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Modern sports activities are associated with a high incidence of spine pain. Low back pain (LBP) occurs in up to 50% of elite athletes (Curr Sports Med Rep 3(1):41–46, 2004). The majority are under 40 years of age. Most acute spinal injuries are soft tissue related, attributed to muscle and ligament strains, which can be successfully managed with non-invasive therapies. LBP may not be spine related but secondary to injury at other sites resulting in a breakdown of the bio-mechanical linkage of the spine, pelvis and lower limb. Changes in training regime, running surfaces and even footwear can all be responsible for LBP. It is therefore vital that athletes have a full clinical assessment prior to imaging of the spine. MRI is the primary imaging modality for diagnosis of most spinal pathology. Fat-suppressed T2W or STIR images are the most sensitive techniques for identifying bone marrow oedema, and should be included in MR protocols for investigation of back pain (Table 10.1). Radiological interpretation should always be informed by clinical findings. Asymptomatic abnormalities such as pars injuries and facet disease in the lower lumbar spine are common in elite athletes (Br J Sports Med 41(11):836–841, 2007). Radiography, CT and SPECT imaging have a limited and specific role in a minority of cases, where MR imaging is normal or required for further evaluation of a bony lesion. Spinal interventional procedures maybe required as part of the diagnostic or therapeutic management following clinical review. These are often safer and more effectively performed under image guidance. [ABSTRACT FROM AUTHOR]