Back pain is one of the most prevalent conditions in the general population, including children and adolescents. Although an underlying pathology may be attributed to back pain in young children, the adolescent athlete represents a different population. Back pain in adolescents may result from acute (macrotrauma) or overuse (microtrauma) injuries. Differences in the adolescent spine as well as sports that require rapid and repetitive hyperextension, hyperflexion, and rotary motion place the athlete at increased risk for developing overuse injuries. The best prevention is early detection. Therefore, it is important that the physician maintain a high index of clinical suspicion when evaluating the pediatric patient, particularly the athlete who presents with back pain. This evaluation should include a thorough history and physical examination, plain radiographs, and, if necessary, bone scans or more advanced imaging techniques. Many conditions may be treated conservatively with bracing, rest, and analgesics, whereas others may require more aggressive therapy such as surgical intervention.