Dynamic Osteopathy of the Pubis: Preventative Program

In today's article, we'll share information about a program that could help prevent injuries to the pubis region. Don't miss it!

Today we’re going to cover a very interesting and complex topic that researchers still have a lot to learn about: dynamic osteopathy of the pubis. The goal is to share the information that we have so far from the scientific literature. We hope to help rehabilitation therapists learn about the foundations of this preventative program.

Preventative program for dynamic osteopathy of the pubis

In general, a preventative program involves the correct tone and balance of all the muscle groups. It’s also important to plan sessions around working and improving the muscles in this area of the body all year round, not just when you feel pain.

To do that, there’s a series of goals you have to meet. Keep in mind the intrinsic, modifiable factors. They’re important for designing the prevention program.

Objectives

Arencibia Sanchez (2012) writes about some of the goals you should aim for with these kinds of programs:

• Strengthen the abdominals.
• Gain flexibility in the adductor muscles.
• Equalize the strength ratio between the adductor muscles of both legs.
• Evaluate the rotator muscles in the hip and hamstrings.
• Compensate for possible alterations in antagonistic muscle pairs.

Modifiable intrinsic factors

These factors are defined as those that you can potentially change to reduce the risk of injury for athletes. These changes happen through the implementation of preventative strategies. Here are some examples of those modifiable factors:

• Specific training level.
• Fat percentage.
• Range of motion of the adductor and hip musculature.
• Strength ratio in the adductor and abductor.
• The strength and length of the adductors.
• Strength and recruitment of the abdominal muscles.
• Activation of the transverse abdominals.
• Postural and biomechanical changes.

Fundamental prevention concepts: dynamic osteopathy of the pubis

This protocol is based on a series of aspects that are essential for the athlete to develop as part of a prevention program. The following are some of the most important:

Flexibility

There are many studies that advocate stretching as the basis of a preventative program. These stretches should be static and focused on muscle groups such as the adductors, the hamstrings, and the obliques. The iliopsoas and the pelvitrochanteric muscles are also important to consider.

Maneuvers based on contraction, relaxation, and stretching can also be very useful, as well as positions that facilitate gains in flexibility.

Proprioceptive re-education

This kind of re-education focuses on developing pelvic control and stability. During the first stage, the patient will do the activities on a stable surface. Later, they move to an unstable service. In both cases, they will do trunk and lower extremity dissociation work, along with balance exercises on the Sitz Bones (ischial tuberosities). Later the patient will complement those exercises with other specific muscle and balance work.

Motor control is key: dynamic osteopathy of the pubis

For any prevention program, working on motor control is key. Exercises should focus on the back of the body, the glutes, and the lumbar region. This training is important because any kind of dysfunction in this area can compromise pubic symphysis stability.

In many cases, dynamic osteopathy of the pubis isn’t an isolated condition. Patients often have some kind of sacroiliac joint issue or lumbago.

Eccentric muscle work: dynamic osteopathy of the pubis

Another factor that’s important for prevention is eccentric training, which involves developing the musculature with contractions while the muscle lengthens. The patient should do this work on the muscle groups that are involved in this pathology. The goal is to fix the imbalance that the injury caused.

Lumbar-pelvic stability

This is another key point that helps understand the dynamic osteopathy of the pubis. That’s because it depends on the relationship between different stabilizing elements that make up the pelvis.

Good neuromuscular control of the trunk and a stable lumbar and pelvic region are crucial. Consequently, a deficiency in either of those areas can cause a sports injury. If you add the role of the adductor muscle into the mix, you could be looking at a case of DOP or “pubalgia”.

Practical application for DOP prevention

So, before planning a rehabilitation plan, it’s important to understand the types of musculature (tonic or fascia). It’s also crucial to know the benefits and application of eccentric or concentric work on a particular structure.

Types of musculature

Muscle fascia or dynamic muscle

• Prevalence of fast-twitch muscle fibers.
• Primary characteristics: anaerobic metabolism intervention, low fatigue resistance, high-speed contraction, movement muscles.
• Musculature that, in reaction to inactivity or pathology, tends towards hypotonia and lengthening.
• The muscles that are part of this musculature are abdominal wall muscles, the vastus medialis, the vastus lateralis, and the gluteus maximus.

Tonic or static musculature

• Prevalence of slow-twitch fibers.
• Characterized by: predomination of aerobic metabolism, high fatigue resistance, slow contraction speed, postural muscles.
• In reaction to inactivity or pathologies, this musculature tends towards hypotonia and shortening.
• Some of the muscles in this group are the psoas, the adductors, the tensor fasciae latae, the hamstrings, the pyramidalis, and the quadratus lumborum.

Eccentric training for tonic muscles

This kind of training is geared towards creating a series’ of sarcomeres. In other words, they tend to lengthen the muscle. It’s also important to note that you can do them at total amplitude or external amplitude.

Total amplitude is characterized by a complete contraction and complete stretching of the muscle. It causes an increase in the movement amplitude. It also increases the total longitude of the contractile component.

The external amplitude, on the other hand, refers to an incomplete contraction and a complete stretch. This causes an increase in muscle length due to the growth in the tendons.

Concentric work for the fascia

The goal of concentric training is to create parallel sarcomeres. In other words, it tends to shorten the muscle. It’s also interesting to know that this work can be done in medial or internal amplitude.

Internal amplitude refers to a complete contraction and incomplete stretching, which causes a decrease of the contractile component as well as muscle lengthening.

On the other hand, the medial amplitude is characterized by an incomplete contraction and an incomplete stretch. As a result, there’s a loss of movement amplitude caused by a decrease in the contractile component.

Dynamic osteopathy of the pubis: conclusions

Pelvic injuries can vary widely, so should we use the same preventative plan for all of them? Does each athlete need an individualized protocol? Also, are preventative measures for DOP the same for all sports?

In conclusion, it’s important to remember that there’s no universal prevention protocol, and different athletes will need different plans. That’s because each individual will need unique adjustments, and every professional will deal with the injury from their point of view and specialty.

Consequently, a multidisciplinary approach is the best option for success, as well as creating an individualized plan for each athlete.