Patrick Test (FABER Test): Purpose, Performance, and Interpretation

What is a positive Patrick test?

A positive Patrick test indicates potential pathology within the hip joint, sacroiliac (SI) joint, or surrounding soft tissues, typically presenting as pain or restricted range of motion when the hip is placed into a specific flexed, abducted, and externally rotated position.

Understanding the Patrick Test (FABER Test)

The Patrick test, often referred to by its acronym FABER (Flexion, Abduction, External Rotation) test, is a commonly used orthopedic special test. It's designed to assess the integrity and mobility of the hip joint and the sacroiliac (SI) joint. This test is a valuable tool for clinicians, physical therapists, and personal trainers with advanced assessment knowledge to help pinpoint the source of groin, hip, or lower back pain.

Purpose of the Patrick Test

The primary purpose of the Patrick test is to provoke symptoms in the hip or SI joint to help differentiate between various conditions. By placing the hip in a position of maximum stress for these structures, it can reveal:

• Sacroiliac Joint Dysfunction: Pain localized to the posterior aspect, specifically over the SI joint, often indicates issues such as inflammation, sprain, or hypomobility/hypermobility of the SI joint.
• Hip Joint Pathology: Pain localized to the anterior aspect, particularly the groin or deep hip joint, may suggest intra-articular hip conditions like osteoarthritis, labral tears, femoroacetabular impingement (FAI), or capsular tightness.
• Iliopsoas Muscle Spasm/Tightness: Anterior hip pain can also sometimes be attributed to tightness or spasm of the iliopsoas muscle, which crosses the hip joint.

How the Patrick Test is Performed

Performing the Patrick test requires the individual to be supine (lying on their back) on an examination table or firm surface.

1. Starting Position: The individual lies flat on their back.
2. Test Leg Positioning: The examiner flexes the individual's hip and knee on the side being tested. The ankle of the tested leg is then placed on the opposite knee (forming a "figure-4" position). This action puts the hip into flexion, abduction, and external rotation – hence the FABER acronym.
3. Stabilization: The examiner places one hand on the anterior superior iliac spine (ASIS) of the opposite side to stabilize the pelvis and prevent compensatory movement.
4. Application of Overpressure: With the other hand, the examiner gently applies downward pressure to the medial aspect of the flexed knee of the tested leg, guiding it towards the examination table.
5. Observation: The examiner observes the range of motion and monitors for the reproduction of the individual's symptoms.
6. Comparison: The test is typically performed on both sides for comparison, as asymmetry in range of motion or pain response can be very informative.

Interpreting a Positive Patrick Test

A "positive" Patrick test is determined by the presence of pain or a significant limitation in the range of motion. The location of the pain is crucial for interpretation:

• Posterior Pain (Sacroiliac Region): If the individual experiences pain primarily in the buttock or lower back, specifically over the sacroiliac joint on the same side as the tested leg, it suggests sacroiliac joint dysfunction or pathology. This could include sacroiliitis, SI joint sprain, or altered joint mechanics.
• Anterior Pain (Groin/Hip Region): If the individual experiences pain predominantly in the groin, anterior hip, or deep within the hip joint, it suggests intra-articular hip pathology or iliopsoas muscle involvement. Common conditions include:
  • Hip Osteoarthritis: Degenerative changes within the hip joint.
  • Labral Tear: Damage to the cartilage ring (labrum) surrounding the hip socket.
  • Femoroacetabular Impingement (FAI): Abnormal bone growth on the femoral head or acetabulum causing impingement during movement.
  • Capsular Tightness: Restriction in the hip joint capsule.
  • Iliopsoas Spasm or Tendinopathy: Tightness or irritation of the hip flexor muscles.
• Restricted Range of Motion (Without Pain): If the tested knee remains significantly elevated from the table compared to the opposite side, even without pain, it may indicate hip joint capsular tightness or adductor muscle tightness. This suggests a mechanical restriction within the hip joint.

Interpreting a Negative Patrick Test

A negative Patrick test occurs when the individual experiences no pain and the tested knee can drop to or below the level of the opposite leg on the examination table. This indicates good mobility of the hip and SI joint and suggests that these structures are likely not the primary source of the individual's symptoms. However, a negative test does not entirely rule out all hip or SI joint issues, as some conditions may only be symptomatic under different stresses or positions.

Limitations and Considerations

While the Patrick test is a valuable screening tool, it's important to understand its limitations:

• Not Diagnostic Alone: The Patrick test is not a definitive diagnostic test. A positive result indicates a potential problem in the hip or SI joint region but requires further clinical evaluation, including a thorough history, physical examination, and potentially imaging (X-ray, MRI) to confirm a diagnosis.
• Multiple Potential Causes: As highlighted, a positive test can point to several different conditions. The exact location of the pain is critical for narrowing down the possibilities.
• Influence of Other Structures: Tightness in muscles surrounding the hip, such as the adductors or glutes, can also limit the range of motion during the test, potentially leading to a false positive for joint pathology.
• Inter-Rater Reliability: The subjective nature of pain reporting and the examiner's technique can influence the reliability of the test.

When to Seek Professional Advice

If you are experiencing persistent hip, groin, or lower back pain, or if a self-assessment or assessment by a trainer suggests a positive Patrick test, it is crucial to consult a qualified healthcare professional. This could include a physician, physical therapist, or chiropractor. They can perform a comprehensive evaluation, accurately interpret the test results in the context of your overall condition, and recommend an appropriate course of treatment. Self-diagnosis and self-treatment based solely on a single orthopedic test are not recommended.