FAIR stands for flexion, adduction and internal rotation. Also known as piriformis test.
Clinically Relevant Anatomy
The piriformis is a flat muscle and the most superficial muscle of the deep gluteal muscles. It is part of the lateral rotators of the hip (obturator internus, superior and inferior gemelli, quadratus femoris, obturator externus, and gluteus maximus).It leaves the pelvis through the greater sciatic notch, until its fixation reaches the superior margin of the greater trochanter. It has a piramidal shape that lies almost parallel with the posterior margin of the gluteus medius.
The piriformis muscle can be used to locate the scietic nerve. This nerve enters the gluteal region inferiorly to the piriformis.If the lateral rotators of the hip are tight they may exert pressure on the sciatic nerve, producing pain radiating into the lower extremity. This is known as Piriformis Syndrome.
The piriformis muscle can be used to locate the scietic nerve. This nerve enters the gluteal region inferiorly to the piriformis.If the lateral rotators of the hip are tight they may exert pressure on the sciatic nerve, producing pain radiating into the lower extremity. This is known as Piriformis Syndrome.
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| FAIR Test |
Technique
Position the patient in the side-lying with the tested hip on top. Passively move the patient's lower extremity into flexion (90 degrees), adduction, and internal rotation. The examiner stabilizes the hip and applies downward pressure to the knee to internally rotate and adduct the hip, thus placing the piriformis on a stretch that compresses the sciatic nerve.
A positive test occurs when pain is produced in the sciatic/gluteal area. Due to the position of the test, pain may produced in the anterior thigh as well as a result of femoral acetabular impingement, so it is important to ask where they are feeling the pain.
Variation
The FAIR test can be performed with the patient supine or seated, knee and hip flexed, and hip medially rotated, while the patient resists examiner attempts to externally rotate and abduct the hip.The FAIR test result is positive if sciatic symptoms are recreated.
Interpretation
Sciatic nerve pain can originate from several factors which include; a disc herniation, sacroiliac joint dysfunction, degenerative joint disease, a tight piriformis, and more.If you suspecting a patient's neural symptoms to be originating from tightness of the piriformis muscle, the FAIR test may be used to help strengthen your hypothesis.
According to Neumann, the piriformis originates at the ventral surface of the sacrum and runs through the greater sciatic foramen to insert on the superior part of the greater trochanter, leading to the actions of hip external rotation, abduction, potentially slight extension (due to the posterior to anterior line of pull).
The position of flexion, adduction, and internal rotation places a stretch on the piriformis muscle and, theoritically, compressing the sciatic nerve. Additionally, a ROM assessment, palpation skills, and movement analysis would be very beneficial in your physical examination to help confirm your hypothesis.
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