They’re the two letters no athlete anywhere in the world wants to hear.

To receive a diagnosis of osteitis pubis, more commonly referred to as “OP”, generally translates as a long period of time out of the game, off the field and into the rehab room.

In medical terms, osteitis pubis is the inflammation of the pubic symphysis, the joint that houses the connection between the left and right side of your pelvis. Put simply, your groin muscles will not support any physical activity.

AFL players are particularly at risk of the disease. Seasons have been shortened, and in extreme cases, careers have been ended because of OP. Nor does the disease discriminate based on talent. Champions like Chris Judd and Luke Ball and young stars of the game like Aaron Black have all suffered from OP at some stage in their careers. Darcy Daniher’s career at Essendon was over before it even began due to a diagnosis of severe OP, which forced his retirement.

AFL players are placed at higher risk for OP due to the sport’s high physical demand. Kicking, running at top speed and suddenly changing directions are all integral parts of being successful at the sport. Unfortunately, they are also the actions most likely to exacerbate the symptoms of OP.

Even training errors, such as exercising on uneven or hard ground, or in incorrect or unsuitable footwear can also lead to gradual build up of inflammation in the pelvic joints.

As OP is resistant to treatment, a careful and prolonged rehabilitation period is often necessary. Often the only way to combat the disease is gradual strengthening of the surrounding muscles and joints, aided by the use of podiatric footwear & physiotherapy. Unfortunately the average period out of the game is generally counted in months, not weeks.

Recent speculation has surrounded West Coast Eagles ruckman Nic Naitanui’s future, as he battles groin issues. Not yet to be confirmed as OP, Naitanui’s high-leaping style places him at risk due to repeated minor trauma, as he lands after each ruck contest onto hard ground.

Local footballers are not immune. Spotswood Football Club captain Tom Langlands has played only two games in the 2013 WRFL season due to OP. He describes the symptoms of OP as “like someone is slowly pushing a knife up into your groin, basically every time you break into a run.”

Langlands voices the frustrations that sufferers of OP feel. “It’s not being able to walk at some stages, it’s not being able to stretch out at all. You can’t kick a footy, you can’t jog laps, you can pretty much only stand there. It’s a very lonely injury.”

Generally, the disease is diagnosed via medical imaging. An x-ray can reveal widening of the pubic symphysis, which is a telltale symptom. More commonly, computerized tomography (CT) is used to acquire a more detailed image of the bone structure of the pelvis. CT radiographer Kait O’Callahan has performed scans on several suspected cases of OP. “To perform the scan, the patient has to step up onto a table, and even that is a struggle for sufferers of OP,” O’Callahan said. “It’s a bit of a giveaway when such a simple movement is causing them such discomfort.”

As a keen tennis fan, O’Callahan is aware that the constant change of direction by tennis players, along with the explosive power generated by the service action, place them at risk. “Like any sport that requires such quick, sharp movements and the use of force through the legs, you are at risk if you have a long career in the sport.”

It appears that in recent years, the AFL is winning the battle against OP. Statistics released by the league in March of this year indicate that clubs reported 2.6 incidences of OP or groin injuries, compared to 4.1 in 2010. The number of games missed by players suffering from OP also declined to an average of 6.9 games a season, compared to a staggering 17.5 games in 2007.

The drop in OP-related cases can be attributed to a smarter approach to training. Clubs are placing more emphasis on careful building of the muscles around the groin area and developing core strength, which is leading to an improvement in stability and placing less strain on the muscles and joints affected by OP.

This is due to the AFL placing more importance on sports science-savvy medical and conditioning personnel monitoring the training loads of young players, as the league attempts to develop a higher sense of professionalism.

Unfortunately for arguably the AFL’s most exciting player in Naitanui, and other players around the league struggling with groin issues, it is cold comfort to learn that the incidences of OP diagnoses are on a steadily downward curve.