Hip pain can come from a surprising number of sources — the hip joint itself, the sacroiliac joint, the hip flexors, the labrum, or even the lumbar spine. Sorting out which structure is actually driving symptoms requires a systematic clinical evaluation. The FABER test is one of the tools physical therapists use to differentiate between these possibilities, and where pain is felt during the test is as important as whether it’s positive at all.
What Is the FABER Test?
FABER stands for Flexion, ABduction, and External Rotation — the position the test leg is placed in during the assessment. The test is also known as Patrick’s Test. Physical therapists use it to screen for hip joint pathology, sacroiliac joint dysfunction, and iliopsoas or groin pathology, depending on where symptoms are reproduced.
The test position places the hip in a combined movement that stresses different structures depending on their integrity. The unique value of the FABER test is that the location of the pain it provokes — groin, lateral hip, or SI region — helps guide the differential diagnosis rather than simply giving a positive or negative result.
How Is the FABER Test Performed?
The patient lies supine (on their back). The physical therapist places the test leg in a figure-4 position: the ankle of the test leg rests on the opposite knee, putting the hip into flexion, abduction, and external rotation simultaneously. The PT stabilizes the opposite anterior superior iliac spine (ASIS) — the bony prominence on the front of the pelvis — to prevent the pelvis from rotating. With this stabilization in place, gentle downward pressure is applied to the test knee, deepening the hip position.
The PT is observing two things: range of motion compared to the other side (how close does the knee get to the table?), and whether symptoms are reproduced. A limited range with a firm end-feel suggests hip joint pathology or significant hip flexor tightness. Asymmetric range without pain is a mobility finding rather than a pathological positive. A positive test requires symptom reproduction — specifically pain in a location that corresponds to a known structure.
What Does a Positive FABER Test Mean?
Location of pain is the key differentiator. Pain in the anterior hip or groin — the most common positive pattern — suggests hip joint involvement, which can include hip labral tear, femoroacetabular impingement (FAI), hip osteoarthritis, or hip flexor pathology. Pain in the lateral hip or over the sacroiliac joint region posteriorly suggests sacroiliac joint dysfunction rather than hip joint pathology. Pain in the medial groin or inner thigh may point toward adductor or hip flexor involvement.
It’s important to note what doesn’t constitute a positive result: tightness or general discomfort in the hip or groin during the stretch, particularly if bilateral and without pain quality, reflects a mobility limitation rather than pathology. The FABER test has moderate sensitivity and specificity for its intended uses, which means it’s most useful as part of a cluster of assessments rather than a standalone diagnostic test. A single positive FABER test is a starting point, not a conclusion.
FABER Test vs. FADIR Test: What’s the Difference?
Where FABER uses Flexion, ABduction, and External Rotation, the FADIR test uses the opposite movement: Flexion, ADduction, and Internal Rotation. These two tests stress the hip joint in opposite directions, and clinicians commonly perform both during a hip evaluation because they screen for different pathologies.
The FADIR test is generally considered more specific for femoroacetabular impingement and labral pathology. In the FADIR position, the femoral head is driven into the anterior acetabular rim, directly compressing the structures most commonly involved in FAI and anterior labral tears. A patient with anterior hip impingement will typically have a positive FADIR but may have a neutral or limited FABER. Together, the two tests build a much more complete picture of hip joint mechanics than either alone.
What Comes After a Positive FABER Test?
A positive FABER test will typically prompt your PT to continue the hip evaluation with additional testing: FADIR, Thomas test for hip flexor length, hip range of motion and strength assessment (particularly hip abductors and external rotators), and potentially a lumbar screen to rule out referred pain from the spine.
The imaging pathway depends on the clinical picture. X-ray is useful for bony pathology — FAI morphology (cam or pincer lesions) and hip osteoarthritis both show on plain films. MRI arthrogram remains the gold standard for labral assessment when a labral tear is clinically suspected. Not every positive FABER test requires imaging; many presentations respond well to conservative physical therapy, and imaging is most valuable when it will change the management decision.
Treatment direction varies significantly by diagnosis. Hip joint pathology requires a different approach than sacroiliac joint dysfunction. Hip impingement and labral pathology are typically managed with a multidisciplinary approach — physical therapy addressing mobility and strength deficits, combined with orthopedic monitoring to determine whether conservative care is sufficient or surgical management is warranted. SI joint dysfunction, by contrast, responds well to physical therapy including manual therapy and targeted stabilization exercises, without surgical intervention in most cases.
Get to the Source of Your Hip Pain
Hip pain, groin tightness, or SI joint pain that won’t resolve on its own? A thorough hip assessment can identify what’s actually driving your symptoms. Highbar’s physical therapists use a comprehensive approach to hip evaluation — not just one test. Book an evaluation at your nearest Highbar location.
Dr. Bobby Dattilo PT, DPT, OCS is the Orthopedic Residency Director at Highbar Physical Therapy. His clinical focus includes hip and lower extremity pathology, orthopedic rehabilitation, and advanced clinical assessment.
