Pubalgia is a condition affecting the inguino-pubic region that is quite common. It can be rather complex to manage, particularly due to its multifactorial nature and the possible presence of a combined form. Let's explore the characteristics of this disorder, the different treatment techniques, and the benefits of the Allyane method, with the aim of facilitating... rehabilitation for this hip condition.
Pubalgia: definition
Pubalgia is a fairly common condition affecting the inguino-pubic region, accounting for between 4 and 20% of sports-related injuries. It generally occurs following physical activity involving rapid acceleration and deceleration, or repetitive high-speed actions with pivots and changes of direction (football, handball, tennis, hockey, rugby*).
Pubalgia is complex and particularly difficult to manage. This is due to its multifactorial nature, as well as the presence of combined forms, as previously mentioned. In 2015, at the Doha Consensus Conference, it was established that pubalgia can involve four types of pain in the groin area, which can also be combined (hence the importance of clearly identifying the different structures involved). These conditions can be related:
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- to the adductors;
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- to the pubis;
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- to the inguinal area;
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- to the iliopsoas muscle.
What pathologies can be linked to pubalgia in athletes?
Pubalgia can be linked to various conditions. These include:
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- inguinal canal pathology;
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- pubic osteoarthropathy;
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- the insertion disorder of major rights;
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- Insertional tendinitis in the adductors.
What are the symptoms of pubalgia?
Pubalgia is generally characterized by the progressive onset of pain localized in the inguinal and pelvic region (the lower abdomen and the pubis), but can also affect the upper adductors or the abdomen.
It should be noted that in the context of sports activity, pain may be felt by the patient immediately after exertion. It may then reappear after the activity has cooled down, but also during physical activity itself.
Pubalgia: what are the risk factors?
Some people are predisposed to developing pubalgia. This is particularly true for those suffering from certain anatomical and biomechanical imbalances. These imbalances can be caused by various conditions, such as an anterior pelvic tilt, asymmetry of the lower limbs, or excessively strong adductor muscles compared to the abdominal muscles. It should be noted that intensive practice of one of the sports mentioned above can also be a risk factor for developing pubalgia.
Furthermore, pregnancy can also be a risk factor for developing this type of disorder. It can appear around the sixth month of pregnancy, particularly when the fetus presses against the mother's pelvis. However, as a general rule, this disorder tends to disappear on its own after childbirth.
How to prevent the onset of pubalgia?
To prevent the risk of developing pubalgia, we strongly recommend adding some muscle strengthening exercises (abdominal development and core strengthening), as well as stretches (adductors and hamstrings) to your sports routine.
This work can allow people more prone to developing pubalgia to improve pelvic support by strengthening the muscular symmetry of their body.
How to diagnose pubalgia?
To diagnose pubalgia, it is first necessary to rule out other conditions that can cause pain localized in the lower abdomen or groin. This initial assessment should be performed by palpating the inguinal and pubic regions.
Subsequently, the healthcare professional will be able to perform some manipulations of the lower limbs. The aim here is to stimulate the hamstrings, adductors, psoas, and abdominal muscles. This manipulation will allow the practitioner to precisely locate the painful area and rule out other conditions, such as tendinopathy, appendicitis, hip pathology, etc.
Note that to confirm the practitioner's diagnosis, the patient may be required to undergo an X-ray of the pelvis, as well as a tendon-muscular ultrasound.
What treatment is available for pubalgia?
Muschaweck described the abdominal wall biomechanically as a matrix of tension bands that attach to the pubic bone. Retraction of the rectus abdominis can cause upward and medially directed stress on the pubic symphysis.
Control of thigh flexion, abduction, and rotation is also important. It requires co-activation of the abdominal wall, glutes, and hamstrings to continuously control pelvic tilt and lumbar spine position. The pubic symphysis is subjected to shear, compression, and torsional forces that can cause pain.
Once a diagnosis has been made by a healthcare professional, rehabilitation focuses on rebalancing these different forces, treating affected areas, and gradually returning to sports. The goal is to correct muscular imbalances in the stabilizers of the lumbar spine, pelvis, and hips.
Core strengthening exercises will then focus on the abdominal wall, lumbar spine, and hips. Stretching exercises will concentrate on the hip rotators, adductors, and hamstrings.
The Allyane neuromotor reprogramming method: a rehabilitation accelerator for pubalgia
Neuromotor reprogramming using the Allyane method has a valuable role to play in this type of treatment. Indeed, as previously mentioned, there are many risk factors for developing pubalgia that can be addressed through this approach. These include, in particular:
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- hip abductor/adductor imbalance;
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- the work of the transverse abdominal muscle;
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- hip mobility work;
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- postural exercises;
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- the stability of the basin.
The Allyane method is based on the scientific principles of motor imagery and the role of proprioception. It combines an innovative form of motor imagery with the listening of low-frequency sounds. These sounds modulate brain activity by increasing the production of alpha waves, which induces a state of reduced alertness in the patient, coupled with hyperactivation of motor control. This ensures a lasting anchoring of the motor changes created by the motor imagery.
The process of a session with the Allyane method
Let's take an example: in the case of adductor weakness, the work will target the proprioceptive sensations of contraction as felt by the patient in the affected area, contrasting them with the unaffected side. The patient will then have to rediscover these different sensations through mental imagery. They are then placed in a state of low-frequency sounds to induce a state of reduced alertness and benefit from the stimulation of their motor areas.
After implementing a general relaxation protocol, the patient works on the positive sensations of adductor contraction using the opposite side. Then, they mentally erase the incorrect muscle recruitment pattern and replace it with the correct sensations of the opposite limb.
This reprogramming phase will then allow the patient to regain effective muscle contraction. It also allows them to focus on rebalancing the stability of their pelvis. Subsequently, the practitioner can then consider having the patient work on other aspects of pubalgia rehabilitation, such as postural control, by repeating this same process.
Are you a healthcare professional with questions about the Allyane method? Feel free to contact our team by phone at +33 4 28 29 48 14 or by email at [email address missing]. contact@allyane.com.
Do you have questions about Allyane sessions? Contact our medical secretary at +33 4 28 29 58 10 or at contact@allyane.com
*Source: Minnich, AJSM, Sport hernia, V39, 6, 2011.