In this article I look back on the past year of developing a serious groin injury. In the hope someone in a similar situation finds some value in this and can learn from it.

October and November

Getting Injured

It’s the 28th of October 2024 and I’m having the time of my life playing a padel tournament. Playing matches and winning was great, until I realised that I could barely play anymore.

After the first match on Monday evening I was stiff around my pelvis, feeling my hips. I told my padel partner I was happy to have a few days off. I felt like an old man the next morning, but I didn’t think much else of it. Next match, Friday evening, stiffness again. But this time much worse. The morning after I had another match, but I ended the match barely able to run.

If it wasn’t enough, I had another match that same afternoon and I took painkillers. During the match I felt awful, I could barely move like I wanted anymore. I was experiencing lots of pain in my groin. We lost the match and I took rest. Finally.

With a week rest I thought I could get going again, but tennis wasn’t going great. I had tennis lessons and played very light tennis sessions. I didn’t play that enthusiastically usually, yet often I experienced the same kind of pain in my pelvis. Whether it was after resting one week or two weeks, it didn’t seem to be enough.

The pain was located somewhere near my left pubic bone and my sitting bone. The feeling radiated through my pelvis and my hips felt stiff. It seemed that especially after making the tiniest spontaneous moves or twists that the pain was stinging the day after.

December and January

Trying to Rest and Improve

After about two weeks of rest I played another padel match, the first hour was okay, but I couldn’t sustain the tempo and had to slow down. That’s when I realised I was in serious trouble. This was about one month after first noticing the injury.

I went to a physiotherapist and started warming up very seriously and doing mobility exercises. But, after about two weeks I decided I was going to need to rest. I took 3 weeks off during Christmas holidays. January was the month of building it up. Sometimes I felt a dull pain after making the wrong moves. For example, I couldn’t explosively sprint or turn quickly. I was starting to feel like a cargo ship. Moving slowly and steadily. My physiotherapist gave me muscle-strengthening exercises for the adductors, like clamshells.

Februray, March, April and beginning of May

Longer Rest

Mid-February, I realized it wasn’t healing after I aggitated it again during a light padel session. I decided to fully rest. March 4, my physiotherapist referred me to an orthopedist. I went snowboarding for 4 days in the Austrian Alps, but didn’t experience any aggitation. April 9 I got an X-ray and it was clean. No hip labral tear or anything out of the ordinary. I decided to go for a slow jogging run. It felt tough, but I also gained about 12 kilos in a year (more about that later) and hadn’t done any running in about 10 months. My groin felt okay. A week later, I played some very light tennis which felt okay too. But another week later, the pain was back playing light tennis. I played carefully, but any sudden or explosive movement, however tiny, could have caused it to reappear.

The next few weeks were tough mentally. I thought I had rested for so long and took it slow. Another few weeks of no activity, but then I made a huge mistake. I planned a tennis double. During the match I got more enthusiastic and when the opponent made I dropshot I sprinted to the net. But the moment of that explosive sprint it felt wrong. That’s when I realized I wouldn’t be playing any tennis or padel anymore until I would be fully healed.

June

MRI

Since that tennis match on May 4, I took rest. June 10 I got an MRI. The results came back and it was clear bone marrow edema. A stress reaction in the pubic symphysis. My sports doctor told me it was quite serious. The MRI showed lots of inflammation/liquid in the pubic bone. His advice: 6 weeks of rest. So, osteitis pubis (OP).

One thing that I haven’t mentioned is that I went to the gym a lot since September. A factor that may have influenced my healing has been training my legs. Most of the time, my groin didn’t hurt when training legs. For example during squats, leg presses or leg extensions. But, by this time I also decided to stop training legs in the gym.

July

Holidays

I typically experienced quite severe pain in my pubic bone during the nights and mornings. It felt stiff and especially when getting out of bed, it hurt. During the day the feeling improved though I was always careful twisting and turning during the day.

I went on holidays for 2.5 weeks and thought it was a good opportunity to rest. However, the days after a long drive in the car my groin felt more painful. It was frustrating. I thought I was resting, but it kept flaring up.

Then finally, at the end of July I was starting to feel more relieved.

I spoke to the sports doctor, July 31, and I was put on a 10 day treatment of an NSAID. The pain did disappear during that period.

August

Pain Reduces and Physiotherapy

During August I was experiencig mixed signals. The pain was mostly gone, but sometimes it flared up and I couldn’t exactly pinpoint it. Because I was basically only walking and cycling I sometimes couldn’t understand what was going on.

August 26, I went to a specialised fysiotherapist in Utrecht. I received 5 exercises:

• Tilting my pelvis back and forth while on my hands and knees
• While ony hands and knees, tilt pelvis and tapping my shoulders with my hands
• Glute bridge
• Clamshell
• Side-lying hip abduction

Each time I did these exercises a little too intensively or explosively, I was aggitating my pubic bone.

About Fitness

In the past year, I started doing fitness. It’s very likely fitness contributed to getting injured. Though I took it slow in the first couple of weeks of fitness, I did start to go heavier quite soon. Going to failure started to become the norm for things like leg presses.

In literature I can find references to examples where (American) football players develop osteitis pubis after starting heavy training load increases. ^source Also, a tennis player that injured his chest when he started doing fitness. As he couldn’t train his upper body or play tennis as a result of injuring his chest, he started running a lot and developed OP subsequently. ^source

It’s also been a common occurrence in the American Football League (AFL) scene. Most research does suggest that mechanical load on the pelvis has to be carefully managed. ^source

From September to March I gained about 0.5 kg a week. Resulting in a total weight gain of roughly 12 kilos in the span of 6 months. This might also have played a role in adding load when playing.

The Road Ahead

Most people injured with OP seem to be looking at at least 6 months of recovery (up to 2 years, or even athletes that seem to never recover). I feel like I’ve already done a lot of recovering in terms of getting the inflammation to calm down. However, it also seems that it flares up easily. My physiotherapist has me believing that I can start doing light jogging in about 8 weeks. And roughly 4-8 weeks after that I should be able to start twisting and turning. Then it should be a matter of time before I can do a super light tennis or padel session.

But I don’t want to become too optimistic. These past weeks of physiotherapy have already showed me that I should be very humble. Taking it easy, watching the signals and building it up slowly, really slowly. I’d love nothing more than to dream I will be back on the court in about 5 months or so. I want to!