Patricks Faber test

Patricks Faber test is a part of the basic chiropractic examination of the hip. Many conditions like arthritis, dysplasia and femoro acetabular impingement syndrome cause pain in the groin and upper leg; it often radiates to the knee.

When upper leg pain is neglected, it often changes the posture and gait, causing an added effect in the buttock and lower back; and then radiating down the leg.

It can become a diagnostic nightmare where the clinician struggles to decide whether this is primarily a hip problem radiating to the buttock and leg; or is it a lower back condition that is affecting the groin, femur and lower limb?

At a guess, I would say that around twenty percent of the letters that I get are related to hip issues. Medical doctors in the field, and some of my own colleagues, battle with pain in and around the upper leg and buttock. It's not always a pinched nerve in the spine.

Could it be a condition called meralgia paresthetica, where a branch of the femoral nerve is irritated both in the mid lumbar spine and the groin? It's the classic so called double crush syndrome.

Is it a Maigne's syndrome radiating to the groin? Perhaps it's a femoral nerve lesion from a lumbar facet or hot disc causing pain in the front of the thigh and around the inner knee and lower leg.

Or are we talking about a sacroiliac joint condition that frequently can radiate to the lower limb?

Add to that various medical conditions like an inguinal hernia, or even swollen lymph glands in the groin, and you have an oft unresolved diagnostic nightmare. Just today a letter from a woman with a five year history of such pain, unidentified and having great difficulty walking; she's not even fifty.

I hope you can grasp that pain in the upper thigh is a complex diagnostic area. Chiropractors may be myopic and see only biomechanical conditions that can cause groin pain. Equally the medical fraternity see everything in terms of inguinal hernias and lymphatic cancer.

The hapless patient find himself with pain in the upper thigh, perhaps also in buttock and back, and down in the lower leg, and no one is quite sure what the hell is going on. Five years later he can hardly walk.

Patrick's Faber test is an important part of the diagnostic examination.

The term Faber stands for

  • Flexion
  • Abduction
  • External rotation

To do Patrick's faber test at home, lie on your back on your bed and place your foot on the opposite knee.

Since you have no idea what's normal, first to do Patrick's Faber test on your good leg.

Now, let your knee drop into the lotus position, noting well whether the hip is much stiffer, and the leg doesn't drop as far; also, do you get pain in the groin or outside of the hip?

Is there pain in the sacroiliac joint?

Since doctors of every ilk often haven't a clue what's causing your pain, doing tests like this may help to come to a correct diagnosis. Remember, fifty percent of doctors graduated in the bottom half of the class; I'm not being cynical. It's just reality and I miss diagnoses too; we all do.

This is a fundamental part of the examination of the patient with hip and groin pain; if Patrick's faber test wasn't done by your doctor, do yourself a favour and go elsewhere. He is either too busy to examine you properly, or hasn't a clue; either way, find yourself a new physician, be he or she, medical or chiropractic. Find someone who has the time and knowledge to be more thorough.

Patricks faber test & hip arthritis

Patricks faber test is to see if the problem is caused by hip arthritis or dysplasia or even femoro acetabular impingement.

A patient with a hip like this will have a very positive Patrick's faber test. The knee will simply be unable to drop down like the other leg. This is advanced hip arthritis caused by that CAM deformity.

Hip dysplasia

In the young person with hip dysplasia Patricks faber test will be normal, or may cause some pain in the groin, the range of motion will be full and even increased. However, as they age, the test will become more restricted and painful as the joint becomes arthritic.

Femoro Acetabular Impingement

It's not uncommon that small growths occur either on the cup or the neck of the hip; the range of motion is greatly reduced causing the stiff hip in the young adult. It has all the appearances on the physical examination of full blown arthritis, but no degenerative change is seen on the x-ray. Only a "pincer" or "CAM" deformity.

Untreated it progresses unerringly to hip arthritis. Early diagnosis is vital to prevent an early hip replacement. Patrick's Faber test will be strongly limited.

Hip arthritis

Hip arthritis doesn't usually come of itself; there's some underlying condition that caused it.

That could be trauma to the hip, and in a fall off a horse, or an MVA, or it could be due to a short leg. Research shows that a leg length inequality has a higher incidence of OA, in the knee too.

Then, both dysplasia and impingement syndromes in the hip lead to a much higher incidence if the condition isn't diagnosed early, and the joint exercised every single day. When Patrick's Faber test is positive, an x-ray of the hip is mandatory in my book.

Never neglect the limping child; see your chiorpractor. Growing pains are in my opinion a medical myth, and the diagnosis simply used as a pretext to admit that we have no idea what the problem is. Perthe's disease, undetected, leads inexorably to an early hip replacement, often in the thirties.


Chiropractic is a form of treatment of joint and muscle conditions that often lead to nerve symptoms and signs. Manipulation, soft tissue therapy and rehab exercises are at the heart of the treatment.

A good examination using procedures such as Patricks faber test is fundamental.

Patrick's faber test

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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost painfree. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.

Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?

Interesting questions from visitors

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Greetings, Dr B.
You helped me quite some time back with a soothing and professional response which turned out to be exactly correct. I now consult a local chiropractor. You write a superb newsletter, too.

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Knowing that up to 70% of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there's a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong! Give plenty of detail if you want a sensible reply.

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