Pain guide · Hip pain

Osteitis pubis (pubic bone pain): rehab, recovery time and how it differs from a sports hernia

Osteitis pubis is pain and tenderness on the pubic bone at the front of the pelvis, usually in people who kick, sprint and change direction. It's an older name: the Doha agreement, an international consensus on groin pain in athletes, calls it pubic-related groin pain. It's thought to be an overload of the bone where the inner thigh and tummy muscles meet, not an infection, and it often comes with a groin strain or a sports hernia.

It usually gets better with graded rehab, but slowly, and the research behind that is thin: two small trials, one group of 14 young footballers and some case series. This guide shows how to tell it from other groin pain, what scans do and don't mean, the warning signs, what rehab, shockwave, injections and surgery offer, and a staged plan back to running, sprinting and kicking, with a 3D demo of every exercise.

4-stage exercise plan When to get help 22 sourcesUpdated 21 October 2026

When to get help first

Exercise is for pain that has been checked or is clearly mild and settling.

Get urgent medical help if

Groin or pubic pain with a high temperature, or feeling hot, cold, shivery or generally unwell; severe pain that started suddenly; or you can't move the leg or put weight on it: ask for an urgent GP appointment or get help from NHS 111. An infected pubic joint can look like osteitis pubis and needs treating quickly, usually in hospital. It's more likely after pelvic, bladder or incontinence surgery, with a weakened immune system, or if you inject drugs.
Same day, and stop running now: groin or front-of-hip pain in a runner, sometimes felt in the thigh or knee, that builds with running, hurts with every step or at night, or hurts when the hip is turned to the end of its range. Keep weight off the leg, using crutches if you have them, and get an urgent GP appointment or help from NHS 111 the same day: a stress fracture of the hip (femoral neck) needs urgent imaging.
Buttock or leg pain with numbness around the genitals or bottom, new trouble controlling your bladder or bowels, or weakness or numbness in both legs.

See a doctor or physiotherapist if

Pain in one spot on the pubic bone that you can point to with a fingertip, worse with every step and later at rest or at night: a possible stress fracture of the pubic bone. Stop running and get it checked.
A lump in the groin, or groin pain when you cough or strain: see a GP, as it may be a hernia. The sports hernia guide lists the hernia signs that need A&E.
Groin pain with blood in your pee, pain when you pee, or no clear link to sport: see a GP, as it's unlikely to be a sports injury.
Pain that isn't linked to activity, pain at rest or at night, unexplained weight loss or night sweats, or a history of cancer: see a GP.
Back pain and stiffness for more than 3 months, worse in the second half of the night or with buttock pain, especially with psoriasis or inflammatory bowel disease: see a GP. Inflammatory arthritis can cause pubic pain too.
A teenager with groin pain that lasts, especially during a growth spurt: get it assessed. The growth plate on the pubic bone can be stressed, and that needs protecting.
No better after about 12 weeks of a supervised, progressive programme, or pain still stops you training: ask for a sports medicine review.
Pubic pain in pregnancy or after giving birth is usually pelvic girdle pain, which has its own guide, with the signs that need your maternity team.

Understand it

What it is, and its namesStrong evidence

The pubic symphysis is the joint at the front of the pelvis where the two pubic bones meet. The inner thigh muscles (the adductors) and the long tummy muscle (rectus abdominis) anchor close together over it. The Doha agreement defines pubic-related groin pain as tenderness of this joint and the bone right next to it, with no particular strength test that singles it out.

Osteitis pubis is the older name, and the one most people search for. The Doha agreement chose not to recommend it, along with sports hernia and athletic pubalgia, and a 2026 review keeps it only for one pattern of symptoms and scan changes within pubic-related groin pain. This guide uses both names.

Sources 1, 2

What's going onEmerging evidence

It's thought to be a stress injury of the pubic bone and the tissues attached to it, from repeated pulling and shearing as you kick, sprint and cut. Magnetic resonance imaging (MRI) scans often show swelling inside the bone (bone marrow oedema), and samples of the bone have shown new bone forming. It isn't an infection, though an infection can look like it (see below).

