Non-surgical treatment of pubic overload and groin pain in amateur football players: a prospective double-blinded randomised controlled study

Knee Surg Sports Traumatol Arthrosc. 2017 Jun;25(6):1958-1966. doi: 10.1007/s00167-017-4423-z. Epub 2017 Jan 16.


Purpose: The incidence of groin pain in athletes is steadily increasing. Symptomatic pubic overload with groin pain and aseptic osteitis pubis represent well-known and frequently misdiagnosed overuse injuries in athletes. This study investigated the benefits of standardised non-surgical treatment for swift return-to-football.

Methods: In a prospective double-blinded controlled study, 143 amateur football players with groin pain as well as radiological signs and clinical symptoms of pubic overload were analysed for 1 year. Two randomised study groups participated in an intensive physical rehabilitation programme, either with or without shock wave therapy. The control group did not participate in any standardised rehabilitation programme but only stopped participating in sports activity. Follow-up examinations took place 1, 3 months and 1 year after the beginning of therapy. Endpoints were visual analogue scale (VAS), functional tests, the time of return-to-football, recurrent complaints and changes in the MR image.

Results: Forty-four football players with groin pain and aseptic osteitis pubis were randomised into two study groups; 26 received shock wave therapy, 18 did not. Clinical examination showed pubic overload as a multi-located disease. Players receiving shock wave therapy showed earlier pain relief in the VAS (p < 0.001) and returned to football significantly earlier (p = 0.048) than players without this therapy. Forty-two of 44 players of both study groups returned to football within 4 months after the beginning of therapy and had no recurrent groin pain within 1 year after trauma. Fifty-one players of the control group returned to football after 240 days (p < 0.001), of whom 26 (51%) experienced recurrent groin pain. Follow-up MRI scans did not show any effect of shock wave therapy.

Conclusion: Non-surgical therapy is successful in treating pubic overload and osteitis pubis in athletes. Shock wave therapy as a local treatment significantly reduced pain, thus enabling return-to-football within 3 months after trauma. Early and correct diagnosis is essential for successful intensive physiotherapy.

Level of evidence: I.

Keywords: Football; Groin pain; Osteitis pubis; Pubic overload; Shock wave therapy; Soccer.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Cumulative Trauma Disorders / complications
  • Cumulative Trauma Disorders / diagnostic imaging
  • Cumulative Trauma Disorders / therapy*
  • Double-Blind Method
  • Extracorporeal Shockwave Therapy*
  • Groin / diagnostic imaging
  • Groin / injuries*
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Osteitis / diagnostic imaging
  • Osteitis / etiology
  • Pain / etiology
  • Pain Management*
  • Physical Therapy Modalities*
  • Prospective Studies
  • Pubic Bone / pathology
  • Radiography
  • Soccer / injuries*
  • Young Adult