0:00

<v ->Let's talk a little bit about athletic pubalgia

0:02

and osteitis pubis.

0:04

No, not the osteitis pubis that you get from laxity

0:08

of the pelvic structures,

0:11

perhaps hormonally mediated in pregnant women

0:14

that usually doesn't occur in sport,

0:16

although it can.

0:17

But let's talk about overuse syndromes

0:20

that involve this skeletal structure

0:23

which is held together by the capsule

0:26

which takes the brunt of the abuse

0:30

and some ligaments which I'm going to draw in for you.

0:33

Probably the most important of these ligaments

0:36

are the arcuate ligament which sits underneath.

0:39

And that is affected after the pubic capsule is

0:43

and the superior pubic ligament.

0:46

There's also an anterior and posterior pubic ligament

0:50

which I'm not gonna draw in

0:51

'cause I'm not in the actual projection right now.

0:53

But these are perhaps of lesser importance.

0:57

Now, one thing as I've emphasized to my trainees

1:00

and colleagues is I do not like to see

1:03

in healthy young men or women,

1:06

whether they're playing football or gymnastics,

1:09

I do not like to see a capsular hyper-intensity

1:13

in the middle of the capsule,

1:14

more than 10 millimeters in any direction.

1:18

So I'll allow some hyper-intensity

1:20

on a proton density fat suppression spur, spare, or special

1:25

in the coronal or axial projection about 10 mm.

1:30

When it gets beyond 10 mm,

1:32

it usually means there are micro tears

1:34

that are occurring here.

1:35

And now you get instability of this joint.

1:39

Now, who gets this?

1:41

Well, people that abuse the joint

1:42

and especially young men that do a lot of squats

1:46

dead lifts and inverted leg presses.

1:50

So they destabilize this articulation.

1:54

So in the earliest stages you see

1:56

extension of this high signal in this capsule.

1:59

As the abuse continues, the overuse continues,

2:02

the ligaments become lax.

2:05

They can even tear.

2:06

Especially the arcuate followed by

2:08

the superior pubic ligament

2:10

because the forces are more cranio-caudal

2:12

than they are anteroposterior.

2:15

And eventually not uncommon

2:17

but surprising the superior and inferior pubic ramus or rami

2:22

and the ischium become adenitis

2:25

as a manifestation of an overuse syndrome.

2:28

And this is indeed how I just described it to you

2:31

is how I grade from least severe to most severe

2:36

the clinical syndrome of athletic pubalgia

2:40

or osteitis pubis,

2:41

which again, remember some segregate out

2:44

from sports hernia syndrome involving the soft tissues

2:47

or muscles others lump them together.

2:51

Dr. PL.