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