Overview of Hip Assessment

Original Editor - Stacy Schiurring based on the course by Shala Cummingham

Top Contributors - Samuel Adedigba, Kim Jackson, Rachael Lowe, Laura Ritchie, Vidya Acharya, Ewa Jaraczewska, Admin, Jess Bell, 127.0.0.1, Kai A. Sigel, Tony Lowe, Naomi O'Reilly and Wanda van Niekerk  

Introduction

Hip pain represents a substantial contributor to the global burden of musculoskeletal disability. The complexity of the hip assessment stems from the variety of structures that can generate symptoms, including bones, ligaments, tendons, bursae, and nerves. Furthermore, the interconnected relationship between trunk and hip mobility, combined with the potential for referred pain from both the lumbar spine to the hip, and from the hip to the lower back and medial knee, necessitates a comprehensive and systematic approach to assessment. Therefore, rehabilitation providers must have a thorough understanding of hip anatomy and both the subjective and objective assessment of the hip to accurately diagnose and effectively manage these conditions.

Subjective History

The L-M-N-O-P-Q-R-S-T mnemonic outlines the essential aspects to cover when taking a patient’s history.

The following subjective reports are useful in pinpointing the source of hip related pain:

• Symptoms worse with activity
• Twisting, such as turning, changing directions
• Seated position might be uncomfortable, especially with hip flexion
• Rising from seated position often painful (e.g. catching or popping)
• Difficulty ascending/descending stairs
• Symptoms with entering and exiting an automobile
• Dyspareunia (painful sexual intercourse)
• Difficulty donning/doffing footwear (e.g. shoes, socks, hosiery)

L: location of symptoms and level of functional impairment

The location of symptoms can help you develop hypothetical diagnoses based on which tissues are in the area. Consider the following pain locations and their associated pathologies:

Table 1.0. Hip and Groin Pain: Location-Based Differential Diagnosis

Location of Pain	Local Pathology	Referred pain sources	Clinical Considerations
Anterior hip (groin area)	Hip adductor strains Iliopsoas strains Osteoarthritis (OA) Femoroacetabular impingement (FAI) syndrome Acetabular labral tears Hip microinstability Femoral head osteonecrosis Femoral neck fractures (if trauma or fall occurred) Hernias (differential diagnosis requiring referral)	Lumbar spine pathology Sacroiliac joint dysfunction Femoral nerve entrapment Ilioinguinal nerve entrapment Genitofemoral nerve entrapment	"C" sign commonly indicates intra-articular pathology Clinical Pearl: the "C" sign: where the patient cups their hand over the front or side of the hip to show the location of pain. This is because the pain is typically felt deep in the groin, which is a region innervated by nerves from the hip joint, and the "C" shape of the hand represents the area of discomfort. Insidious/gradual onset typical May progress from unilateral to bilateral Screen lumbar spine with repeated movements Assess sacroiliac joint with Sacroiliac Joint Special Test Cluster Consider age: OA in older adults; FAI/labral tears in younger, active patients
Pubic region / symphysis	Pubic symphysis dysfunction (pubic-related groin pain) Rectus abdominis strain (pubic attachment) Adductor origin pathology Pubic bone marrow oedema Osteitis pubis	Hip intra-articular pathology Obturator nerve entrapment	Pubic symphysis tenderness has high sensitivity for ruling out pubic-related pain Squeeze test at 0° hip flexion associated with pubic aponeurosis injury "Crossover test" ( also known at the cross-body adduction test) assesses shear forces across pubic symphysis Common in sports with kicking/twisting movements Multiple clinical entities may coexist
Lateral hip/buttock	Trochanteric bursitis (greater trochanteric pain syndrome) Tendinopathy of hip abductors (gluteus medius/minimus) Tendinopathy of external rotators at greater trochanter	Lumbar spine pathology (L4-L5, L5-S1) Sacroiliac joint dysfunction	Often related to gluteal muscle weakness May involve lateral hip snapping Consider lumbar radiculopathy differential Assess pelvic girdle function
Anterior thigh	Quadriceps strain Rectus femoris strain/tendinopathy Femoral nerve entrapment	Hip intra-articular pathology (FAI, OA) Lumbar spine pathology (L2-L4 nerve roots) Femoral head osteonecrosis	Femoral nerve tension test performed prone with passive knee flexion Consider hip flexor complex assessment (modified Thomas test) Deep progressive inguinal pain with axial loading suggests osteonecrosis Screen for red flags (corticosteroid use, alcohol consumption)
Medial thigh/ adductor region	Adductor strains (adductor-related groin pain) Adductor tendon origin pathology Obturator nerve entrapment	Hip osteoarthritis Pubic symphysis pathology Lumbar spine pathology	Most common groin pain entity in kicking sports Adductor origin tenderness has excellent inter-rater reliability (κ > 0.80) Absent adductor tenderness has high sensitivity (93%) to rule out adductor pathology Test resisted adduction at multiple hip positions (0°, 45°, 90° flexion) MRI correlation with clinical findings recommended
Posterior hip/deep buttock	Piriformis syndrome Deep gluteal syndrome Hamstring origin tendinopathy Ischiofemoral impingement	Lumbar spine pathology (particularly L5-S1) Sacroiliac joint dysfunction Hip intra-articular pathology (posterior labral tears)	External rotation in neutral hip position primarily limited by posterior impingement between greater trochanter and ischium Screen lumbar spine and pelvic girdle systematically Consider sciatic nerve involvement

