The FADIR Test, also called the FADDIR Test or anterior hip impingement test, is a hip pain provocation test performed by moving the hip into flexion, adduction and internal rotation. A positive test occurs when the movement reproduces the client’s familiar anterior hip or groin symptoms. The test is commonly used when assessing suspected femoroacetabular impingement syndrome or intra-articular hip pain, but it has limited specificity and does not diagnose FAI, labral pathology or hip joint pathology on its own.

Introduction

Hip and groin pain can come from several overlapping sources, including the hip joint, adductors, iliopsoas, pubic region, lumbar spine, sacroiliac region, femoral neck stress injury, abdominal or inguinal region and surrounding soft tissues.

The FADIR Test is one of the most common clinical tests used in hip and groin assessment. FADIR stands for:

• Flexion
• Adduction
• Internal Rotation

It is also called:

• FADDIR Test
• Anterior Impingement Test
• Hip Impingement Test

The test is often used when femoroacetabular impingement syndrome, labral-related symptoms or intra-articular hip pain are being considered. However, the Warwick Agreement states that femoroacetabular impingement syndrome requires a combination of symptoms, clinical signs and imaging findings. A positive FADIR Test alone is not enough to diagnose FAI syndrome.  

Quick Summary

• Test name: FADIR Test
• Also known as: FADDIR Test, anterior impingement test
• Region: Hip and groin
• Test type: Pain provocation test
• Client position: Supine
• Movement: Hip flexion, adduction and internal rotation
• Positive finding: Reproduction of familiar anterior hip or groin symptoms
• Negative finding: No familiar symptoms reproduced
• Common clinical use: Suspected FAI syndrome, intra-articular hip pain, labral-related symptoms
• Key limitation: High sensitivity but generally low specificity, so it may be more useful for screening than confirming a diagnosis

What Is the FADIR Test?

The FADIR Test is a passive hip test where the examiner moves the hip into a combined position of flexion, adduction and internal rotation.

This position can increase contact or compression around the anterior hip joint region and may reproduce symptoms in clients with hip-related pain.

A positive result is usually reproduction of the client’s familiar:

• anterior hip pain
• deep groin pain
• C-sign hip pain
• pinching sensation
• catching or sharp groin symptoms

The test can support assessment reasoning, but it should not be treated as a diagnosis. FAI morphology is common in asymptomatic people, and FAI syndrome requires symptoms, clinical signs and imaging findings rather than clinical signs alone.  

Why It Is Used

The FADIR Test is used because many hip joint-related presentations are provoked by combined hip flexion and rotation.

It may help professionals:

• reproduce familiar anterior hip or groin symptoms
• identify whether hip joint loading positions are symptom provoking
• compare left and right hip responses
• assess symptom irritability
• guide whether further hip assessment is needed
• decide whether imaging or referral may be appropriate in context
• monitor change over time
• record findings consistently in Measurz

It is most useful when combined with:

• history and symptom location
• hip internal and external rotation range of motion
• hip flexion range
• FABER, hip quadrant or other hip tests
• adductor and iliopsoas assessment
• lumbar and pelvic screening
• strength testing
• sport or activity exposure
• imaging findings where clinically indicated

What It Assesses

The FADIR Test may assess symptom provocation related to:

• anterior hip joint loading
• femoroacetabular impingement-type positions
• labral or chondral sensitivity
• intra-articular hip irritability
• hip flexion-adduction-internal rotation tolerance
• hip and groin symptom behaviour

It may be associated with:

• femoroacetabular impingement syndrome
• labral-related hip symptoms
• intra-articular hip pain
• hip-related groin pain
• anterior hip impingement-type symptoms

It does not directly assess or confirm:

• cam morphology
• pincer morphology
• labral tear
• cartilage injury
• hip osteoarthritis severity
• hip dysplasia
• femoral neck stress injury
• exact source of pain
• readiness to return to sport

Who It Is Useful For

The FADIR Test may be useful for:

• exercise professionals
• allied health support teams
• strength and conditioning coaches
• sport and performance staff
• movement assessment professionals
• students learning hip assessment
• professionals using Measurz or MAT for structured assessment recording

It may be relevant for clients with:

• anterior hip pain
• deep groin pain
• hip pinching
• hip pain with squatting
• hip pain with sitting
• hip pain during cutting, kicking or pivoting
• symptoms during deep hip flexion
• suspected hip joint-related symptoms
• reduced hip internal rotation
• C-sign hip pain description

It should be interpreted cautiously in clients with broad groin pain because multiple structures can be provoked in similar positions.

