In brief Though spondylolysis is a possibility When a patient presents with acute low-back pain, the condition may not be apparent despite careful physical 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 exercises. After radiographs and a technetium bone scan detected subtle stress fractures, better results were obtained by immobilizing the region with an orthosis. For patients whose symptoms don't resolve with immobilization, surgery may be needed.