Tight muscles.
Expert Panel on Pediatric Imaging.

Physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain. USA.gov. Adolescent idiopathic scoliosis: common questions and answers.
More than just a case of chronic tightness of the leg muscles, hamstring syndrome occurs when tissues bunch up and form hard, fibrous bands where both the hamstring muscles and the sciatic nerve insert into the "sit bones." Global Spine J. Lavelle WF, et al. 2020 Jul 1;102(1):19-28. Intervertebral Disc (IVD)-related disorders are the direct result of “degenerative” changes in the lumbar IVD and 60% of all IVD pathology occurs in the lumbar spine.9   While IVD prolapses most commonly occur in middle aged patients, between the ages of 30 to 45, they can also be seen in children as young as 14 of either gender.10   Younger individuals with LBP are commonly afflicted with a IVD-related disorder where the “soul” of their symptoms resides in the acute mechanical and chemical changes in the IVD.11  Age appears to have a direct influence on the source of a patient’s LBP12   and the IVD begins to change at approximately 20 years of age.13  Thus, IVD protrusion and herniation in the adolescent are considered to have a genetic and/or traumatic origin.1,14,15  Although the main causes of adolescent low back pain are often mechanical, associated with lack of physical activity or strenuous exercise, diagnostic management is strongly recommended.16  In order to properly manage these patients, a clinician’s understanding of the pathoanatomy, physiology, and mechanics of the lumbar spine are foundational for clarity in differential diagnosis.

Nerlich AG, Schleicher ED, Boos N. Immunohistologic markers for age-related changes of human lumbar intervertebral discs. Sairyo K. Michael Lancaster discusses potential diagnoses in cases presenting with rear thigh pain, and how to sleuth out the cause. Dockrell S, Hamstring syndrome may be the result of wear and tear to the back and hamstrings. Spine.1983; 8:672-679. Orthopedic literature describes that the extreme stiffness can remain even after surgery.12,26  Lastly, the psychosocial impact on a youngster with undiagnosed and potentially undertreated lumbar IVD herniation can be devastating; this young man was observed over a year’s time to become more angry displaying emotional outbursts, withdrawn from friends and family, with increasing lack of self-confidence.37, There is ongoing debate regarding surgery for IVD herniation in adults in the absence of neurological deficit.

2006 Mar 1;31(5):583-90; discussion 591-2. doi: 10.1097/01.brs.0000201401.17944.f7.


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