Hip pain in the FADIR Test? You need to know THIS.Jan 04, 2023
If you landed on this article, you likely received the FADIR test recently.
Your doctor or PT jammed your knee up and toward you...and it hurt your hip. A lot!
You’re told that the pain is likely due to FAI and/or a hip labral tear.
But what does getting hip pain in the FADIR test really mean? Is it as bad as some sources make you think?
In this article, I’ll explain why getting hip pain in the FADIR test is NORMAL. And how this is especially true if you already deal with chronic hip pain.
Most importantly, I’ll go over what hip pain in this position actually tells you about your hips and what you can do to make it more comfortable.
Read on, hipster!
What is the FADIR test?
FADIR stands for flexion, adduction and internal rotation. These are 3 out of 6 of the main movements the hip can make.
In the test, the subject lays on their backs and is instructed to bend their knee and bring it up toward their chest. The hip is now in flexion.
The therapist or doctor will then manually push the raised leg inward toward the body. The hip is now in adduction and internal rotation.
The set up and execution for the test is simple and straightforward. But what happens when we get pain in this position? What does that supposedly tell us about our hips?
What does a positive FADIR test mean?
A positive test means that the test subject experienced pain in the position.
“A positive test is indicated by the production of pain in the groin, the reproduction of the patient’s symptoms with or without a click, or apprehension.” Source.
The FADIR test is administered at different times. Some people get it when they first complain about hip pain and get referred to physical therapy. While others get it the same day they get an MRI.
But the purpose of the test is the same. It is used to confirm whether someone's chronic hip pain is due to FAI and/or a labral tear in that hip.
Why the FADIR test is unreliable.
The FADIR test is a HARD test. Most people will feel discomfort in this test.
This is true for those who suffer from chronic hip pain but it is also true for those who do NOT suffer from chronic hip pain.
For example, a study from Washington University in St.Louis administered the FADIR test on 431 college freshman athletes with no history of hip pain. 14.5% of these asymptomatic athletes had pain in the FADIR position.
These are 18 year-old college athletes with no history of hip pain. What do you think happens when we perform these tests on a non-athletic adult population?
Another study in Qatar administered the FADIR test on 426 professional soccer players with asymptomatic hips. The study also performed X-rays to identify FAI and other bony morphologies on the soccer players.
6% of soccer players had pain in the FADIR position. But more importantly, the study discovered that there was no correlation between pain in the FADIR position and FAI.
In other words, the athletes without FAI were just as likely to get pain in the FADIR position as those with FAI.
It is not FAI, a labral tear or dysplasia that is causing pain in the FADIR position. Instead, it is a warning signal from the brain and our body that this position is not safe.
What hip pain in the FADIR test actually tells you.
Pain comes from the brain, not the hips.
It is our brain’s responsibility to keep us safe. When the brain determines that there is more evidence of danger than safety, it will send pain signals into our awareness.
The brain works with the rest of our body to make a judgment on whether a movement is safe.
If our bodies lack sufficient strength, flexibility or skill to access a position with comfort, our brains will identify that position as unsafe.
The FADIR test challenges all of these elements. It requires a significant amount of flexibility, strength, control and skill to access with comfort.
When testing a group of college and professional athletes, there will likely be a lower percentage of people in the group that experience hip pain in the FADIR test.
This is because these athletes have a higher degree of strength and flexibility in the hips compared to the general population.
If the FADIR test is performed on a bunch of middle-aged lawyers, you can expect a much higher percentage of people in the group experiencing hip pain during the test.
Pain in the FADIR test tells you that you are not good at this position. It also shows you what type of limitations you have in your hips.
Although it is a great goal to improve comfort in the FADIR position, it is not necessary. You can live a comfortable life without improving this position.
Would you be MORE comfortable if you improved this position through movement training? Yes, of course!
Just like it’s healthier to be able to do at least one pull-up, it’s healthier to be able to access the FADIR position without pain.
Doing a pull-up without sufficient strength is incredibly uncomfortable. And so is accessing the FADIR position without sufficient hip function.
How to improve in the FADIR test safely.
If you decide to improve your performance on the FADIR test, it’s important to understand two things.
The first is that it can take a LONG time. The adult body is very resistant to change. Especially when we spend most of our time sitting and working behind a desk.
Simply put, we haven’t asked our hips to perform this type of movement in a long time. And the daily demands of our survival do not require this amount of hip strength and flexibility.
To convince our brains and bodies that this position is safe will require us to consistently perform exercises that prove it.
The second is that limitations in one joint might be due to limitations in another joint. Hip discomfort in the FAIDR test can be due to that hip taking on too much load on a daily basis.
If other load bearing joints like the shoulders and feet don’t have strength and function, the hips will have to work overtime to pick up the slack.
This can cause discomfort, pain and agitation in one or both hips.
When we do the FADIR test on an already aggravated hip, it will just exacerbate symptoms. So in this scenario, more strength and flexibility work on the limited hip might cause more harm than good.
The way to know whether other joints are causing discomfort in the troubled hip is to include exercises that target other joints in your movement routines.
If you notice major weaknesses in another joint that gives you a sign that you may need more work in that area.
With those caveats in mind, below are two exercises that can help you safely improve your function in the FADIR test.
I recommend performing both exercises for 3 minutes and it is safe to do them everyday if you'd like.
When we feel pain in the FADIR test, it does not mean that there is something horribly wrong in our hips.
People without FAI or hip labral tears get pain in this position. So do people with FAI and hip labral tears.
It is not the FAI or labral tear that is the problem. Although these diagnoses sound scary and seem like the obvious culprit for hip discomfort, research shows the opposite.
The position can be challenging for anyone - even for some professional soccer players. You CAN make improvements in your range of motion and comfort level in the FADIR test.
Is it worth your time? That’s up to you. But pain in this position should not justify getting major hip surgery.