You should also ascertain how a patient's pain is affecting their ability to perform activities of daily living and other work-, school-, and sport-related tasks.

M: medical factors (medications) and mechanism of injury

We need to find out what medications a patient is taking (including supplements) and what co-morbidities they may have. We also want to determine when and how the injury occurred (specific trauma, overuse, etc). If there was a traumatic injury that initiated the hip pain, determine whether neurological symptoms (numbness, tingling, sharp or burning pain) were present at the time of trauma.

Red flags: sudden onset of severe pain without incident or accident, neurological symptoms at the time of trauma

N: Neurological symptoms

Neurological symptoms include numbness, tingling, paraesthesias, and sharp or burning pain. When neurological symptoms are present, we need to determine if they are constant or intermittent, if they follow a dermatomal pattern (suggesting lumbar spine origin) or if they follow a peripheral nerve pattern (femoral or sciatic nerve), and if the symptoms are related to specific positions or movements.

Red flag: Sock-like numbness affecting multiple dermatomes (also consider multiple peripheral nerve involvement)

O: Occupation including limitations

Are there any work- or activity-related factors that are relevant? Is there a possibility of overuse? Does the patient perform any repetitive tasks? Consider sport-specific demands and occupational requirements.

P: What palliates or provokes symptoms?

Find out what increases or worsens symptoms and how long it takes for symptoms to decrease once aggravated. This information provides insight into tissue irritability.

Red flags: constant, unrelenting symptoms; symptoms that never calm down regardless of activity or rest; nothing alleviates the symptoms

Q: Quality of symptoms / pain

Find out if symptoms are sharp, dull, stabbing, aching, or electric shock-like and if there is any numbness, tingling, or a feeling of weakness/clumsiness.

Clinical note: Mechanical symptoms including clicking or popping are commonly reported in patients with labral tears (frequently present alongside catching and locking sensations). However, these symptoms also occur in numerous other hip conditions including loose bodies, degenerative joint disease, and osteonecrosis, limiting their diagnostic specificity. The absence of clicking/popping may be more clinically useful for ruling out labral pathology, though specific likelihood ratios for this symptom in isolation are not well-established in the literature. Clicking should be considered alongside other clinical findings (anterior groin pain, positive FADIR test, limited hip rotation) and imaging rather than as an isolated diagnostic indicator.

R: Radiation of symptoms

Questions to ask relating to radiating symptoms:

• Where do the symptoms radiate to?
• Are radiating symptoms provoked by activities or position?
• How long do radiating symptoms last?

Red flag: Radiating symptoms affecting multiple dermatomes (remember to check peripheral nerve sensory patterns if more than one dermatome appears to be affected)

S: Severity of symptoms

Scales such as the Visual Analogue Scale or the Numeric Pain Rating Scale can be used, but also consider how symptoms affect function and activities. Does the patient have to modify or stop activities due to symptoms?

