Injury in gymnastics is not an uncommon occurrence, and an injury of the spine frequently is a source of pain in a gymnast. Because of the unique demands of this sport, which repetitively place significant forces across the spine, it becomes clear why the spine commonly is injured. Potential causes of back pain in a gymnast include spondylolysis, Scheuermann's disease, intervertebral disc pathology, and mechanical sources of pain. Much of the diagnostic workup and management of spondylolysis lesions remains controversial, but a successful management strategy can be developed for the safe return of a gymnast to the mat. Mechanical sources of pain are common and should be addressed. Psychosocial etiologies of back pain also exist in these athletes. Rehabilitation strategies should focus on improvement in the strength and function of the trunk and lumbar spine and the correction of biomechanical deficits with a goal of pain-free transition back to gymnastic-specific activities.