yogabook / pathologie / symphysitis

(pubic bone) symphysitis

Definition of

Inflammation of the(pubic bone)symphysis is usually a persistent, sometimes therapy-resistant disorder that occurs particularly in various athletes and often means the end of a career due to permanent damage. Blockages in the SI joint and dysfunctions of the lumbar spine in particular can make symphysitis resistant to treatment.

Cause

1. Overuse, often due to risk factors as indicated below

Predisposing

1. Sports: soccer, walking, ice hockey, running, fencing
2. muscular imbalances
3. Leg length difference

Diagnosis

1. functional, clinical, palpatory
2. MRI if necessary
3. Laboratory diagnostics to clarify an infectious event

Symptoms

1. Painful pressure over the symphysis, but also caudally in the area of origin of the adductor muscles and cranially in the area of origin of the rectus abdominis
2. Strain-related pain, e.g. due to shearing forces in vrksasana or hasta padangusthasana sideways, i.e. when standing on one leg with lifting and abduction of the contralateral leg.
3. signs of inflammation, if applicable

Complications

1. Permanent, therapy-resistant disorders with reduced resilience. For athletes: end of career

Therapy

1. Rest, stop loading
2. No cortisone infiltrations! (risk of infection, necrosis, instability)
3. Therapy of the causes/risk factors
4. After the acute symptoms have subsided: stretching of any shortened muscles (local agonists and their antagonists): Rectus abdominis, adductors, gluteal muscles, hip flexors, autochthonous muscles
5. Later and also as a recurrence prophylaxis: strengthening of the above-mentioned muscles
6. Eliminate any imbalances between weak adductors and strong glutes
7. Arthrodesis is rarely necessary in cases of complete instability of the symphysis

Asana practice

Symphysitis is usually caused by inflammatory degeneration of the symphysis tissue over a long period of time due to (relative) overuse, which is primarily associated with pain on exertion. The most important immediate measure is therefore to reduce the load, especially prior to loads that require a high muscular capacity of the adductor muscles. In addition to the classic kicking technique in soccer, this also includes start-stop sequences and rapid changes of direction in various sports, as well as movements caused by contact with opponents or game situations, especially with stronger and faster eccentric contraction in the adductors. The elimination of these triggering/causing factors is therefore an obligatory prerequisite for recovery. This alone will not usually be sufficient, and certainly not within a reasonable period of time. Once this problem arises, there is a clear conflict of objectives between the necessary measures and resources such as time for recovery and elapsed career time, which is a decisive factor in the progression of a career, especially at a younger age, and is also seen not least in monetary equivalents and employment opportunities.

Regular stretching of the adductor group is necessary for movement. If a clear distinction can be made between the biarticular gracilis and the rest of the adductor group when pain is triggered, it is also clear whether the stretching must take place predominantly with the knee joint extended (in the case of the gracilis as the trigger) or flexed. Since the adductor group only contains the part of the adductor magnus that originates at the ischial tuberosity and acts extensorily and endorotatorily as a special case in addition to the biarticular gracilis, the rest of the muscles can be considered in a reasonably uniform manner, whereby it must be noted that the stretches should take place in as many different combinations of exorotation angles and flexion angles in the hip joint as possible.

Parallel to stretching the adductor group, it must be checked whether there are any predisposing factors, especially muscular imbalances and leg length discrepancies. The entire lower limb and the leg-moving hip musculature must be scrutinized and dysfunctions must be addressed as far as possible. Even if the strengthening of the adductors is much less significant here and far less important than with the gracilis symdron, for example, these muscles should still be tested for their competence and improved if necessary in terms of dealing with the expected demands.

Asanas

Asanas in 751: Stretching the adductors
Asanas in 756: Stretching the gracilis