Julien Benneteau shines at the Paris-Bercy tennis tournament. A feat all the more resounding as it comes out of two years of hardship due to a “pubalgie”.
The “pubalgia” is a name which recurs a lot in the vocabulary of the injured sportsmen, especially the footballers, but which can also affect other sports… A pain in the area of the pubis is called a “pubalgia”. Until then, easy to understand. But then the pubic area is a place that people don’t define well. Maybe because it is linked to one of the areas of sexuality? Probably because these are two rather unrecognized bones, welded to the pelvic bones and which are connected by a particular joint, the “pubic symphysis”. It is the set of these bones, the muscles attached to them and the soft parts in front that is called the “pubic region”.
No unambiguous cause for the pain
The pubic joint is not very mobile, but it is animated by micro-movements when walking and during efforts, for example to “shoot” or “dribble” in football. It can therefore be overworked in competitive sport and be the site of a kind of osteoarthritis: it is “pubic osteoarthropathy”. It manifests as pubic pain and is seen on an x-ray.
Bones serve as a structure for our skeleton but also as an attachment area for our muscles. An attachment which is made through the tendons. Inflammation of the tendons that attach the muscles to the pubis is called “tendonitis”, this is the case with “tendonitis of the thigh adductors” in footballers or “adductor disease”. It causes sub-pubic pain and can manifest itself late in a spiky appearance of the bone where the tendons of the adductors are inserted. But usually, it’s ultrasound or MRI that helps the diagnosis.
The inflammation can also affect the muscles which attach to the pubis at the top and this is the “abdominal wall pathology”. In the latter case, in addition to the hyper-solicitations of these muscles of the abdomen, there is also a congenital deficiency of the muscle wall. The x-ray finds late condensations of the pubic bone, but it is the ultrasound that shows the muscle damage.
Why athletes?
The pubalgia would affect more than 10% of athletes, all sports combined, but 40% of professional team athletes. Mainly football, but also tennis and frequent activities for young children such as dancing, hurdling, horseback riding, skiing and fencing.
If the pubalgia covers 3 different entities (tendonitis, arthropathy and muscle disease), the treatment shares many means. Above all, it is necessary to plan a sports rest ranging from 2 to 3 weeks, even up to 3 months, in particular in the event of pubic osteoarthropathies which are often rebellious. Prescribing short-course anti-inflammatory drugs and corticosteroids can help. Physiotherapy is essential to normalize the biomechanical imbalances which participate in the appearance of pubalgia. Resumption of training is only considered if the physiotherapy works and it must be gradual. In the event of failure of a well-conducted medical and physiotherapeutic treatment, corrective surgery may be considered, in particular in parieto-abdominal forms.
The pubalgia, in the end, is a pain that affects a lot of things, but not the pubic area!
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