Low back pain (LBP) is a common musculoskeletal condition in adolescent athletes and an important cause of training interruption. Its prevalence varies across sports and appears to be influenced by age, training load, biomechanical demands, and underlying pathology. Both non-specific and specific causes should be considered. Therefore, the aim of this review is to provide an updated overview of the etiology, clinical evaluation, conservative management and return-to-sport considerations in adolescent athletes with low back pain. Publications in English language from January 2016 to April 2026 were identified through PubMed, supplemented by Google Scholar and reference-list screening; 27 publications were included in the clinical synthesis, supplemented by contextual sources. Non-specific low back pain is commonly associated with muscular, biomechanical, and training-related factors, whereas spondylolysis is commonly reported as one of the most frequent specific diagnoses. Lumbar disc herniation and other less common conditions, including Scheuermann disease, apophyseal ring injuries, and sacroiliac joint dysfunction, should also be considered in the differential diagnosis. Clinical evaluation includes history taking, physical and neurological examination, and imaging when indicated. Conservative management remains the first-line approach in most cases and is based on activity modification, exercise-based rehabilitation, correction of biomechanical deficits, and gradual progression toward sport-specific activity. Because the clinical presentation and recovery process may differ depending on the underlying diagnosis and management, return-to-sport decisions should be individualized and based on symptom resolution, functional recovery, and sport-specific readiness, rather than on time alone. However, evidence for return-to-sport criteria in adolescent athletes remains limited.

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