When to Use This Test

Use the FADIR Test when you want to assess whether combined hip flexion, adduction and internal rotation reproduces the client’s familiar symptoms.

It may be used during:

• hip and groin assessment
• anterior hip pain assessment
• sport-related hip pain review
• intra-articular hip symptom screening
• FAI syndrome clinical reasoning
• reassessment after rehabilitation or training modification
• comparison with other hip provocation tests

It may be especially useful when the client reports pain during:

• deep squatting
• prolonged sitting
• getting in or out of a car
• cutting or pivoting
• kicking
• skating or stride positions
• hip flexion with rotation
• gym movements involving deep hip flexion

When Not to Use or When to Be Cautious

Use caution when the client has:

• acute traumatic hip injury
• suspected fracture
• suspected femoral neck stress injury
• severe unexplained groin pain
• recent hip surgery without appropriate clearance
• marked irritability with passive movement
• neurological symptoms
• systemic symptoms
• inability to lie supine comfortably
• pain that escalates sharply during testing

Stop the test if:

• pain is severe
• symptoms are unfamiliar or concerning
• the client guards strongly
• the client asks to stop
• the test position cannot be reached safely
• further medical review is more appropriate

The test should not be used as a stand-alone decision tool for diagnosis, imaging, treatment selection or return-to-sport clearance.

Equipment Required

No specialised equipment is usually required.

Useful resources include:

• plinth or firm surface
• pain rating scale
• body chart
• goniometer or inclinometer if measuring hip range
• Measurz recording workflow
• optional video notes for movement-related symptoms

Step-by-Step Protocol / Practice

Setup

Explain the test before starting.

Example wording:

“We are going to move your hip into a flexed, crossed-in and rotated position to see whether it reproduces your familiar hip or groin symptoms. This test does not diagnose a condition on its own, but it helps us understand how your hip responds to this position.”

Client Position

Position the client:

• lying supine
• pelvis level
• non-tested leg relaxed
• tested hip and knee relaxed
• arms resting comfortably
• spine comfortable

Examiner / Professional Position

Stand on the side of the tested hip.

You need to be able to:

• support the knee and lower leg
• control hip flexion
• move the hip into adduction
• apply internal rotation gradually
• monitor the client’s symptoms
• stop quickly if needed

Hand Placement

A common setup:

• one hand supports the knee or distal thigh
• the other hand supports the ankle or lower leg
• the hip is brought to approximately 90 degrees of flexion
• the hip is moved into adduction
• the hip is internally rotated

Avoid forcing through pain or using fast end-range pressure.

Movement Direction

Move the tested hip into:

• Flexion: bring the knee toward the chest
• Adduction: move the thigh across the midline
• Internal rotation: move the lower leg outward while controlling the femur

The movement should be:

• passive
• slow
• controlled
• symptom-guided
• compared with the other side where appropriate

Instructions

Ask the client:

• “Tell me if you feel pain.”
• “Where do you feel it?”
• “Is that your familiar symptom?”
• “Is it pinching, stretch, pressure, catching or sharp pain?”
• “Rate the symptom from 0 to 10.”
• “Tell me if it becomes too uncomfortable.”

Positive Finding

A positive FADIR Test is usually:

• reproduction of the client’s familiar anterior hip or groin symptoms during flexion, adduction and internal rotation

Record whether symptoms are:

• familiar or unfamiliar
• anterior, lateral, posterior or deep groin
• pinching, sharp, catching, aching or pressure
• mild, moderate or severe
• associated with apprehension or guarding

Negative Finding

A negative FADIR Test is usually:

• no reproduction of familiar hip or groin symptoms during the test

A client may still feel:

• stretch
• pressure
• non-familiar discomfort
• limited movement without pain

These should not automatically be interpreted as positive findings.

