliac joint anatomy, chiropractic help.

This most disconcerting condition, mainly in women, involves the pelvis, a ring of three bones; an ilium on each side, with the sacrum wedged between them. Between them, labelled in green, are the

  • Two sacroiliac joints and
  • One pubic symphysis


This is a very long and important page for those suffering from groin and upper thigh discomfort; if you don't have at least half an hour, rather come back later.

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

The bones on the left articulate with those on the right via the symphysis joint. Can you see it labelled in green?

The pelvis itself is a unique ring of bones. 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 and prostate. 

The acetabulum is the socket where the ball of the thigh bone, or femur, attaches the leg to the ilium.

The superior and inferior pubic rami complete the picture, enabling one ilium to connect to the other at the pubic symphysis; the singular form is ramus, but two rami, one superior and the other inferior.

The ilium, plural two ilia, make up two thirds of the pelvic ring; the adjective is iliac, as in sacroiliac joint. Then there is the sacrum nesting between them.

Because pregnancy and backache are words often mentioned in the same sentence, many chiropractors' offices are full of pregnant women, and with good reason; and their colicky babies too.


Sacroiliac joint anatomy

What is inexplicable is that first sign that a woman may be pregnant is backache, even before the nausea starts. Subtle unknown hormonal changes begin that affect the musculoskeletal system, preparing her body for the great event.

On the subject of pregnancy and babies, I would like to see some research done on the infertile patient and chiropractic. Every chiropractor has several patients every year who after being infertile for several years, incidentally falls pregnant after chiropractic treatment for one another condition or another. I would have expected it to be a lumbar or pelvic syndrome but, no, that's not the case; sometimes it's for a cervical spine subluxation causing headaches or neck pain.

Perhaps it has to do with pain rather than a subluxated joint affecting the  pelvic organs. Could a chronically painful ankle after an inversion sprain prevent a woman from falling pregnant; or be a contributory factor? Alas, so many questions and too few answers.

And whilst this discomfort may be in some cases be referred from the uterus, in many instances there is a clear musculoskeletal influence. Perhaps bending becomes painful, or turning in bed hurts; or pubic bone pain begins.



Release of the hormone relaxin prepares the sacroiliac joints for the fact that they will have to stretch to allow passage of the sometimes not so tiny babe.

Chiropractors manage low back pain and pubic bone pain very successfully.

Specialised courses for those wanting to specialise in, or update on the treatment of pregnant women and children are now commonly found on the chiropractic continuing education websites.

Hormonal changes that allow for the baby to exit via the pelvis and postural changes due to the increased curve in the back mean that this can be a very difficult time for some women. Fitness and mobility of the joints is of the greatest importance in the management of pubic bone pain. On the other hand, hypermobiliity is a threat too.

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 painful and, untreated, it may last for months and months after the birth. This is not vaginal pain, but the pain associated with this chiropractic syndrome, loosely called pubic bone pain.



United Kingdom practice IsisChiropractic is fairly typical, their website offering some good information on the subject of pregnancy and back pain, which I recommend that you read. Read more about CHIROPRACTIC PREGNANCY care…



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Notice 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 embarrassing pubic bone pain.


Causes of osteoporosis


In this picture you can see the two rami, one ramus, 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 xray of an elderly woman who took a tumble, and fractured both rami. It's often not clearly seen on a plain radiograph and a scan may be needed to confirm the diagnosis.

The causes of osteoporosis, are now fairly well researched and known. It's no longer necessary for most women to suffer from this nasty disease, if only they do something in time. Actually, in pubity is where it all begins. Sadly many ladies take no notice and girls are certainly not interested; osteoporosis only happens to old people, they think.

Children who don't play sport and build up enough calcium in their bones, and young women who develop bad habits is where it all starts. When you're older and already have the disease, it's already too late.



This is the fracture that chancellor Angela Merkel had recently whilst cross country skiing. 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 ramus so, in her case, walking would have also been extremely painful. She was probably on crutches.

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

Notice here how many of these nine muscles, in Dutch the so called bekkenbodem spieren or bottom of the pelvis muscles, are attached to the pubic bones. Hence in pregnancy the pelvic bones often become very painful. This severe discomfort really lends itself to chiropractic treatment.

One small thought of some importance. In order to treat pubic bone pain your chiropractor must encroach on some of the sensitive areas; whilst sexual advances chiropractor is uncommon, it never does any harm to take a friend or partner along.

Read more about the causes of osteoporosis. I think this is the most important of the over 360 pages at chiropractic help; even more so than pubic bone pain but young women have no interest in preventing that nasty disease that is incurable once established. Not just pain, but worse the disability associated with osteoporosis. 