Sources 2, 3, 4, 5

Who gets itEmerging evidence

Footballers, Australian rules footballers, rugby and ice hockey players, and distance runners, mostly men in the studies. In a German professional youth academy, 14 of 189 players (7.4%) developed long-standing pubic-related groin pain in one season, at an average age of 16. In elite junior footballers, a lower training load before joining the squad went with developing it, which suggests building load gradually.

Sources 4, 5, 6, 7

How it feels

Pain over or beside the middle of the pubic bone, on one or both sides, that builds with running, kicking, cutting, sit-ups and squeezing the knees together. It can spread to the inner thigh, the lower tummy, the area between the legs or the scrotum. When it's irritable, walking, stairs, rolling over in bed and coughing can hurt. Pressing on the pubic bone brings on the familiar pain.

Sources 4, 2, 5

How it overlaps with other groin painEmerging evidence

The Doha agreement describes four types of groin pain in athletes, by where they come from: the inner thigh muscles (adductor-related), the front of the hip (iliopsoas-related), the groin canal (inguinal-related, often called a sports hernia) and the pubic bone (pubic-related). Hip-related pain is a fifth, and an athlete can have more than one.

Pubic pain usually comes with something else. In 132 athletes with osteitis pubis on MRI, 90% also had a problem in an inner thigh tendon, and the side that hurt matched the tendon problem much better than the bone changes. In practice, a groin strain is tender on the inner thigh tendon, a sports hernia is tender in the groin canal above the crease and hurts with sit-ups and coughing, and hip-related pain pinches deep in the groin when you bend. Each has its own guide.

Sources 1, 8

What scans show, and what they don'tStrong evidence

A scan can map other problems and rule things out, but a pubic bone finding on its own doesn't make the diagnosis, because the same changes are common in players without pain. Swelling that lingers on a scan shouldn't on its own stop a return once you're pain-free and playing well; a true stress fracture is the exception. In the academy group, a worse MRI grade did go with a longer return.

How common the changes are without pain:

At the start of a season, 11 of 18 elite junior footballers without pain had moderate to severe swelling at the joint.
In contact-sport teams, swelling was found in 53% of players with groin pain and 47% of players without it.
Up to 71% of footballers without pain had some finding on MRI, though higher grades of swelling were more common with pain.
On X-rays, thinning, new bone and hardening around the joint were as common in footballers without groin pain as in those with it.

Sources 7, 9, 10, 11, 2, 5

In teenagersEmerging evidence

The growth plate on the pubic bone doesn't fully mature until the early to mid twenties. In 26 young footballers with groin pain from the inner thigh, computed tomography (CT) scans showed stress changes in it that weren't seen in players without pain. A teenager with lasting groin pain needs an assessment, and their load needs protecting rather than following an adult plan.

Sources 12, 2

What not to miss: infection and stress fracturesEmerging evidence

An infected pubic joint is rare but serious. In a review of 100 cases, 74% had a fever, 68% pubic pain and 59% a painful or waddling walk. It followed incontinence surgery in 24%, sport (especially football) in 19%, pelvic cancer in 17% and injecting drugs in 15%, and it was often mistaken for osteitis pubis.

A stress fracture of the pubic bone or the top of the thigh bone, a hernia, and urinary, gynaecological and testicular problems are also on the Doha agreement's list of conditions not to miss, along with inflammatory arthritis of the spine.

Sources 13, 2, 1

How it usually goesEmerging evidence

Slowly. In one German academy, 14 young professional players on a rehab programme returned after 135 days on average (about 4.5 months): about 72 days with mild bone swelling on MRI, 148 with moderate and 251 with severe. That's one small group of teenagers, so the timings may not hold for adults or amateurs. In a trial of amateur footballers given intensive rehab, 42 of 44 were back within 4 months.

In 27 Australian professional footballers who rested from running sports for 12 weeks, 89% played the next season, but only 41% were free of symptoms at its start, rising to 67% by its end.

Sources 5, 14, 6

What helps, and how strong the evidence is

Active, graded rehab first, though the evidence is thinEmerging evidence

A 2026 review calls active, supervised rehab the first treatment for most athletes. It notes that complete rest can ease symptoms while also lowering what the tissue can tolerate, and delay a return. Programmes build from pain-free squeezes and trunk control, through inner thigh, hip and trunk strength, to running, then changing direction, sprinting and kicking.

