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Hip Special Test: FABER (Patrick's) Test

The FABER (Patrick's) Test is a special orthopedic test used to diagnose problems with the hip joint. It involves a series of movements that assess the range of motion and strength of the hip joint. The test uses physical examination and observation of the patient's ability to perform functional tests to identify potential hip joint problems. The test is used to determine if further testing is needed to accurately diagnose what may be causing the patient's discomfort or dysfunction.

Transcript

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This is Brent of the Brookbush Institute, and in
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this video we're doing the FABER test.
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This is a special or orthopedic test for the hip.
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FABER being an acronym for flexion, abduction, external rotation. This is also
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sometimes referred to as the Patrick's test. I'm going to have my friend Crystal
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come out, she's going to help me demonstrate this test. This is not a difficult
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special test to perform,, and it is definitely helpful in a clinical setting.
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All you're going to do is have your your patient or client lie down, bring the
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ankle of the side of the hip that you're testing over the opposite knee, so they
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create this figure four position. Now you do have one text McGee, that has the foot
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placement on the medial thigh, but honestly McGee is the only place I've
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seen that. I think this is probably the more conventional position that you guys
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will see in the research and other texts, so we'll stick with this for now. I'm
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then going to face her knee, I'm going to brace the opposite ASIS all righ,t so if
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I brace the opposite ASIS when she lowers this leg, it'll keep her from
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flipping off the table. If you flip people off tables they don't come back.
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Alright and what you guys will notice pretty quickly here if you are you're
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good at your kinesiology you guys are good at your functional anatomy is, by
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pushing down this way right, I have taken her into flexion, and now I'm
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pushing her into abduction and external rotation of her femur, hence why this is
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called the flexion, abduction, external rotation test. Alright now as far as what
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is a positive versus what is a negative test, well if I slowly let her leg down,
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just be like Crystal just let it fall all the way down to the table. That
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might be enough alone to cause a provocation of her symptoms, which is
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what we're looking for right. We want to see if this is her concordant sign, the
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sign that replicates what she came in complaining about. Is this the symptoms
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you were talking about, do you feel anything? You, you do feel something and
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it's in the front of your hip. Alright so we already have a positive FABER. Now
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if she had gotten down that far and didn't feel anything,
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personally I think it would be good practice to add a little overpressure,
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try to make sure they're getting down pretty close to parallel with the table
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before you would say it's clear and a negative FABER test right. So I not only
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want her to not feel any pain, I want her to not feel any pain with a little
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overpressure before I'm going to say okay she's negative, this this isn't a problem.
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Now what does a concordant sign, her symptoms being provocated in her
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anterior hip with this test tell us? That's actually kind of interesting when
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you look at the research. This this test has been used for one of two reasons;
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it's either been used for hip issues or sacroiliac joint issue issues. Now I'm
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going to say for sacroiliac joint dysfunction this test by itself is
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probably not very reliable, but if she was complaining about pain in the back
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of her hip, like her SI joint right, like they they start touching that spot like
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that's like low back top of butt area right, then I would go okay let me follow
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this up. I'm going to use this as kind of a pivot point in my evaluation. I'm going to
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follow this up with my sacroiliac joint testing cluster if it's anterior hip. Now
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I'm start start thinking hip issues, is this for example hip impingement, is this
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some sort of small labral tear, since you know I know you guys don't know Crystal
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but she she walked in here and she was not in pain while she walked so I'm
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going to assume it's nothing too serious at this point all right. But if she has
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anterior hip pain, impingement, trochanteric bursitis right is is a
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commonly as a common diagnosis, we already said labral tears, osteoarthritis
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or some sort of some sort of joint inflammation. We could maybe think of
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like psoas tendinitis. Here's the problem, all of those are possible, and this test
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doesn't tell me which one of those it is, and honestly when we look at our hip
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tests they do a really bad job of differentiating
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which pathology we have. As long as we say that this test is for hip pathology
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then it is both sensitive and specific. If we try to get more specific than
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generalized hip pathology, this test is sensitive but not very specific, so I
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hope you guys kind of followed the logic there, and of course we'll post the
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research for you guys when we post this in our articles and our courses. For now
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just know conceptually what we're doing, what we're using this for. Now how I use
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it in clinic is this is a wonderful quick test, remember I'm always trying to
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find that one test that is there concordant sign right, it replicates
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their symptoms so that I can then use it as a pretest post-test
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as I start working through various modalities, and exercises and
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interventions to see what's going to work for Crystal. So if I know okay
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FABER tests boom, FABERs test was positive, this is a great strong
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concordance sign for us. Cool all right positive, do all my techniques right,
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maybe I release her psoas, maybe I release her TFL, maybe I do some glute
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strengthening right. We can go through all of that lumbo-pelvic hip complex
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dysfunction interventions, and then after I've done those interventions I'm going to
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retest. I want to know if it worked, in fact I could even get more specific than
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that, maybe I just want to try a couple things.
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Maybe Crystal thinks that she's had psoas issues in the past, so we're just
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going to release her psoas and then retest. And if it didn't get better then we know
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that that was probably not the issue, and being that psoas release is kind of
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uncomfortable probably not going to do that technique again. So there you guys
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go, I'm going to demonstrate this technique one more time right.
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We're going to take her into flexion by putting her opposite ankle above her
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knee, I'm going to stabilize her opposite ASIS so I don't her roll off the table. I'm
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going to ask her to let her knee fall towards the table, and I'm going
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to add a little bit of an overpressure if I need to, and be like hey Crystal how
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does that feel/ It's uncomfortable, is that the symptoms you were talking about?
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Okay and where do you feel them, okay so if this is the symptoms she was talking
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about when she came in, there in the front of her hip. This makes this a great
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quick test for us, and because they're in the front of the hip I may not have to
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follow up with my sacroiliac joint cluster, I'm going to assume that there
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is some sort of hip issue going on. I hope you guys enjoyed this video. I hope