0:05 This is Brent, of the Brookbush Institute and in this video we're going to go over the 0:07 special, or orthopedic test for the hip, the FADIR test. 0:10 That's an acronym for flexion, adduction, internal rotation. 0:14 You'll also see this test referred to as the femoral acetabular impingement test. 0:18 I'm going to have my friend Crystal come out. 0:21 She's going to help me demonstrate. 0:22 Now this is a very simple test to do, if you remember that acronym, it tells you how to do it. 0:30 We're just going to go into flexion, adduction, and internal rotation. 0:36 And then of course we're going to ask that question, how does that feel. 0:42 Like the pain I came in with. 0:43 Crystal is well trained at this point, and she knows to tell me what's the difference 0:47 between pain that we provoked with a test versus the pain that she was actually complaining about. 0:53 Do be careful with your wording on this one. 0:55 The FADIR test will provoke uncomfortable feelings in just about everybody. 1:03 What we're interested in is the concordant sign, that's the test that replicates the 1:10 symptoms the patient came in complaining about. 1:13 Now lets talk about this test in a little bit more detail here. 1:17 You're going to see in various texts, various amounts of flexion, adduction and internal 1:24 rotation. 1:25 To keep consitent, I usually go: flexion to first resistance barrier, internal rotation 1:34 to first resistance barrier, and then adduction to first resistance barrier. 1:38 I don't usually try to crank people into flexion or get as much internal rotation as I possibly can. 1:45 I find that if you're going to provoke pain on this test, you're going to provoke pain 1:50 fairly easily. 1:52 It's not like I need to jam her hip in. 1:57 The way this test is essentailly working, is as I go into this position I'm taking the 2:02 femoral head and or neck and pushing it up against the acetabular rim. 2:06 You have to imagine if she's already inflammed, I probably don't need that much pressure. 2:11 The other thing we should probably mention with this test, is there are about a dozen 2:16 versions of this test that use various combinations of flexion, adduction, internal rotation and 2:23 axial compression. 2:25 There are all sorts of variations. 2:28 This is the one that I find is probably easiest to use, or easiest to do. 2:34 I find it sensitive enough to gain all of the information I need. 2:42 And I find that I don't gain anything from axial compression, I don't gain anything from 2:48 maximal flexion, that I wouldn't normally get from this test. 2:52 And I do find that if you jam somebody all the way into flexion or you start creating 2:58 an axial load, you might flare somebody up worse, so keep that stuff in mind. 3:03 Now, we already know, because I know Crystal a little bit, I've done her subjective evaluation, 3:10 I know what her symptoms are and I know the sports that she's into, and one of the things 3:14 she does is endurance biking. 3:17 So she's actually very positive for this test, this is one of our tests that we use. 3:23 What does that actually tell me? 3:24 Well I said it was called the femoral acetabular impingment test, but the truth of the matter 3:28 is this isn't a very specific test if we say it is only femoral acetabular impingment. 3:36 It probably is indicitive of arthritis, which is just inflammation of the joint, femoral 3:42 acetabular inpingment and, or labral pathology. 3:46 Now how that's going to effect my treatment, it may or it may not effect my treatment. 3:52 How it's going to effect how we progress, I'm going to know in the back of my head that 3:56 if she was very, very positive on this test, it took very little pressure to provoke her 4:03 symptoms, that maybe I need to keep labral issues in the back of my mind. 4:06 And if my treatment isn't working that maybe I need to send her out for some imaging. 4:14 But for the most part, here's how I use it, it's my quick test. 4:19 I know if I get a concordant sign, this is a really easy test to do, right does that 4:23 cause your symptoms? 4:25 Then do an intervention, in this case because I can feel that she has very little internal 4:30 rotation, good job doing your home exercise program. 4:34 I can tell she has limited internal rotation maybe I'm going to do some TFL release, biceps 4:38 femoris release, piriformis, adductor magnus, do those things that I know may improve internal rotation. 4:46 But I'm not going to count on that, I'm not going to just go well I'm such a smart guy 4:50 that my hypothesis has to right. 4:52 I'm going to do my release techniques and then retest. 4:58 If she says yes, then I know I'm headed down the right path. 5:01 If she says no, I totally screwed up. 5:05 No, that's not it. 5:06 I just found one thing that maybe I don't want to do. 5:11 Maybe despite the fact we're not getting internal rotation, this isn't as much a mobility issue 5:16 as potentially a stability issue, you guys have heard those terms before, is it mobility 5:21 or stability. 5:22 I think generally it's both with most people, sometimes you find that what you need to start 5:27 with is maybe glute activation. 5:30 Maybe we're getting some arthrokinematic dyskinesis because we have glute inhibition. 5:33 But what am I going to do? 5:36 Femoral acetabular impingement test, if this was her concordant sign or FADIR test, and 5:42 concordant sign. 5:43 I'm going to do some glute activation, and then I'm going to redo the test. 5:47 And if that worked, we'll do more glute activation. 5:50 And guess what she's getting for home exercise, more glute activation. 5:55 So last time guys, just to review. 5:58 I tend to use this test as opposed to all of the other tests out there that use combinations 6:04 of axial compression, flexion, adduction and internal rotation. 6:08 As far as the amounts of each one of those joint actions, my tendency is go into flexion 6:13 to the first resistance barrier, internal rotation to first resistance barrier, make 6:18 sure they stay relaxed and they're not guarding, and adduction to first resistance barrier. 6:24 And then remember the key question, is that the symptoms you were talking about? 6:30 Or something very general like, how does that feel. 6:34 Right, like her symptoms. 6:37 You don't want to say, does this hurt. 6:40 Because there is a chance that you can get somebody to say yes, but it's not the symptoms 6:44 that they came in with. 6:45 Guys I hope you find use for this test like I do, it is a quick test I use all the time 6:51 and I hope you will get in the habit of not only assessing when someone walks in the door, 6:56 but assessing after various interventions to keep testing your hypothesis. 7:00 I look forward to hearing your comments, please leave any questions you have at the bottom 7:05 of this video. 7:06 I'll get to answering them right away.