Three other condition in and around the pelvis that commonly cause groin and pubic pain with soft end feel in the hip are the


Treatment of PUBIC BONE PAIN

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:

  • SacroIliac joint fixation.
  • Read more about the SACROILIAC JOINT …

  • 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.

Sacroiliac joint treatment ... is not usually particularly painful, but the treatment of the muscles of the thigh and groin may 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. Sexual advances chiropractor certainly don't occur often but every year a handful of doctors have to appear before the ethics committee for alleged breaches of propriety.


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. KASCH PULSE RECOVERY 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 expecting. Leg pain during pregnancy is very common and readily and safely treated with Chiropractic. Leg pain during pregnancy ...

Deep Pelvic Pain & Pubic Bone pain

Undoubtedly one of the causes of pubic bone pain is referred pain from the deep internal pelvic organs. Some reports that one in seven women suffer from one degree or another from deep, chronic, incapacitating pelvic pain. This could be endometriosis, birth trauma to the uterus or vagina, bladder conditions and other. When all else fails, medicine has been using a procedure called LUNA, cutting the nerves to the pelvic organs, but a new study done on 500 women reveals that it has no benefit at all. Type LUNA into WebMD. Research suggests it doesn't help pubic pain ...

Perthes disease and Developmental Hip Dysplasia 

Another condition with a soft end-feel is Perthes 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, hip, or knee take him or her to your chiropractor without delay. Perthes is such a serious condition that it must be caught early, and is very definitely not one of those 'wait and see' conditions. Don't let anyone kid you with talk about growing pains. They don't exist. Hip dysplasia is a condition that should have been picked up at birth. However mild cases slip through under the radar. Groin pain, a short leg and very mobile hip are the signs. Both, if missed, lead to premature severe hip arthritis. You don't mess with pain in the groin, it can be very serious.


HIP ARTHRITIS and LEG LENGTH INEQUALITY

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 osteo-arthritis. Hip arthritis is more prevalent should you have a short leg which causes an uneven gait and extra stress on the hyaline cartilage in your joints.

Hip arthritis starts much earlier in neglected childhood syndromes such as Perthe's Disease, sports trauma, and a Slipped Femoral Capitus Epiphysis, a condition found primarily in the obese child.

Another only recently understood condition called Femoro Acetabular Impingement Syndrome causes stiffness in the hip but little pain in the young adult. Caught early it's very treatable. Ignored, it inevitably causes premature hip osteo arthritis. Likewise with hip dystrophy. The key sign: pain in the groin.

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 usually characterised by groin and pubic bone pain, click here. HIP ARTHRITIS ...


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"There has been wonderful feedback from the students at WIOC regarding Frog and Bats and I have encouraged them to ask their principal chiropractors to stock them in their clinics for patients to buy for themselves or as gifts. I also read the glowing review from Michelle Wessely in the Back-Space magazine."

Marty Timchur M D, Glamorgan.

And of course, if you buy one of these books now, you could read it first before giving it to your chiropractor!

Aside: Ever think of sending your chiropractor, doctor, surgeon a card, small gift, bottle of red wine... when you know they've gone they've gone the extra mile? Doctors too need encouragement.


Coccyx pillow  and Pubic Bone Pain

Last, but definitely not least, we will briefly consider the coccyx. Direct trauma to the coccyx can fracture or 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, sacroiliac and pubic bone pain may accompany this condition.

Sometimes, because of the association of the coccyx and sacroiliac ligaments, the coccyx may become painful without actual trauma to the coccyx. Here's an anecdote worth repeating; she who must be obeyed recently developed quite acute coccyx pain, along with the lower sacroilac joint ligaments whilst simply sitting in the garden weeding. Sitting became very painful. Luckily both the ligaments and the coccyx responded very quickly to the usual chiropractic help treatments. One can't have a chiropractor's wife going to the medical doctor for such pain in the nether regions.


Yes, truth be known, chiropractors and their wives, and children, need chiropractic treatment too.

Coccyx pain is also commonly associated with childbirth and likewise usually responds very quickly to an external coccygeal treatment and a coccyx pillow.

For more information about the bruised coccyx and coccyx pain relief with chiropractic, see the link below.

I have seen one case of pubic bone cancer in thirty four years and Paget's disease affects this area. Clearly there are medical conditions that also affect the pelvis, and cooperation between your chiropractor and doctor may be necessary to come to the correct diagnosis and appropriate treatment.

There is a fairly small school of chiropractic that doesn't believe in diagnosis. We just adjust subluxated joints, they claim. I don't belong to their school. In fact I think it's quite dangerous though they probably help the majority of their patients if they are skilled adjustors.



More important considerations at pubic bone pain.


