FABER Test For Hip

Introduction to FABER Test

The Patrick’s test, also commonly referred to as the FABER test, is in use in assessing hip, sacroiliac, and lumbar spine dysfunction in orthopedics used in physiotherapy. FABER stands for Flexion ABduction and External Rotation, which is the movement of legs during the test. Its purpose is to assess any abnormality existing in the hip joint  or sacroiliac joint, muscle stiffness or issues with the lower back area. They also use it to determine the pain profiles linked to hip joint pathologies or those typical of impingement syndrome as well as pain due to sacroiliac joint inflammation.

Conditions and Diseases Assessed by the Patrick's  Test

The FABER test is generally used to assess disorders involving the hip joint, the sacroiliac joint, or lumbar spine. Pain or restriction during the test can indicate multiple conditions:

• Hip Osteoarthritis: Disorders in the hip joint cartilage and tendon resulting in joint stiffness and pain.
• Sacroiliac Joint Dysfunction: A condition in which there is inflammation or malposition of the sacroiliac joint which may result to of lower back and pelvic pain.
• Femoroacetabular Impingement (FAI): Damaged interaction between the hip socket and the femoral head, and the affected party experiences pain, limited mobility.
• Hip Labral Tear: A split in the labrum that forms a ring of cartilage in the hip socket with signs of pain, a clicking or grinding sound, or loose feeling hip joint.
• Iliopsoas Syndrome: Contracture or inflammation of the iliopsoas muscle that is known to bring about pain in the groin area or at the hip joint during contraction and flexion.

Anatomy Involved in FABER Test

The FABER test primarily targets the hip and sacroiliac regions, and several anatomical structures are involved:

• Hip Joint
• Sacroiliac Joint: A type of joint that links the sacrum to the iliac bones of the pelvis through which forces between the trunk and the legs are transferred.
• Iliopsoas Muscle: A pelvic muscle lying in the front of the hip joint which acts on the thigh and raises the lower spine.
• Piriformis Muscle: Sitting low in the buttock area is a hip rotator muscle; if tight or inflamed can cause sciatica-like symptoms.

Indications for the FABER Test

FABER test is appropriate in a wide range of musculoskeletal disorders involving the lumbar spine, hip and pelvis. Some of the most common indications include:

Hip Pathologies:

• Hip Osteoarthritis: In cases when the patients complain of groin pain or stiffness that is most uncomfortable in the morning or after longer periods of inactivity.
• Femoroacetabular Impingement (FAI): Thought to be present where patients have pain in the hip joint whilst performing simple exercises such as deep bending movements like squats or when pivoting.

Hip Labral Tears: 

Usually in athletes, or those who have experienced some type of trauma, and the patient has a feeling of clicking or catching in the hip.

Sacroiliac Joint Dysfunction:

• SI Joint Inflammation: This usually manifests as low backache on one side of the body or around the lumbar region with radiation down to the buttocks or down the leg eminently when sitting or standing.
• Pelvic Instability: Many patients with hypermobility or pregnant women can use FABER testing to determine the severity of their pain.

Lower Back Disorders:

• Lumbar Radiculopathy: While the FABER test is highly useful in determining Hip Joint pathology or Hispano from lumbar PSY Spine issues such as disc herniation.

How to Perform Patrick's  Test: Step-by-Step Guide

Patient Position:

1. The patient is placed in position supine, (lying on their back) standing or sitting on the examination table. The test is done on one leg at a time, by flexing the knee and exhaling during each step.
2. Over the next 20 minutes the therapist proceeds with the tested leg into flexion, abduction and then external rotation: the therapist’s knee places the lateral ankle on the opposite knee – forming the ‘figure-four’.

Therapist Position:

1. The therapist also positions him/herself at the side of the patient while holding the opposite hip to reduce any compensatory movements.
2. The operator’s right hand is placed to the left ASIS to block any movement and control the pelvis while the left hand is used to push down the knee of the tested right leg.

Procedure:

1. The therapist then slowly drops the knee of the tested leg towards the examiners table with the other hand resting on the contralateral ASIS.
2. The patient is told to remain still and immediately report when the movement is unbearable or painful.
3. The amount of abduction and external rotation is determined by the therapist; moreover, the compensatory movement of the pelvis or lumbar spine is observed during the given exercise.

Observations:

• Pain location: Groin or anterior hip pain brings out the notion of hip joint pains in this case. Often, pain in the posterior pelvis or the buttocks may point to a dysfunction of the sacroiliac joint.
• Range of motion: Reduced mobility in a particular joint or difference in range in the opposite side may indicate joint rigidity of soft tissue limitation.
• Muscle tension: Hip flexions or external rotators may also be output tightness.

Outcome Measures of  FABER Test Hip

Positive Test:

Taking a faber test for hip  positive means that the patient experiences some form of pain or discomfort while the test is being conducted. The location of pain helps guide the differential diagnosis:

• Groin pain: Suggests hip joint dysfunction, such as arthrosis, Crowe impingement.
• Posterior pelvic pain: Might also indicate that the patient has sacroiliac joint dysfunction or inflammation.

Negative Test:

A negative faber's test result if the patient complains of no pain or discomfort, and the leg may be completely lowered alongside the table. This implies minimal hip or SI joint pathology or processes for one to develop hip/ SI joint pain.

Differential Diagnosis Using Faber Test for Hip

The FABER test helps differentiate between several conditions affecting the hip, pelvis, and lower back:

• Femoroacetabular Impingement (FAI): Differentiated by groin pain when the limb is moved into external rotation.
• Hip Osteoarthritis: Usually positive in patients with stiffness and gro in pain during the test.
• Sacroiliac Joint Dysfunction: PS pain located in the pelvic region, not in the hip joint, indicating the SI joint is the source of the patients’ pain.
• Lumbar Radiculopathy: Hip pathologies from referred pain around the lumbar spine can therefore be distinguished using the FABER test.

Related Tests for Patrick's  Test

Several other tests are commonly used alongside the faber hip test to provide a comprehensive evaluation:

• Thomas Test: Tests for tightness in hip flexors and might assist in distinguishing between hip and lumbar problems.
• Ober’s Test: Assesses tension within the ligament that causes down the lateral aspect of the thigh to the knee, which is known to cause hip pain on the outer aspect of the joint.
• Sacral Thrust Test: Focusing on the SI joint, is commonly employed together with the FABER test for addressing the SI joint pathology.

Current Research and Advances in FABER's Test

This approach has contributed to improving knowledge of the role of faber test for hip in the assessment of difficult hip and sacroiliac disorders. Specifically, imaging and biomechanical assessments have further refined the diagnosis, MRI and ultrasound have given more accurate diagnosis of hip and pelvic alignment and dynamically has shifted to become an important variable in determining testing outcomes of football players.

When studying faber hip test results, scholars identified the necessity of performing detailed movement evaluation and the individual’s functional mobility and muscular disproportion.

Conclusion

The Patrick’s test is widely used in physiotherapy practice in identifying hip, sacroiliac and lower back pathologies. Pain and dysfunction indices are extremely useful in identifying patterns which assist in management decisions. But when combined with other instruments of diagnosis and personal cognitive approaches, it has a great impact in patient performance.