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osteitis pubis symphysis - saddle width?
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Hello All,

I've recently had an MRI and have been diagnosed with ostetis pubis symphysis (OPS). This is inflammation in the pubis symphis joint that connects the pubic bones. I've been having problems with adductor pain and sharp pains up my butt (for lack of a better description) while running. This has been going on since early spring. I can run up to about 4 miles but then things degrade quickly. After doing a half I couldn't walk right for a week. Biking doesn't usually cause any pain though the adductor can feel a bit sore afterwards at times.

When the pain started I had changed a number of things in my routine which is making it hard to figure out exactly what caused the issue. I was ramping my running miles, had just bought a new road bike with a more aggressive geometry, new out my shoes, switched from speedplay to look pedals, and had added in some rowing to my routine. My doctor is pretty convinced it is just the running, but I'm really starting to think it may have more to do with the bike. I've had very limited running all spring/summer because of this and have taken the last 3 week totally off.

I'm wondering if a combination of a more aggressive riding position along with a too soft/wide saddle could be part of the problem? From the reading I've done, switching to a more aggressive riding position will move the contact points with the saddle up the pubic bone. The farther you rotate your pelvis forward the narrower the gap between the contact points on the bones will become. I'm wondering if a saddle that fit great in a more upright position could be pulling on the pubic symphysis as I rotate forward.

I've been riding a Terry Fly saddle for 15 years. Its a bit softer and wider than a normal racing saddle but its always worked for me. Now that I'm trying to get more aero and have rotated forward I'm thinking a saddle with a narrower nose that isn't as soft may help. For what its worth, after the issues started I did have a professional fit done on the bike.

Thoughts? Has anyone had OPS cause by biking?

Thanks
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Re: osteitis pubis symphysis - saddle width? [shaka999] [ In reply to ]
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shaka999 wrote:
Hello All,

I've recently had an MRI and have been diagnosed with ostetis pubis symphysis (OPS). This is inflammation in the pubis symphis joint that connects the pubic bones. I've been having problems with adductor pain and sharp pains up my butt (for lack of a better description) while running. This has been going on since early spring. I can run up to about 4 miles but then things degrade quickly. After doing a half I couldn't walk right for a week. Biking doesn't usually cause any pain though the adductor can feel a bit sore afterwards at times.

When the pain started I had changed a number of things in my routine which is making it hard to figure out exactly what caused the issue. I was ramping my running miles, had just bought a new road bike with a more aggressive geometry, new out my shoes, switched from speedplay to look pedals, and had added in some rowing to my routine. My doctor is pretty convinced it is just the running, but I'm really starting to think it may have more to do with the bike. I've had very limited running all spring/summer because of this and have taken the last 3 week totally off.

I'm wondering if a combination of a more aggressive riding position along with a too soft/wide saddle could be part of the problem? From the reading I've done, switching to a more aggressive riding position will move the contact points with the saddle up the pubic bone. The farther you rotate your pelvis forward the narrower the gap between the contact points on the bones will become. I'm wondering if a saddle that fit great in a more upright position could be pulling on the pubic symphysis as I rotate forward.

I've been riding a Terry Fly saddle for 15 years. Its a bit softer and wider than a normal racing saddle but its always worked for me. Now that I'm trying to get more aero and have rotated forward I'm thinking a saddle with a narrower nose that isn't as soft may help. For what its worth, after the issues started I did have a professional fit done on the bike.

Thoughts? Has anyone had OPS cause by biking?

Thanks

Before you go and switch saddles, I'd consider taking a lot more time off from running....I mean STOP it completely. It is very unlikely its your saddle causing the problem b/c most of your weight should be on your sit bones. I had OP in 2016 and it lasted for about 6 months. Any running, even for a KM was bad and I had to stop all running. Once I stopped running, I tried swimming and biking. Swimming also made the area hurt, so i stopped it as well and stuck with biking. I had zero pain with biking once I stopped ALL running and swimming.

Look at this as a long term healing process (months instead of weeks). Not much you can do to let it heal except give it time.
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Re: osteitis pubis symphysis - saddle width? [eye3md] [ In reply to ]
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Thanks for the feedback. My concern was that I noticed it started to flare up from biking. I'm also trying to find a root cause...what changed to start this whole thing. The only thing I can figure is the change in bike fit. If I someone find I have to stop running and biking I may go insane. I'll also probably gain 100 pounds.
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Re: osteitis pubis symphysis - saddle width? [shaka999] [ In reply to ]
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I missed 22 months...yes almost 2 years...rest rest rest...I saw 8 different docs...and kept looking for all the smoking guns I had created in training and changed and equipment...bottom line for me was too much volume compounded by poor flexibility and lacking core strength... I hate seeing people post about OS...it was so hard to figure out...rest and a huge dose of patience coming back..balance long term plans and goals versus shorterm. Use the focus you had for getting strong for getting healthy and pain free first..
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Re: osteitis pubis symphysis - saddle width? [shaka999] [ In reply to ]
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shaka999 wrote:
Thanks for the feedback. My concern was that I noticed it started to flare up from biking. I'm also trying to find a root cause...what changed to start this whole thing. The only thing I can figure is the change in bike fit. If I someone find I have to stop running and biking I may go insane. I'll also probably gain 100 pounds.