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What Other Visitors Have Said

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seeking non surgical cure of Inguinal Hernia 
I have bilateral inguinal hernia. Ultra-Sound report indicates 38 mm "defect"(term used by radiologist) on left and 31 mm on right.I do not have any discomfort …

Groin vaginal acute pain 
Groin vaginal acute pain I'm having sharp, breath-taking pain upon walking on my inner right groin area. Yesterday the sharp pain dulled out and turned …

Pubic symphysis Not rated yet
I have developed this pain in this region. It is relieved usually during the day .... Felt most on rising out of bed . No bladder problems or other women's …

Inner right groin pain Not rated yet
I have severe right inner leg crease pain radiating to my right buttock. It came on suddenly in the shower and is excruciating. Any thoughts what it is? …

Pubic hip back and leg pain Not rated yet
When sitting I have to hold onto the right pubic area. This gives a feeling towards the hip and back...it's so sore but helps to hold myself, which is …

upper inner thigh pain Not rated yet
I have been having an upper inner thigh pain for 3 months now. it gets worse with massaging and moving my leg outward Hello, Do a little test for me …

Pain in my lower inferior pubic rami Not rated yet
Pain in my lower inferior pubic rami I've had a dull ache only when I take a first step from resting or sitting on my left side, for about 4 months …

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HAVING FRACTURES IN PUBIC & LUMBER 5- SACRAL 1 BONE I need far more detail to give you a sensible answer. How old are you? Falls and injuries? Osteoporosis.

Pubic bone fractures Not rated yet
In January 2012, I was hit by a car and sustained 4 pubic bone fractures, everything you have written, is what I am experiencing. What are my future treatments …

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Interesting challenges of the day

1. Mrs B has had one of the nastiest of conditions; vertigo caused by a disturbance in the inner ear. Falling repeatedly and vomiting she consulted her doctor but medication didn't help. After two sessions of the Epley manoeuvres she was 50 percent better. After two weeks she was 75 percent improved; no longer vomiting or falling. She's not enjoying the Brandt Daroff home exercises.

2. Mr S, a 48 year old man, has right low back pain, groin pain and a numb feeling in his lower leg when he sports. For six months he's been off football. He too has two problems; a very treatable lumbar facet syndrome and a very serious blocked artery in the groin; it's called intermittent claudication. Smokers beware.  

3. Mr S looks like the leaning tower of Pisa; he has a slipped disc at L5 making him lean towards the opposite side. It's called the postero lateral disc hernia; we'll fix it, but he has to stop for a week or two. Antalgias are serious so take them seriously. 

4. Mrs V too has  two conditions; a chronic low grade sciatica giving her an ache in the right leg, and a threatening Morton's neuroma. She's glad I'm back in Holland; chiropractic fixed it before, and we'll fix it again. 

5. Mrs W is one of the lucky ones, says her doctor. I agree. He says only 40% of patients with lumbar stenosis have a successful operation. We fixed a nasty slipped disc three years ago, but it came back two years later; the surgeon did a fine job but she has a weak ankle now giving her subtalar joint pain; it's routine stuff. 

6. I myself had an acute exacerbation of a femoral nerve lesion last year. One immediate treatment of the new strain by my colleague has fixed the pain in the lower back, but there's some residual numbness in the lower leg; no soaring tomorrow alas.

7. This lady is a 86 year old woman with a 63 scoliosis. Chronic lower back has been her lot in life but she's well pleased with chiropractic and comes for chiropractic help once a month; some conditions you can never cure.

8. She is an 78 year old woman, is doing remarkably well with a bad sciatica. But over 200 pounds she is not losing weight; in fact, gaining despite my suggestions. She's high risk for a stroke. I have referred her to a dietician to crack the whip.

9. A 61 year old man with upper cervical pain yesterday; it's not severe but also not getting better of its own accord. He's afraid it may turn very acute as when I treated him three years ago. Since then it's been fine. 

10. A 64 year old woman has had scheuermanns disease; it's left her with a spinal kyphosis and chronic middorsal pain. She responds well to chiropractic treatment provides she come every six weeks or so for maintenance treatment.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mrs D, a middle aged woman with hip pain of one year duration, despite other treatment. Xrays reveal an impingement syndrome and early hip arthritis. There's much to be done.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.



Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?


Interesting questions from visitors

CLS writes:

Greetings, Dr B.
You helped me quite some time back with a soothing and professional response which turned out to be exactly correct. I now consult a local chiropractor. You write a superb newsletter, too.

Your own unresolved problem. Pose a question

Knowing that up to 70% of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there's a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong! Give plenty of detail if you want a sensible reply.


You visited this chiropractic help site no doubt because you have a problem that is not resolving and want to know more about what chiropractors do.

The quickest and most interesting way is to read one of my ebooks of anecdotes. Described by a reader as gems, both funny and healthful, from the life and work of a chiropractor, you'll love them. Priced right at $2.99, though Kindle fiddles the price without telling me.