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