Luckily, the doc I visited was familiar with OP. He said "time" was the main part of healing, and stopping any activity that made it hurt (mine was more of a deep dull ache right at the pubic symphysis). For me that was swimming and running that I had to stop. I ended up doing a lot of "bridges" to see if this would help my core improve, as well.

If you can swim without pain then don't give it up. Same for the bike. If the worsening pain is secondary to a recent bike fit change then figure out what you need to do to put it back to the previous fit. But whatever you do, do NOT try to workout through the pain. If you truly have OP, it is going to take a while to heal. Do a search on here and you do not see anyone healing up quick from this problem (that I can recall)
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Re: osteitis pubis symphysis - saddle width? [eye3md] [ In reply to ]
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So i was diagnosed with this also and the md said let pain be my guide. Well running doesn’t hurt but biking and then running for a few days after biking does. Tri bike. Does this make sense? Is it ok to run if it doesn’t hurt?
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Re: osteitis pubis symphysis - saddle width? [Db11] [ In reply to ]
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Db11 wrote:
So i was diagnosed with this also and the md said let pain be my guide. Well running doesn’t hurt but biking and then running for a few days after biking does. Tri bike. Does this make sense? Is it ok to run if it doesn’t hurt?
In Reply To:


When you read the medical literature on this disease, there seems to be a lot of nomenclature used......osteitis pubis, sports hernia, athletic pubalgia, etc.... I believe the reason for this is it's a regional involvement and not simply one specific area. That's also the reason why some people have this, can do X sport, but another athlete cannot. As I've mentioned before, I could not run nor swim, but I could bike. For you, if you can run without pain then it's probably ok. But, I'd be very cautious with that. Also, make sure you are focusing on strengthening your core whil recovering
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Re: osteitis pubis symphysis - saddle width? [eye3md] [ In reply to ]
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I’m going to pepper you with a few questions:

Just bridges or planks too?
One leg or two leg bridges?
How long did you hold them for and how many did you build up to?

Any insight on your routine would be greatly appreciated.

TIA
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Re: osteitis pubis symphysis - saddle width? [SBRinSD] [ In reply to ]
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SBRinSD wrote:
I’m going to pepper you with a few questions:

Just bridges or planks too?
One leg or two leg bridges?
How long did you hold them for and how many did you build up to?

Any insight on your routine would be greatly appreciated.

TIA


I did one leg and two leg bridges. Usually did 1x20 of each in the AM and then repeated in the PM (as long as no pain). I'd go up, hold for a three second count, and then back down.

I did do planks as well but I was already fairly strong with that, even though I'd never really done them before. My wife was working with a personal trainer and he bragged he could do a four minute plank. My wife asked if I could do one, and I stupidly said "I don't know, let's see". I did it without difficulty so I felt like that part of my core was fine.

As tolerated, I would also try and strengthen the adductors as well. Just clam shell exercise for this. No weights. Progressed with one of those big rubber bands as I built up and was without pain.

I could do crunches but not actuall sit ups (or ab strengthening leg raises). So I did my crunches in the AM and PM

Truthfully, I felt like all of this helped but believe a lot of it was simply time off as well
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Re: osteitis pubis symphysis - saddle width? [shaka999] [ In reply to ]
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I am almost a year into a bout of OP and am very sympathetic; it flat out sucks. You are fortunate to have got to a diagnosis quickly, as others have mentioned it presents itself differently to different people, and often the pain moves around or is triggered by different things. Mine started out as left adductor pain, and then morphed into what my sports chiro thought was psoas pain that developed during a high volume marathon build. We managed it through the race in early March with aggressive massage of the area. The pain went away during an easy build for Galveston 70.3 in April during which I just rode, swam and ran easy. And it came on with a vengeance in late April as I was rebuilding my running volume. At first it was just MP or faster that triggered it. So I ran easy. Then it was anything over 7, then 6, then 5 miles. I couldnt ride my Elliptigo bike, or walk on an inclined treadmill without pain. I could ride my road bike at no more than moderate effort and walk on level ground. I kept running at an increasingly less running volume every week, trying to stay pain free. I started seeing a PT in mid June, and she identified all the biomechanics factors that caused it but was just short of a diagnosis, which I got 6 weeks later when I finally went to an experienced Sports Medicine doc who immediately knew what it was. In retrospect I should have started with the doctor, but had no idea it was potentially such a serious condition.

