Background: Pubic bone stress (PBS) is a common acute or chronic response of the pelvis in sports where sprinting, kicking, twisting and cutting are the dominant movements. Little literature exists regarding non-operative rehabilitation strategies for the condition and the outcome of conservative treatment has not been documented. Case Description: Five professional and aspiring professional soccer players complaining of pubic symphysis pain, confirmed as PBS on magnetic resonance imaging and objective assessment. All cases followed a non-operative rehabilitation program, featuring functional and clinical objective markers as progression criteria. Acute interventions included pharmacological and physical therapeutic modalities to reduce pain initially. Rehabilitation management focused on improving range of motion ant the hips and thorax, adductor strengthening, trunk and lumbopelvic stability, gym-based strength training and field-based rehabilitation and conditioning. Clinical follow-up was performed at least 8 months following return to play. Outcomes: All players demonstrated reduced or resolved pain, increased adductor squeeze strength, and return to pain free training and match-play. Return to training time averaged 40.6 days (range, 30-60) and return to play averaged 49.4 days (range, 38-72) within the 5 players. At final follow up (mean = 29.6 months, range, 16-33) there had been no recurrences. Discussion: This case series suggests a non-operative pathway, using clinical and functional progression criteria is a successful protocol in rehabilitating athletes with PBS in returning to sport within 11 weeks.
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