The treatment of osteitis pubis is essentially conservative. The main treatment goals are to relieve pain and identify and correct the underlying biomechanical imbalances. The mainstay of treatment is rest, which can be combined with physical treatments, especially useful in early stages, and the scrupulous administration of nonsteroid and steroid anti-inflammatory drugs. Initially the athlete will be instructed to refrain from sport activities, as the condition is self-limiting and generally resolves in 6–12 months. Mean duration of prescribed rest ranges from 2 weeks to 3 months, depending on the case. In the acute phase, physical therapies such as ultrasound or TENS may be useful, and alternating ice and heat may help ease the pain. In the early phase, it is useful to prescribe ambulation with an assistive device (e.g. a cane or crutches) and possible orthoses (e.g. a lumbar corset) in the presence of concurrent lumbosacral overload or sacroiliac joint disorder.

In the acute phase, the patient will benefit from physical therapy in water to preserve mobility of the pelvic girdle and coxofemoral joints in a controlled environment. During the acute phase, nonsteroid anti-inflammatory drugs can be prescribed to reduce the pain and inflammation. Less frequently, if the symptoms persist, steroid injections into the pubic symphysis may be taken into consideration [13].

Once the pain has subsided, the patient can start strengthening therapy, with specific exercises for the hip flexors and hip adductors, abdominal muscles and lumbar stabilizers. Stretching exercises for the hamstrings and femoral quadriceps are also commonly included.

A treatment strategy focusing on a programme of active exercises proves to be superior compared to an approach based on physical therapies such as laser therapy, deep transverse massage and TENS. The use of exercises to improve neuromuscular coordination, strengthen the pelvic girdle musculature and strengthen any muscle groups found to be weak on clinical kinesiological tests, such as the gluteus medius, iliopsoas and abdominal muscles, has shown to be more effective, as demonstrated by a prospective randomised trial [17].

In some cases, swimming may be advised, with the exception of the breaststroke to avoid excessive use of the adductors. Manipulations may also alleviate pain, relax muscle spasms and increase flexibility of the pubic symphysis.