Anterior Pelvic Pain in Male

[sibbers2000]

Hi Guys,

Out for ideas and maybe pointing in the right direction a bit here. I have seen a patient today (male, 25) with anterior pelvic pain. He reports after training in rugby a few weeks ago he was running and developed anterior central pelvic pain. he demonstrates no red flags, no urinary symptoms, no constipation, no normal lumber or pelvic red flags. He has pain functionally when running or jogging. He has no obvious bulges or palpable swelling and reports no tenderness or problems in the genital area. he reports having a previous injury similar to this and was scanned for hernia which came up negative. I have asked him to discuss this with his GP again just to double check.
Pain was generally reproduced on palpation of the area (centrally around his pubic symphasis) None of the normal pain provocation tests bought on much tenderness and he finds his main issue is either a forward thrust of his pelvic, resisted SLR and bilateral external rotation/adduction (groin stretches in training type position)
My previous job had a pelvic specialist so I have had very little to no recent pelvic experience, probably not since I was a junior physiotherapist.

Any help or ideas would be greatly appreciated.

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[physiobob]

I does sound like this might be a pelvic alignment issue. Having cleared other obvious things (most of which are not central) you are left with the symphysis itself and the attachment of rectus abdominus. Assess his apparent length in supine and sitting, and also compare with the levels of the ASIS in the same positions. You can also look for any flare often seen by a deviation in the naval from the waist/ilia on each side. I could go on with various stork test assessments etc but a resisted Adduction against your hands that is apprehensive or weak may well support an alignment issue (and in assessing might create a 'click' that results in a reduction in discomfort). See if anyone in your clinic has experience in Muscle Energy Technique etc and have them assist you or work with you on an in-service as this is a fascinating area that you will use again and again in your career.

[mnovikov]

Hi Sibbers,

It's an interesting case. Have you tried a repeated movement exam of his back? He seems to be worst with repeated extensions (jogging, running). Anterior derangements of the lumbar spine may refer pain in the pelvis. Look if he has a good curve reversal while he is standing. If he is stuck in lordosis while in full flexion, try repeated flexion in standing or lying. If it produces low back pain and decreases his central pelvic pain continue and recheck his lumbar spine ROM.

Hope it helps!
Good luck

[physikeerthi]

Hi Dear
Check any derangements of symphysis pubis,Adductor attachments,Iliopsoass, Rectus femoris and finally abdominal tightness.Deffinitly you will find something. Treat what you found.
IF NOT REPLY ME.