Pain in my lower inferior pubic rami

by lorena
(united kingdom)

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 now. It's not getting better nor worse.

When I look at diagram to try and locate the exact area it seems it's right under where my underwear would sit in the crotch area. I thought it was the sit bones area but looking at diagrams it definitely more underneath. Not had this pain before although I've had pain in my coccyx all my life.

I'm 36 have two kids 5 and 8 yrs normal deliveries. My doc says it could be muscular. Feels like bone to me. Just want to see if there's anything I could do?

Hello Lorena,
Certainly after four months a diagnosis needs to be made. It could be muscular is not good enough in my book.

Do two little tests for me. First, lying on your back, pull your knee to your chest, and then the opposite shoulder, and then make a circle with the knee. Same both sides? No pain? Just to rule out a hip condition.

Secondly, lying on your back again, open your legs and ask your husband, using a generous amount of cream to run his thumb up the inner thigh to the inferior pubic ramus, and then through the groin towards the hip, being careful of the femoral artery. Compare sides. Is the left much more tender? Where? Bone? Muscle? In groin?

I would presume this is in some related to the chronic coccyx pain you have. Probably an old fall on some part of the pelvis, now forgotten.

The femoral nerve also supplies this area, but you make no mention of back pain, and I have a feeling that's not the case. But it could be a radiating pain from your back. A femoral nerve stretch test needs to be done.

Then, it could be something gynaecological. The deep pelvic muscles attach to the pubic rami and can certainly be a source of pain down yonder.

So the question. Is this a chiropractic problem? To do with the sacroiliac joint or coccyx perhaps. Or is it a medical problem, perhaps the bone itself, or for a gynae? Perhaps to do with your ovaries, bladder or uterus.

What's needed now is a careful thorough examination by several doctors from different fields. An X-ray of the pelvis would be a good place to start.

You are right to be concerned. Don't continue to be fobbed off by your doctor. Take hubby with you next time, and demand answers.

Let me have answers to above tests.

I hope this contributes.

Dr b

> > Pain in my lower inferior pubic rami

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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost painfree. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

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. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

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.

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