How to Utilise Hip and Groin Tests
I get asked about the utility of hip and groin tests all the time.
The short answer is there’s a big overlap across clinical tests and key pain drivers. No test is particularly specific and some are sensitive.
This is my take based on clinical experience and I’d love to hear your opinions in the comments below. For more information on the assessment of groin pain, particularly in athletes, check out this Masterclass by Dr. Andrea Mosler here.
1. FADDIR test
Starting point and easy to do. This should be your ‘go to’ test for hip and groin assessment.
If this test is negative, then it’s not coming from the hip joint.
If positive, then it could be a Femoral Acetabular Impingement, labral pathology, osteoarthritis, avascular necrosis.
(disclaimer – FADDIR can also provoke irritable pubic related groin pain).
2. Hop test
If the hop test is negative then it’s unlikely they have a femoral or pubic stress fracture. If symptoms are produced by hopping on the side AWAY from pain, this suggests it is pubic / symphysis driven (i.e. pelvic force is being transmitted across the symphysis).
3. Modified Thomas test
This may be a little controversial, but I find the modified Thomas test to have little utility, at least in terms of understanding where the irritable tissue is. Virtually all causes of groin pain can be provoked in this position. It loads the pubis, adductor origin, hip flexor (a rare pain source) and inguinal / lower abdominal tissues.
However, if positive on the contralateral side (i.e. a positive crossover sign), then it might suggest an inguinal related source of groin pain.
4. Superficial inguinal ring invagination
This is particularly unpleasant to do (obviously, worse for the patient) and takes practice.
But can reliably elicit ‘inguinal disruption’ pain.
However, be aware not all inguinal pain comes from local superficial ring pathology.
5. Resisted crunches
Resisted crunches load the inguinal canal tissues and rectus abdominis. Therefore, if positive then it would suggest the driver is from this area.
However, bear in mind that rectus abdominis tendon pathology is a rarity.
Remember, these tissues insert onto the pubis, so if there is florid pubic oedema or stress, then it may give you a false positive.
6. Adductor squeeze
This is a nice baseline test.
If strong with minimal pain provocation, then it’s unlikely an adductor origin tendinopathy or tear.
This has increased utility if there is pain on systematic palpation of origin.
However, again it may give you a false positive if pubic oedema / stress.
Also, this will aggravate anterior pubic soft tissue injury (e.g. PLAC complex).
7. Pubic bone & symphysis palpation
Typically, this is painful in pubic stress issues.
However, confusingly, a small number of patients occasionally have no pain on palpation, only under load, radiating into genitals, inferior ramus and the perineum.
And vice versa – it’s a sensitive area and can be sore in most. It’s essential to clarify, “is this your typical pain?”
8. Cough standing
Athletes can get symptomatic classic inguinal hernia. Be sure to observe and feel in standing over the deep and superficial ring with cough if nothing overt when assessing in supine.
This was a whistle stop tour on some hip and groin tests that I commonly use in the clinic. If you’d like to learn more about groin pain in athletes, check out this Masterclass by Dr. Andrea Mosler here.
Want to learn more about the groin?
Dr Andrea Mosler has done a Masterclass lecture series for us on:
“Groin pain in Athletes: unraveling the mystery”
You can try Masterclass for FREE now with our 7-day trial!
- FADDIR image: https://orthofixar.com/special-test/faddir-test/
- Modified thomas test: https://www.mdpi.com/2076-3417/11/6/2830/htm
- Inguinal ring invagination test: https://www.amboss.com/us/knowledge/Inguinal_hernia
- Groin squeeze: https://www.sportsinjuryclinic.net/sport-injuries/hip-groin/groin-pain/groin-strain-exercises
- Pubic symphysis palpation: https://www.cambridge.org/core/books/abs/highrisk-pregnancy/spine-and-joint-disorders-in-pregnancy-content-last-reviewed-23rd-july-2019/8BEA7C303EDD9CFE19E00AAA774D91C7
- Inguinal Hernia: https://www.brighamandwomens.org/assets/BWH/surgery/general-and-gastrointestinal-surgery/images/inguinal-hernia.jpg
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this was very epic friend. i do need to improve my palpation skills for hernia and also brush up my anatomy on the deep and superficial ring. nice tip to do the tests in standing for palpation + cough as soft tissue is not so much in the area