Low Back / Tailbone Pain
3/10 dull
Chief complaint
Emily is a 34-year-old professional who works from home (recruiting / data security) and has never done structured training. She's active outside the gym — hiking, swimming (recently open-water), playing with her dogs — and dabbles in Pilates / yoga / renegade via ClassPass, but wants to build real consistency. Her stated goals: reduce or eliminate low-back pain, lose some weight, improve flexibility/mobility, and build lasting gym habits, eventually folding in nutrition. She lives right down the street — proximity is a consistency advantage we should lean on.
The chief complaint is low-back & tailbone pain — a dull 3/10 ache when walking and tailbone discomfort lying down, with no pain in the surrounding muscles. The likely driver is structural and lifestyle, not acute injury: a full day of sitting with poor ergonomics (no sit/stand desk) keeps her hip flexors and quads short, while a never-trained core and glutes leave the pelvis without enough support. The screen and force-plate data point to the right hip as the mechanical centre of this.
The right hip is tight and unstable at the same time. Rachel's hands-on screen found a tight anterior/lateral right hip capsule and a tight right quad (Thomas test), an IT-band pinch coming from the right hip in the lunge, and right-hip weakness with glute instability on the tandem squat (trunk leaning left to compensate). The VALD force plates agree from the other direction: on a two-leg squat her right side pushed ~11.5% harder than the left — a quad-dominant compensation typical of a hip that's stiff in front and weak in the stabilisers. Encouragingly, when tested one leg at a time her jump power is essentially identical side-to-side (0.8%) — so this is a control/coordination pattern, not a true strength gap between legs.
One more force-plate note: on landing from a two-leg jump, her left side absorbs ~20% more force than the right — she off-loads the right hip on impact, the same "lean away from the right" pattern seen on the tandem squat. Her reactive/elastic quality is low (deep, slow jumps) — completely expected for someone new to training, and a sign of large, easy headroom to come.
Bottom line for the plan: this is a very winnable case. The priorities are (1) calm the low back by (2) restoring right-hip mobility and building glute/core/pelvic control, while (3) opening up tight hamstrings/quads, and gradually layering in conditioning to support the weight-loss goal. Pressing is modified around her collarbone hardware. Two hybrid sessions a week, plus a short daily mobility routine she can do at home, should move all of her goals at once.
Plan agreed: 2×/week hybrid sessions (strength + mobility + conditioning) at Catalyst.
| Test | Left | Right | Interpretation |
|---|---|---|---|
| Straight-Leg Raise | 90° | 97° | Good passive hamstring length both sides (right slightly more) — note this contrasts with tightness under load (see hinge below). |
| Thomas Test (quad / hip flexor) | R > L | Right hip capsule tight anteriorly & laterally; right quad tight. Primary mobility restriction. | |
| Hip ROM — Internal Rot. | 55° | 60° | Right has slightly more IR. |
| Hip ROM — External Rot. | 45° | 40° | Right ER reduced — consistent with the tight anterior right capsule (more IR / less ER on the right). |
| Multi-Segmental Flexion | Good | Great spinal mobility overall — would like a bit more movement at the lower thoracic. | |
| Multi-Segmental Extension | Good | Good extension, not hypermobile; tight through the paraspinals. | |
Read: The dominant restriction is the right hip — tight in front (capsule + quad) with reduced external rotation. Hamstrings test fine passively (SLR 90/97°) but bind up under load. Spine moves well; paraspinals and lower thoracic are the areas to free up.
| Pattern | Quality | Coach Notes |
|---|---|---|
| Squat (OH / unweighted / weighted) | ★★★★★ | Tolerates squat variations. Sumo: slight knee wiggle at end range. |
| Tandem Squat | ★★★★★ | Right hip weakness & glute instability; trunk leans to the left to compensate — the signature right-hip control finding. |
| Hip Hinge | ★★★★★ | Mechanics look great — but hamstrings are very tight, limiting depth/range. |
| 3D Lunge | ★★★★★ | Sagittal: internal-rotation lunge revealed an adductor deficit. Frontal: right IT-band achy pinch; bilateral adductor tightness. Transverse: left good; right IT-band pinching coming from the hip. |
| Push-Ups | ★★★★★ | Feels the collarbone hardware — modify range/angle (incline / neutral-grip) to keep it comfortable. |
| Horizontal Row | ★★★★★ | Good baseline pulling pattern to build from. |
Captured on VALD ForceDecks (dual-plate), 3 Jun 2026, at 81.9 kg. As a first session for someone new to training, the absolute numbers are a personal baseline to improve on — the asymmetries are the actionable part today, and they line up cleanly with the movement screen.
