Low back pain is common in athletes. It usually requires only conservative therapy for resolution, but some conditions may require surgery. Returning athletes to play after lumbar spine surgery requires a treatment plan that protects them from further injury while also allowing them to regain their former level of conditioning. Evidence-based recommendations on return to play after lumbar surgery are lacking, but observational studies and expert opinions provide general guidelines for clinicians. In most situations, athletes are able to return to non-collision sports, but often they are discouraged from returning to collision sports. It is important to consider each case on an individual basis.