My client is a runner and has Pubic Symphysis/Osteitis Pubis. I was wondering what kind of aerobic exercise he could do without aggravating his condition. He was running four to seven miles four days a week and interval training once a week. He says cycling bothers him, and he can't swim. What kind of exercises should I have him doing to prevent this from happening again?
Thank you for your question. The first strategy I would recommend is to perform an assessment of the intended tasks. In other words, what task(s) must your client perform? Understanding the task will allow you to develop a strategy to help prevent further dysfunction. Let’s take running as an example. Once we understand the task is running, we must assess the transformational zones in running and determine their efficiency. A transformational zone is another way of saying stretch to shorten or efficient reversal of motion. To run efficiently, we must load and explode, attenuate forces from joints as opposed to allowing the joints to be subjected to more stress than they are designed to handle. Although it’s tough to say without a visual assessment, it sounds like your client lacks extensibility throughout the hip region. If this is the case, I would suggest slowly oscillating his hip through functional hip stretches that relate to running (split stance with counter rotation of torso) and position the feet in different planes to emphasize the various fibers of the hip complex. For example, a “toe out” position will place greater emphasis on the adductors whereas a “toe in” position in split stance will emphasize the iliopsoas. Once in the stretch position, attempt to then oscillate the pelvis slightly lateral (frontal plane) and in rotation (transverse plane). The concept here is you’re loading one plane – the split stance lunge stretch stretches the sagittal plane, and while in the stretch position, you’re oscillating the remaining two planes. Switch sides and compare mobility of the pelvis on the femur in all three planes with the right leg in front of the left and then the left leg in front of the right. Once the soft tissue extensibility-mobility is regained throughout the pelvic region, your client has a better chance of preventing trauma to the pubis region. For more information and many great techniques, please see Gary Gray’s Functional Video Digest Series on Flexibility and Running. The key concepts here are 1) three dimensional 2) oscillate (don’t hold stretches) and 3) transform zones – proper reversal of motion to attenuate force efficiency.
Best of luck!