Patrick's Test (FABER Test): Purpose, Procedure, and Interpretation

What is the Patrick's Test For?

The Patrick's test, also widely known as the FABER (Flexion, Abduction, External Rotation) test, is a common orthopedic assessment used primarily to evaluate the hip joint and the sacroiliac (SI) joint for pain, stiffness, or dysfunction.

Understanding the Patrick's Test: An Overview

The Patrick's test is a foundational assessment in physical therapy, chiropractic, and orthopedic medicine. It is named after its developer, Dr. Patrick H. O'Donoghue. The test's primary purpose is to reproduce symptoms associated with pathology in the hip joint or the sacroiliac joint, helping clinicians differentiate between various sources of lower back, buttock, or groin pain. By placing the hip in a specific position of flexion, abduction, and external rotation, the test applies stress to these structures, revealing potential issues.

Anatomy and Biomechanics Behind the Test

To understand the Patrick's test, it's crucial to appreciate the anatomy and biomechanics involved:

• Hip Joint: A ball-and-socket joint formed by the head of the femur (thigh bone) and the acetabulum (socket in the pelvis). It's designed for significant mobility. The FABER position puts the hip joint at the end range of its motion, stressing the joint capsule, articular cartilage, and surrounding soft tissues.
• Sacroiliac (SI) Joint: Formed by the sacrum (triangular bone at the base of the spine) and the ilium (part of the pelvis). These joints transmit forces between the spine and the lower limbs. While designed for stability, they allow for small, subtle movements. The FABER position creates a rotational force and shear stress on the ipsilateral (same side) SI joint and compression on the contralateral (opposite side) SI joint, which can provoke pain if dysfunction is present.
• Muscles and Ligaments: The test also stretches various muscles (e.g., hip adductors, iliopsoas) and ligaments (e.g., iliofemoral, pubofemoral, ischiofemoral ligaments of the hip, and the strong SI joint ligaments) that stabilize and move the hip and pelvis.

The combination of flexion, abduction, and external rotation places a complex stress pattern across these interconnected structures, allowing for the isolation and assessment of potential pain generators.

How to Perform the Patrick's Test (FABER Test)

The Patrick's test is typically performed by a healthcare professional. Here's a step-by-step guide:

1. Patient Positioning: The patient lies supine (on their back) on an examination table.
2. Starting Leg Position: The examiner asks the patient to flex the hip and knee of the leg being tested, placing the ankle of that leg on the contralateral (opposite) knee or just above it. This creates the initial "figure-4" position.
3. Stabilization: The examiner places one hand on the anterior superior iliac spine (ASIS) of the contralateral hip to stabilize the pelvis and prevent it from rotating.
4. Applying Pressure: With the other hand, the examiner gently but firmly presses down on the medial aspect (inner side) of the flexed knee, moving it towards the examination table.
5. Observation and Palpation: The examiner observes the range of motion, noting how close the knee can get to the table, and monitors for any reproduction of the patient's symptoms (pain, apprehension, muscle guarding).

Interpreting the Results

The interpretation of the Patrick's test depends on the location and nature of the pain or limitation experienced:

• Positive Test for Sacroiliac Joint Dysfunction:
  • Pain Location: Pain is reproduced primarily in the posterior aspect of the hip, buttock, or lower back, specifically over the ipsilateral (same side) SI joint.
  • Mechanism: The test applies a rotational stress to the SI joint, which can exacerbate pain in cases of ligamentous sprain, inflammation, or altered joint mechanics.
• Positive Test for Hip Pathology:
  • Pain Location: Pain is reproduced primarily in the anterior groin or deep within the hip joint.
  • Mechanism: This pain suggests an issue within the hip joint itself, such as:
    • Osteoarthritis: Degeneration of the articular cartilage.
    • Labral Tear: Damage to the fibrocartilaginous rim of the acetabulum.
    • Femoroacetabular Impingement (FAI): Abnormal bone growth causing the femur and acetabulum to collide.
    • Capsulitis: Inflammation of the hip joint capsule.
  • Limited Range of Motion: The knee may not be able to drop as far towards the table compared to the unaffected side, indicating stiffness or restriction within the hip joint.
• Negative Test:
  • Full range of motion is achieved, meaning the knee can drop close to the examination table without pain.
  • No reproduction of the patient's symptoms.
  • This suggests that the hip and SI joints are likely not the primary source of the patient's pain, or that the specific stress of the FABER position does not provoke their symptoms.

Important Considerations: A positive test is not solely diagnostic. It indicates a potential problem in the area. Bilateral comparison (testing both sides) is crucial to assess symmetry and identify the problematic side. The patient's verbal feedback on pain location and quality is paramount.

Clinical Significance and Limitations

The Patrick's test is a valuable screening tool for several reasons:

• Differential Diagnosis: It helps clinicians differentiate between hip joint pain and SI joint pain, which can often present with similar symptoms in the buttock or groin region.
• Initial Assessment: It's often one of the first tests performed when a patient presents with hip, groin, or lower back pain, guiding further investigation.
• Monitoring Progress: It can be used to track the effectiveness of treatment over time by reassessing pain reproduction and range of motion.

However, the test also has limitations:

• Non-Specific: A positive result points to a region but doesn't definitively diagnose a specific condition. Further orthopedic tests, imaging (X-rays, MRI), and a comprehensive clinical history are needed for a precise diagnosis.
• Subjectivity: Pain is subjective, and the test relies on the patient's reporting.
• Operator Dependence: The skill and experience of the examiner can influence the test's execution and interpretation.
• Pain from Other Structures: While primarily targeting the hip and SI joint, severe tightness in muscles like the adductors or iliopsoas could also contribute to limited range of motion or pain during the test, albeit usually with a different pain pattern.

Who Benefits from This Assessment?

• Healthcare Professionals: Physicians, physical therapists, chiropractors, and osteopaths regularly use the Patrick's test as part of their musculoskeletal examination.
• Athletes and Active Individuals: Those involved in sports requiring extensive hip mobility (e.g., dancers, gymnasts, martial artists) or repetitive movements that can stress the hip and SI joint (e.g., runners, soccer players) may benefit from this assessment if experiencing pain.
• Individuals with Persistent Pain: Anyone experiencing chronic or acute pain in the groin, hip, buttock, or lower back region should be evaluated by a healthcare professional, who may utilize the Patrick's test.

Conclusion

The Patrick's test, or FABER test, is a simple yet powerful orthopedic assessment tool. By strategically positioning the hip in flexion, abduction, and external rotation, it effectively stresses both the hip and sacroiliac joints, helping clinicians identify potential sources of pain and dysfunction. While not a definitive diagnostic tool on its own, it serves as an essential component of a thorough physical examination, guiding healthcare professionals toward a more accurate diagnosis and appropriate treatment plan for individuals experiencing lower body pain. Always consult with a qualified healthcare provider for proper diagnosis and management of musculoskeletal pain.