Red flag: Sudden onset of severe pain without incident or accident

T: Timing of symptoms

Find out the timing of symptoms over a 24-hour period and in relation to activity. How do symptoms present from morning through daily activities, work, activities of daily living, and into the evening? This provides a complete timeframe of symptom behaviour.

Red flags: symptoms that interrupt sleep or are worse at night; constant, unrelenting pain that remains the same throughout the day regardless of activity

Additional Red Flags

It is important to screen for additional red flags, or constitutional symptoms (symptoms or health issues that affect the entire body rather than a specific part).

Red Flags Requiring Immediate Referral to Medical Doctor or Emergency Department:

• History of trauma with suspected fracture
• Fever with joint pain
• Unexplained weight loss
• Night pain unrelieved by rest
• Prolonged corticosteroid use (osteonecrosis risk)
• History of cancer
• Burning during urination
• Progressive neurological deficit

Self-Assessment Questionnaires for Hip Pain

• Lower Extremity Functional Scale: The most commonly used generalised scale for the entire lower extremity (similar to the DASH for the upper extremity)
• Hip disability and Osteoarthritis Outcome Score (HOOS): Condition-specific scale for osteoarthritis
• Hip Outcome Score (HOS): Hip-specific outcome measure
• International Hip Outcome Tool (iHOT): Hip-specific outcome measure

Objective Assessment

Observation

Remember to look at the entire lower quarter (hip, knee, and ankle/foot complex) and the lumbar spine. Observe both sides of the body to allow for a comparison. Assessment should include observation of both the weight-bearing joint function and static posture:

Table 2.0. Examples of Clinical Observational Assessment for the Hip

Observational Assessment	Important Assessment Areas
Posture assessment	Seated posture Standing posture Note whether the patient bears weight equally on both legs or shifts weight off one side Observe whether the patient sits evenly on both ischial tuberosities
Gait analysis	Observe walking pattern Note any antalgic gait, Trendelenburg gait, or compensatory patterns Look for hip hiking to clear the lower extremity (may indicate increased quadratus lumborum tone) Examples of standardised assessments: Timed-Up-and-Go test (TUG) 6-minute walk test
Functional screening	These functional screens provide information about range of motion limitations, balance deficits, and overall functional capacity before formal testing. Trunk flexion (remember this involves hip flexion in standing) Trunk extension (involves hip extension in standing) Single-leg stance for balance assessment (also evaluates weight-bearing tolerance) Squat assessment (if appropriate for patient's functional level) Sit-to-stand (partial squat) if full squat is not appropriate

Palpation

Table 3.0. Key Palpation Points at the Hip

Anterior structures	Anterior superior iliac spine (ASIS): compare symmetry between sides; attachment site for sartorius muscle Anterior inferior iliac spine (AIIS): attachment site for rectus femoris Anterior hip joint: located just lateral to the groin; tenderness may suggest osteoarthritis, fracture, or avascular necrosis Inguinal ligament: palpate from ASIS to pubic tubercle Pubic symphysis: assess for symmetry with ASIS; tenderness suggests osteitis pubis or core muscle injury Adductor tubercle and adductor origins: palpate for tenderness, particularly with groin pain Hip flexor muscle group (iliopsoas, rectus femoris): tenderness indicates potential strain or tendonitis Femoral artery: passes under inguinal ligament at its midpoint, halfway between ASIS and pubic tubercle
Lateral structures	Iliac crest: palpate from anterior to posterior along the rim Greater trochanter: locate and assess for tenderness; most prominent when hip is in neutral rotation Trochanteric bursa: comprises three bursae (gluteus maximus bursa is the principal one); tenderness suggests trochanteric bursitis Gluteus medius insertion: lnserts into lateral portion of greater trochanter Iliotibial band: palpable over lateral aspect of thigh
Posterior structures	Posterior superior iliac spine (PSIS): located at the level of the second sacral vertebra; visible as dimples; commonly tender with sacroiliac joint dysfunction (Fortin finger sign) Ischial tuberosity: assess pelvic symmetry in sitting and standing Sciatic nerve: located midway between the greater trochanter and ischial tuberosity Piriformis: deep to gluteus maximus Sacrum: palpate midline and sacral sulcus (dimples at PSIS level) Sacroiliac joints: located medial to PSIS; note that the joint itself is anatomically inaccessible to direct palpation due to overlying tissues and its medially facing position
Lumbar and lumbopelvic structures	Lumbar spinous processes: palpate for tenderness and alignment Iliac crest height: a horizontal line connecting the highest points of both iliac crests crosses the vertebral column at L4-L5 interspace or L4 vertebra Quadratus lumborum: assess for increased tone, particularly in patients demonstrating hip hiking during gait Paraspinal muscles: assess for tenderness and muscle tone

The following optional video provides an overview for palpating the major landmarks of the hip region, and gives clinical insights on common pathologies.

