The symphysitis is classified according to cause and course:

1. According to cause:

- Mechanical: Overload or microtrauma due to repeated stress.

- Traumatic: Direct injuries, e.g., from falls or accidents.

- Infectious: Due to bacterial infections, especially after surgeries.

2. According to course:

- Acute: Sudden symptoms due to an injury or an infection.

- Chronic: Slowly developing symptoms due to repeated overload or degeneration.

The causes of symphysitis can be mechanical, traumatic, or infectious:

• Mechanical causes:
  • Repeated stress from sports such as soccer, hockey, or running.
  • Misalignments due to pelvic misalignments or muscle imbalances.
• Traumatic causes:
  • Direct blows or falls on the pelvis.
  • Consequences of surgeries in the pelvic area.
• Infectious causes:
  • Bacterial infections after procedures in the pelvic area or due to systemic infections.
• Risk factors:
  • Pregnancy, as hormonal changes can affect the stability of the symphysis.
  • Overweight, which increases the stress on the symphysis.

The symptoms of symphysitis vary depending on the cause and severity of the condition, but typically include:

• Pain: Localized pain in the area of the pubic symphysis, which intensifies with movement, especially when walking or standing.
• Movement restrictions: Difficulty walking, standing up, or climbing stairs.
• Tenderness: Pain when touching or applying pressure to the symphysis.
• Radiating discomfort: Pain that may radiate to the thighs or lower back.
• Stiffness: Especially in the morning or after prolonged periods of rest.

The diagnosis of symphysitis is made through medical history, clinical examination, and imaging techniques:

• Medical history:
  • Collection of symptoms, stress patterns, and possible triggers such as sports or pregnancy.
• Physical examination:
  • Palpation of the pubic symphysis to determine tenderness.
  • Functional tests to provoke pain, e.g., by lifting a leg.
• Imaging:
  • X-ray: Visualization of changes in the symphysis such as joint space narrowing or calcifications.
  • MRI: Detailed analysis of inflammation or soft tissue changes.
  • Ultrasound: Detection of fluid accumulations or tendon inflammations.
• Laboratory tests:
  • Inflammatory markers such as CRP and ESR to clarify an infectious cause.

Conservative Therapy

Most cases of symphysitis can be treated conservatively:

• Immobilization and Relief:
  • Avoidance of strenuous activities to reduce inflammation.
• Physiotherapy:
  • Exercises to stabilize the pelvis and strengthen the surrounding muscles.
  • Stretching exercises to improve mobility and relieve the symphysis.
• Pain Therapy:
  • NSAIDs: To alleviate pain and inflammation.
  • Local cold therapy for acute discomfort.
• Supportive Measures:
  • Use of pelvic belts or orthoses to stabilize the symphysis.
• Alternative Methods:
  • Shock wave therapy to promote healing in chronic cases.

Surgical Therapy

Surgery is rarely performed, only in severe or therapy-resistant cases:

• Correction of Misalignments: Treatment of structural problems in the symphysis area.
• Reconstruction: Restoration of stability in cases of severe damage.
• Aftercare: Physiotherapy to restore mobility and function.

The following measures are suitable for the prevention and support of the treatment of symphysitis:

1. Strengthening of the pelvic muscles: Regular training to stabilize the pelvis.
2. Avoidance of overstrain: Adjustment of sports activities and sufficient recovery times.
3. Ergonomic movement patterns: Avoidance of incorrect loading in everyday life and sports.
4. Weight control: Reduction of the load on the symphysis through a healthy body weight.
5. Early treatment: Immediate adjustment of the load and medical clarification at the first symptoms.