Osteitis pubis: can early return to elite competition be contemplated?

BACKGROUND AND PURPOSE: In elite athletes, osteitis pubis is a common painful degenerative process of the pubic symphysis and surrounding soft tissues and tendons. We report the diagnostic pathway and the rehabilitation protocol of six elite athletes with osteitis pubis in three different sports, and compare protocol stages and time to return to competition. METHODS: 6 athletes (2 soccer, 2 basketball, 2 rugby players) were diagnosed with osteitis pubis stage III and IV according to Rodriguez classification using standard clinical and imaging criteria. After performing a baseline lumbo-pelvic assessment, the rehabilitation protocol described by Verrall was adapted to each individual athlete. RESULTS: The length of time for each stage of the protocol was as follows; Stage 1 (rest from sport) was 26 +/- 5 days, Stage 2 (to achieve pain free running), 18 +/- 5 days, Stage 3 (squad training) 63 +/- 7, Stage 4 (return to competition) 86 +/- 15. Soccer players took longer to return to competition than basketball and rugby players. No recurrences were reported at 2 year follow-up. CONCLUSION: The protocol presented ensures a safe return to elite athletes. The time from diagnosis to full recovery is longer in football players, and seems to increase with age.

Intratendinous gouty tophus mimics patellar tendonitis in an athlete.

We describe the imaging and pathologic features of a case of intratendinous patellar gouty tophus incidentally discovered in a patient with knee pain. The possibility of intratendinous gouty tophus must be kept in mind by sports physicians, especially in the management of patellar tendinopathy in athletes. It may be associated with other injuries, such as enthesopathies or partial tendon tears.

Paradigm for assessment and treatment of SIJ mechanical dysfunction.

The sacroiliac joint (SIJ) is an integral part of both the lumbar spine and the pelvic girdle. It is frequently the source of low back pain and pelvic girdle pain. Recent research has permitted a deeper understanding of its function and assessment. The mechanical assessment of the SIJ as a transmitter of load between trunk and lower limbs, and as a means to absorb torsion stresses of the pelvis absorber of torsion is examined; history, clinical examination and imaging modalities are explored and the role of exercise and some interventional therapies are described in general terms.