Though spondylolysis is a possibility when a patient presents with acu
te low-back pain, the condition may not be apparent despite careful ph
ysical exam and radiographic studies. In this case of a competitive 13
-year-old female athlete who had recurring lumbosacral pain, symptoms
did not resolve with a trial of activity restriction and flexion exerc
ises. After radiographs and a technetium bone scan detected subtle str
ess fractures, better results were obtained by immobilizing the region
with an orthosis. For patients whose symptoms don't resolve with immo
bilization, surgery may be needed.