The evidence is thin: two small randomised trials, one group of 14 players with no comparison group, and case series. A Danish trial of 68 athletes found that active training got 23 back to sport without pain, against 4 with passive physiotherapy, but it studied pain from the inner thigh muscles, not the pubic bone, so it's indirect evidence here.

Sources 2, 5, 14, 15, 6, 16, 17

Two small trialsEmerging evidence

In a German trial, 44 amateur footballers with pubic overload on MRI were randomised to intensive rehab with or without focused shockwave therapy. Shockwave brought earlier pain relief and an earlier return, and 42 of the 44 were back within 4 months, with no recurrence at a year. A separate group of 51 who only stopped sport took 240 days to return and half had the pain come back, but they weren't randomised, so this can't prove that rehab beats rest.

In 50 teenage footballers in Saudi Arabia, a 12-week active programme (holds, then bands, bridges and slow lowering work, then balance and jumping) built more hip and trunk strength and function than traditional physiotherapy, which eased pain more (by 63% against 25%). Neither group played sport during the trial, and there was no long-term follow-up.

Sources 14, 15

Rehab or surgeryMixed evidence

A 2015 meta-analysis of 56 studies (3,332 athletes, mostly case series) found similar return-to-sport rates with surgery and rehab, and rehab got athletes with pubic-related pain back faster: 10.5 weeks against 23.1. A 2022 review of 10 studies (468 athletes) suggested surgery may return people sooner but advised trying non-surgical care first; the studies were few and of mixed quality.

Surgery is for a small group with persistent, limiting pain after a properly supervised programme. Options include cleaning out or partly removing the joint, or fusing it. A 2026 review reports that 23 of 30 athletes returned to their previous level after an operation on the joint alone, and a 2011 systematic review found only case reports and case series for every operation.

Sources 18, 19, 2, 16

Injections and shockwaveMixed evidence

An image-guided steroid injection into the joint can calm pain that blocks rehab, but the benefit is often temporary, repeated steroid near tendons needs caution, and infection must be ruled out first. A 2011 systematic review found only case reports and case series for steroid and dextrose injections (prolotherapy). Platelet-rich plasma has isolated reports only. Competitive athletes should check anti-doping rules first.

Focused shockwave speeded recovery in one trial. A 2026 review treats it as an addition to loading, not a replacement.

Sources 2, 16, 14

How much pain is OK while you exercise?

Below 3 out of 10, and the next morning decidesEmerging evidence

Our reading of one academy's programme: move up a level only when pain during the exercises, and when you squeeze your knees together, stays below 3 out of 10. If pain goes above 3 during or after training, rest from training for a day, train lighter for the next two days, and go back to your previous level on the third. That rule comes from one group of 14 teenage academy footballers, may not hold for adults or amateurs, and hasn't been tested on its own, so treat it as a guide, not a proven threshold.

A 2026 review adds that mild, steady pain during exercise is acceptable if it has gone by the next day. Pain at rest that keeps rising, a worse walk, weaker performance at the same load, or a long flare after exercise mean doing less, or getting the diagnosis rechecked.

Each morning, check the movements that bring it on: pressing on the pubic bone, squeezing your knees together, getting out of bed or a car, and coughing or sitting up. If they're worse than the day before, the load was too much (our suggestion). With the Copenhagen plank, expect muscle soreness for the first fortnight; sharp pubic pain is a reason to step back.

Sources 5, 2, 1

The exercise plan: 4 stages

Start at the first stage. Each move opens a full guide with a 3D demo.

Stage 1

Settle and start loading (about weeks 0 to 2)

Stop sprinting, kicking, cutting, sit-ups and deep side lunges for now, and keep fit on a bike, in a pool or with upper-body work. The academy programme paused sport for 7 to 14 days. Keep pain below 3 out of 10. The weeks in this plan come from one academy and are rough guides only: move on by the checks, not the calendar. Doses are editorial unless marked.