Stopping Criteria

Stop the test if:

• pain becomes sharp or severe
• symptoms feel unsafe or unfamiliar
• guarding prevents accurate testing
• the client cannot relax
• the movement is not tolerated
• the client asks to stop

Safety Notes

The FADIR Test should be performed carefully because it can be provocative. Avoid repeated end-range provocation in irritable hip presentations.

For highly irritable clients, record available range and symptom response rather than forcing the end position.

Positive and Negative Test Interpretation

Positive Test

A positive FADIR Test means the test position reproduces the client’s familiar hip or groin symptoms.

A positive result may increase suspicion of hip joint-related pain when it is combined with:

• anterior hip or deep groin pain
• C-sign symptom description
• limited hip internal rotation
• pain during deep flexion activities
• positive related hip provocation tests
• imaging findings when clinically indicated
• relevant sport or activity history

A positive result does not confirm:

• FAI syndrome
• labral tear
• cartilage injury
• cam or pincer morphology
• hip osteoarthritis
• need for surgery
• need for imaging
• return-to-sport readiness

The Warwick Agreement is clear that FAI syndrome is diagnosed using the triad of symptoms, clinical signs and imaging findings, not a single clinical test.  

Negative Test

A negative FADIR Test means the test does not reproduce familiar hip or groin symptoms.

A negative result may reduce suspicion of hip joint-related provocation if:

• the test reaches relevant range
• other hip provocation tests are also negative
• hip range of motion is not limited
• functional hip flexion and rotation are tolerated
• history is not suggestive of hip joint-related pain

However, a negative test does not fully exclude:

• labral pathology
• FAI morphology
• intra-articular hip symptoms
• load-dependent hip pain
• symptoms that only occur at speed, fatigue or higher loads
• other sources of groin pain

Sensitivity, Specificity and Diagnostic Accuracy

The FADIR Test is generally considered more useful for screening than for confirming diagnosis because it often has higher sensitivity and lower specificity.

FAI Syndrome and Labral Pathology

A 2015 systematic review with meta-analysis on hip clinical tests reported that impingement tests, including FADIR-type tests, generally show high sensitivity but limited specificity for FAI/labral tear presentations.  

A review specifically focused on FADIR for FAI reported that the test’s diagnostic usefulness remained unclear because of substantial variability between studies. One included study reported sensitivity of 0.75 and specificity of 0.43 compared with magnetic resonance arthrography for labral lesions.  

A clinical test review summary reported pooled sensitivity as high as 99% with very low specificity around 5% in some evidence syntheses, suggesting the test may be useful for exclusion screening when negative, but poor for confirming FAI when positive.  

Cam or Pincer Morphology

A 2020 systematic review on clinical tests for cam or pincer morphology found that available clinical tests had limited ability to confirm cam or pincer morphology on their own. This is important because morphology can be present without symptoms and does not equal FAI syndrome by itself.  

Recent Evidence

A 2025 systematic review of physical examination tests for prearthritic intra-articular hip pathology reported wide variability in test performance. For FAI, it reported that the Internal Rotation Over Pressure test showed the highest sensitivity at 91%, while the FADIR test showed the highest specificity at 47% in the included comparisons.  

Practical Diagnostic Accuracy Summary

For FADIR:

• Condition or presentation: suspected FAI syndrome, labral pathology or intra-articular hip pain
• Population: mostly symptomatic hip/groin pain or specialist hip cohorts
• Reference standards: variable, including imaging and surgical findings in some studies
• Sensitivity: often moderate to high, but variable
• Specificity: generally low to modest
• Best use: screening and symptom provocation
• Main limitation: positive findings are not specific to one diagnosis

How to Interpret This

A positive FADIR Test is common in several hip and groin presentations. It should increase attention to hip-related symptoms, but it should not be used to confirm FAI, labral tear or intra-articular pathology.

A negative FADIR Test may reduce suspicion of some hip joint-related presentations, especially when combined with negative related tests and a non-suggestive history.

Reliability and Validity

Reliability depends on standardised positioning and clear symptom criteria.

A study on quantification and reliability of hip internal rotation and the FADIR Test in supine position used a smartphone application and investigated intrarater and interrater reliability for hip internal rotation range and FADIR positioning. This highlights the importance of standardising hip and knee position when using FADIR as a repeatable clinical measure.  