Neurological Screen

• Dermatomes: assess sensation in lumbar nerve root distributions
• Myotomes: test key muscle groups for lumbar nerve root function
• Straight leg raise: screen for sciatic nerve involvement
• Femoral nerve tension test: screen for femoral nerve involvement

Range of Motion

It is important to assess both active and passive range of motion, including with overpressure. For more information on the range of motion assessment, please see: Assessing Range of Motion.

Table 4.0: Hip Range of Motion and End Feel (AAOM = American Academy / Association of Orthopedic Medicine)

Movement	AAOM Values	Research-Based Range	Typical End Feel
Flexion	120°	110–125°	Soft tissue approximation
Extension	20°	10-30°	Capsular/firm tissue stretch
Abduction	40°	30-50°	Capsular/firm tissue stretch
Adduction	20°	20-30°	Soft tissue approximation
Internal Rotation at 90° hip flexion	45°	30-45°	Capsular/firm
External Rotation at 90° hip flexion	45°	40-60°	Capsular/firm
Internal Rotation (neutral/prone)	45°	30-40°	Capsular/firm
External Rotation (neutral/prone)	45°	40-50°	Firm

The spinopelvic femoral complex (SPFC) refers to the interaction between the lumbar spine, pelvis, and hips, which together maintain upright posture, trunk balance, and efficient lower limb movement. In healthy individuals, these regions move harmoniously to allow smooth transitions between positions (e.g. sit to stand and vice versa). When standing, the pelvis tilts anteriorly (anteversion), increasing lumbar lordosis, and the hips are in an extended position. When sitting, the pelvis tilts posteriorly (retroversion), reducing lordosis, while the hips are flexed. This dynamic relationship enables the acetabulum to change its orientation: opening anteriorly during sitting to accommodate femoral movement, and closing during standing to provide joint stability.

Therefore, the lumbar spine plays an important role in determining hip range of motion through its influence on pelvic orientation and spinopelvic alignment. A flexible lumbar spine allows the pelvis to rotate freely, thereby reducing the mechanical demand on the hip joint during movements such as flexion and extension. Conversely, when the lumbar spine becomes stiff or fused, pelvic mobility is restricted. This limitation forces the hip to compensate with greater movement, often increasing stress on the joint and predisposing to impingement or instability.

Table 5.0. Hip and Trunk Mobility Differentiation

Movement	Common Hip/Lumbar Spine Combined Movements
Flexion assessment	Trunk flexion in standing: assesses combined trunk and hip mobility Trunk flexion in sitting: assesses combined trunk and hip mobility Hip flexion in sitting: assesses hip mobility with some trunk involvement Hip flexion in supine: isolates hip mobility as the trunk remains in neutral on the table
Extension assessment	Trunk extension in standing: assesses combined trunk and hip mobility Hip extension in standing: includes lumbar extension (patient will arch their lower back) Hip extension in side-lying or prone: reduces trunk involvement Clinical note: When assessing hip extension in side-lying, palpate the lumbar spine to ensure you are not getting compensatory lumbar lordosis

Resisted Testing

Assess the strength of the hip flexors (Iliopsoas, Tensor Fasciae Latae, Sartorius, and Rectus Femoris), extensors (Gluteus Maximus, Semitendinosus, Semimembranosus, and Biceps Femoris), abductors (Gluteus Medius and Gluteus Minimus), adductors (Adductor Magnus, Adductor brevis, Adductor Longus, Pectineus, and Gracilis), external rotators (Gluteus Maximus, Piriformis, Quadratus Femoris, Obturator Externus, Obturator Internus, Gemellus Superior, and Gemellus Inferior), and internal rotators (anterior fibres Gluteus Minimus, anterior fibres Gluteus Medius, and Tensor Fasciae Lata).

