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1 · SNAPSHOT

Pubic-Related Groin Pain (Osteitis Pubis / Pubic Bone Stress) body chart — Illustrative, not diagnostic. Canva body chart for Pubic-Related Groin Pain (Osteitis Pubis / Pubic Bone Stress).

Who: Field-sport athletes after a training spike. Kicking, sprinting, change of direction.
What: Pubic-related groin pain, the third Doha entity.
How it behaves: Central pubic or lower abdominal pain. Worse with kicking, sit-ups, sprinting and direction change. May radiate into the adductors or abdominals. Insidious onset. Aggravated by twisting or core strain.

The one thing to take from this page:

Tenderness, not a test count. Doha defines pubic-related groin pain by local tenderness at the symphysis and the bone right beside it, with no particular resistance test required [16]. Squeeze and sit-up can both hurt here, but neither makes the call.

Where it sits in the Doha map

Finding	Entity
Squeeze positive, tender adductor origin	Adductor-related
Tender symphysis and adjacent bone; no particular resistance test	Pubic-related — this page
Cough / sneeze, resisted sit-up, tender canal	Inguinal-related
Resisted hip flexion, tender deep to inguinal ligament	Iliopsoas-related

⚠️ No guideline, no Australian document, and no randomised evidence on this page. The management literature is reviews and case-level work.

2 · SE — THE SUBJECTIVE PATTERN (the 70%)

Five stages, in your course's order. One question separates the two versions of this diagnosis: is this an athlete with a load story, or not?

MAIN PROBLEM

"It's right in the middle, at the front of my pelvis."
"Kicking and sit-ups both set it off."
"It's been creeping up since pre-season."

BODY CHART

Central, at the pubic symphysis. Not lateralised to one adductor origin.
Mark the radiation — into adductors, into lower abdominals, or both.
Mark the adductor origin, the inguinal canal and deep anterior separately. The other three entities.
Any testicular, scrotal or urinary symptoms? Mark and ask.

BEHAVIOUR

	Fits pubic-related	Points elsewhere
Aggs	Kicking, sprinting, sit-ups, direction change, twisting	Cutting with adductor tenderness only → adductor-related
Onset	Insidious, after a training spike	No load story at all → think infective, post-procedural
Eases	Rest	Nothing eases it, systemically unwell → screen
Severity	VAS 0–10 at best / at worst / right now	—
Course	Slow	Rapid, with fever → infection
Weight-bearing	Painful hop	Can't weight-bear → bone stress

HISTORY

The training spike. Volume, intensity, pre-season ramp — get the specifics.
Kicking volume and kicking leg.
Sit-up and core programme volume. Often the missed contributor.
Any recent pelvic, urological or abdominal procedure? Any recent infection? Ask this even in athletes.
Low energy availability, menstrual disturbance, weight loss?

SPECIAL / SCREENING QUESTIONS

Fever, rigors, feeling unwell, night sweats?
Urinary symptoms, discharge, or a recent catheter or scope?
Can they weight-bear and hop?
Any lump, bulge, or cough impulse?

Assessing this region? Download the Hip & Groin assessment template →

3 · HYPOTHESIS RANKING

Competing pattern	The one discriminating feature
Adductor-related groin pain	Tenderness localised to the adductor origin, not central at the symphysis. Where it's tender is the discriminator, not the sit-up.
Inguinal-related groin pain	Tender pubic tubercle, conjoint tendon or canal; pain with cough and sneeze.
Hip-related pain (FAI)	Deep anterior pinch, FADIR, reduced IR in flexion — and it commonly coexists; cam-type morphology has been reported in association with osteitis pubis [1].
Osteitis condensans ilii	A different pelvic sclerosing entity, described alongside osteitis pubis as a diagnostic complexity [2].
Lumbar and sacroiliac referral	Osteitis pubis has been discussed explicitly as a differential against spinal disease [3].

The two that outrank the table

Infective or post-procedural osteitis pubis. Fever, systemic illness, a recent urological or pelvic procedure, or a non-athlete with no load story. Documented after prostate procedures [4] and after infection [5], with its own endourological management literature [6].

Pubic ramus or femoral neck stress fracture. Inability to weight-bear or hop, night pain, RED-S risk.

And the coexistence rule

Adductor lesions on MRI have been described in athletes with osteitis pubis [7]. So this rarely comes alone. Run the whole Doha sequence and treat what you find.

4 · RED FLAGS — DON'T MISS THIS

This section is free, on every pattern, forever. Safety is never gated.

Finding	What it suggests	What you do
Fever, rigors, night sweats with pubic pain	Infective osteitis pubis / osteomyelitis	Urgent medical review
Recent urological, pelvic or abdominal procedure	Post-procedural osteitis pubis; septic pubic symphysis, especially after pelvic surgery [21]	Medical review
Non-athlete with pubic pain and no load story	Infective, inflammatory, or malignant	Medical review
Urinary symptoms, discharge, recent catheter or scope	Infective source	Medical review
Unable to weight-bear or hop	Pubic ramus or femoral neck stress fracture	Urgent imaging. Do not load
RED-S profile — low energy availability, menstrual disturbance	Bone stress injury	Image and refer
A palpable bulge or cough impulse	Inguinal hernia	Medical review
Night pain, weight loss, cancer history	Malignancy	Medical review

The rule: insidious central pubic pain in an athlete with a training spike, who can hop and is systemically well, is yours. Fever, a recent procedure, no load story, or an inability to weight-bear is not.

Cross-links: Adductor-related groin pain · Athletic pubalgia / inguinal-related · Femoroacetabular impingement · Hip / pelvic stress fracture

Members

The 4-minute lesson is for members

Twelve slides on this pattern: what you'll hear, what to examine, what to do. Free with an account.

