Pubic bone pain often radiates to the inner thigh or groin.
This page was last updated by Dr Barrie Lewis on 19th March, 2019.
It's one of the most disconcerting conditions, mainly in women, involving the pelvis, a ring of three bones; an ilium on each side, with the sacrum wedged between them. There are, labelled in green, the
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 the other 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 pubic 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 helps you grasp the nettle; pubic bone pain can be excruciating.
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. Every chiropractor has several patients every few months who after being infertile for several years, incidentally falls pregnant after chiropractic treatment for one 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 difficult, or turning in bed hurts; or pubic bone pain begins.
Chiropractors use pelvic drop tables.
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 uncomfortable 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, but the pain associated with this chiropractic syndrome, loosely called pubic bone pain.
Pubic bone pain may be associated with pregnancy but often lingers after the birth and can occur in any person.
The position of the foetus in utero is very important. Babes who are not lying with the hips in the lotus position, which forms the hip socket, are more inclined to get hip dysplasia; they will almost certainly be suffering from growing pains chiropractic, even as young children.
United Kingdom practice Isis Chiropractic 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…
Google appears to frown on too many links, so phrases in bold, like that pediatrics book above, and Stones in my Clog by Dr Bernard Preston DC below, need to be put into the Site Search function in the navigation bar on your left if you want more information.
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STOP PRESS: Stones in my Clog by my alter ego, Bernard Preston, his third chiropractic book has just become available for the first time as an ebook for just $2.99.
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.
Much of good doctoring, be one a chiropractor, general practitioner or surgeon is about knowing your anatomy. Studying the parts of the body goes back to antiquity, even though it was considered demonic. Michelangelo many long hours at the morgue, secretly sketching the human body by candlelight.
But it was one Henry Gray who systemised the whole of anatomy and who's Grays Anatomy still stands as a legend.
Causes of osteoporosis in the main have to do with lifestyle; you can be sure the woman whose x-ray is below has pubic bone pain.
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 x-ray 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 450 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.
Kefir, a fermented milk drink, is one of the best sources of calcium, and provides all the probiotics that the colon needs.
Three other condition in and around the pelvis that commonly cause groin and pubic pain with soft end feel in the hip are the
Superior cluneal nerves supply the buttock and according to some authorities the groin with sensory supply; pubic bone pain may be a feature.
Groin and pubic bone pain may also be neurological, referred from either one of the branches of the femoral nerve, or the superior cluneal nerves, both of which come from the upper lumbar spine.
Ask your chiropractor to examine this area, if he doesn't.
Chiropractic help involves a thorough examination of the area; that would include an x-ray and perhaps a scan in the case of trauma. Pubic bone pain can be very severe.
Because these pubic bone 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 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
'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
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 ...
Another concern in men of course is prostate cancer which often metastasizes causing pubic bone pain. Prevention as always is better than a cure; a tomato a day reduces the incidence by an enormous 50%.
Tomato soup recipe is so easy to make from scratch; out of a can it probably will have far too much sodium. Getting your salt intake down to about a teaspoon a day is still considered the most important factor in reducing heart, stroke and diabetes disease.
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, and a Pavlik harness used. 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 go hand in hand; perhaps that should be leg in leg! The net result is hip pain.
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.
More about groin and upper thigh pain.
Google appears to frown on too many links, so phrases in bold, like that leg length inequality above, and Bernard Preston below need to be put into the Site Search function in the navigation bar on your left if you want more information.
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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.
Last, but definitely not least, we will briefly consider the coccyx. Direct trauma to the area can fracture or subluxate the bones 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 bones 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 structure. 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.
Are you suffering from pain in your groin or a stiff hip?
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