Validity is strongest when the FADIR Test is interpreted in relation to:

• symptoms
• clinical signs
• imaging where appropriate
• hip range of motion
• functional movements
• sport or activity demands

The Warwick Agreement supports this broader approach by defining FAI syndrome through symptoms, clinical signs and imaging findings together.  

Reliability is stronger when you standardise:

• client position
• hip flexion angle
• amount of adduction
• internal rotation force
• speed of movement
• symptom wording
• criteria for positive test
• pain score recording
• side tested first
• retest conditions

Common Errors and Limitations

Common errors include:

• calling FADIR diagnostic by itself
• recording any stretch as positive
• not asking whether symptoms are familiar
• applying excessive end-range force
• not recording symptom location
• not comparing with the other side
• ignoring hip range of motion
• ignoring lumbar, adductor or iliopsoas contributors
• using the test as return-to-sport clearance
• over-interpreting a positive result without imaging or broader findings

Limitations include:

• low specificity
• multiple hip and groin conditions can provoke symptoms
• asymptomatic FAI morphology is common
• test force and range vary between examiners
• symptoms may be influenced by irritability or guarding
• imaging findings do not always equal symptoms
• a negative result does not rule out all hip pathology
• a positive result does not confirm a labral tear or FAI syndrome

Practical Applications

The FADIR Test can support:

• hip and groin assessment
• symptom provocation mapping
• intra-articular hip pain reasoning
• FAI syndrome clinical reasoning
• comparison with other hip tests
• activity modification planning
• reassessment after rehabilitation
• Measurz documentation

It may help guide discussions around:

• squat depth
• sitting tolerance
• kicking or cutting exposure
• hip rotation demands
• return to gym positions
• running or sport exposure
• whether further assessment is needed

For athletes, FADIR can be useful when interpreted alongside sport-specific tasks such as:

• sprinting
• change of direction
• kicking
• skating
• deep squatting
• loaded hip flexion
• pivoting or rotation

How to Record This in Measurz

Record:

• test name: FADIR Test / FADDIR Test / Anterior Impingement Test
• side tested: left or right
• result: positive, negative, unclear or unable to test
• hip flexion angle if measured
• adduction position
• internal rotation range or end position
• pain score
• symptom location:
  • anterior hip
  • deep groin
  • lateral hip
  • posterior hip
  • thigh
  • other
• symptom quality:
  • pinch
  • sharp
  • catch
  • ache
  • pressure
  • stretch
• whether symptoms are familiar
• whether symptoms match the client’s main complaint
• range limitation
• guarding
• side-to-side comparison
• related findings:
  • hip internal rotation ROM
  • hip external rotation ROM
  • FABER
  • hip quadrant
  • McCarthy Test
  • adductor squeeze
  • lumbar screen
• sport or activity aggravators
• imaging findings if available
• interpretation notes
• retest date
• referral or further assessment notes if appropriate

Recording these details improves:

• repeatability
• communication
• client education
• assessment reasoning
• monitoring over time
• team consistency
• reporting quality

Related Tests / Internal Links

• FAIR Test
• Hip Quadrant Test
• McCarthy Test
• Craig Test
• Adductor Squeeze Test
• Piriformis Test
• Femoral Nerve Tension Test
• Hip Disability and Osteoarthritis Outcome Score
• Copenhagen Hip and Groin Outcome Score

FAQs

What is a positive FADIR Test?

A positive FADIR Test is reproduction of the client’s familiar hip or groin symptoms during hip flexion, adduction and internal rotation.

What does the FADIR Test assess?

It assesses whether a combined hip flexion, adduction and internal rotation position reproduces symptoms. It is commonly used when hip joint-related pain, FAI syndrome or labral-related symptoms are being considered.

Can the FADIR Test diagnose FAI?

No. FAI syndrome requires symptoms, clinical signs and imaging findings. A positive FADIR Test alone does not diagnose FAI.  

Is FADIR good for ruling out hip pathology?

Because FADIR often has higher sensitivity than specificity, a negative result may help reduce suspicion in some contexts, especially when other findings are also negative. It does not rule out all hip pathology.

