Pubic pain – pubalgia
Pubalgia is a broad term for pain in the pubic region, which can have dozens of different causes. Adductor tendinopathy/tendinitis or rectus abdominis tendinopathy is among the most common, caused by overactivation or poor coordination of these muscle groups, usually together with weakness. Treatment involves re-educating these muscles. Image-guided obturator nerve blocks are usually a useful tool for breaking the vicious cycle of pain and sustained muscle contraction.
Ilioinguinal and iliohypogastric neuropathy is an often underdiagnosed cause, resulting from entrapment of these nerves as they pass between the iliopsoas and the abdominal wall muscles. Ultrasound-guided hydrodissection of these nerves usually gives favourable results.
Abdominal hernias are a less common cause, where abdominal contents push through small “gaps” in the abdominal wall. They usually get worse with coughing, and in some cases a lump can be felt at these specific points. Treatment is usually surgical.
There are other, less common causes of pubalgia originating inside the abdomen, so pubalgia should always be investigated thoroughly by a clinician.
Dr. Miguel Reis e Silva
Doctor at Sport Lisboa e Benfica
Medical Director and Founder of Clínica Myalgia
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