FABER test (Patrick's test) for hip and sacroiliac joint pain: procedure and differentiation
In short
The FABER test, an acronym for Flexion, ABduction, and External Rotation, is also known as Patrick's test. It is a dual-purpose screening examination that differentiates between hip joint pathology and sacroiliac joint dysfunction based on exact pain location.
In this guide (4 sections)
Understanding the FABER acronym and mechanics
FABER stands for Flexion, ABduction, and External Rotation. When placed in this figure-4 position, the femoral head is driven deeply into the acetabular socket while simultaneously transmitting tensile distraction forces across the anterior sacroiliac ligament on the tested side.
Pain location is the diagnostic key: Where the patient feels pain determines the affected structure. Anterior groin or hip pain indicates intra-articular hip pathology (osteoarthritis, labral tear). Posterior buttock or sacroiliac pain indicates sacroiliac joint dysfunction.
How to perform the FABER / Patrick's test
Follow these standardized steps to perform the FABER assessment accurately:
- 1. Supine patient stance: The patient lies completely relaxed in a supine position on a firm treatment plinth with both legs extended.
- 2. The figure-4 position: The clinician flexes the knee of the symptomatic leg and places the lateral malleolus across the opposite leg just above the patella.
- 3. Pelvic stabilization: The clinician places one hand firmly over the opposite anterior superior iliac spine (ASIS) to prevent pelvic rotation and tilting.
- 4. Downward overpressure: The clinician gently presses the flexed knee downward toward the examination table.
- 5. Measurement and interpretation: A test is positive if it reproduces the patient's familiar pain or if the knee remains elevated significantly higher than the opposite side due to hip restriction.
Interpreting pain distribution: Hip vs SI Joint
The anatomical location of provoked pain isolates the dysfunctional structure:
| Reported Pain Location | Anatomical Mechanism | Most Likely Diagnosis | |
|---|---|---|---|
| Anterior Groin or Inguinal Region | Femoral head impinging against anterior acetabular rim and labrum | Hip joint osteoarthritis, femoroacetabular impingement (FAI), or iliopsoas bursitis | |
| Posterior Buttock / PSIS Region | Tensile stress across the anterior sacroiliac joint ligament | Sacroiliac joint dysfunction, sacroiliitis, or ankylosing spondylitis | |
| Lateral Thigh / Greater Trochanter | Compression of deep gluteal tendons and trochanteric bursa | Greater trochanteric pain syndrome (gluteal tendinopathy) | |
| Negative / Drops Parallel to Table | Normal joint capsule compliance and ligamentous integrity | Non-articular mechanical lower back pain |
FADIR test vs FABER test
- FABER (Flexion, Abduction, External Rotation): Primarily evaluates anterior hip joint pathology when pain is in the groin, and sacroiliac joint dysfunction when pain is in the posterior buttock.
- FADIR (Flexion, Adduction, Internal Rotation): Brings the femoral neck in contact with the acetabular rim. It is the primary screening examination for anterior labral tears and femoroacetabular impingement.
What is a normal FABER test distance?
In a healthy individual with normal hip mobility, the flexed knee drops easily until the thigh is parallel to the examination table (within 1 to 2 inches of the plinth surface).
Can a tight groin muscle cause a false positive FABER test?
Yes. Severe adductor tightness or iliopsoas contracture will prevent the knee from dropping toward the table and cause tightness, which must be distinguished from true joint pain.
How does physiotherapy treat a positive FABER test?
For hip joint restrictions, therapy uses posterior-inferior hip joint capsule mobilisations, core strengthening, and gluteal activation. For sacroiliac dysfunction, treatment includes muscle energy techniques, SI joint stabilization belts, and pelvic alignment exercises.
- Spine Journal: Diagnostic validity of sacroiliac provocative tests: https://thespinejournalonline.com
- Journal of Orthopaedic and Sports Physiotherapy: Physical examination of the hip: https://jospt.org
- Indian Association of Physiotherapists: Musculoskeletal Care Guidelines: https://physiotherapyindia.org
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