For more information on the strength assessment, please see Assessing Muscle Strength.

Accessory Movements / Joint Mobility Testing

Table 5.0. Accessory Movements of the Hip

Type of Movement	When to Test / Use
Longitudinal distraction	General mobility test Useful for pain inhibition or reduction
Lateral distraction	General mobility test Useful for pain inhibition or reduction
Inferior glide	Check for hip flexion and abduction mobility
Posterior glide	Check for hip flexion and internal rotation mobility
Anterior glide	Check for hip extension and external rotation mobility

Special Tests

Table 6.0. Special Tests for General Hip Pathology

Name of Test and Purpose	Procedure	Precautions	Positive Result	Reliability/Validity
Log Roll TestPurpose: Screening test for general hip pathology and intra-articular pathology	Patient positioned supine Therapist places both hands on the upper thigh Passively rolls the leg internally and externally through available range	Avoid excessive force in patients with acute hip pathology Not appropriate in suspected fracture May provoke symptoms in multiple hip conditions (low specificity)	Pain provocation or restriction in movement during rolling motion	Limited research on diagnostic accuracy Generally used as a screening tool rather than diagnostic test Often positive in multiple hip pathologies, limiting specificity
Hip Quadrant Test/Scour TestPurpose: Identify hip joint as source of symptoms; assess for intra-articular pathology, labral tears, or osteoarthritis	Patient supine Hip placed into 70° flexion and full adduction Compression force applied through femoral shaft Hip moved from 70° to 140° flexion while maintaining compression Test repeated in abduction Alternative method: full flexion and adduction with compression, then scour into abduction	Contraindicated in acute fracture or dislocation Use caution with severe osteoarthritis Avoid in patients with hip replacement May provoke significant pain	Reproduction of patient's hip pain during the manoeuvre	Moderate sensitivity (59-69%) for intra-articular pathology Poor to moderate specificity Better used in combination with other tests Pain location important: groin pain more indicative of intra-articular pathology

Table 7.0. Special Tests for Labral Pathology and Femoroacetabular Impingement (FAI)

Name of Test and Purpose	Procedure	Precautions	Positive Result	Reliability/Validity
FADIR Test (Flexion-Adduction-Internal Rotation) Assess for hip labral tears, femoroacetabular impingement (FAI), or intra-articular pathology	Patient supine Hip flexed to 90° Hip maximally adducted and internally rotated Overpressure applied at end range	Avoid in acute hip dislocation or fracture Use caution post-operatively Not appropriate with hip replacement May reproduce significant groin pain	Groin pain provocation (anterior hip pain suggests labral tear or FAI)	High sensitivity: 78-100% for labral tears and FAI (varies by study and reference standard) Low specificity: 8-33% Positive likelihood ratio: moderate More useful for ruling out pathology when negative Sensitivity varies with imaging reference: 8-100% (x-ray), 33-100% (MRI), 90% (CT) Best used in combination with other clinical tests and imaging
FABER Test (Flexion-Abduction-External Rotation) / Patrick's Test Screen for hip pathology (labral tears, FAI, osteoarthritis), sacroiliac joint dysfunction, or iliopsoas pathology	Patient supine Hip flexed, abducted, and externally rotated (figure-4 position) Lateral ankle placed above opposite patella Pelvis stabilised at contralateral ASIS Hip slowly lowered into maximal abduction and external rotation 3-5 small amplitude oscillations at end range	Avoid in acute hip pathology or fracture Use caution with hip replacement Pain may arise from multiple structures (hip, SI joint, lumbar spine) Ensure patient relaxation to avoid muscle guarding	Groin pain = intra-articular hip pathology Posterior pelvic/buttock pain = sacroiliac joint dysfunction Restricted range without pain = soft tissue restriction	Sensitivity for hip labral tears: 41-97% (highly variable) Specificity: 18-100% (highly variable) For FAI: sensitivity 77%, specificity 17% Inter-rater reliability: moderate (κ = 0.63) 88% sensitive for general hip pathology as screening test More reliable when combined with other tests in a cluster Validity questioned in some systematic reviews due to low quality of evidence Better as screening tool than definitive diagnostic test
Fitzgerald Test (Dynamic Labral Test)Assess integrity of acetabular labrum (anterior and posterior portions)	Anterior labrum assessment: Patient supine Hip moved from full flexion, external rotation, and abduction into extension, internal rotation, and adduction Posterior labral assessment: Hip moved from full flexion, adduction, and internal rotation into extension, abduction, and external rotation	Avoid in acute hip pathology Not appropriate with hip replacement Requires significant hip mobility to perform adequately	Pain with or without audible click during the movement arc	Limited research on diagnostic accuracy No robust sensitivity/specificity data available Mechanism targets labral compression during dynamic movement Clinical utility requires further validation

