Peter Attia· MD
so this is called the scour test or the fadir where I just seeing if that generates pain from there I move to the Faber test which is flexion abduction and external rotation and what I'm looking for is to see how far the knee will flop down will it go all the way to the table or is it elevated and I S just as a general rule I'm sort of seeing how many fists I can get under there if it's less than one fist sometimes that will indicate some laxity of the joint if it's more than two fist sometimes it may indicate some tightness which may be a capsular problem or some muscle tightness but sometimes it's also arthritis of the hip and if it's muscle is it mostly the adductor um yeah it it's because that's what's sort of stopping it we we see less of that for this particular motion often times I'm I'm really thinking about arthritis in that area or some sort of instability if it's if it's too loose and then the other thing is and that would be in a labral tear would it be too loose potentially uh it's a little different than the shoulder in that regard um because of the the socket is different so there are certain individuals who have very loose hips and that's due to developmental problems — it's often due to what their activity is ballet dancers for example are incredibly flexible and so their hips will come all the way out which you know there's a difference just like in the shoulder there's a difference between um instability and laxity so instability is more of a symptomatic laxity so but and I'm also comparing to the other side and if there's any difference and this one comes down a little bit more but again if it's not gener any gener ating any necessary pain I'm not necessarily too concerned about it okay so we did internal rotation external rotation a little bit of abduction motion um now Peter I want to have you sit up because I'm going to check the flexion and extension of your hips so I'm going to have you sit all the way at the very edge like you're about to fall off keep coming keep coming I'm going to grab you want you to grab your left knee and lie down and bring it to your chest it's called the modified Thomas test and I'm going try just let your leg hang down comfortably and a couple of things here I'm looking at the angle between his thigh and the table and if I push down what I'm really assessing is how tight are the um the hip flexor muscles in particular the ilos sois so he's a little bit elevated from neutral some people go all the way down again depending on what the particular complaint is there may be stiffness because of arthritis it may be stiffness because of um a tightness of the flexor muscles or it might be loose because of instability and the other motion I'm checking here is to see the ilot tibial band so some people are easily go towards midline some people pop back and so this may indicate some tightness of the structures on the lateral aspect of the hip and then I'll compare the other one so you bring your knee to this side and let this hang so your ilot bands are probably be a little bit tighter not much and see if and also I'm checking to see can you just let your leg hang that's about it so that will give us indication of some quad tightness too and also to see how much the hip is elevated compared to the table okay so we got more to do so now we move to the lateral position where I have you get lie onto your left side and so I get a first thing I do is I check the spine I want to make sure that that doesn't hurt I check the SI joint to see if that generates any pain this is where I'll check where the Sartorius originates from and the tensor muscle as well um and and again here's be another opportunity to check your abductor train so I'll have Peter lift up your leg and don't let me push down good and that's it's a it's a more sensitive test in the sense if you really have an abductor problem this is hard to do and this relax your leg completely um so before we were looking at it IT band tightness or tightness on the on the lateral aspect of the hip and I want to see if Peter's knee can come all the way down to the table and that's good good so he's pretty good there um and also this is an opportunity we can check to see if there's any instability um just like the shoulder we sort of do this provocative maneuver where I'm pushing on the greater troter to see if I could push the ball forward and