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Osteitis pubis is a painful, inflammatory, noninfectious condition that involves the periosteum, bone cartilage, and ligamentous structures in the symphysis pubis. Osteitis pubis can result from several causes. One of these is mechanical strain, either from a single major event or from repetitive micro trauma, such as from running. The patient typically complains of increasing pain in both pubic areas. The authors report a case of unilateral osteitis pubis in a 46-year-old marathon runner who experienced severe left groin pain after running. Initial radiographs were normal, whereas a Tc-99m diphosphonate bone scan showed unilaterally increased tracer accumulation.