Table 8.0. Special Tests for Hip Abductor Integrity

Name of Test and Purpose	Procedure	Precautions	Positive Result	Reliability/Validity
Trendelenburg TestAssess integrity and strength of hip abductor muscles (gluteus medius and minimus)	Patient standing Asked to stand on one leg for 30 seconds without leaning to either side May hold light support for balance if needed Observe pelvis position	Fall risk in patients with poor balance Provide standby assistance Not suitable for non-weight-bearing patients Acute hip pain may limit test performance	Pelvis drops on the unsupported (contralateral) side Indicates weakness of hip abductors on the stance (supported) side Trunk lean towards stance side (compensation)	Intra-rater reliability: Very strong when assessed with goniometry (ICC 0.95-0.99) Inter-rater reliability: Variable, often poor (κ = 0.22-0.25) Test-retest reliability: Good (κ > 0.75) in chronic low back pain population Sensitivity for hip OA: 55% Specificity for hip OA: 70% Validity concerns: Weak correlations found between hip abductor strength and pelvic drop in healthy populations Poor agreement between practitioner observation and 3D motion analysis Should not be used as primary screening measure for hip abductor strength in populations with strength >30% body weight More reliable in pathological populations than healthy individuals Caution advised when using to assess hip abductor weakness in absence of intra-articular hip pathology

Table 9.0. Special Tests for Hip Flexor Length

Name of Test and Purpose	Procedure	Precautions	Positive Result	Reliability/Validity
Modified Thomas TestAssess muscle length of hip flexors (iliopsoas, rectus femoris, tensor fasciae latae, sartorius)	Patient stands at end of bed with gluteal folds at edge Patient lies back onto bed while flexing both knees to chest Non-testing leg held in 90° hip flexion to flatten lumbar spine Therapist stabilises ASIS on testing side Testing leg slowly lowered as far as possible Observe position at end range	Avoid in acute hip flexor strain or hip pathology Not appropriate with hip replacement (risk of dislocation) Requires adequate knee flexion range Not useful in bilateral hip flexor contractures Careful with patients who have lumbar pathology	Inability to achieve normal end position indicates hip flexor tightness (specific muscles identified by movement pattern) Normal findings: Hip extended to neutral (0°) or beyond Hip in neutral or slight abduction Knee flexed to approximately 80° Interpretation of limitations: Hip extension limited + knee ≥80° flexion = iliopsoas tightness Hip abducts = tensor fasciae latae/ITB tightness Hip abducts + flexes + externally rotates = sartorius tightness No hip extension limitation + knee extends = rectus femoris tightness Hip extension limited + knee extends = rectus femoris tightness	CRITICAL: Validity depends on pelvic tilt control Without pelvic control: Poor validity, sensitivity 32%, specificity 57% With pelvic control: Much improved validity (r = 0.98) Intra-rater reliability with pelvic control: Excellent (ICC 0.97-0.99) Inter-rater reliability with pelvic control: High (ICC 0.83-0.87) Standard error of measurement (SEM): 2.85° overall; 2.35° with active lumbo-pelvic stabilisation Minimal detectable change: 2.35-4.17° depending on method Pass/fail reliability limited when pelvic position not controlled Essential to maintain neutral pelvic tilt throughout test for valid results Previous reports of poor reliability likely due to inadequate pelvic stabilisation

