The complaint of low back pain in the adolescent must never be taken lightly. A high index of suspicion should be particularly entertained in a child participating in gymnastic training or competition. As noted in this article, steps can now be taken, particularly if a specific diagnosis is made early, to institute specific treatment with a high likelihood of success. Young gymnasts complaining of back pain must never be passed off as having sustained a back strain or "muscle spasms" and treated symptomatically. Persistent back pain beyond two weeks warrants, in our opinion, a complete evaluation, careful history and physical examination, a four-view radiographic assessment of the spine, and, if necessary, bone scans or other more advanced techniques to make a specific diagnosis of the cause of the pain.