| Metric | Value | What it tells us |
|---|---|---|
| CMJ Jump Height | 18.8 cm (7.4″) | Lower-body power baseline. |
| CMJ Peak Power | 2,701 W · 33.0 W/kg | Relative power baseline. |
| CMJ RSI-Modified | 0.22 | Reactive/elastic quality is low & the jump is deep/slow (−33 cm dip) — expected for a new trainee, and big easy headroom. |
| CMJ Concentric-Force Symmetry | L 778 N / R 781 N | Pushing force is even side-to-side in the two-leg jump. |
| CMJ Landing-Force Asymmetry | 19.5% (L higher) | Left absorbs ~20% more on landing — off-loading the right hip on impact. |
| Repeat-Squat Peak Force Asymmetry | 11.5% (R higher) | Right pushes ~11.5% harder under bilateral load — quad-dominant compensation on the stiff side. |
| Single-Leg Jump Symmetry | 0.8% (height) | One leg at a time, power output is nearly identical — no true strength gap between legs. |
Read: The pattern is internally consistent. When the task is simple and bilateral, her right side takes over the push (11.5%) and her left takes over the landing (19.5%) — both are ways of working around the stiff, under-stabilised right hip. When she's forced onto one leg at a time, each leg performs almost identically — proving the raw capacity is there and the fix is mobility + stability + motor control, not building one weak leg up to the other.
Cadence: 2×/week hybrid sessions (strength + mobility + conditioning) at Catalyst, plus a short daily home mobility routine (she lives down the street and has the time-at-home to build the habit). Format: 8–12 week foundational block, then re-assess.
| Priority | Focus | Sample Work | Re-Test KPI |
|---|---|---|---|
| 1 | Calm the low back | Core/anti-extension & anti-rotation (dead-bug, bird-dog, Pallof), glute bridges, breathing/bracing, posture & desk-setup coaching | Walking ache < 1/10; no tailbone pain lying down |
| 2 | Restore right-hip mobility | Couch stretch / hip-flexor & quad release, 90/90 hip work, anterior-capsule mobility, IT-band & adductor soft-tissue | Thomas test clears; right ER → 45°+ |
| 3 | Glute-med & pelvic stability | Banded lateral walks, side-lying abduction, tempo split squats & step-downs, single-leg RDL — kill the trunk-lean | Tandem squat stable, no left lean; squat asym < 8% |
| 4 | Hamstring & adductor length | Loaded hinge through range, eccentric hamstring work, adductor mobility, lower-thoracic openers | Hinge depth improves; lunge IT-band pinch resolves |
| 5 | Build strength & conditioning (weight-loss support) | Full-body strength (modified pressing for collarbone), low-impact intervals, leverage her swimming/hiking | Consistency 2×/wk; trend bodyweight & energy |
| 6 | Nutrition habits | Protein-forward simple meals, protein shakes / Barons as recommended, hydration (already good) | Protein target hit most days |
Programming note: Emily is new to structured training with a clear pain complaint, so early sessions bias toward mobility, stability and motor control with conservative, well-cued loading — building confidence and consistency first. Modify all pressing (incline / neutral-grip / partial range) around the collarbone hardware until it's symptom-free. The strength and conditioning ramp serves the weight-loss goal once the foundation and the back are settled.
| Window | Focus | Decision Threshold |
|---|---|---|
| 4–6 weeks | Pain check-in + right-hip ROM (Thomas, ER) + tandem squat | Pain trending down; hip ER improving; less trunk lean |
| 12 weeks | Full re-test (movement screen + VALD CMJ / SQT / SLJ) | Back pain ≤ 1/10; squat asym < 8%; landing asym < 10%; hinge & lunge clear |