Lying adductor ball squeeze demonstrated on the 3D figure

3D demoLying adductor ball squeezeBeginner · Other / check instructions

5 to 10 squeezes held 10 s, building to 30 s holds · Only as hard as you can without pain. The teenage trial's first stage used 30-second holds; the build-up is ours

Harder: Copenhagen plank

Dead bug heel taps demonstrated on the 3D figure

3D demoDead bug heel tapsBeginner · No equipment

2 sets of 6 to 8 each side

Harder: Forearm plank

Glute bridge demonstrated on the 3D figure

3D demoGlute bridgeBeginner · No equipment

2 to 3 sets of 10, with a 5 s hold

Easier: Pelvic tilt into bridge · Harder: Glute kickback (quadruped hip extension)

Half-kneeling Pallof press demonstrated on the 3D figure

3D demoHalf-kneeling Pallof pressBeginner · A band + An anchor point

2 sets of 8 to 10 each side · Trunk control without curling up. Pad the knee

Harder: Pallof press

Stationary cycling demonstrated on the 3D figure

3D demoStationary cyclingBeginner · Cardio machine

20 to 30 min, easy · Only if it's pain-free

Harder: Air bike intervals

Move on when: Walking, stairs, getting out of bed and the ball squeeze stay below 3 out of 10, and they're no worse the next morning.

Follow along: a timer, a cue and the next move, one step at a time.

Stage 2

Build inner thigh, hip and trunk strength (about weeks 2 to 6)

Strength for the muscles round the pelvis 3 times a week, adding the Copenhagen plank at a short lever, as the academy programme did. Keep fit on a cross-trainer, a bike or in a pool. Doses are editorial unless marked.

Standing band hip adduction demonstrated on the 3D figure

3D demoStanding band hip adductionBeginner · A band + An anchor point

3 sets of 10 to 12 each side · Slow on the way back

Harder: Copenhagen plank

Standing band hip abduction demonstrated on the 3D figure

3D demoStanding band hip abductionBeginner · A band + An anchor point

3 sets of 10 to 12 each side · Works the outer hip, for balance

Easier: Hip abduction machine · Harder: Lateral band walk, band at the feet

Copenhagen plank demonstrated on the 3D figure

3D demoCopenhagen plankAdvanced · A bench or box

Short lever (knee on the bench): 3 to 5 each side, 3 times a week · Only while pain stays below 3 out of 10, and expect soreness for the first fortnight. The academy programme started here

Easier: Hip adduction machine

Knee side plank demonstrated on the 3D figure

3D demoKnee side plankBeginner · No equipment

3 holds of 20 to 30 s each side

Harder: Side plank

Single-leg stand demonstrated on the 3D figure

3D demoSingle-leg standBeginner · A wall

3 holds of 20 to 30 s each side · Near a counter at first

Easier: Tandem stance and heel-to-toe walk · Harder: Single-leg reach matrix

Elliptical trainer demonstrated on the 3D figure

3D demoElliptical trainerBeginner · Cardio machine

20 to 30 min · The academy programme used a cross-trainer at this level

Harder: Stair-stepper machine

Move on when: 15 to 30 minutes of easy straight-line running stays below 3 out of 10, on the day and the next morning (the academy programme's test).

Follow along: a timer, a cue and the next move, one step at a time.

Stage 3

Run and get stronger (about weeks 6 to 12)

Build straight-line running, then longer runs and changes of pace, with heavier inner thigh and gym strength work, as the academy programme did. Doses are editorial unless marked.

Treadmill jogging demonstrated on the 3D figure

3D demoTreadmill joggingIntermediate · Cardio machine

15 to 30 min easy, building over the weeks to 45 to 60 min, then changes of pace · The academy programme's running steps. Running outdoors on the flat counts

Easier: Treadmill walking · Harder: Sprint intervals

3D demoCopenhagen plankAdvanced · A bench or box

Build the reps, then move to the long lever (foot on the bench) · Keep the lowering slow

Easier: Hip adduction machine

Split squat demonstrated on the 3D figure

3D demoSplit squatIntermediate · No equipment

3 sets of 8 each side

Easier: Bodyweight squat · Harder: Reverse lunge

Single-leg Romanian deadlift demonstrated on the 3D figure

3D demoSingle-leg Romanian deadliftAdvanced · A dumbbell

3 sets of 6 to 8 each side

Easier: Dumbbell Romanian deadlift

Side plank demonstrated on the 3D figure

3D demoSide plankIntermediate · No equipment

3 holds of 20 to 30 s each side

Easier: Knee side plank · Harder: Side plank with leg lift

Move on when: 45 to 60 minutes of running with changes of pace stays below 3 out of 10, on the day and the next morning.

