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match play – incorporating high
MEDICAL ROOM
Smarter
training
a key to
limiting
OP injury
O
dr jodi r ich a r dson
steitis pubis, or ‘OP’
as it is often referred
to, can be a terrible
diagnosis for an AFL
player. At best, it can mean
weeks of recovery; at worst it
can spell the end of a career.
What exactly is it? Why can
it keep a player off the field
for so long? And how can it be
prevented?
Osteitis pubis is a painful
condition that results in
inflammation of the pubic bones
and surrounding areas. In
biology, ‘oste’ means bone, and
‘itis’ means inflammation.
Dr John Orchard, a sports
physician and co-author of
the annual AFL Injury Report,
says osteitis pubis is an overuse
chronic groin injury.
He describes it as a condition
similar to tendinitis where
typically, one or more of the
tendons attaching the muscles
of the inner thigh to the pubic
bone become inflamed.
However, unlike ordinary
tendinitis, Dr Orchard says
osteitis pubis affects the bone
as well and can cause extra
fluid to accumulate around
the pubic bones and the joint
between them.
It can also lead to
degeneration of the bone and
the formation of bone cysts.
Muscles attach to bones
via tendons and it’s the pulling
of muscles on bones that causes
movement.
A number of muscles
including those of the inner
thigh (adductors), front
of the hip and abdomen,
attach to the pelvis on and
around the pubic bones.
For AFL players, the
volume of training and
News tracker Fremantle has placed Ryan Crowley on the long-term injury list and upgraded Clancee Pearce from the rookie list.
16 AFL Record visit afl.com.au
Treatment for osteitis pubis
running loads, rapid changes of
direction and kicking – means
that high forces are transmitted
through these muscles to the
bone.
Over time, this can result
in overload of the pelvic
region, leading to tendon
and bone damage.
Dr Orchard says the main
symptom of osteitis pubis is
pain, but in the early stages,
pain may not be felt all the time.
“Initially, a player may feel
fine in a game but will be sore
the next day. Early pain is often
felt lifting a leg as the player
gets out of bed or out of their
car,” he says.
“As the condition progresses,
pain is felt at all times and
eventually the player will
begin to lose speed, kicking
power and the ability to change
direction quickly.”
Quite often, he says, players
are more than willing to
continue playing in pain, but
are rested more when their
condition begins to impact
their performance.
END OF THE ROAD: Adrian
Hickmott was forced to
retire from AFL football
due to osteitis pubis.
is mainly load modification
to reduce the stresses on the
damaged tendons and bone, says
Dr Orchard.
He explains that the tendon
and bone can’t take more than a
certain load so, where possible,
that load has to be reduced.
He says that it is much easier
to modify training loads by
decreasing the amount of
running and kicking required
of the injured player, as match
modification, aside from
reducing game-time, is much
harder to achieve.
Former Geelong and Carlton
player and now-Essendon
assistant coach Adrian Hickmott
was forced to retire from the
Blues in 2003 (at 31 after 182
matches) because of the injury,
just nine weeks after noticing the
first symptom.
Hickmott – who also missed all
of 1998 with a knee injury – says
he endured weeks of pain with
osteitis pubis, but did not rest.
An extremely hard trainer,
he kept running but started
experiencing groin tightness the
day after any running. It was his
first indication of a problem.
Hickmott then started feeling
tightness in his lower back, but
kept pushing through. After
this came a small adductor
muscle strain.
“I didn’t take much notice. I
told the physio, missed one week
but then came back and it got
much worse, but I thought it was
just tightness,” Hickmott says.
“I felt really good when I had
warmed up and stretched, and
running felt great. Over time, the
pain gradually came up to the top
of the pubic bone, but I just kept
pushing through.”
Hickmott said when he
would first lift his leg to run,
he would feel a jolt of pain
through the pubic bone and the
condition reduced his speed and
kicking power.
“It didn’t feel like a strain or a
‘corky’, but the pain was there all
the time like an ache, even when
just lying in bed.”
On reflection, he realises
he should have rested but
points out awareness of
the injury back then was
relatively low.
It didn’t feel like
a strain or a ‘corky’,
but the pain was
there all the time like
an ache, even when
just lying in bed
ADRIAN HICKMOTT
He suggests players with
soreness or tightness around
the groin should speak out
immediately, and fitness staff
and coaches ought to hold
them out of normal training.
Swimming, cycling or boxing
should be done instead to
maintain fitness levels.
Dr Orchard recommends
players avoid overtraining,
optimise core stability and report
symptoms early.
Not surprisingly, the AFL
Research Board has made the
issue of osteitis pubis a priority.
A study funded by the board
found that the key to the
prevention and management of
osteitis pubis is the management
of exercise load, pelvic integrity
and the early identification of
warning signs.
Other AFL-funded research
concluded that an elite junior
footballer who sustains a hip or
groin injury is almost twice as
likely to sustain a similar injury
when playing at AFL level.
Therefore, one of the keys to
reducing these injuries in the
AFL is prevention at the elite
junior level.
To help with this, other
researchers are developing a
screening protocol that can be
used to identify elite juniors at
risk of hip or groin injuries.
In addition, the AFL Sports
Science Advisory Board is
running a study across all AFL
clubs investigating the training
and playing loads for first-year
AFL players.
The study is being conducted
in an effort to increase player
longevity at AFL level by
improving the developmental
transition from elite junior to
elite senior competition.
Dr Jodi Richardson completed her PhD
at Monash University, investigating
hamstring muscle training and its
application to hamstring injury prevention
in Australian Football. She specialises in
communicating the science of sport.