Why is FADIR not specific?

The position can provoke symptoms from multiple hip and groin presentations, not just FAI or labral pathology.

Should FADIR reproduce groin pain or any pain?

The most meaningful positive finding is reproduction of the client’s familiar anterior hip or groin symptom. Non-familiar stretch or pressure should not automatically be recorded as positive.

Can FADIR be used for return-to-sport decisions?

It can support assessment reasoning, but it should not be the only measure. Return-to-sport decisions should also consider strength, range of motion, symptoms, workload, sport-specific testing, confidence and professional judgement.

Key Takeaways

• The FADIR Test is a hip pain provocation test using flexion, adduction and internal rotation.
• A positive finding is reproduction of familiar anterior hip or groin symptoms.
• It is commonly used when considering FAI syndrome or intra-articular hip pain.
• FADIR generally has higher sensitivity and lower specificity, so it is not a strong stand-alone confirmatory test.
• FAI syndrome requires symptoms, clinical signs and imaging findings.
• A positive FADIR does not confirm FAI, labral tear or cartilage pathology.
• Measurz should record side, symptom location, pain score, familiar symptom response, range, guarding, related tests and interpretation notes.

References

Caliesch, R., Sattelmayer, M., Reichenbach, S., Zwahlen, M., & Hilfiker, R. (2020). Diagnostic accuracy of clinical tests for cam or pincer morphology in individuals with suspected FAI syndrome: A systematic review. BMJ Open Sport & Exercise Medicine, 6, e000772. https://doi.org/10.1136/bmjsem-2020-000772

Keeney, J. A., Peelle, M. W., Jackson, J., Rubin, D., Maloney, W. J., & Clohisy, J. C. (2004). Magnetic resonance arthrography versus arthroscopy in the evaluation of articular hip pathology. Clinical Orthopaedics and Related Research, 429, 163–169.

Reiman, M. P., Goode, A. P., Cook, C. E., Hölmich, P., & Thorborg, K. (2015). Diagnostic accuracy of clinical tests for the diagnosis of hip femoroacetabular impingement/labral tear: A systematic review with meta-analysis. British Journal of Sports Medicine, 49(12), 811. https://doi.org/10.1136/bjsports-2014-094302

Shanmugaraj, A., et al. (2019). How useful is the flexion-adduction-internal rotation test for diagnosing femoroacetabular impingement: A systematic review. Clinical Journal of Sport Medicine, 29(1), 76–82.

St-Pierre, M.-O., et al. (2020). Quantification and reliability of hip internal rotation and the FADIR test in supine position using a smartphone application. Journal of Manipulative and Physiological Therapeutics, 43(1), 68–75.

Tijssen, M., van Cingel, R., Willemsen, L., & de Visser, E. (2012). Diagnostics of femoroacetabular impingement and labral pathology of the hip: A systematic review of the accuracy and validity of physical tests. Arthroscopy, 28(6), 860–871. https://doi.org/10.1016/j.arthro.2011.12.004

Wörner, T., et al. (2021). Combining results from hip impingement and range of motion tests can increase diagnostic accuracy in patients with FAI syndrome. Knee Surgery, Sports Traumatology, Arthroscopy, 29, 3382–3392.

Youngman, T. R., et al. (2025). Sensitivity and specificity for physical examination tests in diagnosing prearthritic intra-articular hip pathology. Arthroscopy, Sports Medicine, and Rehabilitation. https://doi.org/10.1016/j.asmr.2025.101117

Griffin, D. R., Dickenson, E. J., O’Donnell, J., Agricola, R., Awan, T., Beck, M., Clohisy, J. C., Dijkstra, H. P., Falvey, E., Gimpel, M., Hinman, R. S., Hölmich, P., Kassarjian, A., Martin, H. D., Martin, R., Mather, R. C., Philippon, M. J., Reiman, M. P., Takla, A., Thorborg, K., Walker, S., Weir, A., & Bennell, K. L. (2016). The Warwick Agreement on femoroacetabular impingement syndrome: An international consensus statement. British Journal of Sports Medicine, 50(19), 1169–1176. https://doi.org/10.1136/bjsports-2016-096743