Follow along: a timer, a cue and the next move, one step at a time.

Stage 4

Change direction, sprint and kick (about weeks 10 to 20)

Running on curves and slaloms, then sharper cuts, then sprinting, then drills for your sport and kicking (see the steps below the plan), then partial and full training, as the academy programme did. Keep the Copenhagen plank going once you're back. The FIFA 11+ warm-up and the hamstring and groin injury prevention workout suit this stage. Doses are editorial unless marked.

3D demoSkippingBeginner · No equipment

3 sets of 20 m

Easier: Ankle bounces (mini pogo) · Harder: Alternate-leg bounding

Shuttle runs demonstrated on the 3D figure

3D demoShuttle runsAdvanced · No equipment

Short sets, wide unhurried turns first, sharpening over the weeks

Easier: Treadmill jogging

Lateral bound (skater jump) demonstrated on the 3D figure

3D demoLateral bound (skater jump)Beginner · No equipment

3 sets of 6 to 8 bounds (3 or 4 on each leg) · The move's own starting dose

Harder: Box push-off jump

Sprint intervals demonstrated on the 3D figure

3D demoSprint intervalsAdvanced · No equipment

Build towards full speed over several sessions · Add speed over weeks, never within one session

Easier: Treadmill jogging

3D demoCopenhagen plankAdvanced · A bench or box

Once a week once you're back playing · To keep the inner thigh strong

Easier: Hip adduction machine

Move on when: The pubic bone, inner thigh and lower tummy aren't tender; squeezing your knees together and stretching the inner thigh are painless; passing, kicking and shooting don't hurt; and full training has gone well with no reaction the next day. Those are the academy programme's final checks.

Follow along: a timer, a cue and the next move, one step at a time.

What to change for now

Keep fit while it settles

Keep training what doesn't hurt: cycling, pool work and upper-body strength. A 2026 review suggests cutting down high-speed running, long kicking, repeated cutting, deep side lunges and lots of tummy work early on, rather than stopping everything. If you're not making progress after about 12 weeks, the same review suggests rechecking the diagnosis and the plan with your clinician, not treating it as failure.

Sources 2, 5

Bringing kicking back

Kicking comes back last, over several sessions, once running and sprinting are pain-free. The academy programme moved from half volleys to full volleys and passing over longer distances; these steps are our suggestion, the same as in the sports hernia guide. Move on only when the last step stayed within the pain rule on the day and the next morning.

1. Short passes with the inside of the foot.
2. Longer passes.
3. Crossing and shooting, building to full power.

Source 5

Positions to swap, and why

Habit or position	Why it matters	Instead
Sit-ups and crunches early on	Lots of tummy work loads the pubic bone through the long tummy muscle.	Trunk control without curling up, such as dead bug heel taps.Try: Dead bug heel taps
Sprinting, long kicking and cutting through pain	These are the loads that provoke it.	Bike, pool or upper-body work, then bring them back in stages.Try: Stationary cycling
Deep side lunges such as the Cossack squat	Deep side lunges are among the loads a 2026 review suggests cutting down early.	Split squats in a short range.Try: Split squat
Hard inner thigh stretches such as the frog rock	The academy programme stretched everything except the inner thigh in its early levels.	Pain-free ball squeezes.Try: Lying adductor ball squeeze
Complete rest for weeks	Complete rest can delay your return. In one study, players who only stopped sport took 240 days to return and half had the pain come back, though they weren't randomised.	Keep training what doesn't hurt, within the 3 out of 10 rule.Try: Glute bridge
The Copenhagen plank while pain is acute	The move's own caution: avoid it during acute groin pain.	Squeezes, then band adduction, then a short-lever Copenhagen plank.Try: Standing band hip adduction
Waiting for a scan to clear before returning	Bone swelling is common in players without pain, and a return should go by symptoms and function.	Use the return checks at the end of the plan.
Training through a fever, night pain or pain with every step	These can mean an infection or a stress fracture.	Stop and get checked the same day.

