Pubic Ramus Stress Reaction

I have an athlete with a pubic ramus stress reaction, not quite a stress fracture yet but obviously that would be the next stage if it worsens.

Two questions for anyone- How could this have occurred- It is an injury typically found in female distance runners and post menapausal women. He is a 20 year old football athlete. We don’t use any distances for him over 30 meters to run while we train. He had a hamstring issue in the summer on the same side, then had a groing strain the first week of practice.

The second question is how do I manage it- He is a great kid who loves to train, it will be hard pulling the reins on him.

It is a very obscure injury, I read under 2% of stress fractures occur in this area.

Any help would be appreciated! Thanks

gday mate,

was the groin strain on the same side?
each of the adductor muscles (adductor magnus, brevis, longus + gracilis) attach around the pubic ramus so im thinking there may be an interaction there. have you seen anyone about it or had any scans done? im not sure that gracilis would be exerting a very strong pull on the ramus but it is possible that tightness in the other adductors would increase the stress placed on that bony segment, although this is strange as you haven’t been doing great volumes of work on the track. footballers (soccer especially) use their adductors intensely (kicking from the insole + stabilising) so this would definitely have an influence.
the hamstring injury is probably unrelated (IMO).

pulling on the reigns may be hard now but a stress fracture (especially in this area) could become a serious issue in the long term so i guess its a case of being mean to be nice

Who diagnosed this as such? I would imagine anyone who’s willing to diagnose a “pubic ramus stress reaction” might have some ideas on treatment. Are his pubic rami level?

Did some research and this what I ended up with

Factors contributing to pubic bone stress:

  • Lumber spine + SIJ disfunction (not sure if that would apply)
  • Limited hip ROM (maybe?)
  • Decreased lumbopelvic stability (core control)
  • (frequent) Shortening of iliopsoas muscle (definitely due to sprinting)
  • Increased adductor tone (definitely due to football)
  • Increased rectus abdominis tone (most probably in athletes)

This seems to tick a lot of boxes here

Did some research and this what I ended up with

Factors contributing to pubic bone stress:

  • Lumber spine + SIJ disfunction (not sure if that would apply)
  • Limited hip ROM (maybe?)
  • Decreased lumbopelvic stability (core control)
  • (frequent) Shortening of iliopsoas muscle (definitely due to sprinting)
  • Increased adductor tone (definitely due to football)
  • Increased rectus abdominis tone (most probably in athletes)

This seems to tick a lot of boxes here. Aussie research has also proposed that 77% of footballers (all codes) presenting with localised oedema and longstanding ‘groin’ pain (including pubic symphysis tenderness) has been related to pubic bone stress. This may be attributable to the interaction of a number of stabilising structures (adductors, iliopsoas, abdominal wall).