Osteitis Pubis (Athletic Groin Pain)

Common Symptoms

• Pain centered at or near the pubic bone, sometimes radiating into the inner thigh or lower abdomen
• Pain that worsens with kicking, sprinting, sudden direction changes, or sit-ups
• Tenderness directly over the pubic bone or adductor (inner thigh) tendon attachments
• A gradual onset tied to a training load increase, rather than a single injury, in many cases
• Stiffness or a feeling of instability through the pelvis in more significant cases

Why It Happens

The pubic symphysis and the adductor and abdominal muscles that attach near it absorb enormous repetitive stress during kicking, sprinting, and cutting movements. When this load outpaces the tissue's ability to adapt, it can lead to a mix of bony stress response at the pubic symphysis (osteitis pubis) and tendinopathy of the adductor muscles that attach nearby — the two frequently occur together and are increasingly treated as a related "groin pain syndrome" rather than entirely separate problems.

Why It Can Become Persistent

The muscles involved in this region are used in nearly every athletic movement — running, cutting, kicking — making it difficult to fully offload the area while continuing to train or compete, and inconsistent rehabilitation (or returning to sport too early) is a common reason groin pain becomes a recurring, season-long problem for athletes.

Who Commonly Gets It

This is especially common in soccer players, hockey players, and other athletes in sports requiring repetitive kicking, sprinting, and rapid direction changes. It's one of the more common causes of missed playing time in these sports.

How It Is Usually Diagnosed

A provider evaluates the pattern of groin pain through history, palpation of the pubic bone and adductor tendons, and specific resisted-movement tests. Because several structures can cause groin pain — the pubic symphysis, adductor tendons, hip joint itself, or the abdominal wall (sports hernia) — a careful exam, and sometimes imaging (MRI or ultrasound), helps sort out which structure (or combination) is actually involved.

Traditional Treatment Options

• Activity modification: Temporarily reducing kicking, sprinting, and cutting load while maintaining general fitness.
• Physical therapy: A structured program addressing adductor and core strength, pelvic stability, and gradual return to sport-specific movement.
• NSAIDs: Sometimes used short-term for symptom control.
• Corticosteroid injection: Considered in some cases, particularly when pain is limiting participation in rehabilitation.

Why Someone Might Start Looking for Another Option

Groin pain has a reputation among athletes and sports medicine providers for being stubborn and prone to recurrence, and a rehabilitation program alone can take many weeks — which is a real problem for in-season athletes, leading some to look into additional options alongside their rehab program.

Where Shockwave Therapy May Fit

A 2024 systematic review of shockwave therapy for athletes found it useful as an adjunct to exercise-based treatment specifically for osteitis pubis, and a more recent prospective pilot study combining focused shockwave therapy with a structured rehabilitation program in soccer players reported significant improvements in pain and function — though that study's own authors caution it was a small, uncontrolled pilot that can't isolate the shockwave therapy's specific contribution from the rehabilitation program itself.

How Shockwave Treatment Works for This Area

If considered appropriate for your presentation, acoustic pressure waves would be directed at the tender area near the pubic symphysis or adductor tendon attachment, used alongside — not instead of — a structured rehabilitation program addressing the underlying strength and movement contributors.

What the Treatment Feels Like

Treatment in this area is often tender given its proximity to sensitive structures; your provider will discuss positioning and what to expect in detail before any treatment.

What Happens During Your First Visit

Your visit begins with a provider evaluation focused on your history and a physical exam relevant to your complaint. If shockwave therapy is determined to be clinically appropriate, your first treatment can typically be provided the same visit. See our What to Expect page for the full walkthrough.

Who May Not Be Appropriate

• Groin pain that may represent a hip labral tear, sports hernia (athletic pubalgia), or stress fracture, which need their own specific evaluation and treatment
• People who have not yet had a medical evaluation to identify the actual source of their groin pain
• Active infection, open wounds, or certain bone conditions at the treatment site
• Pregnancy, unless specifically cleared by your provider

This list is not exhaustive. Your provider will screen for contraindications during your evaluation.