Routines to follow

Beginner core workout

A 15-minute beginner core workout on the floor: dead bugs, bird dogs, knee planks, side planks and curl-ups.

15 minBeginner6 movesNo equipment

Hamstring and groin injury prevention

The Nordic hamstring and Copenhagen adduction programmes from the football trials: a 10-week build, three adductor levels, then once a week in season.

15 minIntermediate6 movesA wall, An anchor point

FIFA 11+ warm-up

FIFA's 11+ injury prevention warm-up as its manual sets it out: running drills, strength, balance and jumping at three levels, then faster running.

20 minBeginner20 movesCardio machine, A wall

10-minute dynamic warm-up

A 10-minute warm-up for any workout: raise your heart rate, move each joint through its range, rehearse the main movements, then ramp up to your first lift.

10 minBeginner12 movesA wall, A band

More moves for this area

Questions people ask

What is osteitis pubis?

Pain and tenderness on the pubic bone at the front of the pelvis, usually from repeated kicking, sprinting and twisting. It's an older name: experts now call it pubic-related groin pain, and see it as a bone overload problem, not an infection.

What are the symptoms?

Pain over the middle of the pubic bone, on one or both sides, that builds with running, kicking, sit-ups and squeezing your knees together. It may spread into the inner thigh or lower tummy, and when it's bad, walking, stairs and rolling over in bed hurt.

Is it the same as a sports hernia or a groin strain?

No, but they often come together. A sports hernia is tender in the groin canal above the crease, a groin strain is tender in the inner thigh muscle, and osteitis pubis is tender on the bone itself. In one study, 90% of athletes with osteitis pubis also had an inner thigh tendon problem.

How long does it take to recover?

Usually months, and it varies a lot. In one academy, 14 young footballers returned after about 4.5 months on average, from about 2.5 months with mild bone swelling to about 8 with severe, though that may not apply to adults or amateurs. In one trial, most amateur players were back within 4 months.

What exercises help?

A graded programme: pain-free squeezes and trunk control, then inner thigh and hip strength (including a short-lever Copenhagen plank), then running, then changing direction, sprinting and kicking. Keep fit on a bike or in a pool meanwhile, and move up only when pain stays low.

Which exercises should I avoid?

For now, sit-ups, sprinting, long kicking, cutting, deep side lunges and hard inner thigh stretches. They come back in the later stages, one at a time.

Should I rest completely?

No. Complete rest eases pain but can slow your return. Keep fit on a bike or in a pool, and keep doing the exercises that stay below 3 out of 10.

Do I need an MRI scan?

Not always. An MRI can show other problems and rule things out, but bone swelling is common in footballers without pain, so a scan has to fit your examination.

Does shockwave or an injection help?

In one small trial, shockwave added to rehab got players back sooner. A steroid injection can calm pain that's blocking rehab, but relief is often temporary and the evidence is weak.

When is surgery an option?

Only for the few with persistent, limiting pain after a properly supervised programme, usually after many months. The results come from small case series.

Can women get it?

Yes, though most of the research is in male athletes. In pregnancy or after giving birth, pubic pain is usually pelvic girdle pain, which has its own guide, and severe pubic pain after the birth needs the maternity team.

When is pubic pain an emergency?

Pubic or groin pain with a fever, shivers or feeling unwell, or pain so bad you can't put weight on the leg, needs an urgent GP appointment or NHS 111, because an infected joint can look like osteitis pubis. Infection is more likely after pelvic, bladder or incontinence surgery, with a weakened immune system, or if you inject drugs.

Related exercise guides

Other pain guides

Sources

Exercise education, not a diagnosis or treatment plan. It is written from the guidelines and studies listed above; review by a clinician is pending. If your pain follows an injury, is severe, is getting worse, or comes with any warning sign listed on this page, get it assessed. Health disclaimer.