Table 10.0. Special Tests for Femoral Anteversion/Retroversion

Name of Test and Purpose	Procedure	Precautions	Positive Result	Reliability/Validity
Craig's Test (Trochanteric Prominence Angle Test)Estimate degree of femoral anteversion or retroversion	Patient prone with knee flexed to 90° Therapist palpates greater trochanter Hip internally and externally rotated until greater trochanter most prominent laterally (parallel to table) Angle measured using goniometer along long axis of tibia relative to vertical Interpretation: Normal: 8-15° internal rotation in adults Increased anteversion = 15° internal rotation Retroversion = <8° or external rotation	Requires adequate hip rotation range Examiner experience affects accuracy Difficult in obese patients (palpation challenge) Not appropriate immediately post-operative	Anteversion: >15° from vertical Retroversion: <8° or external rotation from vertical	Intra-examiner reliability: Good to excellent (ICC 0.74-0.90) Inter-examiner reliability: Poor to moderate (ICC 0.25-0.62; improved to 0.62 with laser-guided goniometer) Correlation with CT: r = 0.93 reported in some studies Correlation with MRI: r = 0.97 for MRI vs lower for Craig's test Validity concerns: Multiple studies show Craig's test fails to explain >75% of variance compared to CT/MRI Hip rotation ROM measurements may provide more reliable estimates of femoral version than Craig's test Better for screening than precise measurement Despite limitations, remains most commonly used clinical test for femoral version

Table 11.0. Special Tests for Gluteal Tendinopathy

Name of Test and Purpose	Procedure	Precautions	Positive Result	Reliability/Validity
Greater Trochanter PalpationAssess for gluteal tendinopathy	Patient side-lying with testing side uppermost Hips flexed to approximately 60° Therapist palpates over greater trochanter of femur Apply moderate pressure	Avoid excessive pressure Other structures may also be tender (trochanteric bursa, ITB)	Pain over greater trochanter area	Limited research on diagnostic accuracy as isolated test Often used in combination with other tests for gluteal tendinopathy Palpation tenderness alone has poor specificity
FADER Test (Flexion-Adduction-External Rotation for Gluteal Tendinopathy)Provocation test for gluteal tendinopathy	Passive version: Patient supine Hip placed in 90° flexion Maximal adduction and external rotation applied Resisted version: Same position as passive Add isometric resisted internal rotation	May provoke significant lateral hip pain Avoid in acute gluteal tendon tears Differentiate from trochanteric bursitis	Pain over gluteal tendons (lateral hip/greater trochanter region)	Limited published research on diagnostic accuracy Often used in clinical practice but requires further validation studies

Table 12.0. Special Tests for Hip Instability

Name of Test and Purpose	Procedure	Precautions	Positive Result	Reliability/Validity
Abduction-Hyperextension-External Rotation TestAssess for anterior hip instability	Patient side-lying with affected hip uppermost Top hip lifted into 30-45° abduction, extension, and external rotation Anteriorly directed force applied through posterior aspect of greater trochanter	Risk of subluxation/dislocation in unstable hips Avoid in acute hip dislocation Not appropriate post-hip replacement without surgeon clearance Requires careful technique	Anterior hip pain with or without apprehension	Limited research on diagnostic accuracy More commonly used in post-operative assessment Clinical experience suggests utility in hypermobile patients
Hyperextension-External Rotation TestAssess for anterior hip instability	Patient supine at end of bed with legs dangling free Non-testing leg brought to chest and held Therapist at end of bed lowers testing hip into extension Hip externally rotated	Fall risk - ensure patient safety Risk of subluxation in unstable hips Not appropriate with hip replacement Avoid in acute pathology	Anterior hip pain with or without apprehension	Limited published research on sensitivity/specificity Requires further validation
Prone Instability TestAssess for anterior hip instability	Patient prone Hip passively externally rotated maximally Anteriorly directed force applied over posterior aspect of greater trochanter	Risk of subluxation Avoid in acute dislocation Not appropriate with hip replacement without clearance	Anterior hip pain provocation	Minimal published data on diagnostic accuracy Clinical utility requires further research

Additional Resources

Optional Videos

The following videos provide an overview of each of the movements of the hip.

Please note, the hip external rotation video can only be viewed directly from the YouTube website. Please click on the link to view the video. Or click HERE.

Please note, the hip external rotation video can only be viewed directly from the YouTube website. Please click on the link to view the video. Or click HERE.