I realize Im not directly answering your question because my presently itself differently, but perhaps detailing out my situation may provide a few nuggets that may be helpful for you. The inflammation in OP is caused by shearing forces across the pubic symphysis resulting from some type of imbalance in the hips. In my case I had extremely inflexible hips; tight hip flexors, adductors, hamstrings; all these muscles attach to the hips. I also had weak lower abs, that I actually was not using. This resulted in unstable hips, which allowed the two sides to move relative to each other. And after thousands of repeated motions, inflammation. For me all on the left side.

The fix is complicated, and yet simple at the same time. REST. STRETCH. STRENGTHEN. TIME. And more of each of those things than most of us really want to give it. My PT and Doc also said I could run easy but "let pain be my guide". So I kept my runs at 3x30 min a week in a desperate attempt to keep some marginal level of fitness. As all on here have said, I should have stopped running completely and I would have come back faster. The blood flow is so low in the area that healing of the existing damage is very slow. For stretching, I did a series of daily stretches for each of the muscle groups attaching to the hips. I did numerous dry needling sessions to loosen the muscles, this helped immensely. And I did a series of core exercises, daily, to learn to engage the lower abs and strengthen them to stabilize my hips. At one point I did get a cortisone shot to settle things down so I could do a long planned mountainous backpacking trip. And late in the process my sport doc dry needled the symphysis itself. I think this was very helpful, as it creates micro trauma at the bone and cartilage, and a little bleeding for some blood flow.

Im on the backside of the healing curve now but it has taken months of work. Im stronger, more limber and healthier than Ive been in a long time. And just now rebuilding my running volume in time to run Boston in April
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Re: osteitis pubis symphysis - saddle width? [SuperDave16] [ In reply to ]
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Thanks for posting. OP is not a very common problem that people are aware of daily. Knowing others have struggled with it provides a learning opportunity

I've had several different injuries and this was certainly one of the most frustrating. When I was suffering from OP, I looked for everything I could about the disease process.
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Re: osteitis pubis symphysis - saddle width? [eye3md] [ In reply to ]
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Eye3md I want to thank you! It was months into my injury until I had a diagnosis and a term I could “search” for. The OPS threads here on slowtwitch, and in particular the responses from you and dfwtri, were the most detailed first hand accounts on the internet and very helpful.
Last edited by: SuperDave16: Dec 5, 19 9:57
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Re: osteitis pubis symphysis - saddle width? [SuperDave16] [ In reply to ]
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I am in month 5 now (4 since diagnosis) and have relapsed by trying to jog again (nothing more than 4 minutes at a time, and max 12 minutes every 3 days). Now everything causes pain again (sitting, biking, walking, etc). Sucks because I thought it was healing, but sounds like my 4 months of dealing with this is by no means on the high end of the healing time spectrum. Contemplating a cortisone shot now (doctor recommends), but I’m concerned that it will actually just delay proper healing. Anyone had luck with a cortisone shot? Or would you recommend dry needling or PRP first? My PS is pretty jacked from a car accident 7 years ago (I was hit by a car in a crosswalk while running and partially tore it - but I healed and I was pain free for the next 6.5 years), so perhaps I have a unique case. It is not tender to touch, but it has relatively constant dull pain, throbbing sharp pain at night sometimes (Center, or just to both sides of the center), and pain/tightness in both sides of the groin (hard to describe; feels like a ripping pain kind of). Xrays look jacked and MRI shows OP ... but apparently the X-ray has likely been jacked since the car hit me and I was pain-free for a long time. About at my wits end though right now, probably because I thought I was healing until this setback...
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Re: osteitis pubis symphysis - saddle width? [Dafranking] [ In reply to ]
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I really feel your pain, literally; It’s enormously frustrating. Sounds like yours is quite jacked from an acute injury which is different than mine.

I have had both a cortisone injection and dry needling directly at the symphysis. I think I was a non responder to the injection but I don’t think it caused harm or delayed healing. The dry needling was very helpful for me though. My doc described it as poor mans PRP, because she caused minor trauma and bleeding which promoted healing.

I’m having a minor recurrence of OP over the last month and am considering another round of dry needling, or perhaps even PRP. I’m interested to hear of others experience with it
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