Pubalgia: characteristics, symptoms and management
Pubalgia: characteristics, symptoms and management
Pubalgia is a relatively common complaint of the inguino-pubic region. It can be quite complex to manage, particularly because of its multifactorial aspect and the possible presence of a combined form. Let's take a look at the characteristics of this disorder, the different management techniques and the benefits of the Allyane method, with the aim of facilitating the rehabilitation of this pathology.
Pubalgia: definition
Pubalgia is a fairly common injury of the inguino-pubic region, accounting for between 4% and 20% of sports-related pathologies. It generally occurs as a result of physical activity involving rapid acceleration and deceleration, or repetitive actions at high speed, with pivots and changes of direction (soccer, handball, tennis, field hockey, rugby*).
Pubalgia is complex and particularly difficult to manage. This is due to its multifactorial aspect, as well as to the presence of combined forms, as mentioned above. In 2015, at the Doha consensus conference, it was established that pubalgia can involve four types of pain in the inguinal region, which can also combine (hence the importance of clearly identifying the different structures in pain). These injuries may be related to :
- adductor muscle ;
- pubis;
- inguinal area;
- to the iliopsoas muscle.
What pathologies can be linked to sports pubalgia?
Pubalgia can be linked to a number of different pathologies. These include, but are not limited to:
- inguinal canal pathology ;
- pubic osteoarthropathy;
- large-right insertion disorder;
- insertional tendonitis in the adductor muscles.
What are the symptoms of pubalgia?
Pubalgia is generally characterized by the progressive onset of localized pain in the inguinal and pelvic region (lower abdomen and pubis), but can also affect the upper adductors or abdomen.
It should be noted that in the case of sports, pain may be felt by the patient immediately after exercise. It may then reappear when cold, but also during physical activity.
Pubalgia: what are the risk factors?
Some people are predisposed to developing pubalgia. This is particularly true of those suffering from certain anatomical and biomechanical imbalances. These can be induced by various disorders, such as anteversion of the pelvis, asymmetry of the lower limbs, or over-musculature of the adductors in comparison with the abdominal girdle. Intensive practice of any of the above-mentioned sports can also be a risk factor for pubalgia.
Pregnancy can also be a risk factor for the development of this type of disorder. It can appear around the 6th month of pregnancy, particularly when the fetus presses against the mother's pelvis. As a general rule, however, the disorder tends to disappear on its own after delivery.
How can I prevent pubalgia?
To prevent the onset of pubalgia, we strongly recommend that you add a few muscle-strengthening exercises (abdominal development and sheathing), as well as stretching (adductors and hamstrings) to your sports routine.
For people more prone to pubalgia, this work can help improve pelvic support, by reinforcing their body's muscular symmetry.
How is pubalgia diagnosed?
To diagnose pubalgia, we first need to rule out any other pathologies that may be causing localized pain in the lower abdomen or groin. This initial analysis should be carried out by palpating the inguinal and pubic regions.
The healthcare professional will then be able to perform a few manipulations on the lower limbs. The aim here is to stimulate the hamstrings, adductors, psoas and abdominal muscles. This manipulation will enable the practitioner to pinpoint the painful area and rule out other pathologies, such as tendinopathy, appendicitis, hip pathology and so on.
To confirm the practitioner's diagnosis, the patient may be asked to undergo an X-ray of the pelvis, as well as a musculotendinous ultrasound scan.
How is pubalgia treated?
Muschaweck biomechanically described the abdominal wall as a matrix of tension bands that attach to the pubic bone. Retraction of the rectus abdominus can stress the symphysis pubis upwards and internally.
Controlling thigh flexion abduction rotation is also important. It requires coactivation between the abdominal wall, gluteals and hamstrings to constantly control pelvic tilt and the position of the lumbar spine. The symphysis pubis is subject to shearing, compression and torsion forces, which can cause pain.
Once the diagnosis has been made by the health professional, rehabilitation is based on rebalancing these different forces, treating the areas in pain and returning the patient to a sporting situation. The aim is to correct muscular imbalances in the stabilizers of the lumbar spine, pelvis and hips.
Core strengthening exercises focus on the abdominal wall, lumbar spine and hips. Stretching exercises focus on the hip rotators, adductors and hamstrings.
The Allyane neuromotor reprogramming method: a rehabilitation gas pedal for pubalgia
Neuromotor reprogramming using the Allyane method has its place in this type of treatment. Indeed, as we mentioned earlier, there are many risk factors for the development of pubalgia that can be treated with this approach. These include
- hip abductor/adductor imbalance ;
- work on the transversus abdominis;
- hip mobility work ;
- postural exercises;
- pelvis stability.
The Allyane method is based on the scientific foundations of motor imagery and the role of proprioception. It combines an innovative form of motor imagery with the use of low-frequency sounds. The latter modulate brain activity by increasing the production of alpha waves, which place the patient in a state of hypovigilance, associated with hyperactivation of motor control. This ensures a lasting anchoring of the motor modifications created by motor imagery.
How a session with the Allyane method works
Let's take an example: in the case of adductor weakness, the work will target proprioceptive sensations of contraction as felt by the patient on the affected area, and in opposition to the healthy side. The patient is then asked to recall these different sensations using mental imagery. The patient is then placed under low-frequency sound, to achieve hypovigilance and benefit from stimulation of motor areas.
After implementing a general relaxation protocol, the patient works on the positive sensations of adductor contraction, using the opposite side. The patient then mentally erases the wrong muscle recruitment pattern, replacing it with the right sensations of the opposite limb.
This reprogramming phase will then enable the patient to regain effective muscle contraction. It also allows him to concentrate on rebalancing his pelvic stability. The practitioner can then consider working on other parameters of pubalgia rehabilitation, such as posture control, by repeating the same process.
Are you a healthcare professional with questions about the Allyane method? Please do not hesitate to contact our team by telephone on 04 28 29 48 14 or by email on contact@allyane.com
Do you have any questions about Allyane sessions? Contact our medical secretary on 04 28 29 58 10 or contact@allyane.com
*Source: Minnich, AJSM, Sport hernia, V39, 6, 2011.