Guideline anchor

No treatment guideline exists.

Anchored to the Doha agreement (Weir et al. 2015, PMID 26031643), which names pubic-related groin pain as one of four defined clinical entities and supplies the examination, and to the rehabilitation and return-to-training review (Via et al. 2019, PMID 30613167).

PubMed Source

The Doha agreement is terminology and definitions, not treatment. There is no Australian document, no treatment guideline, and no randomised evidence on this page — the management literature is reviews and case-level work.

Members

The evidence summary is for members

Verified diagnostic accuracy, where the evidence stands and what it doesn't settle. Free with an account.

Sources · 20

Show

Every source on this page resolves and title-verifies against PubMed. Newest first.

2019Akgün & Agirman (2019). Association between cam-type femoroacetabular impingement and osteitis pubis in non-athletic population on magnetic resonance imaging. Journal of orthopaedic surgery and research, 14(1), 329. https://doi.org/10.1186/s13018-019-1368-6
2024Nimodia et al. (2024). Exploring Diagnostic Complexities: A Case Report of Osteitis Condensans Ilii and Osteitis Pubis. Cureus, 16(8), e67543. https://doi.org/10.7759/cureus.67543
2025Jordan et al. (2025). [Osteitis pubis and spinal diseases : Differential diagnosis of groin pain]. Chirurgie (Heidelberg, Germany), 96(8), 641-649. https://doi.org/10.1007/s00104-025-02284-1
2023Smani et al. (2023). Osteitis pubis following holmium laser enucleation of the prostate. BMJ case reports, 16(10). https://doi.org/10.1136/bcr-2023-257637
2023Fernández-Vecilla et al. (2023). Osteitis pubis following tonsillopharyngitis. Enfermedades infecciosas y microbiologia clinica (English ed.), 41(8), 513-515. https://doi.org/10.1016/j.eimce.2023.04.005
2021Madhusoodanan et al. (2021). Endourological management of osteitis pubis secondary to a calcified prostate ossifying into the pubic symphysis. BMJ case reports, 14(5). https://doi.org/10.1136/bcr-2021-242009
2025Eraslan & Kose (2025). Prevalence and patterns of adductor lesions on MRI in athletes with osteitis pubis. Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology, 26(1), 65. https://doi.org/10.1186/s10195-025-00875-6
2023Mohammad & Elsais (2023). Comparison of hip abductor and adductor muscle performance between healthy and osteitis pubis professional footballers. Irish journal of medical science, 192(2), 685-691. https://doi.org/10.1007/s11845-022-03010-0
2026Beyer et al. (2026). Prevalence, determinants, and clinical relevance of MRI signs of osteitis pubis in the large population-based cohort SHIP. European journal of radiology, 202, 112960. https://doi.org/10.1016/j.ejrad.2026.112960
2017Toslak et al. (2017). Evaluation of Diffusion-weighted MR Imaging as a Technique for Detecting Bone Marrow Edema in Patients with Osteitis Pubis. Magnetic resonance in medical sciences : MRMS : an official journal of Japan Society of Magnetic Resonance in Medicine, 16(4), 317-324. https://doi.org/10.2463/mrms.mp.2016-0104
2022Amer et al. (2022). The challenges in diagnosis and management of osteitis pubis: An algorithm based on current evidence. BJUI compass, 3(4), 267-276. https://doi.org/10.1002/bco2.127
2019Via et al. (2019). Management of osteitis pubis in athletes: rehabilitation and return to training - a review of the most recent literature. Open access journal of sports medicine, 10, 1-10. https://doi.org/10.2147/OAJSM.S155077
2020Feldman et al. (2020). Management of a nonathlete with a traumatic groin strain and osteitis pubis using manual therapy and therapeutic exercise: A case report. Physiotherapy theory and practice, 36(6), 753-760. https://doi.org/10.1080/09593985.2018.1492658
2022Athanasiou et al. (2022). Osteitis Pubis in Athletes: A Literature Review of Current Surgical Treatment. Cureus, 14(3), e22976. https://doi.org/10.7759/cureus.22976
2026Jha (2026). Editorial Commentary: Refractory Osteitis Pubis Appears to Respond Favorably to Endoscopic Pubic Symphysectomy. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 42(5), 886-887. https://doi.org/10.1002/arj.70104
2015Weir et al. (2015). Doha agreement meeting on terminology and definitions in groin pain in athletes. British journal of sports medicine, 49(12), 768-74. https://doi.org/10.1136/bjsports-2015-094869
2021Dempsey et al. (2021). Nomenclature for groin pain in athletes. The British journal of radiology, 94(1126), 20201333. https://doi.org/10.1259/bjr.20201333
2022Rodrigues et al. (2022). PELVIC INCIDENCE AND OSTEITIS PUBIS IN PROFESSIONAL SOCCER PLAYERS. Acta ortopedica brasileira, 30(1), e244380. https://doi.org/10.1590/1413-785220223001e244380
2023Dharmshaktu (2023). Primary care level prevalence of osteitis pubis in non-athlete patients in hill region: A short communication and a proposal for simple radiological grading. Journal of family medicine and primary care, 12(4), 783-787. https://doi.org/10.4103/jfmpc.jfmpc_105_21
2024Heijboer et al. (2024). Clinical examination tests for adductor- and pubic-related groin pain in athletes with longstanding groin pain: Inter-examiner reliability and prevalence of positive tests. Physical therapy in sport : official journal of the Association of Chartered Physiotherapists in Sports Medicine, 66, 9-16. https://doi.org/10.1016/j.ptsp.2023.12.008

Mapped to this pattern

HAGOS
Copenhagen Hip and Groin Outcome Score
hip and groin pain in athletes · 37 items · 10 min

Generic measures that also apply

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